Countries around the world have realised that economic growth is not sustained until their populations are healthy and productive. Economic Growth is often lost by families and individuals through expenditure on Healthcare – planned or catastrophic. The current inequity and challenges of access that the majority of populations face is largely due to a broken down healthcare continuum, which is particularly disadvantageous to the lower income and marginalized populations.
This realisation paved the way for the inclusion of Universal healthcare into the Sustainable Development Goals framework with an aim to make healthcare accessible and equitable to all people.
In a broader perspective, 13 of the 17 Sustainable Development Goals are linked to better health for people, which underlines the importance of the concepts of Universal Healthcare and OneHealth.
Why Digital Health?
This calls for semantic interoperability between; not only the vast numbers and varied archetypes of providers, payers, patients and managers within healthcare, but also eventually between the various adjacencies and determinants of healthcare like Food and Agriculture, Environment, Sanitation and Hygiene, Water, LifeSciences and Biotechnology, Infrastructure and so on.
Nations can no longer merely react or respond to healthcare challenges but must aim for Wellness through, Predictive, Preventive and care and promoting Health Seeking behaviours in order to keep universal healthcare sustainable. Recent events like the CovId-19 have underlined the importance of epidemiological intelligence and disease management at speed and scale. Covid was certainly not the last public health challenge that populations will face, going forward.
Clearly leveraging Digital Technologies are key to making this giant orchestra of stakeholders produce the symphony of wellness and care, as they must now perform with real-time synchronicity.
Given that, India is a great potential exemplar for nations in the Global South that are keen to nurture healthier and more productive populations.
This is a proposition that would have generated disbelief in most capitals around the world until not so long ago but is lately gaining grudging acceptance in most academic circles. Harvard for example now has a Project called the ‘India Health Systems Reform Project’ to keep an eye on India’s Health Systems and look at lessons for Health Systems in India and Beyond. Large-scale reforms in India have been triggered by the adoption of a Universal Healthcare Policy in 2017. These include its emerging National Digital Health Ecosystem.
Why India as an Exemplar for the Global South?
Necessity being the mother of Invention is a tired cliché but rings more true today than it ever did.
The Pharmaceutical Industry in India and her Vaccination supply chain which proved to be of stellar importance in the recent pandemic really grew out of an organic and compelling need. That of a giant nation of 1.4 billion people, to address its healthcare challenges in a sustainable fashion. The PPE and Diagnostics industry received its baptism by fire during the pandemic, and rose to the occasion, as did healthcare providers and other ancillary services.
It is easy for doomsday prophets to commandeer attention by pedalling touching stories of failure and loss. Change makers, however, do not lack empathy but have the ability to see beyond the pain. There is lies hope and potential that nations and leaders need to build with.
Beyond the quibbles, the much-maligned governance apparatus delivered above expectations, and the results are there to see.
This is not to say that things could not have been better, but what are we measuring against? The dearth of Primary Healthcare in mature economies with massive resources, and its impact, has been glaringly exposed and they now look to retrofit their healthcare systems. This, even as we rate our own primary healthcare as abysmal.
The fact that India could scramble up and provide triage and appropriate care while the pandemic raged, is easy to overlook but did help public health in India do better than most of the world.
So, let us not throw the baby out with the bathwater and see beyond the gloom and doom.
Why are lessons learnt in India of value to the world?
Clearly, Public Health and its security are now key issues that nations need to address, regardless of their resource levels. Healthy and Productive populations are what lift nations out of poverty and ensure their sovereignty; and address the collective aspiration of societies anywhere, which they entrust their leaderships with.
The Indian experience becomes relevant due to the inherent characteristics of the Indian nation and the paradoxes she must manage.
Diversity and Interoperability
India’s diversity in terms of genetics, culture, lifestyle, food, language climate, environmental issues, economics, education and skills etc. is of a higher order than most societies can fathom. Its culture is ancient and it has legacies of knowledge and practices that evolved organically. These must be folded in to any change that is required to be made. This is unlike younger, more homogenous societies. Health, unlike more fungible domains, is profoundly impacted by all of these variables and therefore involves decision-making that is far more subjective. It also requires the working together of a larger number of stakeholders in tandem to deliver care. Achieving meaningful Interoperability, which is an intricately layered concept to begin with, in such an ecosystem can be a daunting challenge.
Scale and Speed
There are only two nations on the planet that have populations of over a Billion. These are then spread over a huge landmass with a large number of microcosms – which represents a mammoth challenge, both in terms of scale and speed, for health systems to respond and serve, in order to ensure access and equity in healthcare.
Mobility and Federated Governance Structures
Of these two nations, one is a democracy, market-driven economy and also federated in its governance structure. Greater freedom of choice at all levels, calls for more consensual, inclusive solutions and can be challenging both in terms of technology and transformation.
Mobility is therefore high, and providing equitable care across the country requires nimble and evolving solutions.
Resource Optimization and Continuity
Countries like India need to be careful about managing their resources both in development, deployment and operational costs while protecting these investments against obsolescence and waste.
The need to evolve is greater as its population continues to grow in numbers and in life expectancy. This creates unique demography that will need to be cared for longer than ever before.
Asset Light Innovation and Technology Life Cycles
Given the velocity of technology shifts and innovation, the unique paradoxes discussed above require that Transformations be done leveraging asset-light innovation using technology that is nimble and resilient and allows for evolution on a continuous basis.
Leveraging Digitalization as a Nervous system to balance all these paradoxes, maximizing virtualization to conserve resources, both human and material – that go into building facilities and optimizing their utilization is key for nations to be able to sustain the costs of offering universal healthcare.
Leveraging digitalization has been the key to Vaccination success, through in-silico development, and will again be key to addressing challenges in therapeutics as the world moves forward and leverages converging disciplines to innovate efficiently.
Mobile First, Elastic Cloud-Based Open-Source Innovation that India has put in place strikes a judicious balance of these factors. The Minimum Viable Product-based approach allows it to address the bottom of the healthcare pyramid which even mature economies have failed to do adequately.
The Indian journey with Digital Health for Universal Healthcare is rich with potential for the entire global south to leverage and has lessons that will benefit a majority of humanity as it addresses the complexity and paradoxes with great elan.