Strengthening cardiac services in Faridabad District: A facility mapping exercise to explore implementation of a hub-and-spoke model

Abstract

Background & objectives: Improving access to acute cardiac care requires remodelling of existing health systems into a service delivery network with an anchor establishment (Hub) offering a full array of services, complemented by spoke establishments that offer limited services. We assessed the availability of cardiac services in the district of Faridabad in the northern State of Haryana, India and explored the feasibility and challenges of implementing a hub-and-spoke model. Methods: In 2019-2020, we listed all the facilities in private and public sectors in the study-district and mapped their geocoordinates with the help of QGIS (Quantum Geographic Information System) software version 3.20. After consent, we assessed the availability of specific cardiac care-related inputs (medicines, technologies and staff) using a checklist by enquiring from the hospital staff. Each facility was classified as L1 (No ECG) to L5 (cardiac catheterization) as per the national guidelines for the management of ST-elevation myocardial infarction (STEMI). Results: There were 109 health facilities (66% private) in the district, 1.6 cardiologists and 5.4 coronary care unit beds per 100,000 population (94% private). Only one district hospital running in a public-private partnership mode at the L5 level provided any cardiac services. Private facilities were providing a range of services with a considerable number of them functional at L5. The higher-level facilities were concentrated in the central and urban parts of the district. Only 46 per cent of the ambulances had oxygen cylinders and 14.7 per cent had defibrillators. Interpretation & conclusions: Implementation of a hub-and-spoke model for cardiac care in Faridabad district will require significant strengthening of public health services, development of a private-sector participation model, and strengthening of ambulance services.