Inter-State Referral Pathway for Pediatric Congenital Heart Surgery under Rashtriya Bal Swasthya Karyakram: A Nine-Year Operational Analysis from Ganjam District, Odisha (2018-2027)

Background: Congenital Heart Disease is a major contributor to infant and child mortality under the "Defects at Birth" component of Rashtriya Bal Swasthya Karyakram. Odisha lacks in-state pediatric cardiac surgical facilities, necessitating inter-state referrals. Congenital Heart Disease is a leading birth defect under RBSK requiring surgical intervention. Objective: To document the operational framework, outcomes, and year-wise trends of the CHD surgical referral pathway implemented in Ganjam district from 2018-19 to 2026-27. Methods: A retrospective analysis of operational data from DEIC-Berhampur and 46 Mobile Health Teams was conducted. Data on case detection, diagnostic confirmation, surgical referrals, and outcomes were extracted from RBSK portal and DEIC records. Retrospective analysis of RBSK portal data and DEIC-Berhampur records from 2018-19 to 2026-27 was conducted. Media coverage from Sambad, Berhampur Edition 2024-2026 was analyzed for community validation. Results: A total of 819 children received corrective heart surgery with complete RBSK support. Annual caseloads averaged 91 cases, peaking at 193 in 2020-2021. The pathway involves four stages: MHT screening, DEIC confirmation, referral to six empanelled hospitals outside Odisha, and community follow-up. Regional media documented multiple cohorts including 48 children to Mumbai in April 2025 and 18 children to Chennai in March . Conclusion: The Ganjam model demonstrates that systematic inter-state coordination can successfully provide tertiary cardiac care in resource-limited settings. The nine-year data validates the operational sustainability of this referral mechanism for districts lacking pediatric cardiac infrastructure.