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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