The digital revolution in Indian health care
The nationwide rollout of the Ayushman Bharat Digital Mission is a welcome initiative that will define the future of public health and development in India. It marks a significant step in the global push to harness digital health to achieve universal health coverage (UHC) — where people can access quality health services, without facing financial hardship.
The mission aims to help achieve UHC in India by implementing the digital building blocks required for health care, and by making those blocks accessible as digital public goods for all.
The initiative has six guiding principles: Voluntary participation; security and privacy by design; inclusivity; seamless portability across the country; educating and empowering individuals and health providers; and lastly, it is wellness-centric and wellnessdriven.
It is based on a simple premise: Highquality data is critical to good public health policy and management — a fact long known, but which Covid-19 highlighted.
Every day, public health leaders and policymakers take note of the numbers of new Covid-19 infections. They look at districts with high infection and high test positivity rates. This helps policymakers take timely action. It is how India has mobilised the whole-of-government, whole-of-society response that such a crisis requires.
The digital tools that India has developed to respond to Covid-19 have had a significant impact, from software that facilitates RT-PCR testing to the CoWIN vaccination portal. These tools have been developed to address just one disease. With the rollout of the Ayushman Bharat Digital Mission, India is set to create the digital infrastructure necessary to streamline information for other diseases, at all levels of care, and across public and private providers, integrating disease programmes, and enhancing evidence-based decision-making.
Patients stand to benefit in several ways. The Ayushman Bharat Digital Mission can enhance continuity of care, with service providers accessing a patient’s health record following the provision of patient consent. This does away with long trails of paper-based records and potentially reduces waiting time. Every citizen can choose to either be a part of the mission or opt out. This is an important feature.
The mission uses the “public goods, private innovation” model first adopted by the Unified Payment Interface (UPI) — an appropriate way to navigate India’s federated health ecosystem. The proposal to create state digital health missions and use digital tools to enhance health workforce capacity is not only commendable, but necessary. The adoption of the mission into the national health mission pro
grammes and public hospitals is a must.
Given its strong design, the mission’s success will, for the most part, depend on how it is implemented. Several priorities require targeted attention.
First, while uptake of the Ayushman Bharat Digital Mission is voluntary, the value of health data is dependent on wide participation, from patients and health care providers. Policymakers must identify strong incentives and benefits for each stakeholder to voluntarily join the mission. Capturing low-hanging fruit to demonstrate the value of digital public goods can help generate the necessary momentum.
Second, health data contains sensitive information on a range of personal issues, from HIV status to sexual health. With the tabling of the Personal Data Protection Bill, India has announced plans to pass stronger regulations in this area. Given that the bill is pending, it is imperative that the mission strictly implements technical
safeguards that ensure privacy, protect health data security, and gain trust.
Third, the adoption of digital technology by small hospitals and clinics in India is still in its early stages, as is the use of digital health systems by frontline workers.
While this provides an opportunity for the mission to set national standards, efforts are needed to strengthen incentives, and achieve maximum adoption at all levels of care in the public and private sectors.
India is at the start of a marathon — one that must take all runners, walkers, and even spectators along, ensuring better health for everyone. It has every chance of success. Towards that outcome, India can be certain of the World Health Organization’s ongoing and unmitigated support for a responsive, healthier India for all.