‘The biggest hurdle for National Digital Health Mission is India’s meagre health budget’

Interview: Srinivas Goli, Assistant Professor at Jawaharlal Nehru University

14-Muzaffarpur [File] Patients and their relatives at the Sri Krishna Medical College and Hospital in Muzaffarpur | Arvind Jain

Prime Minister Narendra Modi on Saturday announced the launch of the National Digital Health Mission and health ID for every Indian. Srinivas Goli, an assistant Professor at Jawaharlal Nehru University and an Australia India Institute Next Generation Network scholar at The University of Western Australia in Perth weighs in on the National Digital Health Mission and Health ID for all. In an interview with THE WEEK, the demographer and public health researcher  says the challenge is how to bring the private health care sector under the NDHM and ensure both reliability and quality of the information recorded. Edited excerpts:  

What are the benefits of the PM’s announcements on the NDHM and Health ID?

It is too early to comment on it in the absence of a detailed report and mechanisms on how it will work and what the budgetary sanctions will be. On the positive side, if handled well, it can be a good database for diseases and healthcare monitoring. It can revolutionise healthcare provision and public health research in India. It can help to understand disease and treatment history, its hotspots, and social and demographic correlates. Mapping the follow-up of patients and healthcare-seeking behaviour is critical for treatment of many chronic diseases.

What are the probable negatives?

It can be highly misused by the private healthcare sector, diagnostic labs, pharmaceutical and insurance sectors to exploit people in the absence of access to a quality public healthcare system. Dealing with ethical issues, breach of privacy, and dealing with social stigma are significant challenges for the NDHM. Moreover, experience from Aadhaar and Health Management Information Systems (HMIS) raises doubts on ensuring the quality of registration and maintenance of records and their completeness. Such mistakes might cause more damage than good to the health of the people.

How can the NDHM be made successful?

The biggest hurdle for NDHM is the meagre health budget of India. I am unsure how it will provide ‘healthcare for all’ without sufficient health budget sanctions and revamping of existing public healthcare infrastructure.Currently, total health expenditure (both private and public) in India is just 3.6 per cent, while public spending on health is just above 1 per cent of the country’s GDP, which is a low compared to the countries that have some of the best digital health systems in the world. Public sector spending on health in Canada and Australia is around 8 per cent and 6.3 per cent of its GDP respectively. Canada ranks first and Australia ranks eighth among the best healthcare systems in the world.  

Can India’s public healthcare system support NDHM?

Currently, 66 per cent of treatment of all ailments is met by private hospitals and clinics (as per NSS 75th Round:Key Indicators of Social Consumption in India: Health, Ministry of Statistics and Programme Implementation, Government of India, 2017-18).  A large share of diagnostic centres and pathology labs are run by the private sector. Thus, the challenge is how to bring the private health care sector under the NDHM and ensure both reliability and quality of the information recorded while making it adhere to the medical ethics of confidentiality of the information.

What are the other challenges?

One big challenge is how to bring undiagnosed or untreated ailments into account. Self-reported morbidities from successive National Sample Surveys suggest a large proportion of ailments go unrecognised and undetected. Enhancing health literacy and knowledge is the key for reporting, diagnosis and treatment of ailments. Thus, unless the public healthcare system is revamped to increase health infrastructure and healthcare human resources and make healthcare affordable to the poor, it is difficult to bring people to seek treatment for all ailments.

Mere insurance-based (private) healthcare does not work effectively in a country with multiple social and economic hierarchies where 62 per cent of the total healthcare expenditure is incurred by households. Thus, raising the demand for healthcare and treatment-seeking behaviour will not be possible without enhancing public health provision from bottom-to-top approach, access to affordable and quality healthcare in rural areas. Also, the country must develop a clear framework and pathway on ways to bring its private sector into confidence under NDHM-adhering confidentiality and ensuring quality of information. Remember, NDHM is not a lucrative offer for the private sector, especially small private clinics that add an additional burden on their physical and human resources. Given that private sector involvement under the Ayushman Bharat Yojana is not so impressive, handling the private sector will be a greater challenge under NDHM.