Found: Gaping hole in heart treatment

New Delhi: Sixteen states and Union territories across India do not have functional cardiac care units (CCUs) in government-funded hospitals in any of their districts except in medical colleges, if any, a nationwide exercise to assess health-care measures has revealed.

The Health Index, developed by Niti Aayog, the government's policy think tank and described as "the first annual and systematic tool" to measure national health performance, has identified the task of bolstering cardiac care services as a challenge shared by many states and UTs.

The index has listed Assam, Bihar, Jharkhand, Telangana, Uttar Pradesh, Uttarakhand, Arunachal Pradesh, Goa, Manipur, Meghalaya, Sikkim, Tripura, Andaman and Nicobar, Chandigarh, Dadra and Nagar Haveli, and Daman and Diu as territories that "do not have a single district with functional CCUs in public hospitals".

Bengal has the highest proportion (77 per cent) of districts where government hospital are equipped with functional CCUs, sandwiched between Himachal Pradesh (91 per cent) and Rajasthan (70 per cent). Andhra Pradesh, Delhi, Kerala, Punjab and Tamil Nadu also have CCUs in public facilities in at least half of their districts.

Health experts involved in the exercise said the assessment excluded medical colleges and examined infrastructure for CCUs - equipment, including ventilators, defibrillators, portable ECG machines, along with drugs, diagnostic tools and staff required for cardiac services - in district-level government hospitals.

"Medical colleges are tertiary-care hospitals, which would in any case have cardiac services," said Daljeet Kaur, a senior programme manager at IPE Global, a management consultancy that helped validate the findings. "The objective was to look for CCUs in district hospitals that would reduce the workload at tertiary-level hospitals."

Senior cardiologists said shortages of cardiologists, among other medical super-specialities, and lack of government investments in the infrastructure required for CCUs could explain the absence of cardiac care services in the district hospitals of so many states.

"Besides equipment, CCUs require cardiology super-specialists, and DMs (a super-speciality degree obtained after postgraduate MD degrees) in cardiology would prefer to work in cities," said Saumitra Ray, a Calcutta-based cardiologist and vice-president of the Cardiology Society of India.

India's medical colleges and super-speciality hospitals in 2015 generated less than 370 cardiologists. "Since then, this number may have increased slightly, but the number is still woefully inadequate," said Sundeep Mishra, professor of cardiology at the All India Institute of Medical Sciences, New Delhi.

A senior community medicine specialist pointed out that the Union health ministry's Indian Public Health Standards, revised in 2012 specifying infrastructure guidelines for district hospitals, had classified key CCU requirements not as "essential", but merely "desirable".

When guidelines describe services as "desirable", there is less pressure to invest in those services, particularly against the shortage of cardiologists and the expansion of the private sector.

Parthasarathi Ganguly, a community medicine specialist at the Indian Institute of Public Health, Gandhinagar, said: "Can we really expect super-specialists who've spent so much time in private medical colleges to work in district hospitals?"


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