Does healthcare need a new discourse in India? Absolutely. Over the past few years, digital technologies have revolutionised the tools used to seek information, communicate, prevent and treat diseases by increasing reach, participation, transparency and accountability while lowering costs. No matter where they live, people are increasingly voicing their concerns and challenging unilateral decisions taken by health providers. Health outreach has to evolve from being top-down to participatory because people want answers before they agree to be a part of India’s development journey.
Over the past 30 years, health promotion has rapidly evolved from curative to prevention and promotion. This is the decade of population health which, much like the resilience imperative, attempts to improve the social and ecological determinants of health to improve the lives of communities and with it, individuals. Community participation, whether it is in mobilisation to eradicate polio or lately to dispel rumours about immunisation, or in treatment delivery, is a tool public health cannot do without.
Just as the resilience imperative argues for a SEE (social, ecological, economic) change to replace the paradigm of oil- and consumption-fuelled economic growth with a more sustainable economy, the new healthcare discourse must be localised to democratise outreach, improve outcomes and eliminate iniquities in India where catastrophic health expenditure continues to push 63 million – the population of the UK -- into poverty each year.
Increasing digital literacy and smartphone penetration has brought in transparency and given people more access over the management and treatment of their own health. Dealing with people empowered with simplified information makes it more difficult for doctors to use jargon to hedge or obscure the discourse, makes healthcare more participatory and gives people control over interventions that deliver tangible benefits. People want to know why before they agree to measures that affect their health and the lives of those around them. Healthcare providers, especially in the public sector, must accept technology as a force for good rather as an intrusive burden and increase engagement to build trust and improve treatment compliance.
Big data for action
Better use of data transforms quality and lowers cost of services by helping providers quickly identify gaps and introduce real-time course correction. It’s already helping India’s Mission Indradhanush accelerate towards its target of fully immunising 90% children from by 2020. Real-time data is an effective but underused tool for infection control. Pakistan, for example, beat back dengue outbreaks using a low-cost android smartphone and an innovative planning and tracking dashboard. The plan involves three interventions: giving smartphones to field staff to send back photos of action taken for real-time tracking, actively looking for mosquito larvae in neighbourhoods to predict outbreaks, and using hospital data to identify where patients got infected so that the health department can move in quickly for indoor residual spraying to prevent an outbreak. Any upward swing in mosquito larvae or patients in a particular neighbourhood prompts the dashboard’s algorithm to automatically send a text alert to the local nodal officer, who immediately moves in to begin control measures.
Just as industrialisation and improved transport lowered the costs of moving goods across countries over a century ago and transformed developed economies, information technology slashed the cost of moving ideas across national boundaries to fuel outsourcing and push growth in developing countries such as India. If used right, the same technology can help India meet funding, infrastructure and human resource gaps not just within the country but across the region and the world. It’s happening, but not fast enough.
For close to two decades, telemedicine remains a fledgling industry and hasn’t kept pace with the IT boom that gripped the country. Indian Space and Research Organisation’s telemedicine network connects just 60 specialty-hospitals to 306 remote/rural/district/medical college hospitals and 18 mobile telemedicine units in India, but with its South Asia satellite going into orbit on Friday, telemedicine will be among the many industries that will ride the region’s widening communication web to reach many millions who live in remote and underserved areas.
New pandemic threats such as Zika, Ebola and H1N1 remind us every few years that diseases know no boundaries and infections cross continents within hours with frightening ease. India can meet existing and emerging health threats only by accepting that much like in politics, people want to participate in the change they want to see. Those who don’t participate will end up being excluded from India’s growth story.