Project Cardiogram

India has one of the highest burdens of cardiovascular diseases (CVD) in the world. The annual number of deaths from CVD in India rose from 2.26 million (1990) to 4.83 million (2016) whereas the prevalence of Ischaemic Heart Disease  quadrupled in rural areas of India, rising from 1.7%(1970) to 7.4%(2013). The World Health Organization (WHO) has estimated that, with the current burden of CVD, India would lose $237 billion from loss of productivity and spending on healthcare over a 10-year period (2005-2015).

Our goal at World Youth Heart Federation (WYHF) is to strengthen the rural healthcare system by improving access to cardiovascular healthcare services by establishing a scalable and sustainable cardiovascular healthcare referral and treatment service integration with the public sector to improve patient outcomes. We are also working towards raising awareness regarding CVDs and their risk factors among the general population with the support of Accredited Social Health Activists (ASHA) workers and organising community screening camps to screen patients for CVDs and other Non communicable diseases like Diabetes in order to reduce morbidity and mortality by early disease identification.

Globally, the cases of CVDs nearly doubled from 271 million (1990) to 523 million (2019) while the number of deaths from CVDs rose from 12.1 million (1990) to 18.6 million (2019). Hence, it can be estimated that 1 in 3 deaths globally is due to CVDs. Despite such a heavy burden of the disease, very little focus is given towards early identification of risk factors of the disease which can substantially reduce the grave outcome. According to the National Health Mission of India, availability of an ECG machine is a must at all the Peripheral Health Centres (PHCs) but we found out in our pilot study at 101 PHCs that only 2 of the 101 PHCs had an ECG machine.

An ECG machine is a device used to assess your Heart’s rhythm and electrical activity. With the help of this device a health professional can identify any abnormalities associated with your cardiovascular system and hence can aid in early identification of the disease as well as timely referral and treatment in case of emergencies like Heart Attack. In this Project Cardiogram, our team at WYHF is working towards improving the usage of ECG machines at PHCs along with conducting regular screening camps and training of medical staff for interpretation of an ECG and further management. Also, the team is working towards strengthening the referral system by application of digital health and Tele-Medicine.     

Baseline assessment was conducted at 101 PHCs across Gujarat using the above set of questions that yielded very interesting results. Only two of 101 PHCs had functional ECG machines available. There were 32 PHCs where the healthcare workers were able to take ECGs. Although only 24 PHCs had medical officers who could interpret ECGs. Healthcare workers at all 101 PHCs were willing to take part in a training course on Basics of ECG. The total number of patients with hypertension seeking medical care in 2021 ranged from as low as 37 to as high as 400 in some PHCs. A meta-analysis indicated that the prevalence of hypertension was 18.1% in the rural west zone of India. According to this, each PHC catering to a population of minimum 30,000 individuals would have nearly 5,430 people with hypertension, pointing towards the vast majority of hidden cases that are not timely identified. This estimate points towards the vast gap in the identification and treatment of hypertensive patients even in the well performing PHCs. In the first pilot screening camp  in the district of Anand city in Gujarat, we identified 71 patients with cardiovascular risk factors who were followed up with an ECG. Of those 71 patients screened, 21 of them reported an abnormal ECG finding. These statistical data in our pilot study highlighted the importance of screening, training and deployment of ECG machines at various PHCs across the country.

The project Cardiogram is the flagship project of the World Youth Heart Federation - India chapter with an aim  to bridge the gap between urban and rural healthcare. The purpose of the project is multifold starting from baseline assessment of the current healthcare system, training of healthcare workers in order to identify early cardiovascular risk factors and prevent delayed management, deployment of Digital ECG machines at Primary Health centres (PHCs) and other centres in the peri-urban belts, organising community based screening camps to identify the disease progression at an early stage and finally integrating it with digital health and Tele-Medicine. 

