Even though India is a leader in Information and Communication Technology (ICT), it is ironic that such a powerful tool continues to have limited use for health and development. On the other hand, experiences worldwide indicate that India can transform the delivery of and access to essential health services through the use of ICTs.
However, the sceptics of use of ICT in 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 the Indian health care infrastructure which, as we are aware, is highly complex.
How can ICT impact the health of people?
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.(1,2)Â Disease management, effective information management, monitoring and accountable delivery of services are a few aspects ICT can help ensure and improve. Let’s take the example of tuberculosis (TB). TB is one of India’s biggest public health challenges and the use of ICT can and in some cases is being used effectively to curb this disease.
TB control is fraught with critical challenges, particularly in diagnosis, treatment and monitoring. Diagnosis of TB is a long process with the possibility of patients dropping out and discontinuing treatment. 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 ensure subsequent follow ups for treatment. Automatic alerts can be sent to providers for 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 Directly Observed Treatment Short Course (DOTS) providers. An experiment could entail delivering an SMS security code on the patient’s mobile phone. The DOT provider would mark attendance only if the patient provides this code during their visit to the DOTS provider, thus establishing their physical presence. This ensures complete adherence and zero lapses on either side. Simultaneously, the 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 behaviour of the patient. Technologies like the interactive voice response (IVR) also help in eliminating the literacy barrier in delivering health information.
Realizing its 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 on-going activities in India’s digitization and can serve as a model for broader improvements in the country’s health system.
Before Nikshay was implemented, TB was made a notified disease making it mandatory for all health care providers to report every TB case to local authorities. With notification, ICTs will now be used to collect data from the private sector which treats 50% of all TB cases in India. Nikshay will also help the government keep track of drug-resistant TB cases. A TB patient tends to engage with multiple providers – from diagnosis to treatment completion – with patient data being scattered across different health care providers. The Unique Identification/Aadhar (UID) platform could be used as a tool for isolated patient data to converge against one UID number which in turn could provide access to complete patient history
What is the scope of ICTs in TB?
There are other areas where the RNTCP can utilize ICTs to improve the TB landscape. The delay in data entry due to manual notification to the online portal Nikshay has less value in tracking the patients at their early stages of 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 centralized 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 prioritize their work.
More broadly, ICT tools are an important way to make the health care system further accountable and transparent in treatment adherence reporting. With a large disease burden and a rigorous data driven program, innovation in TB can be an example for other national health programs to use this technology/platform cost effectively.
About the authors: Mrs. Gunjan Krishna,Â IAS, Head of SeMT, Karnataka andÂ Mr. Sabyasachi Das, Former Consultant State e-Governance Mission Team (SeMT), Karnataka.