Accelerating the health engine of India with National Digital Health Mission

The National Digital Health Mission (NDHM) was launched on August 15, 2020, by the Hon’ble Prime Minister, Narendra Modi. Spurred by the painful experience of an unprecedented full-blown viral pandemic and based on the Universal Health Coverage principle of health for all, NDHM aims to build the digital backbone necessary to create an integrated National Digital Health Ecosystem (NDHE) that will enable access to safe, timely, and affordable healthcare through a citizen-centric approach. This digital infrastructure is being built following a collaborative approach by public and private stakeholders and will enable real-time health data sharing by consenting patients with doctors, accurate decision-making on medical treatment and will optimize data security. By leveraging the power of technology, the mission is citizen-centric and the makes privacy and security of patient health data its cornerstone.

Even though the physical health infrastructure and the delivery of healthcare services in the country were impacted because of the COVID-19 pandemic, citizens turned to digital technologies in the form of mobile apps, sought teleconsultations from doctors on video calls on their smartphones, and even ordered prescribed medicines on online pharmacies. With its key technology blocks Health ID, DigiDoctor, health facility registry, personal health records, telemedicine, e-pharmacy, and e-diagnostics, NDHM has provided the policy push toward a digitally-powered transformation of how people will seek healthcare in India in the time to come.
Currently, the NDHM is being implemented in six Union Territories (Andaman and Nicobar Islands, Chandigarh, Dadra and Nagar Haveli, Daman and Diu, Lakshadweep, Ladakh, and Puducherry) in Phase: I, on pilot basis. Services like issue of Health ID, creation of registries for doctors and health facilities and personal health records have been initiated. As on February 14, 2021, as many as 18,18,826 Health IDs, 1,498 health facility registry applications, and 5,545 health professionals registry applications have been generated so far.

In a country like India where close to half of our 1.4 billion large population is still not digitally connected, scaling the efforts of such a mission is an uphill task but not impossible. We have about 700 million Internet connections. Hence more or less at least one person in each family has connectivity. Access to timely, safe, affordable, and quality healthcare, especially for citizens residing in the remote and rural areas is challenging due to a combination of supply side and demand side factors.

Inadequate primary care that can provide requisite screening and diagnosis and stop several preventable diseases from escalating into life-threatening illnesses. The lack of enough secondary and tertiary healthcare facilities can further make the scenario more dire, especially if people cannot access them on time or simply cannot afford them. Demand side factors such as low purchasing power, high out-of-pocket expenditure (OOPE) and the prospect of facing catastrophic health expenditure keeps people from seeking healthcare. A large part of this problem has been arrested by the Ayushman Bharat PM-JAY scheme that provides cashless in-patient healthcare with an annual health cover of ₹5 lakh to each of the 10.74 crore poor eligible families. However, the experience of the pandemic has taught us that without wide digital connectivity and availability of verified registries of doctors, other healthcare professionals and health facilities and verified personal health records, the delivery of healthcare will continue to remain a challenge.

Here, I will share some of the major priorities for NDHM that have been flagged since I took charge as CEO of National Health Authority. These reflect how the mission will be further built and its roll-out ramped-up in the coming months. First, after assessing the implementation status & progress so far, we are identifying the incentives and disincentives for all stakeholders to participate and engage in the national digital health ecosystem. It is critical to understand and take the interests, challenges, and needs of citizens, healthcare professionals (doctors, paramedics, and others), health facility owners and managers, insurance companies, and technology providers along since they make the digital health ecosystem we are building. Second, aligning technology and architecture with the above vision while ensuring privacy, security, and consent of owners (patients) and users of health data.

An open protocol approach will allow government and private innovators (both large and small) to freely engage with the ecosystem and drive adoption by creating solutions. Third, enabling integration with other government programs to ensure ease of beneficiary access across regions, health programs, and health facilities. And, fourth, enabling and ensuring modalities for access to benefits of NDHM for all, including the digitally illiterate. Offline modes and hybrid systems for user access in remote areas are under consideration.

The National Digital Health Mission is set to enhance the access to and the quality of healthcare by improving availability of past medical records and history to treating doctors, facilitating portability of data, enhancing the accountability of healthcare providers, and increasing availability of services and medicines through telemedicine and e-pharmacy. With NDHM, patients will be able to securely store and access their medical records (such as prescriptions, diagnostic reports and discharge summaries), and share them with healthcare providers to ensure appropriate treatment and follow-up.