Context

On the occasion of 74th Independence Day, the Government announced a national health ID for every India. The development is envisioned as India’s first step towards ‘Universal Health Coverage’.

Background

• The ambitious National Digital Health Mission finds its roots in a 2018 Niti Aayog proposal to create a centralised mechanism to uniquely identify every participating user in the National Health Stack.
• The blueprint of the programme was launched last year. It seeks to provide an efficient and affordable health coverage through a wide-range of data and infrastructure services.
• According to its strategy document, the NDHM’s vision is:

“To create a national digital health ecosystem that supports universal health coverage in an efficient, accessible, inclusive, affordable, timely and safe manner, that provides a wide-range of data, information and infrastructure services, duly leveraging open, interoperable, standards- based digital systems, and ensures the security, confidentiality and privacy of health-related personal information.”

• In 2015, efforts to augment digital health infrastructure were initiated with the ‘Digital India’ movement.
• Yet, it was the COVID-19 pandemic that necessitated rapid adoption.

Analysis

What is the National Digital Health Mission?

• The National Digital Health Mission is a digital health ecosystem under which every Indian citizen will now have unique health IDs, digitised health records with identifiers for doctors and health facilities. 
• The mission comes under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).
• National Health Authority (NHA), the attached office of the Ministry of Health & Family Welfare and the apex Central Government agency responsible for the implementation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, has been given the mandate by the Government of India to design, build, roll-out and implement the NDHM in the country.
• It is an ambitious plan to create a digital infrastructure for health care delivery, which will include personal health IDs and e-records for citizens.
• Building blocks: The NDHM comprises six key building blocks or digital systems to enable access to timely, safe and affordable healthcare through a ‘citizen-centric’ approach, namely-
  • HealthID
  • DigiDoctor
  • Health Facility Registry
  • Personal Health Records
  • e-Pharmacy
  • Telemedicine
• The key feature of this mission is the technology part - it will leverage open digital systems to provide high-quality healthcare for all.
• It will integrate various digital health services to create an ecosystem which can assimilate existing health information systems.

Governance structure The mission will keep two separate arms, according to the National Digital Health blueprint. One arm will be for regulation One for implementation and operational management. The Group will oversee and guide the NDHM. Its members will include ministers of women and child development, social justice and empowerment, AYUSH and information technology, the principal scientific advisor, Member Health (NITI Aayog), secretaries of health, expenditure and information technology, the National Health Authority (NHA) CEO and others. Empowered Committee: An Empowered Committee will be set up under the chairpersonship of the health secretary, that will take necessary policy-level decisions, help the mission with coordination with different stakeholders and engagement with different ministries and departments to ensure their participation. Its members will include NITI Aayog CEO, secretaries of women and child development, social justice & empowerment, MeitY, AYUSH, and expenditure as well as NHA CEO and directors general of health services and the National Informatics Centre.

What is a Health ID?

• As per the National Health Authority (NHA), every patient who wishes to have their health records available digitally must start by creating a unique Health ID.
• The health ID will contain information about medical data, prescriptions and diagnostic reports, and summaries of previous discharge from hospitals for ailments.
• Each Health ID will be linked to a health data consent manager — such as National Digital Health Mission (NDHM) — which will be used to seek the patient’s consent and allow for seamless flow of health information from the Personal Health Records module.
• This ID is to be created by using a person’s basic details and mobile number or Aadhaar number.
• The health ID will reportedly be in the form of a mobile application.

Will the Health ID be mandatory?

• The health ID will not be mandatory.
• Although the government hopes that the feature will attract more users to it since it allows a person online access to all their health records right from birth.

Categorisation of Health Data The document categorises health data into three distinct layers. Electronic Medical Records (EMR) — This refers to systems that are used within a hospital or a clinic to support patient diagnosis and treatment and are transaction focused. NDHM requires these systems to be updated to support standards and provide access to patients’ data. Electronic Health Records (EHR) — EHRs contain records for a patient across multiple doctors and providers and is used within a Healthcare system (like say across a state government) to provide better care for patients. Personal Health Records (PHR) — PHRs enable patients to compile, update and keep a copy of their own records that can help them better manage their care and are person focussed. It will not be possible to have access to digital health records without creation of a health ID.

