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Why India needs to stengthen its primary helthcare system

While COVID rages on globally and across India a more spirited debate ranges in my mind. Was there a way to anticipate and proactively move on infectious and non infectious conditions in India?

One thing that COVID has exposed is the gross unpreparedness of the Indian healthcare system to deal with pandemics. But it also exposed how little we knew about the situation on the ground. Data available is inadequate and most of the data especially from the villages and districts is not captured.

At the front line for the fight against disease and other illnesses is the Indian Primary Care system. This system is mostly run by ASHA (Accredited Social Health Activists) If something is coming our way, they are the first to know. And while they have been around since the recommendations of the Bhore Committee recommendations were given in 1943, it is easy to see how they are ill-prepared to deal with anything.

This is some data that I have been able to ascertain from public sources.

Number of ASHA Workers 9,00,000
Number of primary health centers 25,000
Average Salaries of ASHA Workers INR 2,000/PM
Average costs incurred by ASHA WOrkers INR 800/PM

So this is the on-ground scenario. These workers have to fill multiple forms for child care, maternal care among others, and then they have made 10-15 home visits per day. There are key reasons why ASHA workers are important.

  1. They are local to an area, they understand the local customs and traditions
  2. They have the trust of the community, communitites in rural India do not like to discuss their health with strangers
  3. While are part timers, going from home to home makes them the best eyes and ears for the healthcare system

But given their situation and low pay, would it be interesting to see what we can do to help their situation. The government is spending close to INR 5000 Crore on the Ayushman Bharat Program. Next year the outlay is close to 10,000 Crore. But at a fraction of this cost, we can increase the pay for the ASHA workers and get much better coverage to prevent patients from getting hospitalized.

In the coming days, I would be focusing on how we can strengthen the primary care system and improve the overall effectiveness of the ASHA workers while providing them better remuneration for their tasks.

We did this video to talk about the challenges of the primary healthcare system. Below is the recording for the same.

As always we look forward to your comments and suggestions on the same.

References

https://thelogicalindian.com/story-feed/awareness/asha-workers-rural-healthcare/?infinitescroll=1

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Privacy Concerns with the Aarogya Setu Application for Covid19

Just this week, we recorded the second episode for the India Health Talk, with Dr Sumeet Kad. During the recording we ended up discussing the privacy concerns around Aarogya Setu, the contact tracing application launched by the Government of India to track Covid19 cases in the country. Aarognya Setu today has more than 10 Crore downloads and is the largest contact tracing application in the world. How do we balance the privacy concerns with managing a pandemic like Covid19? Alo what can we learn about other applications across the world in this space?

While I understand the concerns, in my opinion, during a pandemic we may need to give up some control over our data and privacy for the greater good of society. Pandemic is a national emergency and Covid19 is probably the worst example of it. But using privacy to derail the efforts to combat Covid19 is not a good idea. In the long run this may be our downfall.

Below is the full recording of the episode. Do let me know your thoughts as well.

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Telemedicine services critical to the wellness of senior citizens in India

On my 43rd birthday, I received an unexpected gift with the Medical Council of India along with Niti Aayog released the guidelines for the use of Telemedicine in India.

It was ironic as MCI and other state associations have been fighting a battle to stop teleconsultations and putting regulations around it. But the coming of Covid19 has changed all that.

Today after a long time we have a spurt in telemedicine providers in India. Industry experts like Bharat Gera former CIO of St Johns Hospital, are working with bodies like Telemedicine Society of India to put in a process to benchmark the functionality of these providers.

In the long run, I see this as a very positive move for senior citizens. These individuals fight it difficult to access healthcare. Especially as they have chronic conditions that need management, right from transportation, to long hours in the waiting room.

To discuss this and other associated topics, I got together with industry experts like Ravi Ramaswamy from Philips to discuss the impact telemedicine would have on seniors. We were joined by Dr Neeraj Bhalla and Dr Vallikiran to discuss the impact on areas like Cardiology and Psychiatry respectively.

The recording of the session is below.

I believe that Telemedicine is a boon to seniors. There would be a learning curve with respect to getting used to the platform, training to caregivers, and then managing concerns like security. But I think Telemedicine is here to stay.

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National Health Blue Print 2019

Niti Aayog in July 2019 has finally released the digital health blueprint policy for India. The focus of the digital health blueprint is in line 2017 National health policy which focuses on long with a strong emphasis on the care continuum. National health policy also plays a lot of emphasis on the Triple Aims that include

1)Accessibility

2) Affordability

3) Quality of care

National Digital Health blueprint truly recognises that there is no one entity or organisation that can solve the Healthcare problems of India it calls the blueprint for the entire Healthcare system this is a strong departure from the traditional ideology that the government is the sole provider of healthcare for all citizens.

National health blueprint focuses on three major components

  1. Digital health infrastructure number
  2. Digital data
  3. Standards and regulations

Meeting key healthcare objectives

The key objectives of the national digital health blueprint include establishing the core data model for storing and using healthcare data that would be generated from this ecosystem. Standards for the infrastructure required for its seamless integration using standards for all the components of the ecosystem.

The other interesting aspect is creating a system of Personal Health Records, based on international standards, and easily accessible to the citizens and to the service providers, based on citizen-consent.

There is also a provision for declassifying data for usage for analytics and doing population health management. In addition to these, there is guidance on governance, leveraging information systems already in place.

Finally, the 4 building blocks of the policy are

  1. Identification- Identifying the citizen and ensuring that his corresponding health data is mapped to his id. This is possible through Personal health identifier and through the health registries
  2. Citizen in the center- All access and control of the data lie with the citizen. This is enforced through consent manager, Anonymizer and Privacy Operations Center.
  3. Interoperability- Data should be available through health information exchange and National Health Informatics Standards.
  4. Access – Governed by Mobile First and a Digital Web portal strategy

I would encourage you to download the blue print report and study the implications of the report for your self. Looking forward to your comments.

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