Prime Minister’s National Digital Health Mission: Is it really helpful for the public?

Prime Minister Narendra Modi on 15 August 2021 planned to launch The Pradhan Mantri Digital Health Mission, also known as National Digital Health Mission, on 27th September; 2021 at 11 am via video conferencing. “Narendra Modi Ji to announce the nationwide rollout of Pradhan Mantri Digital Health Mission on September 27. Under this, a unique digital ID will be provided to the people, which will contain all health records of the person.” Union Health Minister Mansukh Mandaviya tweeted the announcement via Twitter. The National Digital Health Mission also coincided with the National Health Authority celebrating the third anniversary of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana.

PMO released a statement saying, “It will be based on the foundations laid down in the form of Jan Dhan, Aadhaar and Mobile (JAM) trinity and other digital initiatives of the government. PM-DHM will create a seamless online platform through the provision of a wide range of data, information and infrastructure services, duly leveraging open, interoperable, standards-based digital systems while ensuring the security, confidentiality and privacy of health-related personal information.” The statement also included that the National Digital Health Mission will also comprise of a health ID for every citizen that will also work as their health account, to which personal health records can be linked and viewed with the help of a mobile application: a Healthcare Professionals Registry (HPR) and Healthcare Facilities Registries (HFR) that will act as a repository of all healthcare providers across both modern and traditional systems of medicine.

In 2018, Niti Aayog proposed to create a centralised mechanism to give a unique identity to every participating user in the National Health Stack and this is where the concept of a Digital Health ID came from that is one of the most important features of the National digital health mission. A Digital Health ID is a unique 14-digit identification number that is going to hold all of a patient's health-related information in one place. It is created by using a person’s basic details such as mobile number or Aadhaar number which will make it unique to the person. According to the National Health Authority (NHA), every patient who wishes to have access to the Personal Health Records (PHR) must start by creating this health ID.

According to Niti Aayog, it will greatly reduce the risk of preventable medical errors and significantly increase the quality of care. The record keeping mechanism of each health care provider varies from the other. While one hospital might have the system of keeping digital health records of their patients, the other hospital might not follow the same system of record-keeping. This gap, in how the management of patients' information is done, can be seen, in the way private hospitals and public hospitals, especially in India, indulge in record keeping. While on one hand, hospitals such as Apollo, Max, and Fortis have already started adopting digitization of the records, on the other hand, many public hospitals still fail to properly include their patients' basic information in their health records.

This is where the benefit of having a digital health ID comes into play. It helps in creating an integrated health information system that enables universal health coverage in an efficient and accessible manner that is inclusive, affordable and safe for the patients. Patients can check their entire medical history with one single click which improves the citizen’s health care experience while also enhancing transparency across all health care sectors. Not only that, but also eases documentation requirements and ensures smooth functioning of the entire record-keeping procedure for both the patient and the health care provider.

But even if this initiative of the government to improve the conditions of health care facilities in India has its positive effects, some cons come along with it. According to critics, it is quite risky and expensive and can cause a financial disaster, if the implementation is not done properly. In 2005 the UK’s National Health Service (NHS) started something similar but it turned out to be the most expensive healthcare IT failures. Moreover, it puts one's data at risk which can lead to data monetisation by different private sector entities and other data breach-related dangers. This is because of its improper framework and outdated laws. The Personal Data Protection (PDP) Bill 2019, which NDHM heavily depends upon as it includes specific user rights related to data protection, has still not been passed. The Centre for Internet Society (CIS), a research organization working on issues of privacy and internet rights, has recommended that the mission should only be launched after the enactment of the proposed law has properly been implemented. This was considered extremely important to make sure that citizens' private information is secure with digitisation.

There are also other security concerns like getting a health ID without consenting to it via the CoWIN portal. According to the first point of sub-section 2 (Use of Information) of Cowin’s privacy policy, If you choose to use Aadhaar for vaccination, you may also choose to get a Unique Health ID (UHID) created for yourself. But, even if this feature is purely optional, many of those who enrolled in the CoWIN portal using their Aadhaar ID, have alleged that they got a digital health ID created without their consent. This is a serious invasion of privacy. However, due to the lack of any proper law, it is difficult to take any legal action.

Exclusion and unfairness due to digital illiteracy as well as the speculation of an underlying aim of privatising healthcare from the government’s side are also some other negative notions that are associated with the National Digital Health Mission. As seen in the Ayushman Bharat project, which aimed at converting the government’s role from a ‘Service Provider to a Financier’ but in actuality, it only allowed insurance companies to further their profit motives instead of playing a part in contributing to the public's welfare.

The analysis done by the Centre for Health, Equity, Law & Policy (C-HELP), ILS Law College, and Internet Freedom Foundation (IFF) clearly says how on one hand, DHM can make healthcare more efficient, cost-effective and accessible, but they also conclude that unless proper laws are established to protect citizen’s information, such initiatives are faulty in their execution and purpose.

And rightfully they include in their paper that, “In order to make a successful transition from paper to a digital system and minimise the risks associated with it, it is necessary to ensure health system and security environment preparedness to support the digitisation. A robust legal and regulatory framework that protects individual rights, through adequate enforcement, transparency and accountability mechanisms, is also imperative,”.

Henceforth, I believe that, while the National Digital Health Mission is a positive move and is going to be helpful for the public, it is also critical to ensure that the following is carried out properly. For the PM-DHM to take off successfully, proper legislation governing the safeguarding of people' data should be first and foremost priority. But, on the plus side, such attempts to improve public welfare are greatly welcomed, and we only encourage the government to take more such actions to promote wellness in all aspects of life for all people.