Digitised healthcare will be inaccessible for majority of Indians

Recently, I visited the GPO to update information for Aadhaar. The data entry operator took an hour to process the details of the person ahead of me. This person had come to update his phone number. The reason for this wait? The trickle-down effect of slow internet connectivity which percolates into every part of this job. Only 32 Aadhaar forms –fresh enrolment and updating existing ones - are processed every day at the GPO, I was informed.

Indians have long suffered from a mismatch between the intent of ‘infrastructure’ and systems, and their capability and capacity to serve the population. The school education system lacks equipment and trained teachers, the healthcare system suffers from a paucity of doctors and hospital beds, the legal system is hobbled by a lack of judges. And more is being added to the list.

The idea of Digital India is well and good if it weren’t built on sand. My experience at the Aadhaar card counter is nothing compared to that of students who have been unable to attend online classes because their families either do not own smart phones or because of lack of internet connectivity. One should not forget that in many parts of India electricity even today is not available 24x7, adding to the woes of these students.

Instead of bridging this last-mile gap, Prime Minister Modi is keen to add to the burden. He recently announced the launch of the Digital Health I Card. This is expected to be a repository of all health information of an individual who registers for this scheme. The supposed benefits include not having to carry their medical files with them on doctors’ visits. It will make choosing a doctor easy and will help identifying pharmacies in a user’s vicinity. Doctors will have all patient information on their fingertips.

Helen of Troy’s beauty was such that it launched a thousand ships, the technical prowess of ISRO enables it to launch Mangalyaan. Mr. Narendra Modi is adept at launching schemes. But instead of focusing on the launching abilities of Mr. Modi, it is best to stick to the reality of the challenges that India may face with Digital Health ID Card.

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Barring the big corporate and government hospitals in major cities, few hospitals and clinics keep digital records of patients treated. That requires computerised systems, manpower and maintenance. In any case, rural India is still short of hospitals, leave alone digital health records. The proposed digital card will also require digital readers and the health eco-system is just not prepared to handle it.

The Digital Health I-Card is therefore focused on large hospitals as they have the resources required to participate in such an eco-system. What happens to individual doctors who have a private practice or the small, private clinics? How will they treat patients? Therefore, the card limits a patient’s choice while providing big data to the pharma majors and insurers besides banks and other financial institutions.

While people with such health cards will be gradually nudged to seek treatment at corporate hospitals and will potentially deprive them of cheaper alternatives for treatment. It is not difficult to guess who will be making money.

According to TopVPN, an internet privacy publication, internet shutdowns ordered by the BJP government in 2020 cost the Indian economy USD 2 billion at the very minimum. The 550-day internet shutdown in Kashmir was a socio-economic disaster as Kashmiris could not transfer money or carry on e-ecommerce activities.

The government also shutdown internet services during the anti-CAA protests and during the farmers protests and most recently in Lakhimpur Kheri. In these situations, dependence on digital health cards will mean shutdown of health services. The government’s proclivity to shutdown the internet, the backbone of Digital India, is however unlikely to go down.

It is possible that Mr Modi’s Master’s degree in Entire Political Science gave him an insight into the Indian electorate – masses become susceptible to certain things when fed a diet rich in vacuous nationalism and hollow national pride. The Prime Minister wants to convert India to a First World country with no concern for the Third World infrastructure and governance. But who can dare to criticise the Prime Minister’s progress to the First World?

The Indian Prime Minister’s ability to invoke national pride in everything that he does is not in question. His recent visit to the US was heralded as a triumph, notwithstanding his cold reception at the White House and the empty seats during his UNGA address. His stress on perception and disdain for reality is well known by now. This, coupled with his contempt for facts and his myopic vision of modernity make most of his plans vulnerable.

Digital India and a digital health card sound cool and are hailed as signs of progress. A Digital Health I-Card is construed to be modern because it will use the internet and thereby purportedly improve access to healthcare for all. But how beneficial will this form of modernity be, and to how many, given that currently old medical records can’t be uploaded?

How accessible can the data be if the government can switch off internet connectivity at will, at any time and without warning? One is not even going to go into the data security infrastructure and auditing requirements for these federated data repositories.

The Digital Health I-Card will not increase the number of doctors or the number of hospital beds. An inadvertent fall out of this initiative may be an increase in the ratio of hospital bed to population because it could make it harder for some to access healthcare.

One needs to ask who benefits from this initiative? Is it designed to benefit the corporate hospitals, the internet service providers, the pharmaceutical industry, the health insurance industry or the computer software and hardware industry? Undoubtedly this is another feather made for Mr. Modi’s cap as it makes him out to be a futurist concerned about all. But what of the health of the Indian citizen?

Will the Digital Health I Card ensure there is enough Oxygen the next time round? The only way India will get better access to healthcare is if Mr. Modi invests in the basics – better healthcare infrastructure which is accessible to all. That may not be possible given the reckless crores being sunk into futuristic projects like the Bullet Train and a cashless economy.

The promised Digital Health Card therefore looks suspiciously like another scheme to facilitate financial institutions access health data.

(The writer is an independent commentator. Views are personal)