Standing at an epochal juncture, India is going to have its first budget amid a pandemic. Though this is not the first pandemic the country is witnessing – under the colonial rule, it has withstood the Spanish flu pandemic in 1918 that killed millions – it is the first time India is facing it as an independent nation. Historically, its tormenting colonial legacy made healthcare focus on providing treatment for diseases, a system that failed to scale itself up with the rising population. India’s healthcare budget has been one of the lowest among the nations forming the Organisation for Economic Co-operation and Development (OECD) and BRICS. In terms of healthcare access and quality, it ranks 145th globally, below Bhutan, Bangladesh and sub-Saharan Sudan. In the past 73 years, India has managed to systematically patch together a highly fragmented healthcare system that direly needs integration.
During the last budget when COVID-19 was gripping the world, the total health outlay was INR 69,000 crores, amounting to 1.6 per cent of GDP against an aimed 2.5 per cent, of which the Ministry of Health and Family Welfare (MoHFW) received about INR 65,012 crores. The allocation for Ayushman Bharat remained the same at INR 6,400 crores whereas the cost varied between INR 17,000 to 27,000 per hospitalisation even before the pandemic. With the pandemic forcing a monumental shift in priorities, it is important to make clear financial provisions for digitisation of Indian health systems as well as breaking its silos.
Digitisation is the first step
While the government-backed health system in India is still largely paper based, especially in rural and remote areas, the private healthcare system is a fragmented market with multiple players – single-doctor clinics, standalone nursing homes, non-profits, and corporate hospitals. All these players can be brought together on one platform under the National Digital Health Mission (NDHM), announced by Prime Minister Narendra Modi in August last year. There are obvious operational benefits of such a move, but the benefit to the people/patient is unmistakable. The six key aspects of NDHM – health ID, DigiDoctor, health facility registry, personal health records, e-pharmacy, and telemedicine – can make it a game changer. In turn, digitisation will foster better understanding and monitoring of disease prevalence, timely and pre-emptive measures in case of potential outbreaks, and gather India-centric population-based data that will boost medical research. In conjunction with Ayushman Bharat that reduces out-of-pocket expenditure for healthcare, digitisation of healthcare can create programs for sending reminders to enrolled patients for their next appointment and prevent people from poorer background to drop follow-up treatment and help them adhere to treatment schedule. This can bring a revolutionising effect on diseases like cancer, tuberculosis, and leprosy that see a large number of patients defaulting (stopping treatment before completion of treatment regimen).
Digitisation can break the silos of healthcare
Digitisation can play an all-important and critical role in breaking the current siloed healthcare system of India. It will create a platform to bring together disparate information – health and health infrastructure, status related to nutrition, disability, sanitation, education, economic standing, etc. which can help in forming a cohesive and holistic action-oriented policy on integrated health. Analysing the data gathered and communicating insights for awareness can be used for behaviour change. Given that private players provide about 70 per cent of healthcare services in India and historically, private enterprises have played a significant role in its growth and economic development, increased budgetary allocation and better public spending will help drive their participation in widening the scope and reach of healthcare. However, as India begins to turn the corner with NDHM and approved vaccines to combat COVID-19 that will help alleviate fear of infection, budgetary allocation must be made to ensure weaker players in the health sector struggling with operational hurdles such as infrastructure upgrade are not left out. The government must allow them access to resources so that end-users, i.e., people, are not left out of the ambit of this second digital revolution and defeat the objective of NDHM. At the same time, it must focus on creating better data security laws, possibly on the lines of General Data Protection Regulation (GDPR) of the EU, to ensure privacy of sensitive user data.