Moving critical care closer to home in Assam

The Assam government’s move to build 50-bed intensive care units in 22 district hospitals and medical colleges in the state will fill a gap in critical care. The availability of critical care facilities within a district boundary will reduce the worries of family members of such patients about delays in getting timely care. Often, the health condition of patients rushed to critical care centres in Guwahati, Dibrugarh, or Jorhat from far-flung district hospitals worsens en route. Besides, the out-of-pocket expenditure for providing critical care also goes up, increasing the healthcare burden on families. The state government’s decision to run the proposed ICUs in public-private partnership mode is a pragmatic decision to ensure the sustainability of the units. The availability of doctors and other trained medical professionals, including technical staff, round the clock is crucial for the smooth running of the ICUs. The government has decided to tie up with private hospitals to meet the requirement for adequate doctors and other healthcare professionals. The patients will not be charged a higher amount for the service rendered by doctors and other healthcare professionals in private hospitals. The state government will subsidise the treatment costs for general patients in ICUs by paying the extra amount to private hospitals. This will ensure that patients requiring critical care in an ICU will be able to avail themselves of it at the government rate and will not be required to pay at the rate of private hospitals. This will be a huge relief for patients and their families. The government setting economic criteria for subsidised treatment at ICU will be crucial to ensuring that the subsidy amount is not spent meeting the treatment costs of the wealthy and rich who can afford to pay for accessing critical care. Special provisions will also be required to be incorporated in the rules and regulations of running the ICUs so that the poor and underprivileged households get priority in the ICUs as they have no other means of availing such care in critical care centres in Guwahati or other places. The proposed ICUs will also play a crucial role in saving the lives of critically injured people in road accidents within the district. Once the ICUs become fully operational in these district hospitals, the availability of ambulances in the district for other needy patients like pregnant women, children, and elderly people will also improve. The ambulance engaged in transferring patients from district hospitals to Guwahati and other places outside the district is available only after it returns to the district, which usually takes at least two days. Reduced pressure for ICU patients referred by district hospitals will also make ICU beds in medical colleges and critical care centres in Guwahati, Dibrugarh, and Jorhat available for other needy patients who otherwise have to seek critical care in private hospitals, which increases their health expenditures. The state government’s decision to start 35 centres for free kidney dialysis within the next two months is another laudable initiative in the health sector. The proposed centres will be established in district and sub-divisional hospitals, which will improve the accessibility of kidney dialysis for rural patients. Accessibility of kidney care has improved in the cities in India, but rural patients continue to suffer from inaccessibility of care for chronic kidney patients due to distance and the higher cost involved in it. Viewed from the perspectives of kidney patients in rural Assam, the establishment of the proposed free dialysis centres will be a significant improvement in critical care access for needy and underprivileged patients. The availability of the required doctors, nurses, and other healthcare professionals to run the ICUs and dialysis centres will be a key factor for long-term sustainability. The district health authorities will be required to draw up a up a meticulous plan for the availability of the required healthcare professionals to boost patientsconfidence in the quality of the services. The coordination with private hospitals must be smooth so that backup plans are ready in the event of shortages of doctors due to personal leave or other professional engagements. Apart from sophisticated medical equipment, uninterrupted power supply and oxygen supply are key infrastructure support systems in the smooth running of critical care centres to help doctors and other healthcare professionals provide the best medical care. Lessons must be learned from critical care services being disrupted due to delays in the replacement of faulty equipment, and adequate measures must be put in place for regular monitoring by district health authorities on the maintenance of equipment so that services are not interrupted by faulty equipment or undue delay in replacing faulty equipment. The proposed establishment of ICUs and free kidney dialysis centres will be a revolutionary addition to the state’s healthcare system, as it will ensure the availability of intensive and critical care for needy patients from rural and semi-urban centres virtually at their doorsteps. District and sub-divisional hospitals efficiently running and managing these services will be crucial to meet the desired objectives.