During the second wave of the COVID-19 Pandemic, the organisation had diverted all the resources towards COVID Relief Efforts under the Local Heroes Project with an aim to reduce mis-allocation of resources. Under a hyper-local model, volunteers from 58 cities worked on a needs assessment followed by finding local funding and finally delivering the required supplies to government hospitals and primary health centres. Interacting with medical officers at PHCs, experiencing and facing the resource constraints due to gaps in the primary healthcare infrastructure and the motivation to strengthen rural heart health led to the inception of Project Cradiogram.

The name CardioGram is derived from two words; Cardio, means heart and Gram refers to a village in Hindi. The project focuses on rural areas owing to the widening gap between the availability of health delivery services and healthcare status of the rural inhabitants.

The project would be implemented in a phased manner. The team would start off with baseline needs assessment and research at 500 PHCs across Gujarat. This includes collecting data of the current status of the PHCs, the equipment present there, staff (trained or untrained), patient flow, etc; Sorting out the PHCs based on the requirements (The ones which do not have ECG machines are prioritised); Contacting Medical Officers (MOs) and District Health Officers (DHOs) for establishing a channel of communication for further assistance. This would be followed up by training the Healthcare workers regarding identification and interpretation of a normal and abnormal ECG along with training for identification of risk factors and symptoms pertaining to cardiovascular diseases. Four training modules have been developed to build capacity among the healthcare workers at the primary centres. The first set of trainings include ‘Basics of ECG’ and ‘CPR Training’ delivered by the youth volunteers for all healthcare workers.The second set has advanced trainings including ‘Approach towards cardiac emergencies’ and ‘Thrombolysis for MI patients’ delivered by trained cardiologists for MOs. The volunteers are provided with a standardised training information brochure for conducting a training. So far we have conducted over 20 such training sessions across PHCs of Gujarat.

Next, the team works towards deployment of ECG machines at the PHCs which do not have a machine followed by organising regular Screening camps.The purpose of the screening camp would be data collection, research and intervention (if necessary). Screening camps also are an effective way to raise awareness regarding cardiovascular diseases in the community. Apart from ECGs, other information like vitals, family and personal history etc. is collected to identify the burden of silent cases, other risk factors and co-morbidities in the community. Currently we are in the process of deploying 52 Digital ECG machines which will provide access to 1.56 million rural inhabitants and have conducted 11 screening camps at various centres.

Finally, the Digital ECG Machines across all PHCs would be Integrated with telemedicine units which would be relaying from an associated common platform. The ECGs taken at the PHCs could be either interpreted by the medical staff/MOs present there or shared on the common platform which would then be then interpreted and reported by the cardiovascular medicine specialists at the Tele-Medicine units with advice given for referral to higher centres or management at the current centre itself. 

This system is what we term the “Hub & Spoke model”. The primary healthcare facilities including PHCs, HWCs and CHCs are considered as spokes. All spokes can serve as the first point of contact for the patient with any cardiovascular disease. Routine patients are treated by the MOs and guidance for further treatment where required is provided by specialist doctors at the telemedicine unit hub. Routine pharmacotherapy for patients with hypertension, diabetes or hyperlipidemia is initiated and followed up by the MO themselves. ECG of the high risk patients sent to the specialist doctors at the hub helps in identifying the requirement of any further diagnostic test or intervention. The patient can then be referred to a suitable hub by the MO. Once the patient has been referred to a higher centre, the MO/Staff nurse informs the respective centres regarding the same and ensures regular patient follow-up. In order to ensure efficient referral services vertical communication is required wherein a HCW, usually the MO is responsible for being in contact with the hub(s) while referring the patient for higher treatment or diagnosis.

Along with the treatment, spokes also organise regular screening camps to identify masked patients with hypertension and diabetes in their catchment area. These camps are often in line with the National Health Mission screening camps, thus handled entirely by the HCWs at the primary facilities. The weekly screening camps added extra burden to the HCWs at these centres and without any direct compensation and limited human resource, the camps were not sustainable. Based on the resource availability the primary facilities are differentiated into P1 and P2 spokes. P1 spokes are the lowest level of primary care facilities in this framework, providing only the aforementioned facilities. The P2 spokes have thrombolysis facility (usually using streptokinase) along with inpatient facilities. Thus initial treatment can be provided to MI patients under time and travel constraints.

