Information Economy and Healthy Citizenry: Role of Internet in Implementing India's Health Policy

Shobhna Gupta,Sridhar Papagari
Center for Research in Information Management, University of Illinois at Chicago

Corresponding Author:
Sridhar Papagari
Center for Research in Information Management
University of Illinois at Chicago
601 S Morgan Street (M/C 294)
Chicago, IL 60607
U.S.A.
Email: spapag1@uic.edu 


Abstract

The National Health Policy (NHP) formulated in 2002 by the Government of India mentions challenges facing the health care delivery in the country today. There is recognition of the changes in the health problems afflicting the society since the NHP-1983. The "Health transition" in the Indian health system poses new challenges that need to be tackled with the aid of information technology. The transition of India into an information economy presents opportunities to tap the information technologies, especially, Internet, for health care delivery. Internet as a medium of communication could help in coordinating the efforts to provide decentralized health services throughout the country under one umbrella. The extent of broadband penetration in recent years provides an opportunity to reach the masses and impart them health education. Promoting preventative care and self-care using the Internet could alleviate the financial burden on the government due to rising health care delivery costs while increasing the efficacy of health care delivery.

Keywords
Health Education, Patient Education, Public Health Informatics, Information Dissemination, Internet, Health Policy. 

Internet Health 2004;3(1):e4

Introduction

India as a developing country seems to be riding on the information economy with the potential of being a developed nation in decades to come. However, much progress remains to be achieved in alleviating poverty, increasing literacy and public awareness, and providing accessible and quality health care to masses. Economists have found a strong correlation between better health and faster economic growth[1]. In developing countries, poor health reflects the poverty and also contributes to it. In India, information and communication technologies especially Internet present an opportunity to counter some of the problems facing the health care delivery in India. In recent years, proliferation of Internet has been tremendous and the number of Internet users continues to rise. Although, India has established itself as a global IT super power and an IT destination for major corporate companies around the world, it has not yet realized the benefits of IT as a support tool for efficient governance as well as health care delivery.

The Indian Health System - "Health transition" 

According to the World Bank report "Better Health Systems for India's Poor"[2], India is in the midst of a "health transition" - the transition being demographic, epidemiological, and social. Preventable infections, pregnancy and childbirth related complications, and malnutrition are still prevalent in the majority of the population. Public spending on health is low and majority of the spending is on curative care and not on preventative health services. The disparity between India's rich and poor extends to healthcare. These problems are confounded by the masses being ill-informed about the health services, their appropriateness and quality. There is a lack of cohesion among central and state governments' initiatives. Some of the main challenges listed by the report are fighting HIV/AIDS epidemic, eliminating gaps in planning, implementation, monitoring, technical leadership, and communication, effective decentralization, dealing with emerging public health priorities such as health consequences of smoking, mental illness, and related injuries.

National Health Policy-2002 - Issues and Challenges

The NHP-2002 of Government of India[3] delved on the state of public health delivery in India. It presented the problems plaguing the current system and formulated certain initiatives to tackle these problems. There is a considerable focus on decentralized public health system while seeking greater contribution by the central government. Equitable access to health care, much wider role of private sector and NGOs, public participation in health care, disease surveillance, and strengthening primary health care delivery are some of the primary issues discussed.

Although, the policy tries to deal with the issues at a broader level by formulating certain goals and strategies, the role and potential of information and communication technologies in achieving these goals seem to be underplayed. In short the NHP-2002 does not seem to take advantage of the implications of the long-term national IT policy[4]. The IT policy mentions citizen-IT interface as a key strategic initiative. A government-wide electronic information infrastructure is proposed to simplify service delivery, reduce duplication, and improve the level and speed of service to the public.

How can Internet Help?

The reach and quality of the public health has been poor due to the inadequate funding on the part of the central and state governments. The public health services effort, essentially decentralized in India, can be boosted with the effective use of Internet as a medium to deliver health information, manage diseases and communicate health policies. The emphasis should be on the preventive health care, which requires access to right information at right time from right sources. A decentralized effort under a central health organization would be suitable and possible by the use of Internet for information capture and dissemination. For such an effort, the initial costs of infrastructure and training could be high but the long-term benefits are immense. The government in taking such initiatives can ensure the quality of the health information, assesses the progress of health interventions, and elicit feedback from the citizens. The NHP-2002 mentions the equitable regional distribution and the uneven rural health indices across the rural-urban divide. The gap in the access to and benefits from public health system is in congruence with social inequities and economic disparities[3]. The low literacy rate and hence the low public awareness in the disadvantaged sections of the society needs to be eradicated while simultaneously educating these sections on the potential uses of Internet for self-care.

