1.1 Background
Universal Health Coverage (UHC) is a pivotal element of the Sustainable Development Goals), particularly included in SDG3 (Kieny & Bekedam, n.d.). UHC entails ensuring that individuals have access to essential, quality health services without facing financial problems. The UN commitment to 'Leaving No One Behind' is important to UHC, as the term “universal” implies that everyone, regardless of social or economic status, must have the right to health protection (World Health Organization, n.d.).
Countries are actively improving their health financing systems to shift from direct payments to prepayment and pooling mechanisms. This transformation is deemed crucial for guaranteed access to services (Myint & Pavlova, n.d.). Notably, numerous emerging economies are actively working to enhance social health protection by implementing publicly funded health insurance (PFHI) schemes (Lagomarsino & Garabrant, n.d.).
As time has progressed, the internet has brought about revolutionary changes in communication, business, education, and governmental operations. A particularly noteworthy influence is observed in the healthcare domain. Historically, healthcare primarily emphasized improving and maintaining health with the specialized skills of professionals involved in diagnosis, treatment, and prevention. Nevertheless, the incorporation of digital technologies has transformed healthcare delivery, tailoring it to individual needs and streamlining processes, thereby diminishing the dependence on direct engagement with healthcare professionals. (Brenner, 2023)
Digital technologies present tangible opportunities to address challenges within health systems, offering the potential to improve the scope and quality of health practices and services. For instance, digital health interventions can be utilized to facilitate targeted communication to individuals, creating demand and broadening contact coverage. Similarly, these interventions can be directed at health workers, providing them with quick access to decision-support mechanisms or telemedicine consultations.
According to the World Health Organization, digital health is a broad term that includes eHealth. As per a 2021 study by Statista, the global digital health market is expected to grow from $175 billion in 2019 to nearly $660 billion in 2025. This substantial growth underscores both the increasing demand for quality healthcare and the expanding influence of digital technologies. The widespread adoption of digital health solutions has the potential to revolutionize global health standards, granting people improved access to services for the promotion and protection of their well-being. (Perappadan, 2023)
Recognizing the profound impact, the Government of India initiated the Digital India Campaign in 2015, a flagship program that included public health initiatives focused on integrating digital technologies to extend healthcare services into rural areas. Subsequently, in 2017, the National Health Policy aimed at achieving a fully digitized healthcare system in India. The policy proposed a time-bound increase in public health expenditure to 2.5% of the GDP, emphasizing the delivery of a comprehensive primary healthcare package through the establishment of Health and Wellness Centres. This marked a significant shift from a highly selective to a more inclusive primary healthcare approach, encompassing services such as geriatric healthcare, palliative care, and rehabilitative care.
The policy advocated allocating a substantial proportion (up to two-thirds or more) of resources to primary care, followed by secondary and tertiary care. It aspired to provide most secondary care services at the district level, a departure from the current practice primarily concentrated in medical college hospitals. The National Health Policy of 2017 laid the foundation for the commencement of the Digital Health Mission in India, now known as the Ayushman Bharat Digital Health Mission. Ayushman Bharat represents a move away from a sectoral and segmented approach to healthcare service delivery, aiming to provide comprehensive, need-based healthcare services.
Ayushman Bharat consists of two similar components:
1.1.1 Health and Wellness Centres (HWCs)
In 2018, 1,50,000 Health and Wellness Centres (HWCs) were established by developing existing Sub Centres and Primary Health Centres providing Comprehensive Primary Health Care (CPHC), including maternal and child health services, as well as addressing non-communicable diseases. The services offered encompass free essential drugs and diagnostic services. The goal is to bring healthcare closer to people's homes, ensuring increased access. It works on health promotion and prevention, aiming to make communities to adopt healthy behaviours and make lifestyle changes.
1.1.2 Pradhan Mantri Jan Arogya Yojana (PM-JAY)
On September 23, 2018, the second component i.e., Pradhan Mantri Jan Arogya Yojana (PM-JAY) was launched in Ranchi, Jharkhand, by Shri Narendra Modi Ji and it is one of the world's largest health schemes.
Initially it was named as National Health Protection Scheme (NHPS) and included the existing scheme of Rashtriya Swasthya Bima Yojana (RSBY) that was launched in 2008 and covers all the families included in RSBY. This scheme is completely sponsored by the Government, with the cost shared between the Central and State Governments. One can Access PM-JAY via Ayushman Bharat Health Account (ABHA) cards.
Another digital aspect of Ayushman Bharat Digital Health Mission is eSanjeevani, a telemedicine initiative with two different components in it. The first is eSanjeevani - Health and Wellness Centre, that offers doctor-to-doctor services, in which patients go the centres and connect with doctors. The second is, eSanjeevani OPD, through which patients directly connect to doctors at the comfort of their home. The aim of both the components is to increase accessibility of the people to healthcare.
India, being home to one-sixth of the world's population, improving the healthcare system in the country is necessary on both national and international fronts. To successfully implement and keep such programs going, robust government involvement and support, especially in rural areas, is necessary (Sriwastva, 2023).
Despite technological achievements, challenges persist in accessibility and affordability. The COVID-19 pandemic exposed the strain on India's healthcare infrastructure, revealing issues such as overcrowded hospitals, uneven distribution favouring urban areas, and a shortage of skilled staff. Affordability is a substantial concern, with high medical costs burdening families. While advanced technologies contribute to modern healthcare, the focus should shift to making basic services more economical and accessible. Ensuring quality healthcare for all, regardless of socio-economic status or location, is paramount. Government initiatives like Ayushman Bharat are positive steps, requiring consistent funding, implementation, and public-private collaboration to bridge healthcare gaps. The emphasis should be on people, investing in medical education, training healthcare workers, and implementing quality control measures to guarantee safe and effective treatment. In summary, while technology plays a role, affordable and quality healthcare accessible to all should be the central focus for India's healthcare system (Maheshwari, 2023).