Transforming clinical challenges into scalable healthcare solutions
India stands at a pivotal moment to transform healthcare delivery through technology, much like how UPI revolutionized digital payments. The Ayushman Bharat Digital Mission (ABDM) can address the country’s healthcare challenges by enabling access, affordability, and quality through telemedicine, AI, and digital infrastructure. With limited spending but a massive scale, India can leapfrog traditional models using innovative tools. From managing noncommunicable diseases to tackling specialist shortages, ABDM holds the potential to reimagine care. Though challenges like digital literacy and infrastructure remain, the mission’s success could redefine global health innovation.
Technology has the potential to fundamentally change healthcare delivery in India, helping us leapfrog traditional infrastructure limitations while addressing our unique challenges of access, quality, and affordability. The Ayushman Bharat Digital Mission could become India’s “UPI moment” for healthcare.
In 2023, US healthcare spending reached $4.9 trillion, or $14,570 per person, accounting for 17.6% of the nation’s Gross Domestic Product (GDP). Despite this huge expenditure, there are significant drawbacks and challenges in the American healthcare system that remain unresolved, as seen in their ongoing struggles with healthcare access and cost containment.
On the other hand, the Government of India has allocated Rs 95,057 Crores (11.18 billion USD) to the healthcare sector for FY26, accounting for 1.94% of the total budget. India’s estimated healthcare spending per person is around Rs 7,775 or $95 – less than 1% of what Americans spend per capita.
India’s population is estimated at around 1.46 billion, while the United States has a population of approximately 347 million. So, we are 4 times the size of the US population and spend a minuscule fraction of what is being spent in the USA. This stark contrast highlights our need for innovative, cost-effective solutions.
India’s healthcare challenges
The challenges are many. India faces a “double burden” of both communicable and non-communicable diseases, as we transition from a low-income country to a middle-income country. According to the Indian Council of Medical Research, while we continue battling diseases like tuberculosis and malaria, we’re simultaneously seeing alarming increases in diabetes, heart disease, and cancer. This requires a multifaceted approach including strengthening primary healthcare, promoting healthy lifestyles, addressing underlying risk factors, and managing non-communicable diseases.
With limited resources, how can we possibly address these massive challenges? The answer may lie in what development economists call the “leapfrog effect” – the ability of countries with less legacy infrastructure to jump directly to more advanced technologies and systems.
The UPI precedent
We’ve already seen this happen with UPI (Unified Payments Interface). UPI has transformed India’s e-commerce landscape by making digital payments seamless and accessible, driving financial inclusion, and reducing reliance on cash. It has simplified payment processes, fuelled mobile commerce, and set global standards for real-time transactions. This “laggards leapfrog” phenomenon has allowed India to bypass traditional payment systems, positioning it as a leader in digital payments and significantly boosting e-commerce growth.
Could healthcare experience a similar transformation?
Ayushman Bharat Digital Mission: The potential UPI of healthcare
The Ayushman Bharat Digital Mission (ABDM) aims to establish a robust foundation to support the nation’s integrated digital health infrastructure. It seeks to bridge the gaps among various stakeholders in the healthcare ecosystem by creating digital highways.
At its core is the United Health Interface (UHI), envisioned as an open protocol facilitating diverse digital health services. The UHI network will connect End User Applications (EUAs) with Health Service Provider (HSP) applications, enabling seamless interactions between patients and healthcare providers. Through UHI, services such as appointment booking, teleconsultation, service discovery, and more will be accessible digitally.
The Ayushman Bharat Digital Mission is making meaningful progress. According to the National Health Authority’s 2023 report, over 200,000 healthcare providers including hospitals, doctors and nurses have already registered on the platform. But can it truly solve some of the major clinical challenges India is facing in terms of access, quality, affordability of healthcare and management of non-communicable diseases?
Reimagining healthcare delivery
India’s healthcare delivery system was designed 5-6 decades ago and hasn’t evolved to take advantage of modern technology. The ubiquitous availability of smartphones (over 700 million users according to TRAI), affordable WiFi, and cloud computing costs can provide the foundation for innovative solutions to healthcare challenges. Here are some concrete examples:
Dermatology: This specialty is ideal for technological disruption to improve access, affordability and quality. Taking District as a unit, Central Command can be set up in the District Hospital where specialists provide expertise, while Primary Health Centres function as smart clinics where paramedical staff (rather than doctors) guide interactions between patients and the command centre through telemedicine. Patients would only need to travel to the district hospital if their problems cannot be resolved through guided teleconsultation. This model could immediately extend specialist care to thousands of villages.
Telepathology and Teleradiology: Both these departments can be transformed using technology to address specialist shortages. In India, we have approximately one radiologist per 100,000 people (compared to 12 per 100,000 in the US), making digital solutions essential. These specialties involve data capture, transmission, storage, and interpretation – all processes that can be digitized. The UHI established under ABDM has the right building blocks for making this happen. Additionally, recent developments in Artificial Intelligence and LLMs in medicine can significantly decrease the need for large numbers of specialists while potentially improving reporting quality and consistency.
Noncommunicable diseases: The scale of India’s NCD challenge is staggering. According to the National Family Health Survey-5, more than 100 million people have diabetes (compared to 37 million in the US), 315 million people have hypertension, and 254 million have obesity. These numbers have increased by approximately 30% in the last decade. Many NCDs require not just medicines but constant counseling and behaviour change support.
The fully rolled out Ayushman Bharat’s Comprehensive Primary Health Care (CPHC) initiative aims to convert Sub-Health Centres and Primary Health Centres into Health and Wellness Centres (HWCs). These centres can serve as ideal hubs for NCD screening and patient counseling. Digital tools integrated through ABDM could help standardize care protocols and enable remote monitoring. Recent advances in generative AI have already enabled applications that can help manage diabetes at scale by providing personalized guidance and support between clinic visits.
Implementation challenges
While the potential is enormous, we must acknowledge significant implementation hurdles:
● Digital literacy gaps: According to the Digital Empowerment Foundation, nearly 50% of our population lacks basic digital literacy, particularly in rural and remote areas.
● Healthcare worker training: Successful adoption requires healthcare professionals to embrace new technologies and workflows.
● Data privacy and security: Strong frameworks must be developed that protect patient information while enabling necessary data sharing.
● Infrastructure limitations: Reliable electricity and internet connectivity remain challenges in many parts of India.
● Integration with existing systems: New digital tools must work with legacy systems during transition periods.
Piloting and scaling
These solutions should be piloted at a district level, taking into consideration the social and cultural nuances of different regions. The lessons learnt can then inform national rollout strategies.
The UPI moment has indeed arrived for India in transforming its clinical challenges into scalable healthcare solutions. Just as UPI changed financial transactions, ABDM has the potential to democratize healthcare access. There is perhaps no better place than India, with its combination of urgent needs, technological capability, and scale, to demonstrate how technology can solve healthcare’s most pressing problems. The journey won’t be simple, but the potential impact on 1.46 billion lives makes it a pursuit worthy of our most determined efforts.
