Essential Drugs, the state-owned pharmaceutical company, is rationing injectable saline to public hospitals to manage the high demand arising from the unyielding surge in dengue patients.

As per the rules, Essential Drugs is the only supplier of injectable saline to about 1,100 public hospitals.

"The demand is 10 times more than usual, so it has become tough to meet it," Ehsanul Kabir, managing director of Essential Drugs, told The Daily Star yesterday.

The surge in demand has compelled the company to ration the supply of injectable saline, said Md Zakir Hossain, deputy general manager of sales and marketing at Essential Drugs.

Essential Drugs is yet to start producing saline in its plant in Gopalganj, which is expected to begin in January next year.

Since 2020, it has been supplying 11 types of saline by procuring through tender from Beximco, Orion Infusion, Libra Infusions, Opsonin, Popular and The ACME Laboratories.

To meet the rising demand, the six companies have been asked to double their daily production in a meeting held at the Directorate General of Drug Administration (DGDA) in Dhaka on July 27.

"Increasing the production is not possible overnight, but the companies have agreed to double or triple their production immediately. We hope the demand can be met with this," said Md Salahuddin, deputy director at the DGDA.

In fiscal 2022-23 fiscal, Essential Drugs supplied around 60 lakh bags of saline -- around five lakhs per month on average -- to hospitals all over the country.

Until the six companies manage to ramp up production, Essential Drugs is giving priority to the hospitals in Dhaka, where the concentration of dengue patients is the highest, said Hossain, who could not immediately share the number of saline bags the company has been supplying in a day in recent weeks.

The hospital authorities in Dhaka yesterday corroborated Hossain's claim: they were able to ensure injectable saline for all patients as per the demand.

"We need 500-700 bags of injectable saline daily and Essential Drugs has so far been able to provide us that quantity," said Khalilur Rahman, director of Shaheed Suhrawardy Medical College Hospital.

The hospital has been maintaining a week's stock of all types of urgent medical requisites, including injectable saline.

If needed, the hospital will buy saline locally, Rahman told The Daily Star yesterday.

Normal saline (.9% NaCl solution) accounts for as much as 80 percent of the demand for saline at Shaheed Suhrawardy, he said. There are 11 types of saline in the market.

Like Shaheed Suhrawardy, the other public hospitals are preparing to procure saline from the local market to meet any additional demand, according to health officials.

Additional funds have been allocated for the unforeseen procurement, said Abul Bashar Mohammad Khurshid Alam, the director general of the Directorate General of the Health Services.

As per the rules, public hospitals cannot procure any saline or any other medicine or medical equipment without a no-objection certificate (NOC) from Essential Drugs. Otherwise, the hospital authorities would be punished.

"So we have arranged NOC for every public hospital," Alam said at an event in Dhaka yesterday.

As of yesterday, Essential Drugs have issued NOCs to three hospitals, according to Kabir.

Meanwhile, the total number of fatalities in dengue infection has risen to 313 as 10 more patients died yesterday. The total number of hospitalisation cases rose to 66,732 including yesterday's 2,764.