In 2021, the Indian government launched Ayushman Bharat Digital Mission (ABDM) with the grand ambition to create India’s first unified health system. With a budget of 1600 crores, ABDM aimed to provide patients with a unique health ID, allowing them to access their health records on their phones and move seamlessly from one healthcare provider to another.
While the project sounds too good to be true, its ground reality is shocking. Patients still wait at hospitals for hours, only to be told that their medical records are on paper and cannot be accessed. Other patients, who are moving cities, start from scratch with their new healthcare provider, as old records are digitally inaccessible.
Despite the lofty goals and the large budget, ABDM hasn’t been able to move the needle. What went wrong? Read along to understand.
ABDM implementation and its challenges
ABDM has a clear vision: to develop a digital infrastructure that supports the country’s healthcare system. It focuses on digitising patient health records and connecting hospitals and medical facilities through an integrated system.
Through this initiative, the government aims to bridge the gap between different stakeholders in the healthcare ecosystem. Its successful implementation will:
- Allow individuals to choose between public and private health services
- Assist in compliance with guidelines and protocols
- Promote transparency and accountability for healthcare services
Overall, ABDM has the potential to transform healthcare in India, making it more accessible and efficient for all. However, it’s all on paper. Reality is quite different.
While the central government formulated the policy and allocated the budget, its implementation was left on the shoulders of respective state governments, as health is a state subject. Every state has its own method of allocating tenders and moving things ahead, leading to bottlenecks in the unified implementation of ABDM.
The Ken, an independent publication, covered the story—how India’s Rs 1,600-crore digital health ID mission is being squeezed at two ends. Here’s what it said:
States struggle with the implementation
States in India are facing difficulties in implementing digital upgrades to their healthcare systems. The main reasons are a lack of expertise in handling tenders of this kind, capacity gaps to procure and implement complex systems, outdated hardware, the need for technical expertise, etc.
- In Jammu and Kashmir, a high rate quote led to the cancellation of a tender, which had to be retendered. The union territory then changed its software buying strategy from procurement to renting.
- In Uttarakhand, the World Bank funded a project two years ago to create an integrated hospital management system. But the process ultimately did not move past the initial ‘Expression of Interest’ stage.
- In Bihar, despite an allocation of Rs 300 crore, the project is being plagued by delays after the tender was awarded to a consortium led by Rodic Consultants, specialising in highways and power distribution projects rather than healthcare.
Connectivity issues
While government-backed systems have proven effective in some hospitals and states, software providers still face limitations.
For example, Bihar’s Jehanabad district pilot project lacks an offline mode of functioning, which can be problematic in areas with unreliable electricity and internet connectivity.
Low adoption rates of the E-Hospital model
In the public sector, agencies like the National Informatics Centre (NIC) and the Centre for Development of Advanced Computing (C-DAC) have developed and tested solutions like ‘e-Hospital’, but adoption rates remain low.
While the e-Hospital setup has become ABDM-compliant in recent months and is being implemented in multiple states—Andhra Pradesh, Karnataka, Madhya Pradesh, Chhattisgarh, and the union territory Chandigarh—other states are far behind the league.
Underutilisation of funds
The Indian government had approved a budget of Rs 1,600 crore over the next five years for the ABDM. However, the allocation for the year ending in March 2022 was only Rs 200 crore. In 2021, only Rs 6.39 crore was spent on ABDM, despite an earmarked budget of Rs 30 crore.
PM-JAY, a scheme that provides free health insurance for poor families and is related to ABDM, saw the same. The utilisation of the PM-JAY’s budget allocation decreased from 83% in 2018-2019 to 42% in 2020-2021, resulting in the reduction of allocation of funds towards the scheme to half in the following year.
Lack of funding for hardware requirements
While some states have successfully purchased software solutions for their hospitals, the question of funding for necessary hardware, such as computers, printers and scanning equipment, remains unanswered.
For instance, in Himachal Pradesh, officials identified 500 locations in 56 health institutes where they need to install computer systems and printers or equip doctors and nurses with tablets to digitise patient data. The total hardware budget is expected to be roughly Rs 20 crore, and the state government is uncertain if the Ministry of Health will provide that funding.
With state governments already facing a shortage of funds due to the pandemic, the lack of funding for digitisation creates a double squeeze on their resources.
Churning leadership at NHA
End-to-end digitisation of health services is a new concept in India, and the National Health Authority (NHA) is taking small steps towards it. However, there is a high churn rate at the top leadership level and uncertainty over whether NHA CEO RS Sharma will receive an extension.
Sharma’s predecessor, Indu Bhushan, accelerated the uptake of PM-JAY. During his tenure, the priorities of public health consultants saw a shift from PM-JAY to ABDM. But since Bhushan’s departure, the scheme’s performance has taken a hit.
Additionally, the departure of NHA’s additional CEO and deputy CEO for Harvard University impacted the camaraderie between bureaucrats and consultants at the NHA.
Ken highlighted that this trend is not limited to senior leadership, as other consultants have also used their government experience to pursue degrees in the US, seeing NHA as a stepping stone towards pursuing academics in Ivy League Universities.
Bottom line
While the Ayushman Bharat Digital Mission (ABDM) has the potential to bring about significant changes to India’s healthcare system, its implementation hasn’t been fruitful.
India’s healthcare system is facing challenges from the lack of experience among state governments in handling tenders and implementing complex systems, shaky leadership at the NHA, unclear funding for the necessary hardware equipment, etc., which is squeezing the attempt to give a digital facelift to the creaky healthcare system.
There is a disconnect between the grand vision of ABDM and the actual work being carried out on the ground, which can only work if the gap between the two is bridged.
What do you think? Let us know in the comments.
