Yamunanagar, Haryana: On 15th July, Raj Rani, 52, an ASHA worker working in Yamunagar, Haryana had just completed her tasks for the day when she again felt a throbbing pain in her left arm and in the middle of her chin. Since the pain persisted for 2-3 days she realised it could be something serious and headed to the Community Health Centre (CHC) at Vyaspur to get an electrocardiogram (ECG) done.
The Additional Senior Medical Officer at the centre, Dr Gunjeet Singh, saw the results of the ECG, gave her a dose of drugs including blood thinners and clotbusters, called a loading dose, and asked her to rush to the district hospital at Ambala Cantonment for further treatment. Raj Rani collected her medical files and left for the hospital, which was two hours away, with her brother-in-law. The cardiologists at the hospital did another ECG and some other tests and told her she was fortunate to have come to them at the right time.
(Raj Rani, 52, an ASHA worker working in Yamunagar, Haryana was detected with a single vessel disease thanks to a new tele-ECG project by the Haryana govt.)
Raj Rani had single-vessel disease where a major coronary artery was blocked. “They scheduled my angioplasty the next day and I got one stent in my heart,” said Raj Rani. “I told my doctors to give me good treatment so that I can resume my work as an ASHA, they reassured me that I can do my duties as before because I came in time,” she told The Hindu from her maternal home in Boh village, 8 km from Ambala Cant.
Had this happened two months ago, Raj Rani would not have received the diagnosis that would have led to quick treatment. Even though the Vyaspur CHC had an ECG machine, there was no technician to conduct it and while the medical officers could interpret the results, they were not confident.
(Dr Gunjeet Singh, Addl Senior Medical Officer at Vyaspur CHC was alerted about Raj Rani’s critical ECG through Spandan’s tele-ECG network.)
On May 29, 2026, Haryana Government tied up with Sunfox Technologies, a health-tech startup, as part of Public-Private Partnership (PPP), to set up a tele-ECG network called ‘Spandan One’. Each medical centre in Haryana received a tele-ECG device that connects to smartphone and tablets, can be operated by frontline workers and gives a clinician-reviewed result in less than three minutes.
(Screenshot of the Haryana Dashboard, accessed on September 17, 2026)
Till date, almost 600 government health facilities including primary health centres (PHCs), CHCs, Sub-divisional hospitals and District hospitals have been equipped by a tele-ECG device along with training in using it. The Spandan dashboard shows till 17 September, 33854 ECG tests were conducted, 1342 critical cases were detected and 9287 ECGs were abnormal.
(Dr Varun Singh, Medical Officer, Ranjitpur PHC in Yamunagar district with the tablet showing an ECG report of a patient.)
In the remote Ranjitpur PHC in Yamunagar district, there is a steady increase in the footfall of patients due to the tele-ECG service available. “This is a new building which we started using just six months ago, there is no fixed nurse or staff or even furniture,” said Dr Varun Singh, Medical Officer who has been running the centre with staff on deputation and through borrowed furniture from other centres. “Ever since we got the tele-ECG, people have been coming to the centre asking for the new test happening here,” he said.
(Ram Saran, 75, with his son Mangaram at Ranjitpur PHC.)
We saw Ram Saran, 75, come to the PHC with his son Mangaram to get his reports examined by Dr Varun Singh. Saran has been experiencing a feeling of his heart racing and breathlessness for many months. He had gotten ECG and blood tests worth Rs. 1200 at a private hospital at Vyaspur but wanted confirmation from the government doctor.
The nursing officer at PHC put the electrodes on Saran and we saw an ECG graph forming in the tablet in her hands and a message that the report was being analysed, two and half minutes later, the report was ready for download. Saran had an ‘abnormal ECG’ and he was asked to consult a cardiologist and a copy of the report was sent to his mobile number.
Dr Singh then consulted Saran and his son and told them to visit the hospital at Ambala Cant. at the earliest. “Before this initiative, I would not be able to interpret ECGs with this level of sophistication, the patient would need to visit a cardiologist available two hours away and wait a long time in the OPD for the diagnosis,” said Singh. For patients who are diagnosed with critical ECGs, an alarm goes off in the tablet to draw the attention of the healthcare worker and a prescription is generated so that patients receive life-saving medicines while they get referred to a higher centre.
“We never thought that we would get results within a few minutes of doing the ECG. This tele ECG service is available in all centres in Yamunagar and is available in even other remote locations in the districts. [Introduction of ECG] is a very welcome step and I think it should be available in all centres at the earliest,” said Dr Shama Parveen, Senior Medical Officer, Yamunagar CHC.
