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Reimagining health system

Lata S. (name changed) had been experiencing breathlessness and a persistent cough for a few days. With Covid-19 high on everyone’s mind, she decided to take action. After speaking to a physician through a teleconsultation, she received a prescription on her mobile phone, suggesting an RT-PCR test and symptomatic medication which she could, again, order online.

Lata booked her test online with an approved designated laboratory, and her sample was collected at home the following day. Two days later, she received her results via email (which, to her relief, were negative). All of this, while never once having to step outside.

The healthcare sector and everybody associated with it, has been under tremendous pressure to adapt, to deliver, despite the odds, to ensure fellow citizens remain safe and healthy. There has been a marked shift — public and private health programmes have pivoted to reinvent service delivery and revise policy, collaborating across sectors to introduce innovative approaches that ensure access to care during these pressing times. What seemed the most unprecedented challenge of the last few years has become an opportunity to bring healthcare closer to people’s doorsteps.

Digital technology, of course, has played a central role, and will continue to push the envelope on how individuals are diagnosed and treated, and how the health system functions as a whole. Last month’s launch of the National Digital Health Mission may usher in a digital revolution for the health sector in India.

The online panel discussion last week (organised by Global Health Strategies and ThePrint) on “Reimagining India’s Health System” touched on many of these areas and panelists presented a range of action points.

Technology, the force multiplier
Technology will connect the dots in the health system, and bridge the gap between the public and private sector to function with a singular vision of better public health management. The creation of an ecosystem inclusive of an electronic health record system and linked health ID will make access to our medical history (including diagnostic reports and prescriptions) far simpler, and connect us remotely through teleconsults with doctors, e-pharmacies and labs for doorstep delivery of services. Patients can thereby rid themselves of the complex and circuitous care-seeking pathway they must navigate at present.

This ecosystem has a critical analytical role to play as well — integrated geographic information systems (GIS) can triangulate prevalence and genomics data to provide information on disease transmission and geospatial coverage, allowing public health experts to judge the patterns and speed of transmission almost in real time, and accordingly suggest the deployment of focused disease-control efforts.

Prescription data from doctors using the platform could be used to analyse variance in prescription patterns, to ascertain if they are aligned (or not) with standard protocols issued by relevant medical authorities. AI or machine learning platforms can be assimilated within digital diagnostics to help screen and triage patients. This could be a game-changer, especially in low resource settings, with the potential to improve efficiency and accuracy of test results.

Admittedly, this will require a clear policy framework and supportive regulations on data, with adequate investments in systems, to ensure privacy and data security.

Capacitate the community and community workers
Equipping frontline health workers and communities has become essential, now more than ever. We witnessed the role played by ASHAs (frontline health workers) and community members in raising awareness, dispelling myths and misinformation on Covid-19, while helping those in need access healthcare.

Whether in the interiors of the country or in Mumbai’s Dharavi, on-ground health workers and empowered community leaders have helped in reining in the spread. We know that community leaders such as sarpanchs or gram pradhans, as well as religious leaders, have a massive influence over the community, making them key actors in promoting health and improving service delivery by coordinating with the administration.

Our community leaders and frontline health workers will play a key role and must continue to be a priority. Clearly defining the roles of ASHAs, ANMs and Anganwadi workers, and capacitating them with the necessary training, can have an exponential impact.

Public private partnerships
The private sector is a natural ally to the public health system — not only to manage the Covid-19 pandemic, but across the spectrum of preventive health, disease management and patient support.

It is important to recognise that the private sector is a diverse, plural pool (including both the large commercial hospital as well as the single-doctor clinic) that caters to three quarters of the population. Programme such as the national tuberculosis programme have contracted intermediary agencies to engage with the private sector, helping them to coordinate better with the public health system and connect their patients to appropriate and affordable follow-up care where needed.

With greater collaboration between the public and private sectors, be it through the PMJAY, or in TB care and reproductive health services, digital health, or even R&D, India can build an inclusive, efficient, affordable and accessible health system that puts the patient at its centre and ensures care in a manner that is agnostic to which sector it is sought in.

The gargantuan shift in the way patients and healthcare providers in India are interacting with each other today is fascinating, and a silver lining in these testing times. Difficult times such as what the world has faced over the last few months go down in history as a testament to the creativity of the human mind, and to human resilience.

It will be critical for us to leverage this moment to adapt and change, to universalise and bring healthcare closer to people. To paraphrase authors Brian Christian and Tom Griffiths’ famous quote: If the rules of the game don’t allow for the right strategies, why shuffle around the same ones — when we should try to change the game. This is good time to reimagine our health system.

Divya Vaidyanathan & Pratyush Pranav of Global Health Strategies. – ThePrint 

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