The Ministry of Health & Wellness takes note of the recent publications made by the sole supplier of medical oxygen to the country, IGL Limited, and wishes to provide some context and clarity as we seek to navigate these very challenging times for the health system and the country.
On May 30,2021 the Ministry of Health & Wellness, on reviewing the situation at the time, including the reproductive number, projected that a third wave could result in over 10,000 cases confirmed in the peak weak , over 180 deaths in the week following the peak and that over 1000 beds would be required in hospitals for COVID 19 management.
At that time of these estimations the Ministry consulted with sole supplier of oxygen to the health facilities, IGL, and it was discussed that at the last peak in March, just over 300,000 cubicmeters of Oxygen was utilized in the Public Health System for the one month period. In that conversation the company indicated that based on its contingency plans that had now put in place the ability to supply just over 400,000 cubic meters for a similar period if the country went into a third surge.
The estimation based on IGL supply was that the country would be able to provide Oxygen up to a possible 30% more than last peak. Thirty percent (30%) above peak demand would be approximately 1,000 beds occupied for COVID-19. This level was also consistent with the Ministry’s internal capacity for staffing to support beds assigned to the clinical management of persons affected by SARS-CoV-2.
At and above the 1,000 beds occupied level the Ministry’s contingency plan required that hospitals be placed in emergency mode which included the reduction in use of public hospitals island wide through the restriction in conducting emergency care services and the suspension of elective surgeries. The plan also required that health facilities would begin discharging patients who can receive homecare. At this level as well, more wards would be converted to care of COVID-19 patients. These actions are to mitigate the overwhelming of the health system as well as to manage the use of oxygen to below the capacity levels indicated by IGL.
On Wednesday, August 25, 2021, IGL informed the Government that based on its plan and due to the increased demand IGL has been importing liquid oxygen to supplement its capacity in country. The company also advised that one of its major suppliers of Oxygen out of the United States had declared “Force Majeure” at short notice and would not be able to provide its projected shipment of Oxygen. This was due, in the main, to the increased demand in its source market and this reduced IGL’s capacity to supply the agreed volume of Oxygen.
IGL therefore informed the Ministry that “over the next 3 to 4 days, we will especially be challenged. We have several tanks expected to arrive on island Sunday, August 29, 2021” and that it is making arrangements with the authorities to clear them immediately as the ship docks. The company further informed the Ministry that they would commence distribution early Monday morning and would normalize supplies by the night of Monday, August 30, 2021.
It is to be noted that the Ministry’s estimation of use has not presently surpassed the capacity for Oxygen as projected and based on the company’s own assessment of its capacity to meet the demands of a third wave. The issue that affected supply, therefore was based on the break in the supply chain due to the declaration of Force Majeure and need for IGL to find, in relative short period of time, a secondary supplier.
At the time of this advice, the Government made several outreach through diplomatic, military and other channels to mitigate the risks that would arise, however, due to the technical nature of the transportation of oxygen none of these mechanisms would improve the timeline for the arrival of oxygen in the health facilities.
It is to be also noted that in the many conversations with the company, at no time was the Ministry of Health & Wellness or the Government informed that IGL could not provide its present demand, at approximately 1,000 bed which was in keeping with our estimation from May 2021. Additional, at no time was there to be a “stock out” of supply as the company gave assurances that its logistic management mechanisms would enable health facilities to meet the needs of patients on beds while it regularized services due to its supply chain issues. Since this week, based on revised projections, the Ministry has indicated to IGL that there will be a need to further increase supplies. IGL has responded that it would be negotiating with its suppliers to facilitate increase supplies as much as possible based on the Ministry’s estimation.
It is to be further noted that the Ministry of Health and Wellness, through its Regional Health Authorities, engages directly with IGL on the supply of oxygen needs to the country. This is based on a framework agreement with established rates per cubic meter of oxygen provided. These agreements are based on existing contracts that support the current rates being paid to the firm. The Ministry, through the Regional Health Authorities, is now in the process of renegotiating current terms and conditions, however, all existing contractual terms are still in place and is honored by the Ministry on the submission of invoices to the Ministry on a monthly basis. These active arrangements are currently the only mechanisms through which the firm is currently providing oxygen.
The Ministry of Health and Wellness, has also revised its policy directive and has indicated that there must be diversification in the supply mix of Oxygen, and that different options should be explored by the Regional Health Authorities to mitigate the risks associated with a single supplier and single method of oxygen supply to the country’s health facility. Additionally, the infrastructure within hospitals for piped Oxygen and bulk facilities is being expanded where over 60% of facilities have been upgraded.