Digital health can drive universal coverage through primary care

Innovative digital solutions have the potential to make the delivery of primary healthcare more efficient, accessible, and affordable

Primary healthcare (PHC), the first line of the public healthcare system in India, is critical for achieving universal health coverage. The rural-urban divide in the country extends to the PHC

The PHC in rural areas is institutionalized in the form of field staff who form interpersonal relations at the population level. However, the quality of service delivery, supply chain, diagnostics, and reachability are huge challenges.

On the other hand, in urban areas, where the population is concentrated in pockets and migratory in nature, service delivery itself and continuum of care are humungous challenges. More so with limited field staff and a demand based supply chain system.

This overall low availability and reach of services is largely influenced by the availability of medical staff, equipment, and medicine. According to a report by the National Health Profile (NHP), the doctor-population ratio in India is 1:1,457 (allopathic doctors), which is below the World Health Organization‘s (WHO) recommended ratio of 1:1,000.

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Deficiencies in primary healthcare centers

This is further aggravated in urban areas where the population density is high, leading to a shortage of medical staff. Out of the 13 lakh allopathic doctors in India, approximately 3 lakh are specialists. The non-availability of specialists in public health is accentuated more by the fact that a number of states do not have specialist cadres as part of their selection process. These issues are also related to the fact that there are limited medical college seats for post-graduation.

One of the studies estimates that India needs to have 30,000 more doctors every year for 10 years to meet the patient doctor ratio recommended by the WHO. The government of India and state governments have been proactive on this front for the past few years and setting up additional AIIMS and medical colleges to meet the shortfall. Uttar Pradesh is setting up atleast one medical college in each of its 75 districts.

Addressing the gaps in primary healthcare centers

To address the problem of early detection of diseases and the lack of laboratory and diagnostic infrastructure at the primary healthcare level, the union government has taken several initiatives, including the implementation of Integrated Public Health Laboratory (IPHL) and Block Public Health Units (BPHU). The IPHL is a network of public health laboratories that provide advanced diagnostic services, such as real-time PCR testing, to detect infectious diseases and other health conditions. These labs will be equipped with state-of-the-art technology and will have skilled staff, ensuring the delivery of timely test results.

Similarly, the BPHU is a primary healthcare delivery system that aims to provide comprehensive healthcare services to rural and urban populations at the block level. These will provide a range of services, including antenatal and postnatal care, immunization, family planning, and treatment for common illnesses. A budget of Rs 64,180 crore has been set aside for these as part of the Pradhan Mantri- Ayushman Bharath Health Infrastructure Mission (PM-ABHIM) from FY 2021 to 2025.

Public health, a gamechanger

According to the National Health Policy 2017, the government aims to increase public health spending to 2.5 percent of the country’s Gross Domestic Product (GDP) by 2025, which is currently at around 1.15 percent. This increase in public health spending will help address the shortage of medical staff, equipment, and medicine and improve the availability and reach of PHC services.

During the epidemic, the benefits of digital health were amply demonstrated. Had it not been for the technology and digital tools, the world could not have been able to overcome the pandemic in the manner it did.

India has reached a stage in the digital health journey where there is a need to think beyond enhancing health systems through the introduction of individual digital technologies. The government needs to consider the digital transformation of health systems in their broader sense, looking at interoperability, sustainability, and scale. Accordingly, the government of India launched the Ayushman Bharat Digital Mission (ABDM) in September 2021. ABDM aims to establish a digital health infrastructure that is interoperable, secure, and accessible to all citizens. This will enable the delivery of high-quality healthcare services to remote and underserved areas, bridging the gap between the demand for healthcare services and the available resources.

The National Health Authority (NHA) is driving ABDM and is focused on providing citizens with access to their health records enabling the seamless exchange of health information between healthcare providers and ensuring that these digital solutions are accessible to everyone, regardless of their location or income level. The government has allotted Rs 341.02 crore for the ABDM in the budget for 2023.

Technology to the rescue

With the growth of digital technologies, innovative digital solutions have the potential to revolutionize the delivery of primary healthcare services, making them more efficient, accessible, and affordable. Another example is telemedicine, that has the potential to transform the delivery of primary healthcare services in urban India. With the help of telemedicine, healthcare providers can diagnose, treat, and manage patients remotely, reducing the need for in-person visits and saving time and resources. This is enabling us to overcome the shortage of doctors, specialists, and health staff. The CDAC developed eSanjeevani Telemedicine platform is the largest in the world today with more than 100 million consultations.

It is crucial that policymakers and healthcare providers across the world work together to ensure that these digital solutions are implemented effectively and reach those who need them the most. India, during its G20 presidency, is taking a lead on this and has proposed the establishment of a Global Initiative on Digital Health with an agenda to identify public health priorities across countries and regions that can be addressed by digital interventions and cross-border Public Private partnerships. The G20 can serve as a catalyst to drive collaboration and cooperation among countries and organizations, and to develop policies and strategies that promote the adoption of digital solutions in healthcare.

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