One often encounters stories of patients and their families suffering from financial losses and succumbing to hidden poverty as a result of catastrophic healthcare expenditures. It is also perplexing to see people living in the shadows of the finest hospitals but unable to access healthcare despite the right to health being declared as a fundamental right under the 15th Finance Commission in India. Realization of these vast disparities concerning access to healthcare has led to unanimous efforts by the nations of the world to ensure healthcare for all. It has been established that explicit health priority setting is important to achieve the goals of Universal Health Coverage.
What is Universal Health Coverage?
Under Universal Health Coverage it is anticipated that all individuals and communities receive the full spectrum of quality health services from health promotion to prevention, treatment, rehabilitation and palliative care that they need without having to undergo financial hardships. It involves protecting individuals and their families from being pushed into poverty as a result of their out of pocket payments.
How can NDHM help achieve UHC?
UHC is not about free coverage for all health interventions. It encompasses health financing, health service delivery systems, the health workforce, health facilities, and communication networks, health technologies, information systems, quality assurance mechanisms, governance and legislation.
NDHM envisions supporting UHC in an efficient, accessible, inclusive, affordable, timely and safe manner through the creation of a National Digital Health ecosystem. It seeks to provide the support for integration of digital health infrastructure through the following means.
- National Digital Health Blueprint (NDHB)
- National Health Stack (NHS)
- Health Data management policy
What is NDHB?
An essential component of the National Digital Health Blueprint, the NDHM action plan, is set to steer the implementation aspect. This can radically transform the healthcare sector in India which is in dire need of reforms now and beyond.
Building blocks form the core of the NDHB. These blocks constitute an establishment of IT components, that will ensure a smooth flow of information across the various entities, besides upholding the privacy of citizens’ data in the health ecosystem. The following building blocks will be rolled out in the UTs as part of the pilot phase of NDHM:
- Health ID: Individuals will need to provide their basic individual, demographic and contact information to the consent manager at the concerned health facility. Self-registration from a mobile or a web application can also be done. Information captured from various health programs like NIKSHAY, NCD, PM-JAY will be included in the patients’ longitudinal health record. This service will also allow users to maintain information regarding their family members by linking the Health IDs.
- Digi Doctor: A comprehensive repository of all Doctors practising modern/traditional systems of medicine that will be linked to the health facilities.
- Health Facility Registry: will maintain a record and unique identifier for hospitals, clinics, diagnostic centres, pharmacies, labs etc. in the country that can be linked with Doctors.
- Personal Health Record: A record generated by physicians, patients, hospitals, pharmacies, and other sources but controlled by the patient.
- A mobile app: The app will allow individuals access to a variety of services on mobile such as creation of Health ID, access to reports, past health records, give informed consent to Doctors to have an access to their health records and add on new records to their longitudinal PHR.
In subsequent phases of implementation, the following services will be provided.
- Telemedicine: Will be made in accordance with the Telemedicine practice guidelines 2020 and other relevant laws, rules, and regulations.
- e-Pharmacy: All the Jan Aushadhi Kendras will be integrated to ensure maximum promotion of generic medicines system.
- Anonymizer: This service will enable removal of all personally identifiable information to protect privacy and will provide the anonymized data to the Health information user (HUI).
- Health Analytics: Aggregated data will be generated on the health information managed by the health information providers.
- GIS/Visualization: This will enable generation of a variety of reports that can be made available to the policy makers, researchers, and public in general.
- Health claims: Creation of a health claims platform wherein healthcare providers can submit their e-claims and the Payers (Insurers and TPAs) receive e-claims via standard APIs.
- Health locker services to be provided by Digi Locker.
Why do we need the National Health Stack?
We need to know how to use the data and gather insights on a scalable platform, so as to drive positive outcomes. Difficulties in data management exist owing to lack of trained data capture staff. Besides this, multiplicity of health initiatives has led to fragmented approaches to healthcare delivery leading to duplication and redundancies. This affects the quality, availability and timeliness of data that is needed for tracking the health goals. 1 The ongoing pandemic has made us keenly aware of capacity constraints and problems in the health care systems that need change.
The National Health Stack provides a platform to bring different pieces of the ecosystem together. This will enable the creation of a registry that will be the single source of pan India master health data and can largely influence healthcare capacity, productivity and patient outcomes.
The components of the NHS are as follows:
India Stack comprises essential layers that allows streamlined delivery of healthcare services by facilitating removal of barriers to people’s participation through digital identities; enabling mobility of digital records along with the patient’s identity; easing monetary transactions and empowering individuals to share their data in a safe and secure manner.
Electronic Registries – This will form the base layer of the stack and will be utilized by all health programs that are built on top of the NHS. These will include data for various healthcare providers (hospitals, clinics, labs, etc), beneficiaries, doctors, insurers and ASHAs, information on drugs and interventions.
Coverage and Claims platform – This will enable provision of large-scale government funded healthcare programs with the help of fraud management services, the claims and policy engines. Policy engine services will allow storage of insurance policies to individuals and families with regular updates on the same.
Digital Health ID – To help facilitate unique identification of every user in the digital health ecosystem.
Federated Personal Health Records Framework- PHR will be maintained in a secure and private environment through trustees or health data Fiduciaries who will ensure consent driven interaction among the various entities in the digital health ecosystem.
National Health Analytics Framework will enable the creation of anonymised and aggregated datasets that will allow data driven decisions and targeted policymaking in the health sector.
Alongside the NHS, the implementation of the health data management policy after passing the Data protection bill in Parliament is the first step for the NDHM in realizing its guiding principle of “security and Privacy by Design”.
What lies ahead?
The NDHM that is currently rolled out in the UTs and yet to scale up has the potential to enable the provision of quality healthcare services for all. One of its biggest roles will be in the management of our current pandemic. “It can support the COVID-19 vaccine rollout for healthcare and allied professionals” – Dr. Praveen Gedam IAS, additional CEO, National Health Authority.