Like we said in the previous parts of the series, while PHCs are the first point of contact of medical care for rural patients, they do not have the necessary equipment or manpower to diagnose and treat heart ailments.
A 2024 pre-print to assess the availability of cardiac care in Vadodara district in Gujarat found only 58% of PHCs had ECG facilities but did not have healthcare workers who knew how to operate or read an ECGs and only 44% of the PHCs had ECGs and used them appropriately. In most cases patients were simply referred to higher centres for treatment. The time lost due to travel between centres can prove to be fatal for patients.
(Dr Kuldeep Singh, former Director General, Health Services, Haryana who was the brain behind the tele-ECG network.)
The impact of the initiative has been incredible, said Dr Kuldeep Singh, former Director General, Health Services (DGHS), Haryana who was the brain behind the partnership. There is now an availability of ECG machines and early treatment in rural centres that had earlier not registered a single heart attack due to lack of diagnosis. “We are already witnessing a 20% reduction in deaths in the emergency departments of District Hospitals because patients are being stabilised before rushing here,” he said, adding that these are early assessments and more data is still being collected.
Once the patient is stabilised by giving the loading dose, the patients are sent to higher centres like district hospital with Catherisation Labs where angiographies and angioplasties are performed. “Given the geography of Haryana, most patients reach the higher centre within 1 hour of the diagnosis, saving lives and heart muscles of the patients,” said Singh. The Haryana Government is in a PPP with private providers to equip and run the cath labs in four locations in the state–Panchkula, Gurugram, Faridabad and Ambala Cant. and soon to be expanded to more locations.
“With Haryana, we are trying to build that complete pathway—from diagnosis to prescription to referral—while giving the state real-time visibility into its cardiac burden,” said Rajat Jain, CEO of Sunfox Technologies.
Based in Dehradun, the company focuses on designing and manufacturing affordable and portable diagnostic tools to solve healthcare challenges. As part of the agreement with the Haryana government, the company provides equipment, training and on-going support for its tele-ECG system apart from maintaining a live dashboard monitoring cases.
“Through the dashboard, we have real-time patient informtion which has given us rich insights–for example we now know that patients between 30-49 years have a higher incidence of cardiac issues than those over 50 years,” said Jain. They have also found the incidence of critical ECGs among women in the age group of 30-49 is as much as men and greater than men in the age group of 70+ dispelling the belief that men have a greater risk for heart disease than women. “These kinds of insights are very important for policymakers but were never accessible before,” he said.
While the project is picking up steam in Haryana, there are some teething issues–many of the centres have to conduct many retakes (repeat ECGs) to get accurate ECG readings (as they were not conducted properly) and some bumps in the road–nursing union had issued a diktat that nurses should not be conducting the ECG test as the post of ECG technicians remained vacant in most health centres--DGHS later issued a letter stating healthcare workers cannot deny conducting life-saving diagnosis and would face disciplinary action if they fail to do so and the matter died down.
There is also the question of what happens when the partnership between the government and Sunfox Technologies ends, would the pathway to diagnosis and treatment change or would it have improved?
(OPD rush at Vyaspur CHC)
Making ECG facility available at the PHC level is a great start but we need to do much more to improve the public health system as a whole to respond well to non-communicable diseases and their complications, said Dr Chetanya Malik who practices in a Surguja, a remote district in Chattisgarh for the non-profit Sangwari.
In Chattisgarh, ECG facility is only available at the District Hospital, “Currently patients with high BP or diabetes do not have access to routine ECGs, this means by the time they come to the hospital–it is already an emergency,” said Malik. Haryana being a more developed and richer state is late in implementing this initiative, he said, “Along with tele-ECG facility, there needs to be a tele-support in finding transport and referral in higher centres to solve the problem of treating a cardiac emergency,” he added.
For long our public health systems have remained focused on infectious diseases and maternal and child health but the time has come to realign the health system to care for complex and non-communicable diseases like heart disease with a high morbidity and mortality. Almost 25-30% of all deaths in India are due to heart disease, “We have the funds and have the technology to prevent the deaths, there is no reason why other states should not implement this programme and tackle heart emergencies,” said former DGHS Kuldeep Singh.
Edited by Christianez Ratna Kiruba
Image by Swagata Yadavar
This is the third part of a three-part series (links of first and second stories) on the health system’s response to heart attacks. This series is a project of Nivarana, a digital public health platform and has been supported by Sunfox Technologies.
