By Kiran Mazumdar-Shaw
Chairperson, Biocon Group and member of The Lancet Citizen’s Commission on Re-imagining India’s Health System
Technology can enable India to leapfrog into an advanced healthcare system that fulfils the vision of the national health policy of promoting wellness, universal access and affordable care for all Indians.
The National Digital Health Mission (NDHM) launched on August 15, 2020 seeks to enable this by bridging the existing gap amongst different stakeholders of the healthcare ecosystem through digital highways.
For such a model to succeed, technological implementation cannot be top down. In India, 66% of the population live in villages, and while they may know how to use a smartphone, they may not know how to download a mobile app. To spur technological adoption and bridge the existing digital divide, India will have to deploy an army of empowered and tech-savvy ‘Digital Health Agents.’
Fortunately, rural India has a huge untapped resource pool of close to 9,00,000 ASHA (Accredited Social Health Activist) workers who act as a bridge between the government and people, and are playing multiple roles – of health care facilitators, health activists and service providers and are operating at the grassroots level.
Many ASHA workers are graduates and others are educated to at least Class 10. Basic training on technology along with access to tablets or smartphones can transform the ASHA worker into a Digital Health Agent to deliver healthcare solutions to the masses. The upcoming Budget is a great opportunity for upskilling ASHA workers with digital training.
Digitalizing Data Capture
Data is becoming the lifeblood of health systems globally. Yet, healthcare in India has long suffered from a lack of reliable data. The NDHM seeks to address this huge deficit. The smart application of telemedicine, artificial intelligence (AI)-enabled medical devices, and block chain can help create repositories of longitudinal data, revolutionizing public healthcare planning and delivery in the country.
Technologies such as the use of voice-enabled records are emerging as a global best practice for improving the ease and reliability of data capture. One such app is mSakhi for frontline health workers in India. It is an open source Android application that has helped digitize multiple paper-based tools and enabled health workers to gain access to the most up-to-date training, stay connected and report essential data. ASHA workers can access this app on their smartphones to update skills, stay in touch with supervisors, and track and report crucial data about health issues in their communities.
In rural India, there are still millions of individuals who do not have smartphones or access to reliable mobile networks. ASHA workers can help these people access the digital healthcare ecosystem.
As Digital Health Agents, they can enable teleconsultations between specialists and individuals, acting as an important digital link between primary and tertiary care in rural areas.
Deploying ‘nudge tactics’ to encourage individuals to make best decisions and actions is a powerful tool that has emerged in recent years. Using technology to make these nudge tactics available to ASHA workers would make large scale implementation of relevant interventions possible.
ASHA workers can also help individuals decipher the significance of their symptoms and seek appropriate care at the right time. This will not just expedite the process of screening and ensure maintenance of a proper health records, but will also take the load off secondary and tertiary healthcare centres, enabling them to focus on critical cases.
Thanks to innovative start-ups, there is a wealth of available and in-development innovative technology which can fundamentally transform the way healthcare is delivered in the country. Validating such innovative technologies requires large field and clinical trials where ASHAs can play a critical data gathering role. Moreover, mobile and point of care technology-enabled testing and screening modalities are replacing the more expensive traditional methods that require immobile equipment and specialist human technicians. Armed with such handheld, affordable technological innovations, ASHA workers can provide screening, wellness and disease awareness services in remote areas of the country.
They can also be trained to interpret data and alert authorities in the event of an outbreak or epidemic.
The COVID-19 crisis has highlighted the important role of ASHA workers. Once coronavirus vaccines are rolled out to the entire Indian population, they will need to be involved in awareness creation to make the immunisation program a success. Through the use of digital communication aids they can help tackle the tsunami of misinformation that is emerging as one of the biggest threats to India’s vaccine drive.
Given their grassroots connect, ASHA workers should be an important element of the government’s communication effort to educate ordinary people on the importance of getting inoculated, besides telling them when and where they can get immunised.
Empowering ASHA Workers with Technology Led Career Development
ASHA workers need to be incentivized to be a part of the vibrant technological ecosystem envisaged by NDHM.
The current task list for an ASHA worker is long and daunting. It involves working and commuting long hours and responsibilities such as disseminating health and nutrition related information, collecting household data including a record of births and deaths, checking for communicable diseases and providing postnatal care and family planning services. Lack of adequate infrastructure, poor pay, insufficient benefits and their classification as voluntary workers add to the burden.
COVID-19 has brought to the fore the poor working conditions of ASHA workers, who form the backbone of public rural healthcare. It’s time they are empowered and enabled to contribute more effectively to transforming Indian healthcare.
Digital enablement will not only add new skills to the ASHA workers’ repertoire, upgrading their role as a healthcare service provider but will also lead to their career advancement to more paying jobs.