National digital health architecture key to transforming India’s healthcare system: Krishna Reddy


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As the world recovers from the effects of the COVID-19[feminine] pandemic, it has become more important than ever to have robust health infrastructure and digital health systems in place to deal with any future health emergencies. In this context, spoke to Krishna ReddyRegional Director, South Asia, ACCESS Health.

Reddy is a board-certified cardiologist with a long and distinguished career. He had participated in the creation of the CARE Hospital Group. Additionally, ACCESS Health is an international think tank, advisory group, and implementation partner working to improve access to high-quality, affordable health care for all.

Excerpts from the interview by email:

Q. Universal health coverage or access to affordable/free healthcare for every citizen is important for a country like India. Your views.

Universal health coverage (UHC) implies that every citizen must be able to access the health care they need without financial difficulties in normal times and in times of crisis (health, environmental, financial, geopolitical, etc.). Given the choice, people should receive care when they want, where they want and how they want. The care they receive must be safe and effective. There is no debate about the need for UHC. We must ensure that at least 80% or more of people have some form of financial coverage (public, social, community or private health insurance) and that out-of-pocket health expenditures (OOPHE) must be lower 20% of total health expenditure. The percentage of the population with financial coverage ranges from 15% to 85% in various states. Currently, OOPHE represents 55% of total health expenditure. This means that we have a long way to go to achieve the goals of UHC by 2030. What is equally important is how UHC is achieved and whether the cost of UHC is affordable for the country.

Q. What is the role of Ayushman Bharat Diet play in achieving this goal?

Ayushman Bharat is the umbrella health reform to achieve UHC. Originally, it had two main approaches – financial protection of hospital care for around 100 million families from lower socio-economic strata under Pradhan Mantri Jan Arogya Yojana (PMJAY) coupled with free access to healthcare comprehensive primary through 150,000 health and wellness clinics. While PMJAY will improve the percentage of people with financial coverage, an estimated 500 million people are without any financial coverage. Informal labor and the self-employed make up the bulk of these – the so-called “missing middle”. Efforts are being made to address the missing middle coverage. Since the majority of health insurance plans cover hospital care, OOPHE might not decrease significantly despite an increase in financial coverage. Ayushman Bharat Digital Mission (ABDM) and Ayushman Bharat Health Infrastructure Mission (ABHIM) were announced during the Covid-19 pandemic to enable the goal of UHC. These are the main milestones on a long journey to UHC. The quality of their implementation will determine whether we progress towards the goal of UHC.

Q. The Indian government has launched the Ayushman Bharat Health Account, which is the first step towards establishing a digital health system in the country. What will be the importance of the role that this health identifier will play in the future to come?

Health ID is the most critical of the building blocks developed under the ABDM framework. Interoperable, standards-based health data related to health identification will constitute personal health records (PHR) throughout a person’s life. Patients will have the right to share their personal health data through a consent mechanism. More than the health ID, it is the robust national digital health architecture that is critical for the future success of ABDM in transforming the Indian healthcare system. In addition to Health ID, it consists of other basic elements, namely national registers of professionals and institutions, consent manager, health information exchanges and personal health records. The Data Privacy Bill will address privacy and security issues.

Q. How are Indian state governments supporting the idea of ​​universal health coverage?

Since health is a State subject, the success of these national reforms will depend solely on the implementation of these reforms by the States. Almost every state has joined in the implementation of PMJAY and health and wellness clinics. The ABDM has just been deployed in various states. Lack of fiscal space and institutional capacity can hamper deployment plans. Given that the private health sector accounts for more than 50% of health care, governments should engage the private sector collaboratively and constructively to achieve the goal of UHC by all states.

Q. What role can Access Health International play in enabling digital health in India?

The main objective of ACCESS Health International is to support various efforts aimed at making our health systems stronger and more resilient. He took a systemic approach to achieve this. He has undertaken policy research and analysis to articulate potential solutions to transform India’s health systems. He shared his open source ideas and designs for creating a robust digital health architecture. It has engaged various actors in the health system (providers, payers, producers of health technologies, etc.) in a dialogue linked to the national digital health program. It attempts to address the critical role of human resource capacity in the implementation of ABDM.

Q. What do you see as lessons for India from the COVID-19 pandemic?

The main learnings are:

Lives and livelihoods are inseparable

Increased investment in health is not only essential, but has significant economic returns

Engagement and partnership with the private health sector is key to strengthening health systems

Health workforce is most vital for strong health care

Strategies to deal with supply chain disruptions that are observed for various reasons

Building people’s trust in leadership and governance is key to organizing an effective response during crises

Investment in digital and molecular technologies is essential to build resilient systems

Clear communication from a trusted source is essential to counter the growing dangers of misinformation flooding society

Social protection systems are just as important as financial health protection to prevent situations of impoverishment


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