The existing digital-divide in the Indian society cannot be ignored in this context. Accessibility to computers and Internet is a basic requirement for any electronic information mission to succeed. Projects like "Sankhya Vahini"[5] promise to create a high bandwidth national Internet backbone that could provide faster and reliable Internet access to major towns and cities. A further expansion of the Internet infrastructure to the rural areas is being considered through projects like Health InterNetwork[6] and Sustainable Access in Rural India (SARI)[7][8]. The Health InterNetwork, a United Nations initiative, aims to support and strengthen public health services and to provide access to high quality, relevant and timely health information. It recognizes the challenges posed by the digital-divide and aims to imp rove the communication and networking among public health care workers, researchers, and policy workers. A public health portal is being planned along with number of information access points equipped with Internet technology to access the health information. SARI is another such initiative dedicated to creation, deployment, and delivery of information and communication services and technologies in poor rural areas to improve leading to improvements in health, empowerment, learning, and economic development amongst the poorest and most disadvantaged communities.

It has to be recognized that provision of infrastructure and facilities does not lead to ameliorating the digital-divide as such. There is a need to recognize that the digital-divide is not binary in nature and social inclusion of information and communication technologies is crucial[9]. Appropriate training with clear incentives are needed. The long-term IT policy proposes a joint working model between the government and private sector in setting up information kiosks at public places, and upgrading the telephone kiosks to IT kiosks and operating them as Public Tele Info Centers (PTICs)[4]. This would greatly increase the Internet accessibility to the masses.

The term eHealth can be defined as an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies[10]. The concept of eHealth might sound similar to telemedicine but there are subtle differences in how the health care is delivered. Telemedicine is linked to the medical professionals providing services remotely while eHealth is driven mainly by the health consumers who are looking for information and knowledge on health services. In other words, eHealth promotes public participation in health care and leads to informed patients. Internet is the medium to deliver such information to practice and preach self-care and preventative care. eHealth equips citizens with tools to enhance their knowledge on diseases, monitor their health and at the same time interact with the healthcare providers. Informed patients can demand better health care and services. Hence, the government can create pull for health services by implementing eHealth initiatives.

Private providers need to tap the Internet to keep their patients informed. Internet is the best medium to market the services offered especially to international patients. E-mail correspondence and online medical records could go a long way in establishing better patient physician/provider relationship. Interactive applications that could help monitor chronic illnesses like diabetes could help manage the diseases effectively. The consumers could be assessed a service fee to access the health portals and also encouraged to do so with certain incentives. The Center for Health Services Research, Henry Ford Health System in Detroit, Michigan, developed a Web-based Diabetes Care Management Support System (DCMSS) to educate the diabetic patients about the benefits of routine care [11]. The findings suggest that factors such as inclusion of clinical practice guidelines, patient registries, and performance feedback in web-based systems have the potential to improve the rate of routine testing among patients with diabetes.

There are numerous benefits involved in public health delivery due to Internet connectivity. Internet enables flow of up-to-date information in real time, which facilitates centralized control but decentralized operations, ensures quality of health information and elicits citizen feedback on services provided. It can help capture key data in case of a major epidemic or a natural disaster and hence help in allocating resources more effectively. National health surveillance can be implemented effectively by investing on high-speed Internet infrastructure and promoting exchange of information at the point of care.

Future Directions

India seems to be heading the right way in taking initiatives to develop its information and communication infrastructure. eGovernance seems to the new mantra for development. It is necessary not to be carried away by the technology though. The real potential of Internet for the development of public health can only be realized when it is viewed in the context of effective planning and coordination among various stakeholders and using technology to reach the health consumers. Health information dissemination should be included among the various eServices (eGovernment initiatives) developed in the future. The quality and reliability of the information has to be governed by regulatory bodies in order to avoid chaos due to misinformation. Legal and ethical guidelines need to be passed and implemented.

