We recently reached the end of a chaotic year filled with uncertainties. For most of us, 2020 symbolized a loss of lives, loss of jobs and global political and economic shifts. However, surprisingly the year has also accelerated digital transformation across countries and across sectors. In the words of Australian Prime Minister Scott Morrison, the pandemic seems to have pushed decades worth of digital adoption within just a few months.
Healthcare has been at the core of all uncertainty in 2020. The pandemic was an eye-opener for governments in terms of how under-emphasized healthcare expenditure was and how unprepared countries were for a global health emergency of this scale. Policymakers were forced to race against time to save the lives that were at risk, and many turned to digital solutions to better equip themselves. Several governments used digital tools to increase awareness, contact trace potential cases, provide remote healthcare through teleconsultation and to enable social distancing in public places.
In India, the government implemented several measures ahead of time, including the Aarogya Setu app (for contact-tracing), eSanjeevani (national telemedicine platform), SMS alerts and public awareness campaigns. The government crowdsourced ideas from citizens to recognize and utilize innovative digital healthcare solutions. The pandemic pushed the government to focus on overcoming the deficiencies of the healthcare sector, particularly in terms of infrastructure lags and access to quality healthcare services. Experts have called for an increase in healthcare expenditure (per capita and as a percentage of GDP) and targeted initiatives to engender unprecedented developments in Indian healthcare.
Even before the pandemic, the government has been working towards the creation of a digital health ecosystem. The National Health Policy (2017) clearly recognized the role of emerging technologies in healthcare delivery and advocated for its extensive use in the sector for increased efficiency and better health outcomes. Technology is perceived as an enabler that can help the country leapfrog systemic inefficiencies in healthcare, and accelerate existing schemes like Ayushman Bharat, that aim to achieve universal healthcare coverage.
The National Health Stack (NHS) (2018) and the National Digital Health Blueprint (NDHB) (2019) have framed the technology and policy guidelines for implementation of digital health in India respectively. The former draws out the technology-specific layers of the platform on the backend, and the latter details out the policy framework of how the national digital ecosystem will be implemented across the country. But the most important learning curve for the government has been its tryst with the COVID-19 pandemic. It has not only tested the government’s capacity to move at speed but challenged its potential to move at scale.
Behind the scenes, the government has been quick in developing the elements of the NHS. Prime Minister Narendra Modi announced the National Digital Health Mission (NDHM) in August 2020. The mission is being piloted in union territories like Andaman & Nicobar Islands, Chandigarh, Dadra & Nagar Haveli and Daman & Diu, Lakshadweep, Ladakh, and Puducherry, before being rolled out at a national scale in January 2021., NDHM would provide unique health identifiers to each individual, enable them access to digital health records, connect healthcare institutions and verify and register medical practitioners.
Keeping in mind the COVID-19 pandemic, the government also aims to develop a public health surveillance mechanism as part of the NDHM. The platform will help store, analyze and autogenerate relevant reports for action using data analytics, artificial intelligence and machine learning. This will help prepare the healthcare sector in the country to potential future pandemics.
Interestingly, the pandemic has encouraged collaborative working models across the public and private healthcare sector. For example, the Swasth Alliance saw more than a hundred different ecosystem players coming together to strengthen India’s healthcare infrastructure during COVID-19. The NDHM’s open digital health ecosystem (health ODE) concept envisions a shared public digital infrastructure that can be leveraged by both public as well as private players to develop innovative healthcare solutions.
The main aim of the mission is to unlock the economic value of the healthcare sector in the country, estimated to touch US$200 billion by the year 2030. Its architecture opens significant opportunities for technology firms and digital healthcare startups. As per the framework, private sector stakeholders can co-develop technology elements of the ecosystem as part of NDHM’s sandbox platform. So far, nearly 300 applications have been given access to the sandbox and may potentially be integrated to NDHM upon security testing. The CEO of NDHM, Indu Bhushan has indicated that the government aims to minimize regulation to enhance the participation of the private sector in NDHM. Although, the government will expect the private sector to ensure 1) the security and privacy of health data, and 2) interoperability of solutions proposed as part of the ecosystem.
Going forward, NDHM will also create opportunities for India to engage in cross-country collaborations in digital health. A good example is the recent e-health initiative between India and the Netherlands. While NDHM will start with implementing EHR and national health registries in its January 2021 roll-out, it will eventually include e-pharmacy and telemedicine services. The mission is expected to open up the true potential of the sector to provide affordable healthcare services to the vast Indian population.