Editorial: NDHM - Putting the fundamentals first

Announced by Prime Minister Narendra Modi during his Independence Day speech this year, the National Health Authority has been mandated with setting up the NDHM. The policy document has been placed on NDHM’s website for public’s feedback.

As per the document, the project ‘intends to digitise the entire healthcare system of India’. This would be done by creating digital health records and creating and maintaining registries for healthcare professionals and facilities. There are a few issues related to the draft that has been highlighted by the public and those in the political fraternity. Earlier this week, Chhattisgarh Health Minister TS Singh Deo wrote to Union Health Minister Harsh Vardhan stating the draft policy is bereft of any provisions that would offer long-lasting constitutional and legal safeguards to the citizens. There is also no reference to the Personal Data Protection Bill 2019, which is currently being debated in the Parliament.

Deo expressed his doubts on whether the draft policy will be used as a tool for surveillance, in the light of the data sought from citizens. A case in point is the definition of sensitive personal information that is part of the draft policy which includes an individual’s religious/political affiliation, gender status, caste, sexual orientation, apart from his or her financial data such as credit or debit card details. In fact, the concept behind data management in healthcare should be centred around access to quality healthcare services and improving the quality of one’s life, factors which it seems has been ignored in the draft, as per Deo.

The Centre on its end says any personal data being collected would be only through consent of an individual and that he or she has the right to revoke their permit too. The window for the public to share its opinion has been extended till Sept 21 after a petition was filed in the Delhi High Court saying the one-week window for feedback was too short, considering the magnitude of the project. Stakeholders in healthcare including medical practitioners, management teams of hospitals and research centres and public also believe this is an inadequate period to convey constructive criticism.

On paper, the idea seems revolutionary – every citizen’s health record stored on a centralised database, that offers data portability not witnessed in India’s healthcare sector to date. But the implementation will open up a Pandora’s Box vis-a-vis logistical and technological challenges, considering the quantum of Indians who have still do not have access to the Internet - almost 60 per cent. Apart from this, there is the need to digitally onboard facilities of all kinds – hospitals, diagnostic centres and pharmacists to be part of the ecosystem. Sceptics in the policy space have other concerns too. For instance, rather than concentrating on the absence of an affordable healthcare infrastructure right now, why would the government conduct a speed-run in pushing for a digital healthcare ID? There are also apprehensions regarding whether the project is an exercise by the Centre in asserting control over private (corporate) healthcare sector which is currently operated as per policies of different states.

For a nation that has already witnessed how Arogya Setu was introduced by the Centre, pitching it as an unshakeable tentpole to aid in the battle against COVID-19, the app has become somewhat like an afterthought. Privacy concerns aside, what the nation’s healthcare sector needs at this point in time are some rudimentary essentials – timely care, presence of hygienically maintained healthcare facilities, and a decent public health network. No level of digitisation can make up for the absence of such fundamental requirements of a population that has grown tired of repeated instances of government mismanagement.