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News and social media feeds often bring you face to face with the grim realities of the country’s public healthcare situation. Instances of how the lack of proper access to treatment and medication claims the lives of several children, women, and men in India are unfortunately too many to count. In 2012, it was reported that nearly 16.9 million in the country died due to the unavailability of anaesthesia and surgical facilities. 

Corruption, bureaucratic hassles, lack of public healthcare expenditure, ineffective government initiatives, unutilised funds, unavailability of doctors and inaccessible hospitals – problems plaguing India’s public healthcare system are plenty. In the last 70 years, preceding administrations have achieved little in the way of improving the state of healthcare delivery in India.

India’s per capita spend on healthcare was less than 1% of the GDP until a few years ago. With the passage of the National Health Policy 2017, the government announced increasing the healthcare budget to 2.5% of the GDP, a significant improvement over the past. India’s status as a fast-growing economy is indisputable. However, glaring inadequacies in basic areas such as healthcare undermine the country’s status globally. India’s current public healthcare system is in dire straits, plagued by problems such as lack of financial resources, inaccessibility, low doctor-to- patient ratio, absence of basic infrastructure and high out-of- pocket expenses for patients. While free, universal healthcare is a far-off dream for the average Indian, there are, however, technological solutions to some of these immediate problems concerning healthcare delivery in the country.

The pace of growth in public healthcare infrastructure has been almost stagnant over the past few decades. As a result, the accrued problems and inefficiencies have considerably increased the scale at which immediate remedial action needs to be taken along with the expenditure required on healthcare. The number of primary healthcare centres in India is abysmally low. A country with as high a population as India must ideally have 74,510 primary health centres per million, but the real figure is barely half of that. Adding to it are inefficient drug testing and developing facilities that make it extremely difficult to develop affordable drugs for patients. People living in the remote geographies often die of minor, treatable diseases owing to the inaccessibility of basic healthcare services.

Although, e-Governance may not be the ultimate solution to India’s healthcare problem, it is certainly the best place to start. Applying ICT in healthcare will significantly increase optimum utilisation of resources, provide assistance to healthcare personnel to improve patient care and enhance overall productivity.

e-Governance:

Governance involves extending the benefits of public services, amenities, and economic growth to all citizens. Moreover, governance also includes protecting the fundamental rights of citizens and ensuring they have access to basic necessities such as food, shelter, healthcare and education.

Transparency, accountability, and efficiency are pre-requisites of good governance. However, these are qualities the Indian government has seldom been credited as having, as a complex system of paperwork and bureaucracy having dominated governance for decades.

China, a country much like India in terms of its culture and demography, has also faced major hurdles in governance over the past few decades. Despite similar problems such as high population and complex bureaucratic policies, China has integrated technology into its economy and public systems unlike any other developing country.

India’s public systems management needs a complete overhaul in its processes, outlook, legal and social framework, and interaction with citizens to achieve the said qualities of transparency, accountability, and efficiency. This is where e-governance has a substantial role to play.

The key to building a robust foundation for e-governance is in leveraging Information and Communication Technologies (ICT). ICT provides highly efficient and cost-effective tools for storing and accessing data, processing and transmitting information instantly, and managing public systems far more efficiently. ICT has the ability to expedite government processes and decision-making through a data-driven approach, effecting greater transparency and accountability. Technology further enables the government to reach out to geographies and demographics who have previously been unable to interact with the government.

e-Health: Mending India’s public healthcare

Digitisation has the ability to transform nearly every vertical of healthcare by enabling more efficient information management and communication.

Tele–health and online video consultations enable quicker and convenient diagnostic help to patients situated in a remote village or town. Use of data and analytics can help hospitals to significantly improve management of resources and plan ahead. Data-driven healthcare services can enable improved and personalised patient care through data derived from extensive sources like hospitals, referral networks, labs and imaging centres, ambulance services, wellness centres.

With Electronic Health records (EHRs), the exchange of patient data between doctors, specialists, and hospitals becomes much easier, thus helping them to provide appropriate treatment on the basis of their medical history. Moreover, a digital information processing system reduces the likelihood of errors.

