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Prime Minister Narendra Modi recently launched the Ayushman Bharat Digital Mission via video conferencing. Currently, the program is being implemented on a pilot basis in six Union Territories. Ayushman Bharat Digital Mission has the potential to bring revolutionary changes to our health facilities. It marks a new phase in 7-year efforts to strengthen health facilities.

Ayushman Bharat Digital Mission will create a seamless online platform that will enable interoperability within the digital health ecosystem and will now connect the digital health solutions of hospitals across the country with each other. Under the New Mission, every citizen will now get a digital health ID and their health record will be digitally protected.

Background

Before knowing about the latest initiative, let us look at India’s flagship ‘Ayushman Bharat Scheme’.

What is Ayushman Bharat Scheme?

The Government announced two major initiatives in health sector, as part of Ayushman Bharat programme.
Health and Wellness Centre
National Health Protection Scheme
Aimed at making path breaking interventions to address healthcare problems holistically, in primary, secondary and tertiary care systems.
Covers both prevention and promotion of health.

Need for Ayushman Bharat

India is in a state of health transition.
Infectious diseases such as tuberculosis, malaria, dengue, H1N1 pandemic influenza and antimicrobial resistance are a threat.
Also the country is facing the emerging problem of chronic non-communicable diseases such as cardiovascular diseases, diabetes, cancer which are now the leading cause of mortality.
New factors are emerging that threatens the country’s health security like ageing population, climate change, globalization, urbanization and changing lifestyles.
We lag behind in addressing healthcare delivery across the length and breadth of the country.
We have one of the highest levels of out-of-pocket spending on health.
Average cost of treatment in private hospitals is 4 times higher than that of public. This pushes many people below poverty line.
Funding for healthcare has been a major concern.
Several states have implemented or supplemented their own health protection schemes. Ayushman Bharat programme builds on these schemes.
Failure of Rashtriya Swasthya Bima Yojana (RSBY).

Health and Wellness Centre

Health and Wellness Centres will be the foundation of country’s health system.
1.5 lakh centres will bring health care system closer to the homes of people.
Will provide comprehensive health care, including for non-communicable diseases and maternal and child health services.
Will also provide free essential drugs and diagnostic services.
Also provide mental health services, vaccinations against selected communicable diseases, and screening for hypertension, diabetes, and some cancers.
Allocation of Rs. 1200 crore for this flagship programme.
Contribution of private sector through CSR and philanthropic institutions in adopting these centres is also envisaged.

National Health Protection Scheme

National Health Protection Scheme will cover over 10 crore poor and vulnerable families or around 50 crore people.
Will provide coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization.
Identification of eligible families through the socio-economic caste census (SECC) data.
World’s largest government funded health care programme.
National Health Agency will govern the implementing mechanism.
Adequate funds will be provided for smooth implementation of this programme.
Cost of packages will be decided by National Health Agency.

Significance of Ayushman Bharat

Move towards the goal of universal health coverage
Creating Swasth Bharat.
Accessible healthcare at secondary and tertiary level institutions for the bottom 40% of the population.
High involvement of states as the states are the custodians and the implementers of the scheme.
Ensures enhanced productivity, well being and avert wage loss and impoverishment.
Generation of lakhs of jobs, particularly for women.
Like Jan Dhan scheme did for financial inclusion, Ayushman Bharat will create huge awareness of health insurance
A higher life expectancy.
The country will meet its social development goals.
With respect to infrastructure and trained medical professionals, tertiary healthcare faces a big challenge. This problem is more acute in rural areas. AB will address this challenge.
Will improve access to healthcare and bridge the demand-supply gap.

National Digital Health Eco-system

It is a National Digital Health Eco-system that supports Universal Health Coverage in an efficient, accessible, inclusive, affordable, timely, and safe manner, through the provision of a wide range of data, information, and infrastructure services, duly leveraging open, interoperable, standards-based digital systems, and ensuring the security, confidentiality, and privacy of health-related personal information.

Knowing in detail the main scheme, let us look at the current developments and initiatives by the government to bring the health sector and Digital India mission in confluence to provide better services to the people of India and increasing governance through ICT.

What is Ayushman Bharat Digital Mission?

It aims to provide digital health IDs for all Indian citizens to help hospitals, insurance firms, and citizens access health records electronically when required.
The pilot project of the Mission had been announced by the Prime Minister from the ramparts of the Red Fort on 15th August 2020.
The project is being implemented in the pilot phase in six States & Union Territories.

Features of the Mission:

Use of technology

There had also been an unprecedented expansion of telemedicine in the corona period- so far about 125 crore remote consultations completed through e-Sanjeevani.
The Ayushman Bharat Digital Mission would now connect the digital health solutions of hospitals across the country with each other.

