Context: Congenital Heart Disease (CHD), which the Centres for Disease Control and Prevention (CDC), U.S., acknowledges to be the most common congenital disorder, is responsible for 28% of all congenital birth defects, and accounts for 6 to 10 % of all the infant deaths in India.
Congenital heart disease is a general term for a range of birth defects that affect the normal way the heart works. CHD is a defect in the structure of the heart or great vessels that is classed as a cardiovascular disease (CVD). The term “congenital” means the condition is present from birth. Congenital heart disease is one of the most common types of birth defect.
Status of CHD:
Paediatricians say timely medical intervention can save 75% of these children and give them normal lives. The lack of a national policy for the treatment of cardiovascular diseases in children keeps a huge number outside the ambit of treatment.
According to the Paediatric Cardiac Society of India (PCSI), the prevalence of congenital cardiac anomalies is one in every 100 live births; or an estimated 2 lakh children are born with CHD every year. Only 15,000 of them receive treatment.
At least 30% of infants who have complex defects require surgical intervention to survive their first birthday but only 2,500 operations can be performed each year. A case in point is the premier All India Institute of Medical Sciences (AIIMS), where infants are waitlisted till 2026 for cardiac surgery.
A 2018 article by the Department of Cardiothoracic Cardiology, AIIMS, states, “paediatric cardiology is not a priority area in the face of competing demands for the resources”.
A distressing perception, ground realities:
There has been more neglect and little improvement in child health care because creating a comprehensive paediatric cardiology care service is usually considered economically unviable.
There are 22 hospitals and less than 50 centres in India with infant and neonatal cardiac services. Geographically, these centres are not well distributed either.
A 2018 cardiology department report of AIIMS, highlighted how South India accounted for 70% of these centres; most centres are located in regions with a lower burden of CHD.
It taxes the vulnerable and the marginalised the most:
For 600 districts with a 1.4 billion population, there are only 250 paediatric cardiologists available. The doctor to patient ratio is an abysmal one for half-a-crore population.
Apart from the low number of paediatric cardiologists and cardiac surgeons, and critical care centres, poverty is another barrier before treatment.
It is not just unaffordability but also inaccessibility that constraints paediatric services. In addition, there is the non-availability of crucial equipment that is essential for diagnosis of heart diseases in the unborn.
Antenatal checks are crucial:
The Child Heart Foundation, an NGO working with underprivileged children with CHD, has been flagging the need for Fetal echocardiography a test that is done usually during the second trimester of pregnancy to check for CVD/ CHD in the foetus.
Paediatricians say antenatal detection of congenital anomalies is crucial for neonatal care and management. But certain congenital defects such as accurate heart health assessment are not visible in a normal ultrasonography of an unborn baby.
Fetal echocardiography done in a pregnant woman of 18 to 24 weeks allows better visualisation of the structure and function of the heart.
There are programmes worth emulating such as Kerala’s ‘Hridayam (for little hearts)’, aimed at early detection, management and support to children with CHD or the Tamil Nadu Chief Minister’s Comprehensive Health Insurance Scheme offering free specialised surgeries.
The Ayushman Bharat, is expected to financially assist 10 crore poor families but has still to take off.
So far, a few states like Maharashtra, Karnataka, Gujarat and Andhra Pradesh have started to implement it.
Ayushman Bharat Scheme/National Health Protection Scheme:
Launched as recommended by the National Health Policy 2017, to achieve the vision of Universal Health Coverage (UHC) and to meet SDG and its underlining commitment, which is “leave no one behind”.
The mission adopts a continuum of care approach, comprising of two inter-related components, which are:
Health and Wellness Centres (HWCs).
Pradhan Mantri Jan Arogya Yojana (PM-JAY).
HWCs are upgraded primary healthcare centres. It also envisages developing 1.5 lakh such HWCs to cater to the healthcare need at the grassroots level.
Key Features of PM-JAY:
The world’s largest health insurance/ assurance scheme fully financed by the government, it provides healthcare cover of 5 lakhs per family per year, for secondary and tertiary care hospitalization across public and private empanelled hospitals in India.
Coverage: Over 10 crore poor and vulnerable entitled families (approximately 50 crore beneficiaries) are eligible for these benefits.
Provides cashless access to health care services for the beneficiary at the point of service.
PM-JAY is envisaged to reduce India’s Out of Pocket Expenditure (OOPE) on healthcare, which used to be one of the highest in the world. From the levels of 65%, OOPE in India has now come down to around 49%.
Benefits and significance
Helps reduce catastrophic expenditure for hospitalizations, which pushes 6 crore people into poverty each year.
Helps mitigate the financial risk arising out of catastrophic health episodes.
Eligibility Criteria:
No restrictions on family size, age or gender.
All pre–existing conditions are covered from day one.
Covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
Benefits of the scheme are portable across the country.
Services include approximately 1,393 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician’s fees, room charges, surgeon charges, OT and ICU charges etc.
Public hospitals are reimbursed for the healthcare services at par with the private hospitals.
Way Forward:
There is a need to explicitly include CVD/ CHD under the ambit of PM-JAY and to raise public awareness on people’s entitlement towards these services.
On the World Heart Day (September 29) we need to act fast to help India’s many children in need.
