Role of Technology in Revolutionizing Primary Healthcare and Tackling the NCD Surge
The emergence of non-communicable diseases as major killers of humankind and an emergent need to move towards a rights-based approach to healthcare have in recent years fuelled the need to redefine and widen primary healthcare approaches.
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With newer public health challenges bedevilling the world, the WHO redefined the concept of Primary Healthcare in 2018 to include strategies to improve access, enrich service, improve quality and safety, and increase the efficiency and coordination of healthcare services. The emergence of non-communicable diseases as major killers of humankind and an emergent need to move towards a rights-based approach to healthcare have in recent years fuelled the need to redefine and widen primary healthcare approaches. WHO also envisages the use of technologies to enable communities to identify their health needs, and play an active role in the planning and delivery of healthcare services.
According to Sustainable Development Goals (SDG3), Universal Health Coverage should be a reality by 2030. This includes financial risk protection, access to quality essential healthcare services, affordable medicines and vaccines for all. New-age technologies are set to play a defining role in making these goals a reality.
Primary Healthcare in India
In terms of policy approach, India has been in lockstep with the global understanding of primary healthcare and at times, even ahead. The National Health Mission, launched by the central government in 2013, was designed as a unified healthcare delivery service platform, and the National Health Policy 2017 promised to integrate technologies in primary healthcare, and direct two-thirds of public health investment towards primary care. A Health Technology Assessment cell was established, followed by the formation of Health Agencies at the National and State levels.
The announcement of the largest public health insurance system under the Ayushman Bharat Scheme was a welcome move away from segmented and sectoral healthcare delivery to a more comprehensive need-based service. Strategic actions like the upgradation of services package at the sub-centre level and the placement of Multi-level Service Providers (MLSP) under the Health and Wellness Center (HWC) scheme are promising policy approaches. However, they need to be converted into actionable processes on the ground to be able to make a real difference in the lives of people. New age technology such as artificial intelligence-based systems can play a significant role in improving accessibility and efficacy of primary healthcare in India.
The Role of Technology in Primary Healthcare
WHO defines medical technology as devices, drugs, medical, and surgical procedures used in the prevention, diagnosis, and treatment of diseases as well as in rehabilitation, and the organizational and supportive system within which the care is provided. Medical technologies are an effective tool for fast-tracking Universal Health Care (UHC) and reducing gaps in financial protection, healthcare services, and human resources – the three main pillars of UHC.
Human resource and infrastructure gap continue to bog down the Indian primary healthcare system. There is just one government doctor for every 10, 189 people, a figure that is woefully short of the WHO recommended the doctor-patient ratio of 1:1000. The nurse-patient ratio is 1:483, compared to the ideal ratio of 1: 4. As it stands, we have a shortage of 600,000 doctors and 2 million nurses. Major vacancies of specialists plague primary healthcare centres in rural areas while pathology and lab services remain inadequate to serve a large population. Technology can, therefore, play an important bridging role in reducing these gaps.
India and its academia have been gradually building its capacities during the last few decades in technology development, its application in social sectors and in creating evidence of its value for social good. During the last couple of years, it has taken the form of flagship initiatives such as start-up promotion, innovation-driven initiatives, Artificial Intelligence and Virtual reality-based initiatives, BIRAC-driven initiatives, and smart cities program, almost in all social sectors including public health.
Private Organizations Can Bridge the Public Healthcare Gap
Even as the government finds itself strained for resources, it can engage private players working in the field to help improve access and availability of primary healthcare through the use of technology. Non-profit organizations like the WISH foundation are playing a vital role in improving last-mile access to healthcare by incorporating technology-driven innovative approaches.
Technology-Enabled Health and Wellness Centers Help Streamline Healthcare Delivery
• Screening & Preventive Care – With the help of medical equipment, the likelihood of diseases such as cancer, diabetes, etc. can be screened in people even before they start displaying symptoms. Remote diagnostics will make it easy to operate machines that can diagnose patients in a village and transmit data to be read by physicians in the city.
• Diagnosis & Consultation – Based on the data received from diagnosis, a physician sitting anywhere can study the case, consult a specialist if required and give advice to the patient located remotely via video conferencing. Internet of Medical Things will help reduce the cost of maintenance through remote preventive maintenance with all machines being monitored centrally.
• Treatment & Restoration – With virtual reality, a surgical specialist can perform surgeries through remote-controlled robots. E-ICUs enable specialists based in the command centre of a super speciality hospital to read vitals and treat patients in a local hospital.
• Continuous Health Monitoring – Post-discharge, self-use of medical devices enable patients to regularly monitor their own health, reducing the probability of re-admissions. Many self-monitoring devices (IBE breast examination) and wearable (Fit bit) can now sync data to patient’s smartphones via Bluetooth or internet enabling post-care monitoring as well as early diagnosis of diseases.
• All diseases - Irrespective of its aetiology, pathology, risk factors, the spectrum of treatment are well within the domain of technology- more so the 12 listed groups of diseases, covered by HWC scheme of MOHFW.Technology cover physiological conditions like pregnancy/safe delivery, infant and child health, accidents including head and spinal injuries, hypertension, diabetes and cardiac problems, depression and mental diseases, cancer and its diagnostic intervention, ear and eye diseases, which are presently under examination, field trial or validation under THWC of WISH.
There are strong take-home messages as far as technology application in health care, especially for NCD s, as experienced in the Technology-enabled HWCs:
· Technology in primary care can provide solutions to many perpetual problems in India
· The beneficiary accepts technology very quickly, provided it offers solutions to the felt needs
· Existing state-owned public health system is open to integrating it, provided scientific evidence are created
· Technology application is cost-effective when compared to its existing parallel
· Technology integration promotes entrepreneurship, creates self-employment, assists in start-up and ‘Make in India’.
However, despite the good intent, initiatives, programs and investment, implementation is going to be a time-consuming exercise on account of huge inadequacies and gaps in the public health system in India. If planned and implemented well, technological progress can make a significant contribution to India’s healthcare needs.