A roundtable meeting on problems that plague critical care centres especially in rural areas saw experts from various fields coming together to brainstorm on possible solutions. Here’s a short summary.
In late April this year, the Compassionate Pandemic Response (CPR) Group – a voluntary group comprising doctors and healthcare entrepreneurs – and the Raj Reddy Center for Technology and Society at IIITH jointly organised a roundtable session to discuss the challenges posed by healthcare in its last mile delivery. Appropriately titled, “Sustain and Support Operating Healthcare Infrastructure to the Last Mile’, the closed-door meet saw NGOs, government agencies, technologists, medical practitioners, med-tech startups, and other healthcare executives brainstorming to identify gaps and explore possibilities to sustain and support the existing infrastructures through building critical care centres with skilled healthcare frontline workers and other technology powered solutions.
What Ails The System?
With participation from panellists such as Ramkrishnan Balakrishnan from Care India, Dr. Prasad Sistla from Care Foundation, Dr. Satish Ghanta from Choice Foundation, Renuka Bodla from Novartis, Mahesh Iyer from Paraxel, Varma Konala from INAI, Prem Kumar Vislawath from Marut Drones, Emmanuel Murray from Caspian and Renu John from IIT, deliberations on gaps ailing the critical care systems were held. This was done in the light of the infrastructure shortage problem that was glaring during the peak of the Covid-19 crisis. While monetary support was not lacking during the time, logistical issues hampered the setting up of critical care infrastructure such as ICU beds and so on. Determining the right location for establishing such a facility where it can be guaranteed full occupancy is paramount for sustaining it in the long run. Last mile availability of critical care is hampered by a gamut of delays – in critical decision-making in patients’ homes, in getting to the facility due to an absence of transport connectivity, and in obtaining reports at the diagnostic facilities. In addition to this, in areas of low patient traffic, healthcare expertise gets whittled down over a period of time. It also leads to a Catch 22 situation where specialised care is lacking in case of emergencies. All these are the factors that affect not only adoption of technology in rural areas but also its adaptation in the long run.
How To Sustain and Scale Critical Care
The need of the hour is targeted training of support staff such as frontline workers who can accurately identify critical conditions and respond accordingly. But then, mere training or equipping them with the required skillset is not adequate. There ought to be self-driven and self-aware healthcare professionals who are also conscious of their own and their staffs’ limitations so that they can tap into the resources of their networks. The key performance indicator of any critical care system is the capacity utilisation of its installed medical equipment. A system that allows us to track not just the location of the installed equipment but also its usage will help safeguard against theft, under usage, and condition of the equipment itself. The adoption of a hub and spoke model has been mooted where initial admission and care can happen at a low tier hospital with the scope for a shift to a higher tier hospital as and when the need arises. To sustain the critical care system in the long run, appropriate hardware and software solutions must be designed and implemented for a long-term perspective such that frequent changes to the system are obviated. Similarly, a public-private partnership – with the government pitching in with land provision for hospital infrastructure development – should be done with preemptive measures for real-world hurdles.
With the purpose of the brainstorming being to identify, define and design a perfect model to build critical care centres, it was agreed that it was not only imperative to build such care centres for the benefit of the underprivileged but also to identify not-for-profit stakeholders who can train the required manpower needed for sustaining the infrastructure. The CPR group along with the Raj Reddy Center will facilitate another meeting to pursue continued efforts in the same direction.