Prime Minister Narendra Modi formally launched Ayushman Bharat Digital Mission on September 27, 2021. Under this scheme, a unique digital health ID card would be issued to each individual citizen and this scheme would cover all 130 crore citizens of the country.
The citizens can get this card by registering on the official digital mission site. Using this digital ID and a Digital Health Mission app, every citizen can upload all her/his health records in a central data base voluntarily and could access them whenever needed. Entering this portal, the healthcare institutions treating the patient can also access all the stored past health records of that person.
Apart from this a registry for all healthcare professionals to store all their personal information and a registry for all healthcare institutions under which the details of all their patients and the treatment details given to them would be stored are also part of this Digital Health Mission (DHM).
Lack of Transparency
The medical community at large and the political observers are puzzled by the utter lack of transparency about this scheme. Except the sketchy details stated above, the government has shared no other information about the scheme with the public. It is indeed very strange for a Prime Minister to formally launch a scheme without giving out the details and keeping the people in the dark.
Many controversies have already arisen about this scheme. Modi Government did not consult all the stakeholders about the details of this scheme. It was not discussed with any organisation of doctors or any other category of healthcare personnel or healthcare providing Institutions. Despite vastly increasing the cost of the State governments, which will have to ensure collection of immense quantity of data and their digitization and hand them over to the Central database, no State government has been consulted. This is a gross transgression of the federal rights. Above all, the people have not been consulted through their representatives at different levels, especially through the opposition parties representing them. And there was no discussion in the Parliament.
Though this appears like a ‘Digi lock system’ where people can store their medical records and which they can supposedly control, it is not like that. It is much more. Digital record-keeping, is different from centralizing the data. Instead of decentralized digitalized record-keeping, the DHM represents a massive ‘Big Data’, comprising all the health records of all the citizens in one giant database. Such centralized data can easily be mined by vested interests. Corporates in advertising agencies, pharma businesses and insurance companies can obtain the data from healthcare institutions like private hospitals and clinics, for a price if needed, and collate them and do data mining from that base to promote their own self interests. They can bombard the citizens with their advertisements, improve their own marketing and insurance businesses.
Mr. Modi claims that this would revolutionize healthcare provision in the country. But a leading doctor in Chennai who had worked with the government and who spoke to The Rising Sun on condition of anonymity asserted that, “Digitization of health records has nothing to do with improving the health status of a community. It has not happened anywhere in the world. Therefore, the only major use of this digitization can only be putting this giant database at the disposal of the corporates”.
From The Rising Sun, this author talked to a few doctors and all of them vouch for the fact that in most instances even if the patients do not have previous records, it will not lead to wrong diagnosis or treatment.
Why the government is not transparent about this scheme at the launch stage is not clear. It is not just an announcement and not a new one either. Mr. Modi announced this scheme in his Independence Day address to the nation in August 2020 itself. The government has already started the work for this database. For instance, all the data about nearly 75 crore people who have been vaccinated so far are already part of this database. Their individual accounts are seeded with Aadhaar numbers. Under the larger ‘India Health stack’ proposal of the
government, it would be made mandatory on the part of all the registered healthcare institutions and even clinical laboratories to upload their data to this centralized and unified database.
A New Health Sector Scheme without a Single Additional Health Benefit to the People
It is really bizarre that the Central government is going ahead with a digital health mission without announcing a single additional health scheme or health benefit under it. It has been labeled ‘Ayushman Bharat Digital Mission’ extended to cover the entire population without, however, expanding the limited coverage under even the minimal ‘Ayushman Bharat’ facilities to all of them.
In fact, no patient has ever demanded this sort of digitization of records. Most doctors and private nursing homes still rely on manual records in the form of case-sheets or a small notebook in which doctors enter the case history and treatment details. If all the healthcare data of all the patients are to be digitized, it would naturally involve a huge additional cost and enormous amount of human resources and the additional cost would ultimately have to be borne by the patients.
Violation of Federal Rights
For instance, take the Rajiv Gandhi Government General Hospital. It treats on an average 10,000 outpatients per day and 2000 in-patients. Even if one data-entry worker can key-in and upload the data on 100 patients per day, it requires at least 120 new workers doing this digitization work alone. There are 387 hospitals, 238 dispensaries, 1,806 primary health centres and 8,706 health sub-centres under the government in Tamil Nadu. The State government will have to employ new workforce running into lakhs to digitize all their health records. Who will foot the bill? Will Modi pay from the Centre? No, the State will have to pay from its own exchequer.
The private healthcare institutions would far outnumber the government institutions. The big ones among them can take up digitization. But if the small ones are also burdened with digitization and uploading the daily data to the Central database, then the huge additional cost would make them economically unviable and many would go out of business or would be swallowed by big corporate moneybags in the health industry.
No major health issue is going to be tackled by digitizing the health records. Patients want affordable healthcare, and quality medicine and surgery. This is not available in most parts of the country. Not long ago, Modi Government became the laughing stock in the eyes of the world due to its inability to provide even oxygen and essential medicines to the Corona patients in government hospitals and numerous people died. The number of children dying due to encephalitis in Gorakhpur, the home district of Uttar Pradesh’s BJP Chief Minister Yogi Adityanath, even now runs into hundreds every year. Every winter, the National Capital Region shudders more due to dengue than due to the biting cold. The real problems on the ground are totally different.
Diversion from Real Issues
Let the government first tackle the basic problems of unaffordable private healthcare. Introduction of ‘Ayushman Bharat’ could not make even a minor dent on the private loot but only facilitated the private sector by government footing the bills of the patients to some extent. Despite Ayushman Bharat, the majority of the population still depends on out-of-pocket expenses for healthcare mainly. A single hospitalization of any member of the family with some serious illness still remains the single most major cause of poverty and many slip below the poverty line due to that. Digitization only appears to be an attention diversion tactics. The deliberate ambiguity and opaqueness maintained by the government on the details of the scheme only reinforces doubts about Modi Government’s ultimate intentions. Digitization appears to be a scheme for the corporates and not to promote the health of the people.
What is the guarantee that the personal health data of the citizens in this database would not be misused by the corporates? Modi Government has kept the Personal Data Protection Bill in limbo and has not passed it. If any citizen wants to file a case against the misuse of her/his personal data, under which law they can do it? Without any such legal guarantee, Modi Government is going ahead with digitization initiatives like ‘Agri Stack’ and ‘India Stack’ etc. Like the three Farm laws, all these digitization initiatives are all intended to serve the corporates and not for people’s health.
