Good morning and thank you to India Inc for inviting me to address you at this agenda-setting forum – the India Global Forum.
The COVID-19 pandemic has exposed cracks in health systems across the world.
In countries rich and poor, hospitals have been overwhelmed, essential health services have been disrupted, and health workers have been inadequately protected from infection, burnout, stigma and violence.
For almost two years, the poor, the marginalized and left behind have found it tougher than ever to access the health care they need to stay healthy and well, and to contribute to sustainable social and economic development.
In many health systems, the pandemic has exposed not just cracks, but deep fissures – fissures that cut to the core of how health systems are organized and who they are organized for.
That point is – I believe – fundamental to this discussion, and to considerations of how remote and digital health care solutions should be identified and applied to improve access to and efficiency of diagnostic tools and health care services.
For several years now, the WHO South-East Asia Region has been committed to a bold vision: achieving universal health coverage (UHC).
UHC is when all people can access quality health services – wherever they live, and whoever they are – without financial hardship.
Primary health care (PHC) is the bedrock of UHC.
It is where most people’s health needs should be met throughout the life-course.
Orienting health systems towards strong PHC services is how health systems should be organized, and underscores who health systems should be organized for – communities.
So, then: How can the delivery of remote and digital healthcare solutions contribute to building strong PHC-oriented health systems?
The WHO Global Strategy on Digital Health, which India had a significant hand in developing, is clear in its approach.
Digital health interventions must benefit people in a way that is ethical, safe, secure, reliable, equitable and sustainable.
They must be based on the principles of transparency, accessibility, scalability, replicability, interoperability, privacy, security and confidentiality.
Digital health interventions will be valued and adopted only if they are accessible and support equitable and universal access to quality health services; if they enhance the efficiency and sustainability of health systems in delivering quality, affordable and equitable care; and if they strengthen and scale up health services in a way that respects the privacy and security of patient health information.
By sheer necessity, the COVID-19 pandemic has catalysed so many opportunities to accelerate access to and uptake of digital health interventions, which both public and private sectors must harness and apply to maximum effect.
And while the possibilities are many, we must consider how best to prioritize our efforts.
Towards that goal, I take this opportunity to highlight several key areas of action, which if appropriately targeted, will support Region-wide efforts to build PHC-oriented health systems that are fit for the future, and which accelerate progress towards our Flagship Priorities and the Sustainable Development Goal targets.
First, leveraging the potential of Artificial Intelligence (AI) for health promotion, prevention, treatment, rehabilitation and palliative care in a manner that advances equitable access while maximizing resources.
For example, at Aravind Eye Hospital in Madurai, AI systems that can quickly and accurately diagnose diabetic retinopathy have been applied with great success.
Diabetic retinopathy is a key cause of permanent eye damage, and a focus of the Region’s efforts to address preventable vision impairment and blindness and achieve the updated 2030 targets.
The Region-wide roll-out of AI technology to address diabetic retinopathy and other causes of visual impairment could drive massive gains, especially if available at the primary level.
Similarly, we see AI technology being used to increase the efficiency and impact of malaria control activities.
In one ground-breaking innovation, AI technology has been used to identify malaria hotspots through rapid and detailed analysis of satellite images and topographical maps.
This information is then delivered to health workers in the field, ensuring their efforts are appropriately and efficiently targeted.
Challenges must be navigated.
WHO’s first Global Report on AI highlights the need for ethics and human rights to be at the heart of AI design, deployment, and use.
It notes the need to prevent unethical collection and use of health data, biases encoded in algorithms, risks to patient safety, and cybersecurity.
And it emphasizes that systems trained primarily on data collected from individuals in high-income countries may not perform well for individuals in low- and middle-income settings – an observation that is especially important for India and the South-East Asia Region.
The second priority I want to highlight is the need to enhance data collection, analysis and sharing, with full recognition that health data is a strategic asset and public good.
In the Region and across the world, more health-related data is being captured than ever before.
Open, inclusive, and responsible data can help improve service delivery, ensure transparency and accountability and drive inclusive and sustainable growth.
But for health data to have a value-impact as a global public good, it must be available in aggregate.
For example, individual genomic sequence data has very limited value. Value can only be realised when global sequencing is made available at scale.
Sharing health data as a public good requires policy makers to make data available with the right degree of openness or restriction at the right points in the data spectrum, while reducing potential harms.
The launch of India’s Ayushman Digital Health Mission (ADHM) is well received.
The initiative will help create a national digital health eco-system to support UHC in an efficient, accessible, inclusive, affordable, timely and safe manner.
It aims to create a seamless online platform by leveraging open, interoperable, standards-based digital systems, while ensuring the security, confidentiality, and privacy of health-related information.
The key building blocks of the ADHM include every individual’s registry – or Unique Health ID – a registry of health care professionals – the Unique ID – and a registry of each health facility.
Unique IDs then store personal health records linked to Unique Health IDs, e-pharmacy and tele-medicine.
With patient consent, a Unique Health ID can be linked with the Aadhaar
Notably, the ADHM uses the “public goods, private innovation” model first adopted by the Unified Payment Interface – an appropriate way to navigate India’s federated health ecosystem.
Given that one in every six people on the planet are from India, the ADHM’s success will significantly influence the future of global digital health and could pioneer best practice policies.
My third priority, which is linked to the first two, is the need to align private sector growth in digital health with public sector priorities, especially with regard to orienting health systems towards primary health care.
COVID-19 has transformed how individuals, health practitioners, health facilities, and the wider health system engage with digital technology.
With that transformation, we have witnessed an increase in public-private partnerships in a range of areas that support progress towards health security and UHC.
On tele-health and m-health, several companies have partnered with the Ministry of Health & Family Welfare to launch a mobile app that helps screen and manage noncommunicable diseases (NCDs) at the primary level, building on previous support to the NCD IT system.
A Bangalore-based company is now providing tele-radiology services to several states in India, and several countries in the Region. Through its Foundational arm, it is providing free teleradiology support to health facilities in rural and underserved areas.
In all aspects of digital health innovation, private sector strengths should complement public sector reach, accelerating progress towards India’s targets and goals, and a health and economic recovery from COVID-19 that is more equitable, resilient and sustainable – a message I want to close on.
If wisely applied, private sector innovations can transform the lives of hundreds of millions of people.
If unwisely applied, they can distort priorities, create new inequities, and lead to unethical practices that diminish trust and accountability.
Together, we must identify and apply digital health solutions that are effective and ethical, which respect human rights, and which are aligned with how health systems must be organized, and who they must be organized for.
I once again thank India Inc and wish you engaging and inspiring deliberations.
Thank you.