Tertiary care hospitals and cardiac speciality hospitals are considered as hubs. These are higher centres where specialist doctors are available for the treatment of patients referred from the spokes. They also facility to admit patients and thus provide indoor treatment where required. In order to ensure effective referral services vertical communication is required wherein medical staff at the hub is responsible for being in contact with the spokes when a patient is referred from there to prepare sufficiently for the incoming patient. The medical staff at the hub is also responsible for horizontal communication with other hub(s) for availability of beds and other services. In order to save the patients from catastrophic health costs, only government tertiary care centres that provide highly subsidised treatment and private hospitals that accept Ayushman Bharat Card are registered as hubs. Aysuhman Bharat Card, provides coverage upto rupees 500 thousand per family per year for secondary and tertiary care hospitalisation. The list of registered hubs with the available facilities along with the rates are provided to the MO at each spoke to help them make an informed decision along with the patient to practise effective referral and save time and in turn lives in emergent situations.There are two types of hubs based on the availability of interventional facilities. H1 hubs are hospitals that lack interventional facilities (cath lab) and cardiac surgery facilities whereas H2 hubs have these facilities. Similar to the spokes, hospitals that are functional 24x7 are denoted by an ‘x’ in front of the hub type (H1x or H2x). Since both public and private institutions are involved in providing care at this level, a standard public private partnership agreement has to be approved by the District Health Officer of the respective districts.

A telemedicine unit (TMU) is established at all the hubs which is responsible for interpreting the ECG within 5 minutes and guiding the MO for the next steps for the patient. The interpreting professional may be called if necessary by the MO for further plan of action and guidance.Although the TMU does not have the authority to sway the referral decision for the patient for commercial purposes, the MO has the ultimate authority to refer the patient based on the clinical guidance provided by the specialist doctors. The functional capacity and structure of the TMU varies based on the resource availability at the hospital. In a stand alone system, a special telemedicine dashboard is established with at least one specialist doctor solely responsible for providing telemedicine services. Whereas, at the other units an integrated system is established where specialist doctors including cardiologists, emergency medicine and internal medicine physicians are to the TMU group wherein all the doctors receive the ECG on their mobile application and as soon as a physician responds to the query, it disappears from the other physicians’ application. Thus the TMU helps in responding to the digital ECGs with basic patient history for OPD patients, screening camps and acute emergencies.

In the upcoming 12 months we aim to complete the baseline assessment of the remaining PHCs of Gujarat and start the assessment in three other states of India namely Goa, Jammu-Kashmir and Assam. We also aim to train 1000 staff nurses and medical officers at rural PHCs to use ECG machines, identify a normal ECG and even perform cardiopulmonary resuscitation (CPR). We plan to deploy 500 ECG machines at various PHCs across the selected states and screen 50,000 individuals for cardiovascular diseases and other comorbidities through community level screening camps. We also plan to establish 15 district level clusters including PHCs and higher referral centres with Telemedicine facilities and Hub & Spoke Model.

Our solution is focused on strengthening the Rural healthcare system that would directly impact the Rural population of our country which accounts for more than 65% of India's total population. Mainly our solution would serve the rural inhabitants as well as the rural healthcare workers. People living in rural areas do not have direct access to advanced healthcare facilities present at a Tertiary Care centre in urban areas due to reasons like poor connectivity, financial constraints, lack of awareness etc. and hence it is imperative to provide these people access to basic lifesaving healthcare facilities like ECGs in order to timely and effectively manage and thereby decrease the burden of cardiovascular conditions. 

Access to ECGs at a PHC level would help the individuals in getting early information on their condition which would lead to early and effective management and thereby decreasing the morbidity and mortality. The screening camps would help in identifying hidden and asymptomatic cases of cardiovascular diseases and also aid in raising awareness regarding cardiovascular health. Also, one major purpose of installing digital ECG machines is that the individuals would be able to have a record of their own ECGs with themselves. The ECG machines which we deploy at the PHC have the facility of sending a copy of ECG to the patients as well. This would serve as their baseline ECG and hence help the healthcare professionals in identifying any changes, if at all later, on subsequent examinations.

