Technological advancements are reshaping the ways in which people, systems, and health information interact. With the largest global population, huge social-cultural diversity and wide geographical variation, the Indian scenario presents a complex and unique healthcare challenge. To meet the demands of overburdened healthcare system, accessibility, affordability and good quality care for all, the country is rapidly integrating innovative technology solutions across all domains of healthcare including diagnostics, monitoring, treatment, record keeping, patient communication, care delivery and payments for care access.
Like any initiative of this scale, there are going to be successes and failures, lessons learned and opportunities for improvement. But so much of how India is addressing rural healthcare could easily be applied to the United States and how it takes care of underserved health populations in rural and remote regions, including the hot topic of the week: Appalachia.
The Indian government is taking strategic steps to build a robust digital infrastructure. The National Health Policy 2017, centered on ‘leaving no one behind’ and strengthening health equity, paved the way for a milestone step - developing Ayushman Bharat Digital Mission. Launched in 2020, this ambitious initiative demonstrates India’s commitment to harnessing technology. It aims to create an integrated digital health ecosystem that supports universal health coverage in an efficient, accessible, inclusive, affordable, timely and safe manner. Its key components include:
Health ID - a unique identification number for every citizen to facilitate easy access to their health records.
Healthcare Professionals Registry - a comprehensive database of all healthcare professionals across the country.
Health Facility Registry - a directory of healthcare facilities (hospitals, clinics, and diagnostic centers).
Personal Health Records - a system to maintain and access personal health records electronically.
This ‘digital backbone’ is crucial for delivering healthcare services to all including the vulnerable communities. By January 2024, over 51 million health accounts and 33 million linked records have been created. With rapid ongoing registration of health professionals, public and private health facilities, and allocation of health cards under the mission, India is striding towards its goal of Universal Health Coverage. Some interesting initiatives in this domain are:
eSanjeevani - the National Telemedicine Service has gradually evolved into the world’s largest documented telemedicine implementation in primary healthcare. It has two platforms:
Provider-to-provider - patient walks into a remote health facility and is virtually connected to a specialist by the community health officer.
Patient-to-provider - patient unable to travel to the facility, seeks virtual consultation from home.
Over 197 million consultations have been done using this platform since its launch in 2019 and more than 50% of the users are women. The platform has brought healthcare services to the masses specially the vulnerable and rural communities bridging the gap of accessibility and affordability for millions.
Mobile Health (mHealth) - Significant investments were made in the past decade for expanding high-speed internet connectivity and smart phone penetration to remote areas. With 1.03 billion mobile users (March, 2023) and third most affordable internet connection globally, India is leveraging mobile technology to optimize healthcare. Mobile services have gained huge traction in rural India to provide health information, deliver healthcare interventions and monitor patient conditions. The network of community health workers (ASHAs, AWWs, and care providers like ANM) use mHealth to provide preventive, supportive, curative and timely care to the rural population. Examples include mSakhi, Poshan tracker, Anmol and several others, developed and implemented by the federal or state government to help deliver better quality care to the communities.
Point-of-care-diagnostics (POCD) are increasingly recognized as crucial tools in expanding diagnostic coverage in rural and remote areas. They offer rapid and cost-effective means facilitating timely and efficient healthcare delivery. These tools play an important role in early detection and infection control for non-communicable as well as infectious diseases. There is impetus on research and innovation, leading to development of more efficient and accurate tools. Additionally, integration of Artificial Intelligence, Machine Learning, and Internet of Things is making diagnostics more personalized and data-centric helping patients and informing decision-making for care providers.
Overall, the emphasis is not just on treatment but meeting the varying needs of the population and improving the overall health scenario. From building electronic health records for efficient patient management, addressing affordability for the most vulnerable with the world’s largest cashless health assurance scheme (PM-JAY) to delivering emergency medicine via drones in remote areas, and using UPI-based digital payments, there is rapid evolution in healthcare ecosystem. India’s flourishing startup ecosystem is accelerating this change. To continue reaping the benefits of these advancements, efforts should be bolstered for sustained investments, continuous capacity building and multilateral collaborations with diverse stakeholders.
Conclusion
India's journey towards a technologically empowered rural healthcare system is a testament to the country's resilience and its commitment for Universal Health Coverage. Its experience demonstrates how technology is used as a powerful ‘equalizer’. Navigating the challenges with new ideas and innovation, India is pioneering a healthcare revolution and developing an ecosystem that supports its rural population to realize the benefits of technology for their overall health and well-being.
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