Electronic vaccine intelligence network was the first and foremost digital technology solution introduced way back in 2014. Now that digital technologies, especially telemedicine, teleconsultation, point-of-care devices, and multiple solutions, are available, we are ensuring not only access to healthcare, especially at the primary healthcare level, but also the quality of healthcare services through this digital technology and AI solutions.
Shahid Akhter, editor, ETHealthworld, spoke to Rakesh Kumar, CEO, WISH (Wadhwani Initiative for Sustainable Healthcare) Foundation, to figure out the need to bring digital technology to the forefront and fine-tune it to accomplish the goals of the National Rural Health Mission in the new avatar.
Primary Healthcare: Growth and Journey
Let me give you a bit of background on this. Independent India started its journey way back in 1947 with a population of 33 crore. If you look at the mortality ratios, they were very high. Our under-five mortality was too high—200 per 1000 lives across the country. We didn’t have many medical schools; we didn’t have those kinds of health resources and health professionals across the country. If we look at mortality, a total of more than 50% of deaths used to happen because of communicable diseases and in less than 10-year-olds. If we looked at the population at that particular point in time, the adolescent population was quite low.I would also like to highlight one thing here. If you even look at the life expectancy, it used to be as low as 32 and 33 years. So, after that, India started its journey, I would say, very slowly and steadily. We started working primarily on communicable diseases, on immunisation programmes, but the main focus was on communicable diseases, that is, tuberculosis, leprosy, malaria, and other kinds of diseases. If you look at the transition, as far as non-communicable diseases are concerned, way back in 1990, the transition happened, and non-communicable diseases certainly took over communicable diseases. The 1990s were a transitional era for the country. We started focusing more on primary healthcare in the early 1990s.If we look at our routine immunisation programmeme—the universal immunisation programmeme in the country—that started way back in Then, we started with a polio eradication programme that was launched way back in 1995. And beyond that, then we started looking at different schemes and programmes, especially targeting maternal mortality, under-five mortality, contraceptives, anything you talk about; this routine immunisation coverage got increased. Since 2005, our main focus has been on immunisation programmes and communicable diseases.
In 2005, the Government of India launched a very important initiative: the National Rural Health Mission. Then the focus was brought on different kinds of schemes and programmes targeting under-five mortality, maternal mortality, the increase in the number of contraceptives, and early marriages; how best can we stop those kinds of early marriages or malnutrition? These were the issues that the government of India started targeting through the National Rural Health Mission programme.
Again, in 2013, looking at the kind of urbanisation of the country, India thought it was high time to focus on urban health also, and we talked about urban health, especially focusing on and targeting urban slums, because, if anything pulled down the country in terms of our indicators of health, it was mostly in the remote and rural areas of the country. I think that was one. And second were urban slums and tribal pockets. India then started focusing more on urban slums, more on tribal pockets, and also on remote and rural areas in the country.
Primary Healthcare: Digital technology to reach the last mile
India is a digital leader when you talk about the world. I think we were clear on one point: unless we ensure digital technology solutions in the country, access to primary health care would still be a problem. When we talk about an electronic vaccine intelligence network, that was the first and foremost digital technology solution introduced way back in 2014. Now that digital technologies, especially telemedicine, teleconsultation, point-of-care devices, and multiple solutions, are available, we are ensuring not only access to healthcare, especially at the primary healthcare level, but also the quality of healthcare services through this digital technology and AI solutions.
Universal Health Coverage
You might be aware that in 2015, when the SDGs were being conceived, they started the implementation with effect from January 2016, and one of the important goals under the SDGs—health and wellness—is SDG goal number three, and under SDG, goal number 3.8 is a target that is called universal health coverage.