The availability of ECG machines at PHCs would also help in decreasing the burden of suspected cardiovascular disease presentation at the tertiary care centres by filtering the false positives at the primary and secondary care levels. Many times the patients present with cardiovascular symptoms like chest pain but have no underlying serious condition. These patients are unknowingly referred to higher centres due to unavailability of ECG machines and fear of a worst outcome, ultimately putting the patients through unnecessary travelling and financial loss.

Apart from that, presence of ECG machines would lead to inclusion of special cardiovascular disease prevention programs at the primary health centres which in turn would also create job opportunities for the people from the local community for positions like ASHA worker (Accredited Social HEalth Activist) and Anganwadi workers.

WYHF currently has a Volunteer network of around 600 medical students, junior doctors, and business professionals in all the states of  India actively working on ground to bridge the rural-urban gap in Healthcare system and collaborating with other student organisations to achieve common goals. Our team has been working since the past 12 months, initially planning and establishing a framework to later on doing on-ground work to create an actual impact in order to understand the burden of problems from various perspectives. Our pilot project made us realise the intricacies which need to be focused upon and divert our attention towards prioritising the involvement of local community members like ASHA workers, Anganwadi workers and Female health workers (FHWs) to support us in achieving maximum community outreach and help us understand their difficulties and requirements better.

In our pilot studies we identified several factors that acted as hurdles for our project which include financial constraints, passive health seeking behaviour, fear of hospital admission, ignorance of severe health conditions etc. To address these concerns, both external support such as that being provided by WYHF or government schemes as well as internal support from the surrounding community is necessary. 

The involvement of the local community comes at a very crucial stage of the project. After establishment of the desired system, it is equally important for us to maintain the same and hence, the involvement of community is very crucial to ensure sustainability. We plan to involve representatives from the locality nearby the respective PHCs or CHCs for ‘Monitoring’ of the project and they would be working together with the WYHF local team in ensuring proper chain of communication and smooth flow of the system. These representative individuals would be supported and trained with basic life skills and would be provided with opportunities for their own progress.

Our goal at WYHF is to establish a scalable and sustainable cardiovascular healthcare referral and treatment service integration with the public sector to improve patient outcomes and also raise awareness regarding cardiovascular diseases and their risk factors among the general population. We believe that via the medium and support of Solve we can achieve this herculean task. Via your support, many previous projects working towards improvement of healthcare like projects for prevention of chronic diseases, projects for simplifying healthcare data recording, projects for digitalization and use of technology in healthcare etc. have been successful in implementing their solutions. 

One of our biggest barrier is the development of a digital health solution. We are trying to create an online platform with a one stop solution for the majority of the information related to cardiovascular health and disease. For our project Cardiogram we aim to integrate Tele-Medicine and the Hub & Spoke model on this online platform wherein a group of expert healthcare professionals can come together to help patients get correct interpretation of ECGs and timely management and referrals in case of emergencies. This platform would also serve as a medium for storage of the collected data for Research purposes. 

As we have a pan India presence, we also face several cultural barriers like differences in language of communication, cultural beliefs, level of education etc. and legal barriers such as ethical issues pertaining to data privacy, medical interventions etc. Major financial barriers include funds required for procurement of ECG machines for deployment at the PHCs and CHCs. We believe that with the support of Solve we can overcome these barriers and implement our solution at a national as well as global level. 

The COVID-19 pandemic made people realise the increasing importance of healthcare but the involvement of only the healthcare workers in improving the healthcare of the society can bring very limited change which we aspire to see. Hence, we started this project at WYHF with an objective of intersectoral collaboration which is a new concept in the field of healthcare in our country. Project Cardiogram is an innovative solution to tackle the rising burden of Cardiovascular Disease in India with the use of digital health solutions and utilisation of telemedicine to provide diagnostic and therapeutic aid in rural areas, where there is scarcity of resources. With the use of digital health, we can provide the rural population with access to quality healthcare in an effort to move towards Universal Healthcare coverage.

