Leveraging Technology to Enable Effective Preventive Screening of NCDs at Population Scale: Initial Observations

Abstract

India is undergoing an epidemiological transition to non-communicable diseases (NCDs), with NCDs contributing to nearly 60 percent of all deaths in India. NCDs are challenging to manage given their silent onset, low health awareness, significant informational asymmetry, and low health-seeking behavior among the rural population and the poor in India. The Ministry of Health and Family Welfare (MoHFW), Government of India, launched Ayushman Bharat to move from a sectoral and segmented approach of health service delivery to a more comprehensive one. As part of this effort, a program was launched for population-based screening (PBS) and management of five common NCDs—hypertension, diabetes, oral, breast, and cervical cancers. The success of the program, among other things, will be determined largely by the early detection, timely treatment, and diligent follow-ups to manage the five NCDs. In line with WHO’s Global action plan for the prevention and control of NCDs 2013–2020, India is the first country to develop specific national targets and indicators aimed at reducing the number of global premature deaths from NCDs by 25% by 2025. However, challenges like human resource shortfall, limited capacities of the health workers, heavy burden of managing multiple health priorities, and poor utilization of public health facilities may affect the outcomes of this ambitious initiative Technology can serve as an enabler in solving some of these problems. Dell Technologies and Tata Trusts have partnered with the Ministry of Health and Family Welfare, Government of India, to develop a technology solution for the PBS NCD initiative. It consists of a suite of mobile and web apps on a cloud platform for health workers, doctors, and health administrators to enable care delivery for people across the country. The solution has been deployed in states across the country with adoption gaining momentum amongst health care providers. While early process indicators are encouraging, it is important to examine individual clinical outcomes, population outcomes and cost effectiveness which are the primary objectives of such a program. The learnings from this digital health program can then be transposed to similar healthcare settings. The paper covers four challenges commonly encountered in the context of running large-scale digital health programs in a multi-state, multi-facility, and multi-stakeholder system. These are adoption of technology by health workers with low digital literacy, feasibility of running tech solutions in remote areas, value proposition of the solution for users and finally the know-how on building and rolling-out technology at scale to reach millions of people.