Instead of pro-corporate plans like NDHM, Modi govt needs to scale up spending on public sector healthcare
National Digital Health Mission will just give Centre more power to surveil people. Instead, Union budget allocation on health needs to be hiked from 1 per cent of GDP to 5 per cent at the very least
Prime Minister Narendra Modi launched National Digital Health Mission (NDHM) on September 27, 2021, giving high hopes that it will bring about drastic improvement in healthcare of our people. The mission is basically to collect and compile health data which has been made easy by modern technology. Maintaining database on health can be helpful in planning for healthcare. It is also useful for the epidemiologists and research workers in health to analyze health situations from time to time.
Already several IT organizations have come up with systems to maintain such details. A patient does not have to carry several pages of her/his medical record as these can be obtained with the click of a button. Many corporate hospitals have such systems installed.
But the present mission, which is supposed to cover all citizens, has several contentious clauses. There are several issues which need to be addressed: Whether this data collection in present form will address to the healthcare needs of our people; whether confidentiality of patients will be maintained; has the issue of cyber hacking been addressed; health is a state subject, how will this matter be sorted out; whether this mission will take care of inequities in healthcare?
As per the NDHM, healthcare providers will collect data which will then be shared with the state health authority and the central health authority. Medical ethics demand that a patient’s health status is a confidential issue between him/her and the doctor. No doctor should share it with anyone unless permitted by the patient himself/herself. By sharing the data with three parties, this basic ethical issues has been completely ignored and flouted. With a poor track record of controlling cybercrime in our country, how can it be guaranteed that the data will not be leaked?
The healthcare provider will give consent for his/her enrollment in this mission to collect the data. Similarly, the consent of the principal, the person/individual, will be necessary to collect data about his/her health status and share it with the state and Central health authorities. There is also a provision that the healthcare provider or the principal will have the right to opt out of this mission.
But according to the mission, the person’s record isn't erased after they have opted out but is simply locked. Moreover, it cannot be erased for a certain period of time.
Extensive due diligence is required by all stakeholders to ensure that a right balance is created between the public healthcare needs and the legal rights of the citizens, specifically the right of privacy and data protection. One of the main concerns with the NDHM is that it suggests a framework that severely overlaps with the fundamental right to privacy as per the privacy principles recommended by the Group of Experts on Privacy (Justice A.P. Shah Committee) and the more recent Justice B.N. Srikrishna Committee report whose recommendations on data protection form the core foundation for the draft Personal Data Protection Bill, 2018.
The argument of maintaining confidentiality is belied by the fact that the job of compiling/managing the data will be given to private setups, thus completely negating the security issue. With this, a person's privacy will be completely undermined under this mission. There is no provision of sufficient safeguards against commercial exploitation of sensitive personal data by private entities that will be linked to public entities under this system. These include insurers, pharmaceutical companies, and device manufacturers.
Many issues mentioned under "sensitive personal data" are perplexing. It says that “such personal data, which may reveal or be related to, but shall not be limited to, financial information such as bank account or credit card or debit card or other payment instrument details; physical, physiological and mental health data; sex life; sexual orientation; medical records and history; biometric data; genetic data; transgender status; intersex status; caste or tribe; and religious or political belief or affiliation”. Why should sensitive personal data include religious or political belief or affiliation of data principals or about their sex life or sexual orientation for that matter?
The fear that such a data could be used by the State on some pretext or the other is not unfounded. We have the example of Aadhaar card which is now compulsory to be linked with almost any activity and the State has complete knowledge and control of the activities of the people in our country.
Gradually, the digital health card will be made compulsory to join the Ayushman Bharat/RSBY/CGHS/ECHS/ESI or any other government-sponsored scheme or insurance by companies. It is difficult to comprehend that when there is Aadhaar card for every citizen, what is the rationale behind another card?
Health is a state subject. Collecting data by the Centre will be complete infringement on the rights of the states.
The contention of the government that this will help improve the health policies is unacceptable. The government already knows the problems of healthcare in our country but it needs political will to sort out those problems. Several health activists/civil society groups and experts have already given their viewpoint on how to improve the healthcare system.
Health is a basic human right, but despite so much talk, health is not a fundamental right in our country. Healthcare is based on holistic approach, covering safe drinking water supply, sewerage facilities, clean air, healthy nutrition, good working environment, guarantee of job and sufficient remuneration etc. All these require planning with priorities towards health.
Our patients are highly burdened with the cost of the healthcare. The National Health Policy document clearly admits that 6.3 crore people are pushed below poverty line due to high out of pocket expenditure on health. With a meagre spending of 1 per cent of the GDP by the State sector on public health as against required minimum of 5 per cent recommended by the WHO, the patients are left to remain at the mercy of the private sector which accounts for nearly 80 per cent of the healthcare in our country. It is no secret how the patients have been fleeced even during pandemic by the corporate sector.
Universal healthcare system is the only answer. There is enough information now on how the corporates hospitals fleeced the patients during COVID pandemic. The pharmaceutical industry minted money at the cost of seriously-ailing people. In the pre-COVID period, there were 100 billionaires in India, whose number increased to 140 during the pandemic. These billionaires earned Rs 12.7 lakh crore between March 2020 and March 2021.
During the second wave of COVID pandemic, 24 of these 140 companies who deal in health sector were doing business of Rs 500 crore per day in April - May 2021. In contrast, despite several difficulties, the public sector institutions provided services to people with healthcare workers risking their lives.
The NDHM type of exercise is useful in a healthcare system which is comprehensive and universal. In a system like ours, healthcare delivery is very diverse, right from faith healers, alternative medicine to the system of modern scientific medicine. The medical practitioners vary from small scale sector to corporate sector.
For the small scale single person clinic, it is extremely difficult to maintain such records. They will have to employ new people for the job, the cost of which will ultimately fall upon the patients. This will further create inequities as the elite section will get NDHM benefits because they will link themselves to the corporate health facilities.
To ensure equity in the benefits of NDHM, inequality in the healthcare has to be abolished through a universal State owned healthcare system.
The whole exercise in no way seems to be of help in improving the health needs of our people; it will rather be another means to give power for surveillance of the people. People will be carrying just another card in their pocket.
As of now, there is a need to increase budget on health from 1 per cent of the GDP to 5 per cent immediately if the people’s health issues are to be addressed in the real sense. Several countries invest 10-15 per cent of the GDP on the health of the people. Why can’t we?
Views are personal