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The phased implementation of our Project enables us to take a systematic approach towards our solution and the work done at each step sets up the foundation for the subsequent steps. Baseline assessment would help us obtain actual data of ground reality which would in-turn help in policy making. Our countries' current diagnostics and management criterias are based upon data collected from foreign countries with populations very different from ours. The data collected via this project would help us bring changes in policies which are more suited to our population. Apart from that, the installation of ECG machines at rural centres will open further opportunities for digitalization of rural healthcare system as the government of India is also planning to bring healthcare cards for each individuals of our country which would help us incorporate a patients baseline cardiovascular health record through this project.   

The conduction of community screening camps would ensure that our project not only helps in management of acute cardiovascular accidents, but also has long term benefits in reducing mortality due to CVD by early risk factor identification. The concept of ‘Hub & Spoke model’ is also a new and innovative solution to give access to people with advanced diagnostics and treatment options which were earlier only limited to the financially stable urban population. This intersectoral collaboration will not only benefit the rural inhabitants and healthcare workers but will also allow individuals from fields apart from healthcare to contribute towards betterment of the society. Digitalization of Healthcare would also open up opportunities in the IT & engineering sector, marketing & management sector, medico-legal sector etc.

Goals for the next year: 

To provide access to ECG Machines to 10 million people by installing ECG machines at 500 PHCs in rural areas in four states of India namely Gujarat, Goa, Jammu & Kashmir and Assam.

To decrease mortality due to Cardiovascular Diseases by training 1000 staff nurses and medical officers at rural PHCs to use ECG machines, identify a normal ECG and perform cardiopulmonary resuscitation (CPR). Also, identification of cardiovascular symptoms and risk factors. 

Establish 15 district level clusters including PHCs and higher referral centres with telemedicine facilities.

Screen 50,000 individuals for cardiovascular diseases and diabetes through community level screening camps.

Goals for the next 5 years- 

Impact- Educate 3,00,000 patients in local languages about their CVDs; Support 5 cardiovascular health (CVH) startups; Publish 25+ relevant research papers; Advocate for implementation of project CardioGram (backed by cost effectiveness analysis study) by NDHM support; Procure 2 CVH tech patents; Provide access to 30 million rural inhabitants of India to digital ECG machines and in turn establishing telemedicine facilities at PHCs and CHCs to provide specialist cardiovascular healthcare facility; Screen 75,000 individuals for NCDs including CVDs and diabetes; Train 10,000 primary health doctors to provide emergency cardiovascular life support; Design an online platform that would serve as a telemedicine interface and increase the efficiency of the process and Save 5,000 lives.

Outreach- Mobilise 15,000 young individuals from diverse backgrounds to improve CVH; Establish 20 new National Chapters including LMICs from all 6 WHO regions; Collaborate with 30+ National and International NGOs to collectively achieve our goals.

We measure the impact we make at every stage of our project through needs assessment surveys and other questionnaires. At the preliminary stage we conduct a needs assessment at rural healthcare centres to assess the existing resources, population and healthcare worker characteristics to ensure that the deployment of an ECG machine would provide maximum benefit. Our training sessions are equipped with a pre and post session questionnaire to ensure that the training was successful and adequate. 

The data collected in our community screening camps helps highlight high risk patients who would require further management. The collected data helps determine the impact of early detection and management on mortality rates due to cardiovascular disease. The individuals with high risk factors are followed up regularly at the PHCs to evaluate their treatment progress. The ECGs collected after deployment help assess the prevalence of cardiovascular disease in the community. The ECG manufacturers also provide us with weekly data on the usage of the machines and other factors like reporting turnaround time, number of referrals, individual location information, hub statistics for the entire cluster etc.   

We present this report to the Chief District Health Officer (CDHO) who is the top most healthcare official for a district. Based upon the reports, the CDHO implements subsequent necessary changes which would help improve the outcomes of the project. Apart from this, we also plan to do a cost effectiveness analysis at each step of the project to help us use and divert (if necessary) the collected funds efficiently. For our previous project ‘The Local Heroes’ as well, we conducted cost effectiveness analysis with promising outcomes. Ultimately, a reduction in cardiovascular disease morbidity and mortality over time in the region of our presence will serve as the greatest impact for our project.

