Expert Speak Health Express
Published on May 01, 2020
Mission resilience: A clarion call for India’s future of health


Healthcare had already begun to ride the technology wave to undergo a radical transformation before Covid-19. This transformation will blow into a full-fledged revolution in the post-Covid19 world with rapid adoption of Digital Health by countries in more ways than one. Supplementing health systems with digital solutions is the only way forward to bring a tangible and significant change to lives of people within finite resources. In recent years, India has been planning to make health-tech integral to its growth story. It is time for concerted action now. A strong case for India to adopt Digital Health solutions across the care continuum already existed – it has become more compelling and urgent than ever.

Caution: Steep curves ahead

While Covid-19 is the number one terror-monger now, it must not be forgotten that other time bombs – as morbid and more prevalent diseases such as cancers, tuberculosis, cardiovascular and neurological ailments – have not stopped ticking for India. With all forces diverted to win the Covid-19 war combined with lockdown restrictions, hospitals and clinics have seen a steep decline in consultations for any other health conditions. Out-patient visits, comprising about 74% of total medical consultations in India, have come down to a halting zero. Consequently, chronic diseases that normally require periodic clinical reviews for medication adjustment or procedures such as dialysis, transfusions, radiation therapy have been left largely unmanaged, allowing them to gain a stronger grip on affected individuals and vulnerable communities.

When lockdowns are pulled down, health systems will find themselves caught up in a dense jungle of fast-rising curves of varied sicknesses all equally deserving to be planked as the Covid-19 curve.

Call for action: Mission Resilience

In parallel to the Covid-19 task force, a post-lockdown task force must be inducted by the Government of India with immediate effect with a mission to build resilience in the health system. Mission Resilience should aim to remodel the system into a trustworthy, hardy, all-weather one. One that is better-prepared for handling future pandemics without having to stop basal-level health services for other conditions. Three design principles for the mission are proposed:

  1. Go phygital: To manage transition of health services delivery from Covid-19 battle mode back into the routine of dealing with old predicaments with partly- virtual modus operandi.
  1. Build a digital-savvy health workforce: To arm health workers with new-age digital apps and Artificial Intelligence (AI)-powered tools at the point-of-care, to ease their workload and stress; to train and orient health workers on acceptance and use of digital technology in medicine for becoming future-ready.
  1. Empower patients as equal participants in health management: To democratise primary health across population with digital infrastructure, data digitisation, and awareness campaigns; adopt relevant use-cases, best practices and synergies from retail and banking sectors.

Roadmap: Policies, solutions and nimble action

Policies and regulations are known to trail years behind innovation. However, the current situation dictates breaking clichés. Simply because time is currency, when fighting against an existential crisis brought on by Covid-19. Policy making must catch up pace to match that of innovation in biosciences and health-tech to pull together a fairly effective offense against second-order effects of the pandemic and the lockdown.

Speed and proactiveness in policy making must not discount robustness, though. Good science, if not backed by good policies, can slip fast into a spiral of mediocrity, resulting in sub-optimal public goods – an unacceptable outcome, both for people’s health and the economy. For example, telemedicine guidelines for India had been lurking in oblivion for nearly two decades. As a reactionary, yet timely response to Covid-19, the pre-existing guidelines were quickly reviewed, filled for gaps, and accorded legal status. Not just India, many countries have followed suit by legalising and expanding the scope of virtual consultations, and extending reimbursements for telehealth amidst the pandemic.

In a knee-jerk, the world drifted from decades of policy paralysis and inaction to be wired by the virus, towards a futuristic connected care eco-system. While searing matters of data privacy, patient consent and cybersecurity are yet to be resolved, it is a force-start for telemedicine in India – a promising solution that has been in-waiting for too long to address the health accessibility challenge, and to enable value-based care. Below par access to health for all Indians is not only due to income inequity or terrain tyranny, but also due to severe shortage of health workers – doctors, nurses, paramedics and lab technicians. It is critical not to lose momentum on telehealth implementation towards achieving inclusivity so that the unconnected and the digitally illiterate are not left out.

It must be acknowledged that virtual cannot replace real. Telemedicine is not a be-all end-all solution. There is an obvious limitation of inability to do physical examination during virtual consultations. Patients have to be on-premises for full clinical examination, advanced diagnostics tests, day-care procedures and treatments, and more.

In addition to telemedicine, the following two priorities need immediate policy attention and follow-up action to build resilience and nimbleness into India’s health system with digital innovations:           

Acceptance for Software as a Medical Device / Diagnostic / Clinical Decision Aide

The most pressing intervention needed in India’s overburdened health system is to reduce physical and mental stress on health workers to ensure quality of health outcomes. Digital tools can enable health workers as well as patients to participate equally in managing one’s health condition, thereby reducing the load on the system.

Clearly, the medical products of future will not just be pills, injectables, scanning machines, dialysers, and many such. They will include wearables or apps as devices for real-time tracking of vital parameters to transmit early warning signals for the patient and the managing physician for timely intervention. AI and robotics-enabled diagnostics will bring routine tests and scans right inside the doctor’s chamber, that is, at point-of care. Also, clinical decision making and case discussions will be assisted with AI, adding robustness in the practice of medicine by making it quicker, evidence-driven, less prone to errors and personal judgements, and more humane, wherein the doctor-patient interactions become empathic and care-oriented, rather than time-pressed and transactional.

Most innovative ideas and products from indigenous and international start-ups will fall in one of the above three categories. Just so that policymaking doesn’t lag once again, it is time that these are brought under discussion. The United States and the European Union have instituted regulations to treat software as a medical device (in a limited scope) recently. These could be taken as initial references to design policies and action plans specific to use-cases applicable for India.

Readying the health workforce of the future:

Within a month of lockdown, and with easing restrictions and reimbursements for telehealth, the US has seen a 50% increase in virtual consultations. Few telemedicine providers reported a surge in video-consultation requests of up to 15,000 per day. In contrast, India’s announcement of legalising telehealth guidelines has not had a marked effect for two reasons: 1. The providers and clinical services aggregators had to scramble to get the infrastructure and connectivity in a jiffy. 2. A very selective and small segment of populations, ones with financial and technological means are the early adopters. While the health system gets ready to support digital infrastructure and tools, parallel efforts must be made to tide over user inertia for technology adoption as a new way of life, for patients as well as for practicing health workers. Health-tech must be introduced as a specialised subject in the medical, nursing and para-medical curricula to prepare a technology oriented, digital-savvy health workforce of future.


The devastating impact of Covid-19 on the socio-economic order of the world is an in-the-face warning for India to remodel and overhaul its health infrastructure and priorities with immediate effect. Fortune favours the prepared. It is time to go bold and adopt digital health for a stronger and more resilient health system for India to be better prepared for any eventuality in the future.

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Sheetal Ranganathan

Sheetal Ranganathan

A biomedical researcher-turned-business leader: Columnist and Opinionator in health and policy: Start-up advisor and investor in Health and Life Sciences: Mentor at National Health Authoritys ...

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