Before the Covid-19 pandemic hit, India and several developing countries around the world were already beginning to embrace digital innovations to combat challenges of socio-economic inequality. The pandemic accelerated the humanizing of digital technology – it brought people together at a time when physical distancing was legally mandated in many parts of the world. No longer just a tool, technology became an enabler and vehicle of human connection for family, friends, and colleagues who were, overnight, asked to stay at home for an indefinite amount of time.
One year on, digital solutions – in every sector – have truly come of age. The pandemic has ushered in a new era and meaning for digital tech, as organizations, businesses, and institutions began to function through virtual mediums almost exclusively. Perhaps most crucially, it demonstrated just how powerful digital interventions can be in last-mile delivery of essential services, particularly in hard-to-reach, underserviced areas, and how they should be leveraged even in times of normalcy without such severe supply chain disruptions.
Nowhere is this more apparent than in health care services. In the early months of lockdown in India, several essential health services were disrupted, and one of the hardest hit was maternal health care. Childbirth stops for nothing and no one – the ecosystem had to adapt almost overnight to meet the new challenges of maternal health care delivery. For instance, a quality improvement and assurance program called Manyata, which trains health care staff in private maternal care facilities on a set of 16 evidence-based clinical standards for quality and safe care, moved its entire training and certification architecture online to continue providing this crucial capacity-building to under-resourced nursing homes. And thus, digital interventions came to the rescue.
With the immediate challenges of the pandemic addressed by a plethora of digital innovations, we must retain this momentum to chart a path for realizing India’s Universal Coverage Health goals. The digital ecosystem offers path-breaking and efficient solutions for accelerating the three pillars of UHC – availability, affordability, and quality – by advancing transformations in health care on both the demand and supply side.
For example, two significant obstacles to UHC in India are rural reach and adequate capacity building. One of India’s biggest deficits is the low number of skilled health care providers. India’s doctor-patient ratio stands at 1 doctor per 1,445 people, lower than the WHO guideline of 1 per 1,000. In addition, distribution of health workers – doctors, specialists, nursing staff, technicians, etc – is a concern as most skilled professionals prefer to stay in urban areas, where their income opportunities are greater. This has left India with a deep fault line between rural and urban sectors, and a void of specialized care in rural communities.
This deficit in skilled resources reflects in our health care indices, such as the Maternal Mortality Ratio (MMR). Although institutional deliveries have doubled from 39% to 79% in a decade, the MMR remains high – 113 as compared to the SDG 3.1 target of 70 deaths per 100,000 live births. Many of these deaths are entirely preventable, with skilled care during and immediately after childbirth.
This is where digital tech can be a game-changer. In terms of supply, it is enabling reach and scale at levels that were previously unimaginable. Digital solutions can increase the penetration of quality care mechanisms to remote parts of the country through telemedicine and remote training sessions for health care staff. On the demand side, tech has tremendous potential to amplify grassroots voices from beneficiaries and patients, both as a means to incorporate their feedback in designing healthcare solutions (or improving existing ones), and encouraging demand for affordable, high-quality care.
However, while leveraging digital interventions for improving healthcare and service delivery is crucial, it cannot be done in silos. The pandemic has exposed fragilities in the very foundations of our healthcare ecosystem. We must therefore create strong structural support that can enable availability, affordability, and quality to become all-pervasive, by rallying the health ecosystem and incentivizing the participation of both private and public sector.
Perhaps most crucially, the private sector needs to be integrated into the total health system in order to complement and augment government efforts in strengthening the health care ecosystem. The important role of the private sector was amply reinforced in the aftermath of the Covid-19 pandemic, as the government turned to private sector facilities to help in its frontline response to the virus. So, too, with building a digitally-enabled health ecosystem.
In India, for instance, the government’s ambitious flagship Ayushman Bharat program, which is the world’s largest health care program covering 50 crore Indians, extensively leverages technology to deliver quality care. By digitizing implementation processes and using data-driven monitoring mechanisms, the program has significantly enhanced operational efficiency and injected accountability into the system. Similarly, the visionary National Digital Health Mission (NDHM) is poised to revolutionize Indians’ experience of health care access and delivery. However, for the NDHM to achieve scale and speed of impact, extensive private sector involvement is crucial.
The health care ecosystem has demonstrated incredible resilience and rallied together to foster symbiotic public-private linkages in order to tide us through this crisis. Now, it needs to do the same to revolutionize health care delivery in a digitally-enabled post-Covid world. A strengthened and integrated health system must put its weight behind digital interventions if we hope to facilitate a transformation in the months and years ahead.
2.National Family Health Survey – 4 (NFHS-4) http://rchiips.org/NFHS/NFHS-4Reports/India.pdf; p205
Views expressed above are the author’s own.
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