Some of India’s richest people and health-tech startups have created an alliance to try and transform India’s failing health-care system.
The loose alliance, whose backers include Infosys Ltd. co-founders Nandan Nilekani and Kris Gopalakrishnan as well as prominent startups from Practo to Policybazaar, will be formally unveiled as soon as this week in an attempt to salvage a decrepit system by digitizing everything from patient data and records to creating online platforms for hospital care and doctor consultations. Called Swasth — meaning health in Hindi — its 100-plus members have pledged to build new services and coordinate efforts to improve emergency responses.
Faced with an exploding health crisis as coronavirus infections look likely to surpass a million, the country’s digital health-care backbone — the Bharat or National Health Stack — has come into focus and will buttress Swasth’s efforts. Much like the digital payments system that today underpins e-commerce, the Stack is designed to wrench into the 21st century an industry whose deplorable conditions have become increasingly apparent as the pandemic broadens across the world’s second-most populous nation.
In India, where hospitals and clinics are rife with corruption, only a fraction of its 1.3 billion people have access to insurance and private health-care costs keep millions in poverty. Many rural health centers don’t have electricity, running water or toilets, while public hospitals are often so filthy that coronavirus patients have fled the squalor. Many years in the making and sporting elements from a verified registry of doctors and portable personal health records (with patient consent), the Stack was conceived to improve access to affordable services and boost research.
“Coronavirus has exposed glaring vulnerabilities, and technology can improve reach, quality and cost-effectiveness of health care and be the leveler in a country with a woeful shortage of hospital beds, doctors, nurses, medicines,” Gopalakrishnan, a member of Swasth’s governing council, told Bloomberg News. “Bharat Health Stack will form the backbone of a platform that aims to offer multiple services from hundreds of vendors and give individuals flexibility,” said Gopalakrishnan, the billionaire co-founder and former chief executive officer of Infosys.
Privacy advocates have raised concerns over the handling of sensitive information like medical history and test results. Those are likely to get linked to India’s ubiquitous biometric digital ID system, called Aadhaar, making it personally identifiable. Such leaked health data could compromise privacy and endanger a person’s economic future. Swasth’s website says it is non-profit and its coronavirus initiative is non-commercial.
But some activists aren’t convinced. “India needs to modernize the flow of health-care information but this move-fast-and-break-things, by outsourcing the entire health infrastructure to a coterie without any checks and balances, is undemocratic,” said Mishi Choudhary, legal director at the New York-based Software Freedom Law Center.
India’s United Payments Interface offers a model of sorts. Just as a real-time financial technology platform impelled digital payments in just four years, the cloud-based digital health framework — owned and operated by the government — may spur speedy creation of health services by doctors and entrepreneurs.Shocking videos of coronavirus patients lying next to corpses in overrun hospitals and ambulances with critically-ill driving around in search of hospital beds have conferred fresh impetus to the task of rescuing Indian health care. Swasth draws together more than 100 health-care providers and startups like online insurer Policybazaar, e-pharmacy 1MG and telehealth provider Practo. Its influential backers also include venture capital firms Sequoia Capital and Accel.
In addition, volunteers from dozens of companies, including online retailers Amazon.com Inc. and Walmart Inc.’s Flipkart, are writing code or engaging with regional governments on information exchanges.This week, Swasth will begin offering a bucket of Covid-related services. Individuals can call a helpline to speak with a doctor for free or get information about the nearest testing center and hospitals. More than 1,000 doctors on the platform will offer free consultations, share advice on emotional wellness and dispense instant prescriptions by text. Those with mild symptoms can access monitoring services for home isolation or quarantine.
While the coronavirus is the starting point, the coalition’s larger goal is to devise protocols and mechanisms for testing and treatments for the masses, as part of the National Health Stack.It’s working with iSpirt, a software think tank, to set health standards and build interoperability across players and segments. In the coming weeks, iSpirt is set to release open application interfaces for the Stack that’ll allow information exchanges on once-closed areas like billing information for insurers or diagnostic lab results.
“India needs an open digital ecosystem to unlock innovative solutions to key societal challenges,” said Roopa Kudva, managing director of Omidyar Network India. Such platforms have emerged in areas like financial services and education. “Health care is a very relevant area, given the benefits an interoperable system can bring.” Omidyar is among the donors to a 1 billion-rupee Action Covid Team fund, which is also backing the Swasth alliance. Kudva also sought to alleviate privacy concerns.
“In designing such a system, getting the rules of data exchange and safeguarding individual privacy are important,” she said.