Friday, 6 October 2006

Andhra Pradesh plays a role model: Screening for children with heart ailments



By Syed Akbar
Andhra Pradesh is going to add yet another feather in its cap. This time for 
taking up the gigantic task of providing medicare and conducting heart 
surgeries free of cost to around 5000 children, mostly from the lower strata of 
society.
The second phase screening of heart diseases in children, under an innovative 
scheme launched by the State government in August 2004, is currently on in 
the State. Already 3,200 children have been identified for surgery in medical 
camps held in September. Another round of medical camps is scheduled for 
October 8 at 44 centres across the State. Once the screening process is 
completed, heart surgeries will be performed on these children in about 50 
corporate, private and government hospitals.
In the first phase screening held in 2004, over 5500 children were identified 
for surgeries and of them 4700 underwent heart operations. The remaining 
700 children could not make their way to the operation theatre for want of 
infrastructure. These children will now be included in the list of fresh 
beneficiaries in the second phase.
Andhra Pradesh is the first and so far the only State in the country where 
children under 12 years of age are provided free heart treatment in the state-
of-the-art corporate hospitals. They are also provided with free follow up 
treatment. Only the neighbouring Karnataka State has a health insurance 
scheme for children belonging to below the poverty families. Unlike the 
cardiac programme in Andhra Pradesh, the scheme in Karnataka provides for 
general health problems. A CM’s Children Relief Fund was exclusively set 
up for the purpose. 

How the Scheme Began:

It was August 7, 2004. The new Congress government was just settling 
down. Hundreds of children suffering from heart diseases gathered in 
Hyderabad to press for their demand for free medical treatment. The 
Mahajana Sangarshna Samithi had organised the demonstration by 
mobilising poor children and their parents from all most all the rural areas of 
the State.
Tragedy struck the demonstration. One of the children, T Sobhan (12), of 
Shanigaram of Karimnagar district, collapsed on the Lower Tank Bund road 
apparently unable to bear the stress of walking and standing for long under 
the hot sun. A couple of days later, two more children, Rajasekhar from 
Prakasam district and Konda Saidulu from Nalgonda district succumbed to 
heart ailments. Incidentally, these two children too had participated in the 
demonstration.
This moved the new Congress government and Chief Minister YS Rajasekhar 
Reddy announced a special package for children suffering from cardiac 
ailments which includes free heart surgery. Andhra Pradesh thus became the 
first State in the country to introduce free heart treatment for children below 
12 years of age.
In the first year the government conducted screening tests for 5500 children 
and of them about 2000 children underwent surgeries. Another 2700 children 
were operated upon in 2005. The government has initially allocated Rs 8 
crore for the project and announced that it would be a continuous 
programme. Keeping its assurance, the government has now called for the 
second phase of screening tests in all the 23 districts to identify new patients.
The government has also taken up an ambitious programme to strengthen 
facilities in government hospitals so that state-of-the-art medicare is provided 
to poor children. The government has also roped in children specialists to 
perform surgeries.
Now buoyed by the success of the cardiac programme, the government has 
decided to introduce a universal health insurance scheme to take care of the 
health needs of children suffering from various ailments. Children below 12 
years and belonging to below poverty line families will be covered under the 
proposed scheme. According to a rough estimate, two lakh children under 12 
years are suffering from heart problems in the State and about 20,000 
children add to this number every year.

How It Works:

Unlike in other States where free treatment is provided to the poor only in 
government hospitals, the Andhra Pradesh government has made a provision 
for treatment of poor children even in corporate and top class hospitals. The 
provides financial aid to corporate hospitals towards these surgeries and other 
follow up treatment if any.
These private hospitals charge 20 per cent less than the rates fixed by the 
State-controlled Nizam’s Institute of Medical Sciences. The payment is  
made by the Director of Medical Education to the hospital concerned after 
getting scrutiny of bills by a committee constituted for the purpose. 
The State government has divided heart diseases into various categories for 
purpose of treatment. The category I covers PDA interruption 
pericardiectomy, closed mitral valvotomy and PA banding, while category II 
covers BT shunt coarctaion of aorta repair. Under category II, surgeries like 
ASD closure, VSD closure and AP window repair.
The other categories are: category IV: Intracardiac repair of TOF, 
intracardiac repair of TAPVC; Category V: Intracardiac repair of TGA, 
DORV, tricuspid atresia, trunkus arteriosus etc., and other surgeries needing 
special conduits like pulmonary atresia; Category VI: Valve repair, mitrial 
valve repair, tricuspid valve repair; Category VII:  Mitral valve replacements, 
aortic valve replacements, tricuspid valve replacements; Category VIII: 
double valve replacements (mitral valve replacement and aotric valve 
replacement); Category IX: Interventional procedures like percutaneous 
balloon valvuloplasties, balloon septostomy including cardiac catheterization 
and cine angiograms. 
Initially there was no provision for permanent pacemaker implantation (PPI) 
but now the government has included this category also. A new category - 
Category X - has been included to provide for permanent pacemaker 
implantation. Other cardiac problems not included in the above categories, 
whenever they come up would be examined and put in appropriate category 
on a case to case basis by the central cell at Gandhi Hospital in consultation 
with the Director of Medical Education.

Special Cardiac Cells

Moreover, special cardiac cells have been created in seven government 
teaching hospitals, which will treat, operate or refer patients to other 
hospitals. These cells are located at Osmania General Hospital, Hyderabad, 
King George Hospital, Visakhapatnam, Mahatma Gandhi Memorial Hospital, 
Warangal, Gandhi Hospital, Secunderabad, Government General Hospital, 
Kurnool, Government General Hospital, Guntur and Government General 
Hospital, Kakinada. 
On being approached by a child cardiac patient, the cardiac cell in the 
Teaching Hospital will conduct necessary screening and render advice to the 
child patients and his/her parents/attendants. The cardiac cell will undertake 
treatment of the paediatric cardiac ailments at the same teaching hospital 
including surgeries. 
If the surgeries for which facilities are not available or the required expert 
cardiac surgeon personnel are not available in the teaching hospital, then the 
cardiac cell of the teaching hospital will first enquire with the other 
government teaching hospitals as to whether they can handle the required 
type of surgeries.
If any of the other teaching hospitals in the State have such spare capacity, 
the case will be referred to there. If not, it will be referred to the nearest 
private hospital that can perform such surgery. An identification card is 
issued to the patient for this purpose, by the government cardiac cell of the 
teaching hospital.
In case, the patient comes back to the hospital concerned at a later date, 
where surgery is performed, the hospital should have to take proper care of 
the patient. It should not insist reference from the cardiac cell.
Congress MP V Hanumantha Rao demands that the Central government bear 
the cost of operations. "Thousands of children are in a critical condition for 
lack of medical facilities. The State government does not have the resources 
to fund the critical heart operations of children who are waiting for months 
for heart operations. Many children are also dying while they wait for heart 
operations in Andhra Pradesh. The Central government should pay attention 
to this critical problem," he pointed out.

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