Where will the Health ID be applicable?

• The ID will reportedly be applicable across states, hospitals, diagnostic laboratories, and pharmacies.
• According to its strategy document, the NDHM will pilot the mission in Andaman & Nicobar Islands, Chandigarh, Dadra & Nagar Haveli and Daman & Diu, Lakshadweep, Ladakh, and Puducherry.

What about data privacy?

• Personal data, especially health data, is sensitive, and its privacy must be protected.
• The government has assured that the data provided will be protected and health records will only be shared after authorisation by an individual.
• The NDHM's document also states that health records will be accessible and shareable by the patient with appropriate consent and complete control of the records will remain with the patient.
• The mission will also require doctors/hospitals to upload a digital copy of any health reports being physically shared with the patient to enable the creation of health records.
• An appropriate digital consent framework as per standards specified by NDHB (leveraging DigiLocker consent management framework to the extent possible) will be adopted for consent management.

India and its health sector

• India is a large, growing country and its health care needs are immense. Advanced health care expertise is concentrated in large cities whereas a large population with health care needs is geographically distant from such expertise and facilities.
• Not everyone can get admitted to the All India Institute of Medical Sciences at short notice not only because such capacity is limited but also because costs and time constraints prevent most from being able to access such care.
• Tele-medicine can alleviate these limitations to a great extent. If the patient cannot reach the right doctor or the right facilities, the doctor can reach the patient through tele-medicine and test-results can be communicated electronically with speed.
• Only a fraction of the patients would need to be moved to facilities far away from home, and while the patient travels, the diagnosis, some palliative care and tests can continue seamlessly without interruption.

Key-roadblocks for India’s healthcare industry:

• Population:India has the world's second-largest population, rising from 760 million in 1985 to an estimated 1.3 billion in 2015.
• Infrastructure:The existing healthcare infrastructure is just not enough to meet the needs of the population. The central and state governments do offer universal healthcare services and free treatment and essential drugs at government hospitals. However, the hospitals are, as we said, understaffed and under-financed, forcing patients to visit private medical practitioners and hospitals.
• Insurance:India has one of the lowest per capita healthcare expenditures in the world. Government contribution to insurance stands at roughly 32 percent, as opposed to 83.5 percent in the UK. The high out-of-pocket expenses in India stem from the fact that 76 percent of Indians do not have health insurance.
• Rural-urban disparity:The rural healthcare infrastructure is three-tiered and includes a sub-center, primary health centre (PHC) and CHC. PHCs are short of more than 3,000 doctors, with the shortage up by 200 per cent over the last 10 years to 27,421.

There are, however, potential catalysts to improve the quality of healthcare in India.

Significance of the NDHM

• More efficient, effective and transparent system: The National Digital Health Mission (NDHM), which comes under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), is expected to improve the efficiency, effectiveness, and transparency of health services in the country.
• A big revolution in health sector: The health ID will store every individual's medical records and the Mission will herald a new revolution in the health sector.
• Facilitation of health data: This will greatly facilitate tele-medicine, e-pharmacy, and collection, consolidation and inter-operability of health data.
• Achieving the SDGs: It will be a major stride towards achievement of the United Nations Sustainable Development Goal 3.8 of Universal Health Coverage, including financial risk protection.

Conclusion:

Universal Healthcare (UHC) by 2030 is a pivotal commitment for India, as it impacts achievement of all other SDGs. In this regard, the National Digital Health Mission is a holistic, voluntary healthcare programme that will effectively reduce the existing gap between various stakeholders such as doctors, hospitals and other healthcare providers, pharmacies, insurance companies, and citizens by bringing them together and connecting them in an integrated digital health infrastructure.