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Why detailed ICU Mapping for Rural India is a Vital Step to Strengthening the Critical Healthcare Infrastructure?

More than 65% of our country’s population resides in rural areas. With more than half of the population concentrated in rural areas, one would naturally assume that the rural areas are well-equipped on the healthcare front. The stats, however, have a different story to tell. Rural India accounts for only 3.2 government hospital beds per 10,000 people. The doctor to patient ratio is well below WHO recommended levels and critical care facilities like ICU beds are seriously inadequate. On the contrary, the burden of critical illness is high in rural areas as patients don’t have access to quality medical care and hence delay treatment or neglect early symptoms due to poor awareness until the condition gets worse.
The distribution of critical care facilities in our country is largely skewed in favour of urban areas. ICUs in rural areas are poor or absent at the district level. Out of the total 95,000 ICU beds in the country, about 59,262 beds are concentrated in the private sector. The penetration of ICU beds in the country is uneven with some districts within the same state having very few ICU facilities compared to other districts. The differences in bed capacity and ICU bed distribution need to be analyzed with detailed mapping. ICU mapping for rural areas is therefore imperative to strengthen the rural critical healthcare infrastructure.
“Mission ICU has recently launched the ICU Mapping project. In the first phase, with a focus on the Northeast, Mission ICU will map all district hospitals in the state of Meghalaya, Manipur, Sikkim, and  Maharashtra.”
Here’s how ICU mapping can serve as a practical solution to transform critical care infrastructure in rural areas:

1. Facilitates mobilization of resources in the right direction

Economic disparity plays an integral role in determining access to critical care. ICU care is expensive and districts with lower per capita income naturally have low penetration of ICU beds. The disparities and the gaps may not be evident when we simply look at the total number of ICU beds installed in a particular state. Only detailed mapping can give insights into the on-ground reality. Funds and resources can be mobilized to needy areas only if there is accurate information about whether the ICU beds installed are in proportion to the total population of that area and ICU mapping is an effective method to achieve that.

2. Useful to bolster bed capacity of existing hospitals in rural areas

District hospitals in 15 states and UTs have less than the recommended 22 beds per 1 lakh population. When the pandemic struck, rural areas found it difficult to cope given the scanty medical infrastructure in these areas. ICU mapping however is an effective solution to bolster the existing facilities. Several district hospitals can accommodate more ICU facilities. Especially during events of unprecedented disasters, enhancing the existing infrastructure is a more feasible option rather than building facilities from scratch. ICU mapping in rural areas is crucial to identify existing eligible hospitals that can be strengthened with better critical care infrastructure.

3. Helps assess quality and type of ICU beds

The quality of ICU facilities differs from hospital to hospital. ICU mapping can help assess the quality of ICUs in rural areas along with understanding the type of ICUs such as level 1, level 2 and level 3 ICUs. Level 1 ICUs provide oxygen and facilitate non-invasive monitoring and better intensive nursing care, compared to other wards. Level 2 ICUs provide invasive monitoring and basic life support whereas level 3 ICUs are the most advanced type with enhanced monitoring and life support technologies. ICU mapping can give detailed insights into the quality and type of ICUs available in rural areas that will help government authorities, policymakers, private organizations and NGOs to decide the best course of action.

4. Aids in the deployment of intensivists

ICU bed facilities cannot function without trained intensivists and nurses that can cater to critically ill patients. ICU mapping is an effective solution to assess whether the ICU facilities are performing as intended. While the doctor to patient ratio is generally low in rural areas, the lack of trained intensivists is also a major concern. ICU mapping will be extremely valuable to ascertain whether the ICU facilities are in working condition and functioning at full capacity with enough support staff in the hospitals to deliver critical care services.

5. Beneficial for the creation of an extensive database

The paucity of information is a major deterrent to enhancing the rural healthcare infrastructure. ICU mapping will ensure that we have accurate information and a clear picture of ICU bed availability across the country. This information can be used to create a database that helps organizations willing to contribute to gain clarity about where the resources need to be concentrated.
Detailed ICU mapping is pivotal to transforming the critical care infrastructure in rural areas. States like Andhra Pradesh have around total of 4162 ICU beds out of which just about 1157 ICU beds are in the public sector whereas about 3005 beds are in the private sector. Out-of-pocket expenses increase for patients when the concentration of ICU beds is higher in the private sector. India stands at 155th position in the Human Development Index with just 5 beds per 10,000 Indians and the wide gap in urban-rural healthcare infrastructure is easily a major contributing factor. ICU mapping can play a critical role in bridging the urban-rural divide and also augmenting the public healthcare infrastructure by identifying areas that need attention.
Views of the author are personal and do not necessarily represent the website’s views.
Dr Ashwin Naik, Co-Founder, Mission ICUAshwin Naik is an author and award-winning entrepreneur. He is widely regarded as the go-to expert on Affordable Healthcare Innovation, Scaling Social Impact and Mental Wellbeing. As an entrepreneur he has started multiple healthcare organisations – Manah Wellness (Platform for Preventive Mental health), Let’s Talk (Helpline for Mental Health Support during COVID19), Vaatsalya (India’s first rural hospitals network), Seraniti (India’s first integrated mental health organization, acquired by Curefit) and We Scale Impact (Global Health Consulting). He is an Ashoka Fellow as well as a TED Fellow and a Young Global Leader of the World Economic Forum. Other recognitions include Economic Times Leaders under 40, Young Leader by Asia Society Asia21 in 2011, Finalist for the India Social Entrepreneur of the Year Award 2010 by Schwab Foundation. Dare Magazine India in its April 2011 edition profiled Ashwin as 50 inspiring Entrepreneurs of India.