August 23, 2020

Drive for Privatisation of Healthcare: NDHM

J S Majumdar

IN his Independence Day speech this year, the prime minister has made a ‘major’ announcement. It is about the launching of NDHM (National Digital Health Mission). He said, “From today, a major campaign is being launched in which technology will play a big role. The National Digital Health Mission is being launched today. This will bring a new revolution in India’s health sector and it will help reduce problems in getting treatment with the help of technology,” PM has said.

What NDHM scheme proposes to do for the citizen’s healthcare? ‘The NDHM will reduce the existing gap between various stakeholders such as doctors, hospitals and other healthcare providers, pharmacies, insurance companies and citizens by bringing them together and connecting them in integrated digital health infrastructure,’ claimed a statement of NHA (National Health Authority) of AB-PMJAY (Ayushman Bharat - Pradhan Mantri Jan Arogya Yojna), which is the main designer and the promoter of NDHM under the advice of NITI Aayog.    

It is being introduced at the first instance in six union territories of Andaman & Nicobar Islands, Puducherry, Dadra - Nagar Haveli & Daman and Diu, Lakshadweep, Chandigarh and Ladakh. 

NDHM healthcare scheme has six parts or six modules for digital interface i.e., digitally to see, hear and talk between the patient or anybody else about him/her, and other stakeholders. The two modules of each citizen will be of ‘health ID’ and ‘personal health records’. Other modules include other stakeholders - ‘digidoctor’, ‘health facility registry’, ‘e-pharmacy’ and ‘telemedicine’. While modules of personal ID, doctor and treatment facility selection will be with the government; for the other three i.e., ‘personal health records’, ‘telemedicine’ for online diagnosis and prescription and ‘e-pharmacy’ for online supply of medicines, the private sector will be integrated for creating and operating these modules. “Private stakeholders will have an equal opportunity to integrate with these building blocks and create their products for the market”, said Indu Bhusan, the NHA chief and its CEO on the launching of the scheme.

The announcement about NDHM and the propaganda surrounding it through the mainstream media goes beyond Goebbels doctrine- camouflaging the real intents. Ayushman Bharat project was for converting the government’s role from a ‘service provider to a financier’, as was told by the former union health secretary, Sujatha Rao, for the insurance companies to provide healthcare with profit motive replacing central and state governments institution-based primary to tertiary healthcare infrastructures; instead of strengthening these to provide free and universal healthcare. Similarly, NDHM is converting the government’s role from a ‘service provider to a broker’ for the private healthcare sector.

NDHM is a scheme for (i) privatisation of healthcare system replacing governments’ healthcare services; (ii) promoting ‘e-pharmacy’ for online supply of medicines and ‘telemedicine as a mode of online diagnosis to digital prescription for the private sector and (iii) to make an individual’s medical history and other details available for governmental control and commercial purposes by the private sector including a trial for new medicines of multinational drug companies.

AB-PMJAY was announced by the PM in his 2018 Independence Day speech and was launched on September 25,  2018. It was a major policy change of the central government in healthcare. It completely reversed the healthcare policy of government since independence.

Public healthcare system evolved out of and remained an important part of the planning process since the beginning. Health planning was an integral part of the community development programme. Based on the WHO 1978 Alma-Ata Declaration-‘Health for All by 2000 AD’, India adopted its first National Health Policy (NHP) in 1983 which was replaced by NHP-2002. Added to this were National Rural Health Mission, 2005 and National Urban Health Mission 2013 integrated in the National Health Mission 2013. ICDS has had an important contribution in healthcare while the ASHA scheme is an integral part of the public healthcare system.

Modi government replaced NHP-2002 by its NHP-2017 putting healthcare in privatisation mode stating about the emergence of a private ‘robust healthcare industry’ growing at double digits and to “align the growth of the private healthcare sector with public health goals” to “enable private sector contribution to making healthcare systems more effective, efficient, rational, safe, affordable and ethical.”

Data released by DIPP (Department of Industrial Policy and Promotion) shows that private hospital and diagnostic centres attracted FDI worth $4.83 billion during 2000-17. According to the National Family Health Survey-3, the private medical sector remains the primary source of healthcare for 70 per cent of households in urban areas and 63 per cent of households in rural areas. The burgeoning private sector hospitals having substantial FDI must have a growing market.

In this background, AB-PMJAY replaced public healthcare system by insurance-driven healthcare system the premium of which is being borne by the central and state governments. The profit motive of insurance companies in the health sector aligned with health facility corporates (of hospitals, nursing homes, diagnostic centres etc.) and private medicine companies.

Now comes NDHM to target mainly those who are outside PM-JAY and proposes alignment of private doctors including payment of fees, corporate hospitals and other healthcare providers like diagnostic centres, pharmacies, insurance companies etc.,  through its digital platform.

The NITI Aayog in may, 2020 has analysed the situation and has five points’; conclusions promoting (i) Work from home (WFH); (ii) Breaking the supply chain out of China and India vying with some other countries to grab this opportunity and, hence, labour reforms, diluting FDI norms and speeding up corporatisation and privatisation etc. (iii) NITI Aayog also concluded that Covid-19 would cause a phenomenal rise of ‘tele-medicines’, a euphemism of the patient-doctor-prescription relation through IT and a mechanism to replace public health services network. “This is in addition to the insurance-driven health services, including private hospitals in the loop, in the Ayushman Bharat project already in place;” and (iv) Increasing contactless delivery like e-commerce, e-pharmacy.

Taking advantage of Covid-19, NITI Aayog had already prescribed about the last two points as in above – the ‘tele-medicines’ and ‘e-pharmacy’. NDHM is to operationalise it.

NDHM has two modules as has already been mentioned – personal health ID and personal medical data. Personal medical data will be available to private companies and the government will control the personal ID. That means an individual’s medical history and other details will be available to private companies and will be in the public domain. The consequences are unimaginable including their use for other commercial purposes and potential subject for a trial of new medicines by the MNCs like COVID vaccines etc.

The government will control the personal data of the citizens through a health ID and may use it for any purpose including giving threats or trial under different laws.