The purpose is that, as far as you know, the whole world, especially India, really expands its services. Number one, secondly, is the expansion of its services to a larger population. Thirdly, how best can we cut down on out-of-pocket expenditure as far as people are concerned? If we look at out-of-pocket expenditure, especially drugs and diagnosis, they contribute more than 60%. So looking at these three things: the expansion of services; second, the expansion of services to a larger population. And thirdly, financial risk protection means cutting down on out-of-pocket spending. These three things, put together, constitute universal health coverage.
It is absolutely important for us to ensure that universal health coverage does not mean that we provide all the services to everyone free of charge; that is not the purpose. The purpose here is that, slowly, we should keep expanding our services and population coverage. With this sort of mandate in the backdrop, all the stakeholders—wwhen I talk about stakeholders—wwhether we are talking about the government, the private sector, or the NGO sector, civil society organisations, or institutions and organisations working on healthcare—need to put their heads together and work towards one common cause: universal health coverage, and digital technological solutions are important in ensuring and achieving universal health coverage.
Further, I think that there are three or four grey areas. Data is very important; if you don’t have pure or robust data, then our planning process also suffers. Similarly, when we keep on monitoring, what do we monitor? Ultimately, unless we have robust data collection and analysis, that’s also very important. There are three or four, I would say, important elements of universal health coverage. To achieve that, we need to have quality healthcare providers, so human resources become important. Finances become very important, and data becomes very important. Similarly, technological solutions or digital technological solutions. And then, obviously, drugs and diagnosis. Everything put together constitutes health system strengthening, and that will help achieve universal health governance in due course.
WISH Foundation: Growth and Journey so far
WISH was established by our founder-donor, Mr. Sunil Wadhwani who’s a tech and also a philanthropist of the highest order. And that happened way back in 2014-15. They started their journey in Rajasthan, by working with the state government on a public-private partnership model, where they adopted more than 30 primary health centres, and operationalized them very successfully in Rajasthan.
From there, the journey started. Then they started expanding their footprints to different states.Rajasthan was the first, followed by Madhya Pradesh, Assam, Delhi, and also some parts of UP.
We started with the public-private partnership. But then ultimately, we realized that the importance of how best we can help support the governments in expanding their quality primary healthcare, services and solutions in different parts of the country. We started our footprint, as I said, in different states, but the main, I would say the goal and the purpose of this particular organization are that the WISH Foundation is helping the most marginalized people in the country in achieving universal health coverage, and especially, through those kinds of innovative and digital solutions. Innovations and digital solutions have always been in the backdrop and have always been, in the centrestage, as far as comprehensive family healthcare services are concerned which have been provided by WISH Foundation as of now.
WISH Foundation: Expansion Plans
Going further, we envision that the WISH Foundation should have its footprints almost in every state and Union Territory of the country, primarily focusing on comprehensive primary health care solutions coupled with digital health and AI solutions.
How we want to take it forward is as follows: I think our strategy is slightly different. We are going to focus more on advisory and technological solutions and supporting the state governments at the National Health Mission in different states. At the national level, the NHA is also called the National Health Authority because digital solutions are being planned there. The different strategies we are trying to adopt are that we are trying to identify certain areas—I will say certain problems—that need those kinds of solutions.
We’ll establish something called Learning Labs in different states, where we will test one or two solutions that are problematic for the state. The second is that we’ll also get into core implementation, where that part is just going to be about 30% of total energy. But mostly, I want to focus on the state and national levels.
Vertically, we’re also trying to expand to non-communicable diseases because it’s all about non-communicable diseases right now. If I just quote some data, you will be surprised to know that beyond the 30-35-year-old age group, more than 30% of people are diabetic. Similarly, more than 50% are hypertensive beyond the age of 35, so more focus needs to be placed on non-communicable diseases. So we’re trying to support the state governments on non-communicable disease, reproductive, maternal-newborn, and child health, and on immunisation solutions, but I said our primary focus is going to be on strengthening the health systems across the country while working with the state governments and different partners. Whether we talk about the Bill and Melinda Gates Foundation, UN agencies, or USAID, any partner who is like-minded is going to work with them..
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