Sir,
We read with interest and concern the two publications on the state of the pediatric cardiology profession in India.[1,2] We would like to present a perspective from the Children’s HeartLink’s 25-year experience, engaging in the training and development of Pediatric Cardiac Centers of excellence in India and many countries such as China, Brazil, Malaysia, Vietnam, and Bangladesh and our 54 years of focusing on the needs of children with heart disease.
This point of view is not typically considered among subspecialists who see the decision to become a pediatric cardiologist as a very personal one. The medicine in pediatric cardiology and pediatric cardiac surgery has made tremendous achievements in the past 50 years, and even more so in the past 25 years. The number of subspecialty health professionals has grown exponentially globally due to the promise of an intellectually stimulating profession and truly saving lives. Conversely, this has also made the profession difficult, as outlined in the articles. Perhaps, it is time to think about a health population health-based policy approach to the development of subspecialists such as pediatric cardiologists and pediatric cardiac surgeons. That would suggest engagement with the government to develop national health policies and plans that will address the needs of the patient population served by people with training in pediatric and congenital cardiology.
The idea of specialized health policy for patient populations with chronic diseases has only started coming up recently. As our ability to understand demographic trends has grown, so has the ability to predict, barring unpredictable catastrophic events, the number of people in need of these services, and this is especially true for children born with congenital disorders in general, and congenital heart disease (CHD) in specific. The World Health Organization published in 2020, its toolkit,[3] aiming to improve global birth defects surveillance, and many countries have been implementing it, including India. The data are clear on how many children will be born with CHD, which should in turn help with planning for the health-care services they will need.
We want to propose a population health approach to both delivery of care, in terms of the development of infrastructure and services, and most importantly, to the development of a specialized workforce for pediatric and CHD. Moreover, we believe that countries like India have an incredible opportunity to lead the world in these efforts. The process of developing health policy is long and arduous; however, given the challenges so eloquently outlined in the paper by those practicing pediatric cardiology, and the knowledge that only a fraction of the children in need of their services are getting the care, we should be thinking about a new approach. It is time for professional societies to join forces with patient and family advocates to address this issue through policy advocacy at both the national and state levels. Unless we do that, we are going to lose the amazing momentum this field has had in the past 50 years, and the only people suffering will be the patients and their families.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Sachdeva S, Dhulipudi B. Current career perspective of pediatric cardiologists in India. Ann Pediatr Cardiol. 2023;16:201–3. doi: 10.4103/apc.apc_121_23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Ramakrishnan S. Being a young pediatric cardiologist in India: Aspirations versus reality. Ann Pediatr Cardiol. 2023;16:163–7. doi: 10.4103/apc.apc_127_23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.World Health Organization. Birth Defects Surveillance: A Manual for Programme Managers. 2nd ed. Geneva: World Health Organization; 2020. [Google Scholar]