National Digital Health Mission- Technological universalization of Health Care
First, let me ask you a question. If I order a pizza and call for an ambulance at the same time, which of the two do you think is more likely to arrive first? Yes, I agree with you. The pizza is more likely to come first at your doorstep than the ambulance. This is because the companies into the business of food delivery put immense importance on being technologically advanced, inclusive, and delivery-driven. One might wonder what would be the results if such principles were applied to a sector as essential as our health care system.
The answer to this is the newly announced National Digital Health Mission. Under this, every Indian will get a new Aadhar-like health ID that will electronically store the individual's medical records, including doctor visits, diseases, the line of treatment, etc. The key feature of this mission is the technology part - it will optimally use open digital systems to enable access to timely, safe, and affordable healthcare for all. The mission aims to create a digital health ecosystem. The NDHM is implemented by the National Health Authority (NHA) under the Ministry of Health and Family Welfare. Ayushman Bharat is also implemented by the National Health Authority (NHA).
The key features of the scheme are-
Health Id- The health ID will be in the form of a mobile application. The national health ID will be a storehouse of all health-related information of every Indian. The Health ID will be a voluntary initiative and will be applicable across states, pharmacies, hospitals, etc. The willing individuals who wish to have their health records available digitally must create a unique Health ID, using their basic details and mobile or Aadhaar number. The extent and duration of sharing of health-related information from the Health ID will be governed solely by the individual with the help of a health data consent manager who will ensure a safe and seamless flow of information.
Digi Doctor- The Digi Doctor option will allow doctors from across the country to enroll voluntarily under the scheme and their details, including their contact numbers if they want to provide them, will be available. These doctors will also be assigned digital signatures free of cost for writing prescriptions. It will be voluntary for the hospitals and doctors to provide details to be available under the scheme.
Personal health records and health facilities registration will be automated under this mission as well. Health facilities would also be assigned a unique electronic identifier to facilitate discovery and accessibility.
The platform is also likely to include e-pharmacy, which is a pharmacy that operates over the Internet and sends orders to customers at their doorstep, and telemedicine services which allow doctors to evaluate, diagnose and treat patients using telecommunications technology from a distance. These are in the planning stage and regulatory guidelines for the same are being formed.
In a country like India which is characterised by different cultures, backgrounds, visions for development, acceptable norms, tolerance NDHM is a holistic and voluntary healthcare program that unites the entire country with the common denominator of a technologically fused health care system. If implemented optimally it will reduce the existing gap between various stakeholders such as doctors, hospitals, and other healthcare providers, pharmacies, and citizens by connecting them in integrated digital infrastructure. It will alleviate citizens from the challenges of finding the right doctors, payment of consultation fee, making several rounds of hospitals for prescription sheets. It will empower all Indians with the correct information to make informed decisions at the right time. Moreover, such a scheme would help the government not only providing just and uniform healthcare all throughout the nation but also makes data collection and hence policy betterment more efficient and relevant.
The biggest advantage of the scheme is also it’s biggest disadvantage-Technology. Firstly, a survey states that the internet penetration rate in India stood at around 50 percent in 2020. This meant that only around half of the 1.37 billion Indians had access to the internet this year. Adding on to this the interconnectedness of the people across the country especially the ones living in tribal and hilly areas makes the automation of the health care system a ginormous task which can only be accomplished by huge infrastructural developments only in the long run. Secondly, the vital dependence on technology makes it less appealing for many citizens on account of data security and privacy concerns. In a survey conducted by local media, a group social media platform 60% of the people surveyed wanted to have a digital health id but did not want to share their personal information.
The outlook of the mission also speaks for it is efficiency and emergence. The NDHM does not recognise ‘Health’ as a justifiable right. There should be a push draft at presenting health as a right, as prescribed in the draft National Health Policy, 2015. The standardisation of NDHM infrastructure across the country will need to find solutions to accommodate state-specific rules. It also needs to be in sync with government schemes like Ayushman Bharat Yojana, Reproductive Child Health Care, etc, and should also account for various functionality differences in insurance companies, hospitals, pharmacies to ensure absolute universalization. Moreover, the various factors that led to the failure of NPfit (The National Programme for IT in UK’s healthcare system) should also be considered as lack of accountability amongst officials, poor strategy and business planning, hasty procedure, and lack of incentivization of various stakeholders to cooperate.
Under the mission, the advantages of public-private partnerships are also being considered and private stakeholders like Insurers, Health Tech companies, and Third-Party Administrators (TPAs), will have an equal opportunity to integrate and create their own products under the scheme. However, such products will be restricted to secondary functions like Electronic Health records, personal health records, etc, and regulated as per guidelines framed under NDHM. The core activities and verifications for example generation of the Health ID will be solely undertaken by the government without private participation.
It is difficult to predict the success of and utility derived from a project in advance and the same can be said for NDHM. However, considering the government's steps to incentivise domestic start-ups, rapid urbanisation, an all-time surge in internet penetration rates, more focus on ease of doing business, greater initiatives for digital literacy and for health-care provisions, and increased acceptance of us as a society, the future can be said to be nothing but optimistic. The scheme has been rolled out in pilot mode in six union territories excluding Jammu and Kashmir and the drive has started towards more affordable, attainable, and accessible health-care.
By Yashvardhan Bajpai