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Insights into Editorial: Mind the gaps in India’s health care digital push

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Introduction:

The Independence Day address of the Prime Minister launching the National Digital Health Mission (NDHM) during an unprecedented novel coronavirus pandemic crisis, caught everyone’s attention. Yet, despite all his eloquence it was not clear to many what to expect in substantial terms.

‘Going Digital’ has no doubt been a magic phrase that has often been repeated in multiple contexts in the country, and as yet another ‘Mission’ for the health sector, they waited for more news to emerge.

Even that leaves insufficient time for discussions among medical practitioners, hospital managements, associations of various stakeholders in the health-care sector and other members of civil society for any meaningful feedback.

What are the probable negatives?

It can be highly misused by the private healthcare sector, diagnostic labs, pharmaceutical and insurance sectors to exploit people in the absence of access to a quality public healthcare system.

Dealing with ethical issues, breach of privacy, and dealing with social stigma are significant challenges for the NDHM.

Moreover, experience from Aadhaar and Health Management Information Systems (HMIS) raises doubts on ensuring the quality of registration and maintenance of records and their completeness. Such mistakes might cause more damage than good to the health of the people.

COVID-19 triggered an introspection of India’s Healthcare System:

  1. Treatment and Viewing of Healthcare System: The headlines of the tragic loss of lives, the exponential increase in cases, economic morass and social disruptions have emerged a deeper subtext on how the healthcare sector is viewed and treated.
  2. Emergence of Reports on Healthcare’s Problem: The pandemic has raised reports on longstanding problem of healthcare workers protesting the shortage of equipment, patients charging doctors and hospitals for profiteering, policy makers issuing edicts against providers and reported cases of hoarding of essential medicines.
  3. Increasing lack of interest between stakeholders of the Healthcare System: The growing lack of trust between patients and their doctors and providers and the wider mistrust between policy makers and the industry found fresh ground during the pandemic.

How can the NDHM be made successful?

The biggest hurdle for NDHM is the meagre health budget of India.

How it will provide ‘healthcare for all’ without sufficient health budget sanctions and revamping of existing public healthcare infrastructure.

Currently, total health expenditure (both private and public) in India is just 3.6 per cent, while public spending on health is just above 1 per cent of the country’s GDP, which is a low compared to the countries that have some of the best digital health systems in the world.

Public sector spending on health in Canada and Australia is around 8 per cent and 6.3 per cent of its GDP respectively. Canada ranks first and Australia ranks eighth among the best healthcare systems in the world.

What are the other challenges?

  1. One big challenge is how to bring undiagnosed or untreated ailments into account.
  2. Self-reported morbidities from successive National Sample Surveys suggest a large proportion of ailments go unrecognised and undetected.
  3. Enhancing health literacy and knowledge is the key for reporting, diagnosis and treatment of ailments.
  4. Thus, unless the public healthcare system is revamped to increase health infrastructure and healthcare human resources and make healthcare affordable to the poor, it is difficult to bring people to seek treatment for all ailments.
  5. Mere insurance-based (private) healthcare does not work effectively in a country with multiple social and economic hierarchies where 62 per cent of the total healthcare expenditure is incurred by households.
  6. Thus, raising the demand for healthcare and treatment-seeking behaviour will not be possible without enhancing public health provision from bottom-to-top approach, access to affordable and quality healthcare in rural areas.
  7. Also, the country must develop a clear framework and pathway on ways to bring its private sector into confidence under NDHM-adhering confidentiality and ensuring quality of information.

Status of India’s Healthcare Sector:

  1. The general perception behind the inadequate provision and availability of healthcare services is attributed to the country’s developing nation status.
  2. India lags behind its BRICS peers on the health and quality index (HAQ index).
  3. As per the National Health Profile 2018, India’s public health spending is less than 1 per cent of the country’s GDP, which is lower than some of its neighbours, countries such as Bhutan (2.5 per cent), Sri Lanka (1.6 per cent) and Nepal (1.1 per cent).
  4. According to the World Health Organisation, India finishes second from the bottom amongst the 10 countries of its region for its percentage spending of GDP on public health.
  5. As per the OECD data available for 2017, India reportedly has only 0.53 beds available per 1,000 people as against 0.87 in Bangladesh, 2.11 in Chile, 1.38 in Mexico, 4.34 in China and 8.05 in Russia.

Indian Healthcare System based on Empathy:

  1. The society must reframe its outlook and notions about healthcare workers as standard bearers of these professions are not grubby mercantilists, but people wanting to serve with a sense of purpose.
  2. The faith in the doctor and trust in the hospital/healthcare system is the bedrock of an efficient non-paternalistic, equitable health delivery system.
  3. The governments need to make laws more effective and watchdogs less virulent and more constructive as regulation by legislation or through watchdogs has not led to an increase in trust in the system.
  4. The social media needs a dedicated group of health evangelists to fact check, correct and inform the public, especially when fiction is being passed off for facts.

Public health professionals estimate the cost in thousands of crores for all government and private HIPs to upgrade their hardware and connectivity systems, training of present staff, the entry of data afresh apart from other indirect costs.

Indian healthcare on the cusp of a digital transformation:

  1. Healthcare has become one of India’s largest sector, both in terms of revenue and employment.
  2. Healthcare comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment.
  3. The Indian healthcare sector is growing at a brisk pace due to its strengthening coverage, services and increasing expenditure by public as well private players.
  4. Indian healthcare delivery system is categorised into two major components – public and private.
  5. The Government, i.e. public healthcare system, comprises limited secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of primary healthcare centres (PHCs) in rural areas.
  6. The private sector provides majority of secondary, tertiary, and quaternary care institutions with major concentration in metros and tier I and tier II cities.
  7. India’s competitive advantage lies in its large pool of well-trained medical professionals. India is also cost competitive compared to its peers in Asia and Western countries.
  8. The cost of surgery in India is about one-tenth of that in the US or Western Europe. India ranks 145 among 195 countries in terms of quality and accessibility of healthcare.

Conclusion:

Public health practitioners at the grass-root level would continue to wonder if digitisation is the immediate problem facing the health sector or the best way to go about addressing data gaps.

In their eyes, what millions face in the country are unreliable health-care facilities in both the government and private sectors, difficulties in getting timely care, availability of beds and hygienically maintained hospital premises, availability of doctors physically or on line, and the continuous neglect of preventive and community health initiatives.

They may be blamed for trying to delay the inevitable; the inexorable march to digitisation. Perhaps they need to discover that data is the only cure, for all our ills.