The role of private health care institutions and practitioners needs to be recognized in promoting public health. Telemedicine and eHealth initiatives need to be encouraged. A small step towards a healthy citizenry with the help of information and communication technologies could be a giant leap towards developed economy. Information dissemination could be on communicable diseases such as AIDS, TB, etc., on lifestyle disorders like diabetes, heart ailments or it could be partially or entirely on after care services. Information on vaccines, nutrition, diet, sanitation, and drugs can increase patient compliance,reduce drug abuse and improve overall health.

The challenge is to coordinate the various groups (NGOs, rural health workers, state government, central government, and private practitioners) to formulate an integrated strategy in delivering health care. The roles of each entity need to be clearly defined, their experiences shared and knowledge exchanged. There is
a need to recognize the cultural and behavioral impediments to Internet usage and overcome them with training and education. Community health centers and primary healthcare centers need to function as the facilities for health information gathering and dissemination. The Indian society, especially in rural areas, is used to subsidies in various products and services over the years. It is important to change this outlook to be a more self-reliant society to foster rapid development. This is true in the case of health care too. The government schemes impeded by lack of funds and personnel need to encourage self-care and preventative care among the local communities. Both timely and reliable health information is key to such efforts. A health society can have a positive outlook and hence can learn to be a self-sufficient citizenry. 

References

1. Tyson LDA. For Developing Countries, Health Is Wealth. BusinessWeek Online 2002 Jan 14, 2002. Available at: http://www.businessweek.com/magazine/content/02_02/b3765071.htm . Accessed Nov 25, 2003.
2. Peters DH, Yazbeck AS, Sharma RR, Ramana GNV, Pritchett LH, Wagstaff A. Better Health Systems for India's Poor: Findings, Analysis, and Options: The World Bank; 2002. Available at: http://www.wds.worldbank.org/servlet/WDSContentServer/
WDSP/IB/2002/05/30/000094946_02051604053640/Rendered/PDF/multi0page.pdf . Accessed Nov 25, 2003.
3. National Health Policy 2002 (India): Ministry of Health & Family Welfare, Government of India; 2002. Available at: http://mohfw.nic.in/np2002.htm. Accessed Nov 25, 2003.
4. NASSCOM. Action Plan - III: Long-term National IT Policy: NASSCOM. Available at: 
http://www.nasscom.org/download/action_plan_3.pdf  Accessed Nov 25, 2003.
5. Sankhya Vahini. National project synopsis; 2000. Available at: 
http://rajyasabha.nic.in/rsdebate/synopsis/189/05052000.htm . Accessed Nov 25, 2003.
6. India HI. Health InterNetwork India (HIN) India. In; 2003. Available at: http://www.hin.org.in/ . Accessed Nov 25, 2003.
7. SARI (Sustainable Access in Rural India). In; 2003. Available at: http://edevelopment.media.mit.edu/SARI/mainsari.html . Accessed Nov 25, 2003.
8. Kumar SV. A village where IT is a way of life. In. Online ed: The Hindu; 2002. Available at: http://www.hinduonnet.com/thehindu/2002/04/22/stories/2002042201340500.htm . Accessed Nov 25, 2003.
9. Warschauer M. Demystifying the Digital Divide. Scientific American 2003;289(2):42-47.
10. Mea VD. What is e-Health (2): The death of telemedicine? Journal of Medical Internet Research. 2001;3(2):e22. Available at: http://jmir.org/2001/2/e22/index.htm . Accessed Nov 25, 2003.
11. Baker A, Lafata J, Ward R, Whitehouse F, Divine G. A web-based diabetes care management support system. The Joint Commission Journal on Quality Improvement 2001;27(4):179-190.

List of Abbreviations used
1. NHP: National Health Policy
2. IT: Information Technology
3. HIV: Human Immunodeficiency Virus
4. AIDS: Acquired Immune Deficiency Syndrome
5. SARI: Sustainable Access in Rural India
6. PTIC: Public Tele Info Centers
7. TB: Tuberculosis
8. NGO: Non-Governmental Organization

Cite as: 
Gupta S, Papagari S,
Information Economy and Healthy Citizenry: Role of Internet in Implementing India's Health Policy
Internet Health 2004;3(1):e4
URL: www.internet-health.org/ih200431e04.html 

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