The Healthcare Revolution Under National Digital Health Mission And Why Structural Reforms Are A Must
This Independence Day (15 August), Prime Minister Narendra Modi is set to announce the National Digital Health Mission (NDHM), reports Times of India.
Reportedly, the proposal has received an in-principle cabinet approval and the formal green light will be given by the end of the week.
What is the the mission about?
The mission envisages an integrated platform for the healthcare in the country. The platform will serve as the focal point of a complete digital health ecosystem.
It will contain:
personal health ID for every Indian
digitised health records
registry of doctors
registry of health facilities across the country
registry of e-pharmacy and telemedicine services
The regulatory guidelines are being framed for the last feature.
The users will be able to access the platform via an application on their phones and get enrolled. The enrolment will be voluntary.
In July 2019, NITI Aayog had released a blueprint for National Health Stack (NHS) - a unified software platform that would bring the health data of public and private sector together. It recommended that the platform be owned and operated by the government, and accessible to anyone who wants to build on the data using open API software.
The blueprint recognised the need of a specialised organisation, called the National Digital Health Mission that can drive the implementation.
National Digital Health Mission (NDHM) was recommended to have complete functional autonomy on the lines of Unique Identification Authority of India (UIDAI) and Goods and Services Network GSTN.
The blueprint recommended unique identification of Persons, Facilities, Diseases and Devices using Aadhaar and other identifiers.
It also suggested setting up a Command, Control and Communication Centre for real-time monitoring and real-time interventions.
It emphasised the ‘Mobile First’ principle with regards to the healthcare services, given the significant spread of smartphones and the prospects of its further growth.
In the year 2015, the PM Modi-led government had published a note on establishing a National e-Health Authority (NeHA) - a regulatory body to oversee digitisation of the health information.
NeHA is tasked with formulating policy, enforcing regulations, setting standards and giving certifications.
The government has also brought a healthcare security law, ‘Data Protection Framework on Digital Information Privacy, Security & Confidentiality’ Act which is under process by the Ministry of Electronics and Information Technology.
The law will reportedly give the complete control of digital health data to the owner of that data. The owner of digital health data will have the right to allow/refuse the clinical entities to generate and collect their data; know where the data is being transmitted and to whom; and get compensation for any breach/damage.
The healthcare entities will have to comply with the law in maintaining security of the information and user privacy.
How will it help?
It will ensure interoperability of dispersed healthcare data
Good quality collection, storage and dissemination of health data
Rich resource of health data that can be used for Research & development purposes using Big Data analytics, artificial intelligence etc.
Spur in the entrepreneurial activity - mobile applications to facilitate both patients and doctors
Easier and effective monitoring of outbreaks like that of Japanese encephalitis, dengue, malaria, novel coronavirus etc.
Effective monitoring and assessment of various health schemes
Electronic records minimise possibilities of errors, tampering, damage
Important for development of the fields of the future - precision medicine, gene-based therapies etc.
What the future looks like?
Experts argue that at 4 per cent of GDP, India’s health expenditure is abysmal as compared to the developed countries where the number is almost always above 10 (India’s public health expenditure, that is, government expenditure on health is about 2 per cent of the GDP).
However, even the countries with similar levels of health expenditure have performed better in India. Thailand, for example, has infant and mother mortality rates much less than that of India.
The difference can be attributed to the fact that during the early part of the century when Thailand was experiencing fast economic growth, the Thai government launched Universal Healthcare, carried out structural reforms in the health sector and brought around 75 per cent of the population under its coverage within one year.
It is important to remember that while digitisation is facilitative, it cannot replace core reforms in the health sector. Countries like Thailand provide valuable lessons.
For a health system to be successful, it must ensure that the health needs of a sizeable population are met without people experiencing financial hardships. Healthcare doesn’t need to be free, but accessible, affordable and good quality.
The policy bias of the Socialist Raj propels government health schemes towards freebies from a maai baap government and selective targeting of the poor. This leads to failures because others who are outside the ambit have no stake in the success of the scheme. Selective targeting increases red tape, is prone to corruption, and wrongful inclusion and exclusion.
The approach of the current government continues to be similar to the past, where regulatory burden keeps piling on a broken healthcare system with government diktats on pricing, certain number of EWS patients in private hospitals etc.
Digital technology will provide much needed data for an insight into the Indian healthcare and open up entrepreneurial opportunities, but structural reforms are a must.
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