National Digital Health Mission (NDHM): A mission within National Health Mission (NHM) 2017

     I remember adoption of National Health Mission (NHM) 2017 after merger of National Rural Health Mission (NRHM) 2005 and National Urban Health Mission (NUHM) 2014, which presents a holistic approach to improve health care services in the country. It envisage the "Continuum of Care " and seek to end the fragmentation of health care services across the country by increasing access to health services, improving quality of health service from Primary Health Centre (PHC) to Tertiary level and significant lowering of the cost of health care delivery by leveraging digital technology. NHM 2017 vision is to build comprehensive health ecosystem on the latest digital architecture and technologies.

    It visualizes use of digital technology at all level, component and stakeholders. Care providers to care takers, testing to diagnostics, education to training, medicines to vaccines and above all building a system where mobility of data, record and diagnosis is simpler, easier and fast from public hospital to private care providers, one diagnostic to other diagnostics, PHC to referral to district hospital to specialized hospital. The idea is to build a system for NHM 2017 which is not only effective and efficient but also less time consuming, affordable and timely.

    Then what is new in National Digital Health Mission (NDHM) set for launch on 15th August 2020? Nothing, it is one of the most important components of NUM 2017 and just being launched as a new mission as though it is a new program. Just to seek fresh attention.

    This was the much desired component of NHM 2017 and without this the vision and mission of NHM 2017 cannot be met. It took three years to come out with this blueprint and that too through a separate mission. It all started in 2018 when NITI Aayog started working on  National Health Stack (NHS) as one of the task of NHM-2017 and submitted a report in 2019 to MoHWF as National  Digital Health Blueprint (NDHB) as one of the important component of NHM-2017.

    However without going into reasons for its new nomenclature as new mission which could have been avoided. This much needed digital blueprint will prove to be a game changer and significantly complement and strengthen the health system across all spectrum in India and also help in optimizing the health resources for better outcome from human resources to infrastructure.

    Since the advent of NRHM 2005, technology for health care has increased significantly but still at the level of electronisation of services rather than realistic use of digital technology to improve the health care services. It is at best at facility level and here also highly fragmented between various departments/sections of the health centre.

    The digital ecosystem which has been visualized in the NHM 2017 is actually a complete ecosystem encompassing and integrating all services from entry in to health care to hassle free exit with regular advice, monitoring and supervision.

    Digital ecosystem as envisaged in NHM 2017 has potential to change the landscape of health sector in India and will immensely improve the quality and access of heath delivery to all its citizens.

1. It will create a digital health ID like Aadhar for all citizens.

2. This digital health ID will conveniently store all health related data and records of a person since birth including history of diseases, family history, environmental health and diagnostic report etc.

3. Data and records stored in a person’s digital health ID can be accessible across the country for the treatment. The mobility and choices will increase tremendously including taking second opinion etc. 

4. Out of pocket expenses will substantially reduce due to upkeep of record and data and doing away with the need of isolated test and diagnostics. These days out of pocket expenses have grown significantly and with digital ecosystem it will be reduced substantially.

5. Digital health records can be accessible equally by public or private health facilities.

6. Integration of all domains 

7.  It will attain the much needed both way linkage of health facilities from primary to secondary and to tertiary and help in continuity of care by achieving Super Health network.

8. Like Aadhar one can travel anywhere carrying their own Unique Health ID so that in case of immediate health care need, it can be provided on the basis of available records, data, previous diagnostics and disease history.

9. Digital ecosystem will also help in future to include health IOT, AI for diagnostic and more advanced robotic technology for health care in India.

10. Digital health ecosystem once implemented will immensely help in forecasting, planning, implementing, controlling and containing any future pandemics and epidemics.

11. The enormous personal/community data will help in advance research and analysis and that will be helpful in innovation and invention of new molecules, drugs, medicines, vaccines etc

12. It will help in optimal use of hospital facilities and also improved home care through technology.

    It is a win- win situation for both the peoples of this country and also for the government who is struggling since independence to provide affordable, modern universal health care to its citizen.

    The digital road map is already three year delayed since it is part of NHM 2017 and launching it as separate mission will have their own systemic delay. So it is important that it should be taken on priority and no time is better than this period to speed up its implementation and usher in to a new digital health ecosystem in next 3-4 years. The unfortunate Corona time has in fact test run many of digital health initiatives out of compulsion of this planned digital ecosystem. So in fact learning during this period will help in speeding its implementation to provide a digital health umbrella to the country in shortest time. However to meet the resources required for such a system the government must think of increasing  the spending on health sector from current 1 % of GDP to 3 % of GDP.