MANSUKH MANDAVIYA: G20 offers rare chance to forge global vision for digital health

Imagine a world without the internet, where computer networks don’t talk to each other. In such a disconnected world people in one country may continue to reinvent the wheel, which has been in use for years in another part of the world. Without a standardised internet protocol (IP), our version of reality would have looked radically different — one with many local area networks but no common internet to plug into.

This alternate version of reality is similar to the flux the digital health space is facing today — on the brink of disruptive technologies but awaiting direction, a standard framework and a decisive nudge from the international leadership to ensure innovations that can benefit billions of people residing in the Global South can be scaled up and sustained.

The exciting world of digital health is brimming with small but powerful pilots and innovations across subsectors — smart wearables, internet of things, virtual care, remote monitoring, artificial intelligence, big data analytics, blockchain, tools enabling data exchange, storage, remote data capture — but it is stuck in a fragmented ecosystem without a unified global vision. This at a time when the Covid  pandemic has made us realise the enormous potential of digital tools in healthcare space.

Designing a digital health push — the great experiment in India

We in India have lived and experienced the transformative potential of digital tools in public health space in recent times. During Covid-19 platforms such as CoWin and e-Sanjeevani proved to be absolute game-changers, transforming the way vaccines and healthcare services were delivered to over 1-billion people, including those who were the hardest to reach.

CoWin, the digital backbone of India’s Covid-19 vaccination programme, on the one hand tracked the logistics of vaccines and on the other registered every beneficiary for Covid-19 vaccination, the actual vaccination process, and generated digital certificates, which acted as proof of vaccination among its other features.

By reducing the information asymmetry between people and the system, CoWin democratised the vaccination drive, ensuring the vaccines become accessible to all eligible beneficiaries. Rich or poor, everyone had the same access pathway to vaccination, and all stood in the same queue for their turn for vaccines. Realising the potential of the tool, our prime minister, Narendra Modi, offered it as a gift to the world.

Similarly, e-Sanjeevani, the telemedicine platform that allowed people online consultations with doctors from the comfort of their home, was an instant hit and has handled hundreds of millions of consultations. 

A digitally enabled Covid-19 war room helped us make evidence-based policy decisions, almost in real-time. A special surveillance system, Covid-19 India Portal, tracked the disease by geography and monitored the inventory for essential supplies, predicting demand at national, state and district level based on caseloads. Aarogya Setu, RT-PCR app and other digital tools allowed our country to convert data into policy that strengthened our Covid-19 policy response by an order of magnitude.

To harness the full potential of digital tools in public health, India is already building/creating a national digital health ecosystem — Ayushman Bharat Digital Mission (ABDM). It empowers patients to store and access their medical records and share them with healthcare providers to ensure appropriate treatment and follow-ups. It helps patients access accurate information on health facilities and service providers.

India is willing to share its learnings and resources to build similar digital health ecosystems for the world, particularly in the low- and middle-income countries so that its experiences can shorten their effort curve on digital public goods. Vulnerable people in these parts of the world can derive the benefits of cutting-edge digital solutions and innovations and the dream of universal healthcare coverage can come true.

What ails the global digital health ecosystem?

Access to digital solutions is blocked by copyright regimes and proprietary systems. Most transformative digital solutions are not easily accessible because they are unevenly distributed in terms of language, content and infrastructure required to access them.

Even when relevant digital public goods or open-source solutions exist, their utility is limited as they are bound to a platform, data and logic for which there are no common global standards. Also, there is no overarching global governance framework for digital health that can take care of interoperability across different systems while addressing concerns about data security and privacy.

There are several independent efforts afoot to create global standards about digital health, but these initiatives are working in silos and remain largely uncoordinated without any support for enforcement. These challenges can turn into opportunities if we as a global community can resolve to converge all efforts under one effective umbrella. The G-20 is effectively poised as a powerful platform to deliberate and build a future-ready vision for digital health.

G-20 India presidency will strive for a digital health breakthrough

Imagine the tremendous potential that can be unlocked if we build and implement an effective global blueprint for digital health for humanity. For that we need to collectively agree to converge scattered ongoing efforts into one global initiative on digital health, institutionalise a governance framework and collaborate on a common protocol, just as was done for the internet decades back. We must also identify and scale-up promising digital solutions in healthcare as digital public goods, set up structures to bring all relevant stakeholders from different disciplines and sectors on-board, build trust for global health data exchange and find ways to fund such initiatives.

As part of our G20 presidency, India will strive to build consensus and a road map on some of these issues, along with feasible mechanisms to operationalise them so that the fullest potential of digital health can be unleashed for the entire world, including countries in the Global South. All it takes for us to script a breakthrough in digital health is to place the collective good over our narrow interests and grasp that the “universe” in universal healthcare coverage extends far beyond our own countries.

What must drive our intention and action in the G20 is vasudhaiva kutumbakam, which means the universe is a family. And it is our responsibility to secure health for that family, the universe, at any cost.

• Dr Mandaviya is India's minister of health & family welfare; chemicals & fertilisers.