National Digital Health Mission, this ambitious mission is a move forward in strengthening the Indian health infrastructure lacking patient records and health.

The government’s proposal, now put up for public review, focuses on necessary data privacy measures that need to be put in place in order to safeguard the confidentiality of sensitive health information of citizens.

Announced by the Prime Minister, the mission aims to “voluntarily” give every Indian citizen a unique health ID which will serve as a digital repository containing all their health data as well as provide an ​enrolment of​ doctors and health facilities.

Is it all smooth?

Yet, despite all the promises the scheme holds, there are serious concerns about the efficiency of the plan.

“To put it mildly, we are not really enthusiastic about the plan,” says Dr. RV Asokan, the general secretary of the Indian Medical Association. “We are not sure how the program will improve access to health care. If the idea is to collect data, there are initiatives such as the national health survey, which does a great job. As far as patients are concerned, 99 percent of them don’t leave their district. In that sense, how does interoperability help?”

All those blooms are not flowers, there are thorns attached as well — similar is the situation with the launch and implementation of NDHM. There are many strings attached that need to be addressed correctly for a successful working of the entire implementation:

1. It won’t be possible without addressing the concerns on data security and effective implementation.

India is yet to have a data protection law and initiatives like Aadhar have earlier also generated significant data security concerns.

According to Max Healthcare CIO Prashant Singh, “There would be a need to have 24×7 security surveillance ensuring every data byte is highly secure else it would open doors to hackers also in terms of exploiting the vulnerabilities and getting the access to relevant and valuable healthcare data.”

2. The end consumer needs to be aware and educated for the use of a well-defined system.

Enhancing health literacy and knowledge is the key to reporting, diagnosis, and treatment of ailments.

The rural and semi-urban populations are the major target under this scheme and they are the ones responsible for making this implementation a huge success. Hence, counseling them well and walking them through the entire process becomes an added challenge.

3. Probing the possible 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.

Tackling ethical issues, privacy concerns, 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.

4. The Internet challenge needs to be addressed!

According to a senior health ministry official, for effective telemedicine and telehealth services, the minimum Internet speed required for consultation with a patient through a computer is 2 Mbps, which is not available in most of the villages.

With 159 Internet service providers in India, broadband penetration in the country is less than 2%, according to the government.

India, a country with already weary health infrastructure and resource shortages, is further exhausted by the COVID-19 pandemic. The complete technology-based initiative — having the potential to be a game-changer — is expected to face hurdles in rural India with low internet penetration and little digital health resources.

We hope the government and all the stakeholders work in harmony towards the success of the draft for NDHM. For a developed nation, it becomes immensely important to prioritize health and all the related services for the wellbeing of its citizens. Overcoming all the listed challenges and more will not be a cakewalk, but indeed is the need of the hour for the success of the nation and all the citizens.

As it’s been rightly addressed by Dr. Harsh Vardhan (Minister of Health and Family Welfare), “Finally, and equally importantly, the design of NDHM has been built on the principle of partnership with all key stakeholders — doctors, health service providers, technology solution providers and above all citizens. Without their belief, trust, adoption, and stewardship, this mission will not achieve its desired result.”