With the rise in the number of cases of cardiovascular diseases and other non-communicable diseases, the shift of focus towards CVDs is imminent. Studies across the globe in lower-middle income countries have successfully proven the feasibility of establishing telecardiology solutions in rural setups.

We require people with understanding of the local community and on-ground expertise like ASHA workers and Anganwadi workers, a team commitment towards working in partnership with the community and flexibility in fulfilling their needs, a network of healthcare professionals and other active and enthusiastic volunteers and also a good advocacy and leadership capacity to achieve our goals. We would apply our learnings from the previous experiences and guidance from mentors towards bringing more effective and better solutions. Our training sessions and screening camps will provide us with ground reality and other insights which would help us take a more practical and achievable approach towards bringing affordable and believable outcomes.  

Our efforts would be diverted towards the benefit of the underserved rural population, raise awareness to improve health seeking behaviour, improve the basic skill set of healthcare staff through training, create self development opportunities and improve overall quality of life. The prospective outcomes of our solution are aimed at bridging the technology and resources gap between urban and rural areas, changing the knowledge, attitude and practice towards cardiovascular healthcare, avoiding unnecessary financial losses, balancing the distribution of the burden of the disease amongst the healthcare sector and ultimately decreasing the morbidity and mortality related to CVDs.

Our long term vision is to aid in decreasing mortality due to cardiovascular health by 30% by the year 2030 and we believe that our current solution is the first step towards achieving that goal. In our early stages itself we are able to see a strong impact through our solution. For instance in our pilot screening camp, we were able to identify 21 abnormal ECGs from 71 patients screened with the ECG machine of which 3 patients needed emergency management and urgent referral to higher centres. Hence, we believe that we are on the correct path to achieve a major impact through incorporating telecardiology solutions in rural areas. Our project will help us achieve several sustainable goals, the most important of which is universal health coverage.

Our project mainly relies on digital health to provide the expertise of highly trained doctors in rural areas to identify and manage cardiovascular disease. We use digital ECG machines to record ECGs that are sent to doctors (from public or private hospitals) at the associated Tele-medicine units who can remotely provide the diagnosis and suggest steps for further management. These tele-medicine units would be incorporated onto a common web portal which would also provide educational material and access to other resources related to cardiovascular health to different groups of people including patients, healthcare professionals as well a general population.  

Currently for ECG report transmission as well storage of data we are relying on external apps and communication platforms like WhatsApp but considering appropriate ethics involving data privacy and sharing we aim to be self sustainable and use less of the general/public platforms for future endeavours. We plan to incorporate block-chain technology for individual data privacy which would prevent misuse of the vast majority of the available data by monetary businesses for personal gains. In all, our purpose is to create a safe, secure, efficient and sustainable digital platform for logistics, administration and smooth implementation of our projects.

Currently for this solution, two forms of data are being collected. First, the data for baseline assessment as well as that for the screening camps is being collected by WYHF volunteers who are medical students and social health workers. Secondly, the ECGs are being taken by the Medical Officers at PHCs and stored in the WYHF database which is integrated with the ECG machines. Data collection by the WYHF members and MOs is voluntary and no incentives are provided.

The inception of WYHF was based on the concept of Intersectoral collaboration wherein people from different fields like medicine, engineering, business, designing, technology etc. come together to work towards a common objective of improving Cardiovascular health of the society. The idea behind this was to indulge with professionals and experts from various sectors to understand the problems better and thereby work towards implementing more effective strategies and solutions. Our focus is more towards empowering Youth to take up leadership roles and, aside from their personal development and profession, divulge some of their knowledge and energy towards the betterment of the society. 

Our Pan India presence in each and every state of the country is representative of our geographic and cultural diversity. For administrative purposes we have divided India into 4 regions (North, South, East, West) with equal representation from each of these. Each and every member of the organisation is eligible for participation in any of the projects or activities taken up by the working committees. In our previous project, The Local Heroes, volunteers were involved from 58 cities from all states across India. Apart from paid memberships, we also have provisions for internships wherein students who are willing and motivated enough are provided with free of cost opportunities to gain experience letting aside their financial restrictions. In the upcoming years we also plan to expand our organisation and outreach to other countries and have started conversations regarding the same with people abroad.

