KARACHI, Sept 28: The National Institute of Cardio-Vascular Diseases (NICVD) gets about Rs130 million as fixed grant from the government every year. This grant is supposed to take care of the needs of over 500,000 outpatients and inpatients from Sindh and Balochistan every year.

Three years ago, approximately the same amount was made available but the intended beneficiaries numbered about 300,000 patients, the NICVD’s executive director told Dawn the other day. “One can imagine how hard it must be for the institute to maintain the quality of patient care in the face of acute financial stringency,” said Prof Azhar M. Farooqui.

NICVD stood at a crossroads today, said the professor. “This is the make-or-break period for the institute. If no worthwhile step is taken within the next few years, NICVD may not be able to provide even the minimum and basic care expected of it.”

Society and the government must decide now what they want to make of the public sector healthcare centres, he said. “You are what you make of us. In the last three years that the grant has remained constant, the prices of consumable and durables have all gone up sharply. Yet we are supposed to maintain our standards in the shrinking portion of funds available each year for running the hospital.”

Prof Farooqui believes that the institute’s autonomous status has become an impediment in its growth. “As you know, we are an autonomous healthcare centre. We are supposed to raise some of the funds needed for our operations on our own.”

A big portion of the amount needed is raised through investments. “The other ways in which we are supposed to raise funds are through user charges and trust fund,” said Prof Farooqui.

“Now, a big problem being faced is the low return on investment available to us after investing in the public sector banks and DFIs. The interest rates are low. And as a government-funded institution, we cannot invest in privately-run investment schemes.”

He pointed out that whenever funds were allocated in the federal and provincial budgets, government-run hospitals like the Civil Hospital Karachi were given priority over autonomous institutions like the NICVD. “Moreover, these organizations are not supposed to raise a single penny on their own as all their requirements are met by the authorities.”

The areas in which the NICVD specialized were capital intensive, stated Prof Farooqui. “One machine for angiography costs between Rs40 million to Rs50 million. You can well imagine how cost-intensive this field has become.” But since 1986 the hospital has had to do without government and foreign grants for acquisition and improvement of equipment.

Asked about the hospital’s future plans, he said a master plan had been prepared and submitted to the government for approval. “But the government does not seem too interested in the plan as the money is slated to be acquired as a loan and not as grant from any agency.”

He added that the hospital administration nevertheless planned to double the capacity of the emergency ward which at the moment stood at 28. “After expansion we are going to have 56 beds in this ward. The aim is to drastically reduce the long queues at the ward, with 400 to 500 people coming in every day.”

One portion of the expanded emergency ward will have beds for patients who should be observed for about ten hours after a heart attack. This kind of facility is known as a ‘step-down unit’. At present, even the patients who normally should not be sent home immediately after a heart attack have to be released.

Prof Farooqui said some equipment was acquired with money provided by some philanthropists more than four years ago. The outpatients department has also been expanded and renovated recently with the help of donations.

Answering a question, the NICVD’s executive director said there was a limit to how much could be raised through donations, especially when the funds needed related to day-to-day operations of the hospital. “The authorities have also been telling us for the last three years that there’s a limit to what they can give us in the shape of grants.

“So, what we are facing is a time bomb,” he remarked.