Using Technology to Solve Large & Complex Problems in Primary Healthcare

Devesh Varma, Chief Technology Officer, Piramal Swasthya Supported by Piramal Foundation, Piramal Swasthya is a registered not-for-profit organization bridging the last mile gap in primary healthcare service delivery using ICT and innovation to make healthcare accessible to even the remotest places of the country.

Primary healthcare(PHC)refers to 'essential healthcare' that is based on 'scientifically sound and socially acceptable methods and technology, which make universal health care accessible to all individuals and families in a community. It is through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination’~ WHO Alma Ata declaration.

While primary health care has adopted many appropriate technologies such as Oral Rehydration Solution, Colour coding for biomedical waste and so on, the adoption of information and communication technologies in the health sector is poor and this is more pronounced in the public primary healthcare space in India. There are umpteen challenges which act as roadblocks in the implementation of technology in the public primary healthcare space. Healthcare giants in the secondary and tertiary care space will look for their ROI which will not come from the primary healthcare space because primary health care focuses on preventive and promotive care. In addition, public primary healthcare is most commonly focussing on rural India where the population is generally not able to afford the high cost of treatments and specialist consultations. And, hence, implementing ICT based solutions is very difficult, despite these solutions having a definitive role to play in improving the delivery of primary health care services.

How do we then solve this conundrum? One of the solutions for the government is to work with development partners and not for profit organizations to implement the interventions in the primary public healthcare space. The development partners and NGO’s are able to put rigor in the implementation and reach out to areas where the government has not been able to.

Persisting reproductive maternal and child health problems, along with the rising burden of non-communicable diseases like Diabetes, Hypertension and Cancer (breast, cervical and oral) make India an extremely difficult country to manage healthcare services. The development partners and the not-for-profits can design targeted interventions, using their risk capital, focusing on specific health issues in the
primary public health space which will have an impact and result in an outcome by reducing the specific disease burden.

"The 'first time right' tenet to capture quality data will happen only when there is accountability and ownership which technology is going to bring"

In order to show the impact of any health intervention, there is a dire need to get quality data. Unless you have quality data, no one will be able to assess the impact and show outcomes. This is where the use of appropriate ICT can be a game changer. The reason I use the term ‘appropriate’ is because not all the cutting-edge technology will solve our problems in the primary healthcare space. Technologists will have to take a judicious call when they try to build beneficiary-centric and technologically advanced systems which can be deployed at scale in deep remote areas and which have to be very cost effective and robust.

We must also remember that technology will always be an enabler and will never be a panacea for healthcare problems. If used correctly and appropriately, technology will help solve and address basic problems of accessibility, availability, affordability, and appropriateness. It will also be able to address the challenges of accessibility and accountability, which means that using technology the government will be able to assess how people are using the technology to capture information which is pertinent to the intervention and is of quality. The 'first time right' tenet to capture quality data will happen only when there is accountability and ownership which technology is going to bring.

Another challenge with technology solutions in the primary healthcare space is that they are not comprehensive, continuous and complete. Majority of the systems work independently and try to focus on a single aspect of data collection which is related to a particular health intervention. It is imperative that India focuses on building a comprehensive technology strategy for the primary health care space which is continuous and complete. This means we should be working on building a system which spreads across multiple levels, taps into variety of service providers, and health facilities. In a nutshell India needs a healthcare platform for the primary health care space.

This platform will act as a foundation or the first step in achieving transformed health care. It will allow disparate systems to be able to connect to it and use the Patients Health Records or the Electronic Medical Records (EMR), thereby creating a unified and ubiquitous presence of Health Data of the patient across India with unique Beneficiary ID.

The idea that any person in India can go to any health service provider/practitioner, any diagnostic centre or any pharmacy and yet be able to access and have fully integrated and always available health records in an electronic format is not only empowering but also the vision for efficient modern age healthcare delivery.

This is a humongous task and will need multiple players to co-build and co-create with the Government of India. This also has to be looked in from the interoperability factor as there is a plethora of systems available at both secondary and tertiary level of healthcare. If we want to build a system which caters to the 70 percent of the population living in the primary care space then we need to think big and plan this meticulously otherwise it will become another pipe dream for us. Having said that, it will also involve a lot of behavior changes that need to be worked upon in the people using technology-based systems. No matter how appropriate your technology solution is, if we can’t address the behaviour and attitude of people using it, then this exercise becomes futile.

In closing, I will like to say that we surely need an appropriate technology driven platform-based approach to act as an enabler in solving healthcare problems. Also, the onus is on technologists who will build this platform to make sure that people using it don’t see it as a threat and see it as something which will help them in causing a huge impact in solving India’s healthcare problem