With the launch of the e-Hospital initiative, an information management system, the Digital India program is taking public healthcare to the next level of digitisation. e-Hospital facilitates online appointments, payments, access to diagnostic reports, information on availability of blood, etc. With over 300 hospitals connected as part of the initiative, the government is on its way to building an inter- connected database that can facilitate exchange of patient information between multiple players across the country.

Challenges and Opportunities for e-governance:

The success of e-Governance in healthcare hinges on accurately identifying the challenges and turning them into opportunities. By focusing on developing the following aspects, we can overcome the system’s shortcomings to leverage the underlying opportunities:

• Building a digital infrastructure: Internet connectivity

The primary pre-requisite to e-Governance is establishing a digital infrastructure to facilitate access to e- health. The government’s National Optical Fibre Network (NOFN) plan has been unable to achieve its goal of providing the promised 2.5 lakh villages with internet connectivity by 2016. Internet penetration in India is only 28% and largely centred in the urban areas. However, a majority of the population resides in the villages and towns where access to basic healthcare is a major challenge and they are the ones who can benefit the most from e-health. Moreover, unaffordability of internet and smartphones remains a major impeding factor for low income groups, thus excluding them from most digital initiatives in the country.

• Updating technology

Data originating from multiple digital media can now be stored and accessed easily with cloud storage and will be critical to providing the right care to patients. Smartphone penetration in India is currently over 300 million and is rapidly rising, especially in the rural regions. The government launched four new mobile healthcare services in 2016 directed at pre-natal and post-natal care, TB awareness and treatment, tobacco de-addiction, and training of social healthcare activists.

• Increasing awareness among medical and healthcare professionals

For e-health to be successful, there needs to be greater awareness and acceptance of digital technology and initiatives among doctors and healthcare professionals. Electronic Medical Records (EMR) are only used by large, private hospitals, while public healthcare systems still rely largely on inefficient manual storage of data. Awareness about digital technologies, even among urban doctors, is much lower than it should be. Digital technology is also an extremely valuable tool in facilitating training and education among healthcare professionals and upgrading their skills to provide better patient care.

• Raising public awareness

A visible lack of awareness on digital healthcare initiatives among the public is an obstacle to the adoption of e-health in India. Furthermore, inadequate digital literacy, lack of information in regional languages, and unavailability of digital devices are other significant hindrances to the effectiveness of e- health services in India.

• Implementing service standards: Interoperability and co-operation

A collaborative effort between various government departments such as Department of Electronics and IT (DeitY), Department of Telecommunications (DoT), health and law ministries, etc. is imperative. These independent bodies will need to co-operate in maintaining the quality of e-governance and e-health and ensuring that the benefits of government digital initiatives reach those individuals who do not have access to medical services.

Future of e-governance in India

The National e-Governance Plan (NeGP), that came into effect in 2006, included healthcare as a mission mode project (MMP) in 2011. e-Healthcare was also added to the government’s highly ambitious Digital India programme launched in 2015.

Bhoomi, a land records management system is the first e-Governance project to have been successfully implemented in India. Additionally, Gyan Doot, a project for the tribal population in Madhya Pradesh and Smart Andhra Pradesh Foundation, established by the respective state governments are examples of the increasing relevance of e-governance in the development and welfare of citizens in the digital age. However, going digital and implementing e-governance on a national level will require the government to first devise a legal regulatory framework. Furthermore, e-governance must be granted the status of a separate ministry to legitimise it like other departments such as health, education, or human resource development, making it eligible for annual budgetary allocations.

A successful e-governance program requires a top-down approach, with a focus on delivering multi- lingual informational services at the micro level. Moreover, a coordinated effort by government departments like information technology, health and law are required to overcome the challenges faced in bringing e-governance to the nation’s healthcare system. The foundation for a digital ecosystem has already been laid, and the democratisation of healthcare is only a matter of time.

Authored by: Ravi Virmani, CEO and Founder, Credihealth

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