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Millennium Post

The health connection

Even though India is one of the world’s leaders in Information and Communication Technology (ICT), it is ironic that such a powerful tool continues to have limited use for health and development in India. Experiences worldwide indicate that India can transform the delivery of and access to essential health services through the use of ICTs. India must use its strengths in ICT particularlyto transform its health system.

 The skepticsof use of ICTin health often argue about ‘too much technology’. Contrary to such misconceptions, ICT is one of the few cost effective interventions that can work well with Indian healthcare infrastructure which is highly complex.

Nearly 70% of India’s population resides in rural areas and 42% survives below the international poverty line of less than US$1.25 a day. How can ICT impact the health of these people? Disease management, effective information management, monitoring and accountable delivery of services are somethings ICT can ensure. How? A case in point is tuberculosis (TB). TB is one of India’s biggest public health challenges and the use ofICTcan and in some cases is being used effectivelyto curb this disease.

Realizing this potential, the Revised National TB Control Programme (RNTCP) known for its rigorous data collection launched Nikshay, a web portal for tracking and recording TB cases. This example can pave the way for a spectrum of ongoing activities in India’s digitization and can serve as a model for broader improvements in the country’s health systems.

TB control is plagued by several challenges, particularly in diagnosis, treatment and monitoring. Diagnosis of a TB suspect is a long process with the possibility of patients dropping out. An ICT solution to monitor patients at each stage can ensure the patient completing the process from diagnosis to treatment.  This can be used to track the patients, deliver test results and subsequent follow ups for treatment. Automatic alerts can be sent to the providers for positive identified cases probing for immediate registration and treatment initiation.

ICTs can also be used to monitor patients’ adherence to treatment.In the public sector, the primary responsibility of provisioning treatment is of the DOTS (Directly Observed Treatment Short Course) operators. An experiment could entail delivering an SMS security code on the patient’s mobile phone. The DOT operator could mark attendance only if the patient provides this code during their visit to the DOTs operator thus establishing their physical presence. This ensured complete adherence and zero lapses on either side. Simultaneously, the entire treatment adherence data can be analysed for performance linked incentives to both patient and the provider.

ICTs can also be used to generate demand for health services and enhance health seeking behavior of the patient. Technologies like IVR (interactive voice response) also help in eliminating the literacy barrier in delivering health information.

Before Nikshay was implemented, TB was made a notified disease making it mandatory for all healthcare providers to report every TB cases to local authorities. Thus ICTswill now be usedto collect data from the private sector which treats 50% of all TB cases. In TB, a patient tends to engage with multiple providers during the entire process from diagnosis till treatment completion with the patient data being scattered across different healthcare providers. Unique Identity (UID) platform could be used as a unifying agent of all these isolated patient data to converge against one UID number which could provide access to the entire patient’s history.Nikshay will also help the government keep track of drug-resistant TB cases.

There are other areas where the RNTCP can turn toICTs to make improvements in the TB landscape.The delay in data entry from manual notification form to Nikshay has less value in tracking the patients at their early stages of their treatment. Single mobile phone based applications can be developed and used for direct notification by the private practitioners on a real time basis.

After a centralised database has been established, automated reports and dashboards could be created for better policy decisions and research. Localized case management dash boards available on mobile phones of the RNTCP functionaries could also help health providers to prioritise their work.

More broadly, ICT tools are an important way to make the healthcare system more accountable and transparent in their treatment adherence reporting.

Once ICTs for TB are successfully implemented, it can serve as an example for rolling out similar technologies for other diseases.With a large disease burden and a rigorous data driven program the innovation in TB can be an example for other national health programs to use this technology/platform cost effectively.

Sabyasachi Das is Consultant, State e-Governance Mission Team, Centre for e-Governance, and Gunjan Krishna is Head e-Governance mission, both in the Karnataka government.
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