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National Digital Health Mission and Data Compliance (4 September 2020)

National Digital Health Mission and Data Compliance (4 September 2020)

Why in News:

On August 15, Prime Minister Narendra Modi announced plans to give every Indian citizen a unique health ID as part of the National Digital Health Mission (NDHM), which will digitise health records as well as provide a registry of doctors and health facilities.

Context:

The decision has immense potential to change India’s health infrastructure, while also raising concerns over privacy and efficient implementation. To begin with, the health ID will undoubtedly give a much-needed technological impetus to a sector that has long been found wanting, more so amid the ongoing Covid-19 pandemic. However, unlike Aadhar, the health ID isn’t mandatory and is only one of the components of the Mission, which the government reckons will go a long way in providing universal health coverage to over 1.3 billion people. The NDHM has been rolled out on a pilot mode in six Union Territories. It comprises six areas, including health ID, DigiDoctor, health facility registry, personal health records, e-pharmacy, and telemedicine.

Background:

The work on the National Digital Health Mission started with the National Health Policy 2017, wherein it was clearly mentioned keeping in mind World Health Assembly resolutions about the digital health, which was also the same year that the digital technology are to be integrated within the health care system and thereafter, there were year after year changes going on globally as well as nationally.

When The national blueprint was prepared somewhere in 2018, at similar time WHO guidelines for the Digital Health Program also came and finally it culminated in to National Digital Health Mission which was announced by the Prime Minister with 6 major components on 15th August from the Red Fort.

The National Health Authority (NHA) released the Draft National Health Data Management Policy on 26 August 2020 for comments and feedback from the public.

Summary of the Debate

About the National Digital Health Mission (NDHM):

The 7 pillars of the pilot which government is trying to work out and try to establish some types of sanctity to it at the end of completion of the pilot are:

  • Unique id: Under the National Digital Health Mission, a digital health ID would be created for all Indians. There are legal and personal debate on it and whatever type of formulation the NHA is going to adopt for this, unique id is ultimately going to harmonize and acceptable unique health related id which can gradually go into the system.The health ID would work like a health account, containing details of every test, every disease, doctors visited, medicines taken, and diagnosis. The ID card would be linked to the Aadhar or mobile number.
  • DigiDoctor: It is something which has got different type of understanding in the eye of ordinary user. Some find it a telephone consultation, some find it a virtual doctor try to consult, some find it a basic information in the primary healthcare. The DigiDoctor will be able to identify the digital segment of various DigiDoctor which are available there within the pilot states.
  • PHR (Personal Health Record): It is entirely different from the EHR. It is a citizen own record.Electronic health records of individuals can now be accessed from anywhere in the country digitally.
  • e- Pharmacy: At present, it is not within the system but there are various kind of techniques which are being used, for example; Janaushadhi.

Opportunity for private sector:

  • The NDHM will make private participation a necessity given the strained finances of the Centre.
  • There Have been number of startups which were struggling but now they would register with this platform and the number of opportunities will arise for these companies.
  • Huge amount of money is going to spend on creating that kind of infrastructure and the private players are going to benefit out of this spending.
  • The NDHM will improve the efficiency, effectiveness, and transparency of health services in government as well as private hospitals in India.

          What does the draft 'National Health Data Management Policy' contain?

Challenges:

  • Data privacy and the data security will be a huge challenge especially in this kind of data base which has got extremely critical personal data.
  • Taking infrastructure to the last mile of the nation especially in rural areas.
  • The small clinics run by small doctors in the villages might not be able to update records due to lack of computer.
  • In the last 7 to 8 years, the kind of digitisation country having and at the kind of speed at which digitisation is moving, the cyber security in the digital awareness have not moved along with it. People are still falling to simple lottery scam, SMS scam and Email scam.
  • There are 98 percent complaints which are pending for the financial frauds in the police system across India are of OTP frauds.
  • This is not a mandatory policy. Therefore, convincing a large section of population to opt for it would be not an easy task.

Way Forward:

  • There should be partnerships between all those stakeholders and players who are relevant in the system and focus on primary healthcare, the top-down approach in digital health and bottom-up approach in primary healthcare should blend somewhere.
  • Government should come out with several laws for protection of different kinds of datasets being used by the government, like Aadhar, DNA profiling, Aarogya Setu etc.
  • This is going to be the game changer in health sector, the key lies in implementation.
  • This could be an important step towards achieving United Nations’ Sustainable DevelopmentGoal of Universal Health Coverage by covering financial risk protection, increasing access to quality essential healthcare services, medicines, and vaccines for all.

Important points made by the Guests

R. K. Srivastava, Former Director General, Health Services, GoI

  • The reason why the technology integration was necessary is very well explained within the reason, component on the National Digital Health Mission.
  • All the gaps which are seen in the delivery of the Health care services, it was analysed and found very clearly that all the gaps can be very well addressed by the digital technology.
  • If we want really to achieve the Universal Health Coverage, all this technology should be tested, standardized and thereafter integrated within the delivery system in a mission mode.
  • The component which are there in the digital health coverage ultimately is; it should be efficient, it should be accessible, it should be inclusive, it should be affordable, it should be timely and safe also and it should create a large amount of data base, lot of informations and create good infrastructure.
  • Digital Health Mission can change the health sector if it properly handled, properly integrated into the National Health Mission, it will lead not only for development of quicker quality delivery of services but also create a large data base.
  • The government has announced it on pilot basis which is operating in 6 Union Territories but before this, a good number of Non-government and non- profit organisations have been running the component of Digital Health Program in different states in different size.
  • During the covid period, the lesson we have all learned that how the digital technology can be adopted in a fast track mode to solve major problems in education sector, health delivery sector.
  • The digital technology has helped in transforming the front-line worker into a trade workforce in numbers which would otherwise have not been possible if government had not adopted this technology.

 D. K. Aggarwal, President, PHD Chamber of Commerce & Industry

  • The infrastructure spend or public spend is hardly around 1.3 percent.Canada is spending more than 8.3 percent of their GDP which is number one in the healthcare in the world. Australia is spending 6.3 percent of their GDP.India is sort by 6 lakh Doctors and the Doctor Patient Ratio is 1:1456.
  • The government is talking of increasing the spend on infrastructure by almost 2.5 percent of the GDP by 2025.
  • National Digital Health Mission would create huge data base, the government has to make sure that this data and privacy should be maintained and these data can be put for various analysis and the concept of National Data Sandbox, where sandboxcan be used for testing various products, number of research can be carried out, pattern of diseases which are there, they can be looked at and any pandemic which is going to happen, the early warning signals can be given and similarly the data stats, which can be used by the Insurance agency to devise good products and can also be used by the health facility providers to create the suitable infrastructure system.
  • The real problems start in implementation, there are small clinic, there are Doctors who might not have that kind of infrastructure.

 Jiten Jain, Digital Technology Expert

  • The Data Privacy Lawis still under consideration with the parliamentary standing committee. So, whatever we have as a right to privacy or right to data privacy is through judicial pronouncement of Supreme Court orders.
  • Aadhar went into controversy and finally when the culmination came in privacy judgement, several schemes of the government had to be dealing with Aadhar because they said Aadhar can not be linked with everything. If they had allowed Aadhar to be linked as government wanted, the need of separate unique id for health services may not have arrived.
  • The government has figured out a temporary arrangement which take care of accounts of data privacy issues, which also ensures that our policy have willingness to serve so, the society does not suffer because of this tricky issue of Aadhar and data privacy.
  • So, they have decided to give a unique identifier to every single citizen or patient in India and that unique identifier could be used across all hospitals, private labs, private hospitals.

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