The World Youth Heart Federation (WYHF) is a not for profit, registered as a section-8 company. We are a healthcare based non-government organisation providing services to improve the cardiovascular health of the society. The structure of the organisation consists of an Executive Board, Working Committees and Board of Advisors.

The Executive board includes the President along with Vice-Presidents for Internal Affairs, Finances, Networking, External Affairs and Public-relations, each with their well defined roles. The Working Committees on the other end go with the acronym of HEART namely Health education, Entrepreneurship, Advocacy, Research and Technology which take up different projects related to cardiovascular health independently or in unison. 

The Health education committee works towards making health education videos for normal individuals, patients as well as healthcare professionals. These videos are made in multiple languages to improve outreach and include various training sessions, patient education material, disease and risk factor awareness etc. The Health Education committee also organises health-education webinars with special guest speakers and conducts quizzes for medical students. Currently they are working on videos related to CardioPulmonary Resuscitation (CPR) training modules and Hypertension awareness and home based blood pressure monitoring.

The Entrepreneurship committee works on setting up networks of mentors who can guide startups working towards cardiovascular healthcare. The committee also organises Hackathons in collaboration with incubators to give opportunities to young individuals in bringing effective cardiovascular health solutions. 

The Advocacy committee works in two tiers, first towards raising awareness regarding various cardiovascular diseases via online and offline awareness campaigns and secondly they also work towards policy making in unison with the Research committee. 

The Research committee primarily focuses on establishing multicentric research projects, which may be local or national via means of small working groups. They are currently working on a pan-India Hypertension research project along with various other smaller projects.

The Technology committee works in unison with the entrepreneurship committee in developing new technological advancements and indegenous healthcare solutions in the field of cardiovascular health. 

The World Youth Heart Federation India receives funding via various means but the most effective solution for self sustainability working for us is the ‘Hyper-Local Model’. through this model, our objective is to empower the local teams to look for funding options and raise donations locally to use those funds locally. This also serves an important concern of the donors regarding the usage of their funds making them assured that their philanthropic efforts were acknowledged. The donors see for themselves the changes brought about by their donations in their own surroundings which gives them a sense of security and develop increased interests in donations for the future as well. Another source of indirect funding for our cause which is similar to Hyper-Local model is the direct benefit to the beneficiaries by providing necessary requirements directly by the donors without any third party intervention but through the channel of WYHF. In some cases, funding from philanthropic donations are also used as seed funds for a working group until it becomes self sustainable. 

We also plan to monetise the products of the Working Committees like training sessions of the Health education committee with a subscription based model for fund generation or monetary partnership with incubators and tech companies in collaboration with the entrepreneurship and technology committee or even possible monetization of potential and expensive research projects taken up by research committee etc. 

Other sources of funding include crowdfunding collected via fundraising campaigns or membership fees which could be used for seed funding of various national and local projects and also help cover administrative expenses. One of the potential sources of funding also includes Corporate Social Responsibility (CSR) funds which could be used for large scale projects and also aid in long term sustainability. These funds are provided by profit making companies as a part of their social responsibility towards betterment of the community.

During the initial months after inception, our main source of income was from membership fees but as we started taking up different projects, we began receiving donations via crowdfunding and CSR funding as well. Recently we have been inclined towards the Hyper-Local model as our primary source of revenue. During our first conference we organised various workshops and webinars and the funds collected were sufficient enough for successfully conducting the conference. 

For our previous project, The Local Heroes, we pooled a donation of more than rupees 2.5 million towards providing essential medical supplies at PHCs and tertiary care centres across various cities in India. Recently,for our Pilot project Cardiogram in Vadodara itself, we received a CSR funding worth more than rupees 800 thousand from a well known hospital for procurement of ECG machines and deployment at various CHCs across the district.