Health ID:

It will be issued for every citizen that will also work as their health account. This health account will contain details of every test, every disease, the doctors visited, the medicines taken and the diagnosis.
Health ID is free of cost, voluntary. It will help in doing analysis of health data and lead to better planning, budgeting and implementation for health programs.

Healthcare Facilities & Professionals’ Registry:

The other major component of the programme is creating a Healthcare Professionals’ Registry (HPR) and Healthcare Facilities Registry (HFR), allowing easy electronic access to medical professionals and health infrastructure.
The HPR will be a comprehensive repository of all healthcare professionals involved in delivering healthcare services across both modern and traditional systems of medicine.
The HFR database will have records of all the country’s health facilities.

Ayushman Bharat Digital Mission Sandbox:

The Sandbox, created as a part of the mission, will act as a framework for technology and product testing that will help organizations, including private players intending to be a part of the national digital health ecosystem become a Health Information Provider or Health Information User or efficiently link with building blocks of Ayushman Bharat Digital Mission.

Who will be the implementing agency for the mission?

National Health Authority (NHA) under the Ministry of Health and Family Welfare.

What are the intended benefits of the mission?

Indians will be able to use IT-enabled tools to share prescriptions, blood test reports and X-ray diagnostics with doctors, irrespective of where they were generated.
It involves the creation of a unique health ID for every citizen and a digital registry that aims to facilitate seamless interactions between healthcare experts.
This is a much-needed intervention given that management of chronic diseases has become a critical public health challenge in the past 15 years.
Data portability could expedite the treatment of the critically ill, especially those who suffer from more than one ailment.
The severity of Covid-19 effects amongst those with comorbidities has highlighted the need for a repository that alerts a doctor to a patient’s medical history at the click of a computer mouse.
In the long run, the creation of a health record system could improve public health monitoring and advance evidence-based policymaking.
It ensures ease of doing business for doctors and hospitals and healthcare service providers.
Enable access and exchange of longitudinal health records of citizens with their consent.
Create integration within the digital health ecosystem, similar to the role played by the Unified Payments Interface (UPI) in revolutionizing payments.
Old medical records cannot get lost as every record will be stored digitally. The Digital Ecosystem will also enable a host of other facilities like Digital Consultation, Consent of patients in letting medical practitioners access their records, etc.
Based on the foundations laid down in the form of Jan Dhan, Aadhaar and Mobile (JAM) trinity and other digital initiatives of the government, Ayushman Bharat Digital Mission will create a seamless online platform.
Through this platform, the provision of a wide range of data, information and infrastructure services, duly leveraging open, interoperable, standards-based digital systems while ensuring the security, confidentiality and privacy of health-related personal information.

Global learning

Globally, the tryst with e-health innovations has been a mixed one.
The UK’s National Health Service was one of the first to deploy a digital system to make patients’ records accessible to doctors across the country.
The programme did not earn the trust of doctors and failed to adequately address issues related to data confidentiality. Aborted in 2011, the project is regarded as amongst the most expensive failures in IT history.
In the US and Australia, where digital healthcare has enjoyed a relatively better outing, the creation of a patient and physician-centric e-healthcare ecosystem remains a work in progress.
The US medical system has witnessed regular debates on what must be jotted down in hospital records and prescriptions.

What are the challenges and concerns?

The lack of a data protection bill could lead to the misuse of data by private firms and bad actors.
Exclusion of citizens and denied healthcare due to faults in the system are also a cause of concern.
Evolving a language of communication in the digital health ecosphere could pose unforeseen problems in India given the country’s diversity and its chronic shortage of doctors, especially in public health centres — the main source of medical care for a vast number of people in the country.
Poor internet speeds could make data entry an onerous proposition for the rural healthcare provider.

Way Forward

The NDHM still does not recognize Health as a justifiable right. There should be a push draft at making health a right, as prescribed in the draft National Health Policy, 2015.
Learning from the global experiences, India has to wisely draft the policy rules and implement according to current infrastructural limitations and present needs. The experience out of corona pandemic will be the key guiding factor behind the implementation of the mission.
The standardisation of NDHM architecture across the country will need to find ways to accommodate state-specific rules.
It also needs to be in sync with government schemes like Ayushman Bharat Yojana and other IT-enabled schemes like Reproductive Child Health Care and NIKSHAY etc.
The Ayushman Bharat Digital Mission gives patients the option to choose the records they want to share. The areangements should be accordingly made to protect the privacy of the people and save them from further exploitation.