The excessive optimism associated with transformational impacts of digital technologies is misplaced on at least two counts. One, there are limitations to how much digital technologies can move the needle in addressing complex issues. Two, even where relevant, technology initiatives have to overcome formidable implementation challenges and most often require time to stabilise and realise their outcomes. I have blogged earlier on the former, including here (targeting beneficiaries). This post will focus on the latter.
This and this are examples illustrating implementation challenges with agriculture and credit. An example from health is the proposed National Digital Health Mission (NDHM),
The NDHM has been planned as a complete digital health ecosystem that will comprise unique health IDs (voluntary participation), digitised personal health records, and a registry for doctors, hospitals, diagnostic labs, and pharmacies. There will be four key building blocks — the health ID (which government officials say will resemble a UPI ID instead of an Aadhaar-style number), personal health records (PHR), Digi-Doctor, and registry for health facilities... Citizens will be in full control of their data, said officials. The scheme plans to achieve this through three building blocks — Consent Manager, Anonymizer, and Privacy Operations Centre (POC) — according to the final version of the blueprint, released by the Ministry of Health and Family Welfare. The goal of the Consent Manager is to ensure the citizen/patient is in complete control of the data collected and with whom it is shared. The Anonymizer collates matter from health data sets, removes all personally identifiable information and provides anonymised data to the seeker. The POC will monitor all access to private data, review consent artefacts, audit services for privacy compliance, and evangelise privacy principles on which the ecosystem will be built on.
The National Health Authority (NHA), which administers the PMJAY, will be responsible for its implementation. The benefits are well known,
With personal health records collated, patients can walk into a health facility without historical documents. Diagnosis becomes easier for a physician who now access historical records. Any need for a follow-up test can be customised or avoided, if not necessary. Hospitals will have higher inter-operability. The government will have access to anonymous and macro-level data like immunisation, infant mortality, childbirth, and chronic diseases like diabetes, hypertension, and nutrition that will help policymakers target their initiatives.
The challenge is, like all else, in implementation. Take for example, the Consent Manager, Anonymiser, and POC. Each of those, whether fully public sector or quasi-public, need a level of institutional integrity and maturity in managing these high-stakes activities, with consequences whose damage can be irreparable. Such integrity and maturity takes time to emerge.
For a start, just the supply of the various service providers and professionals of good quality with the different kinds of expertise who need to be hired will be limited. There are new types of activities which will require supply of people with new sets of skills. It's not like turning on a tap and accessing the supply of such services at scale. Or, the process work-flow and co-ordination among different agents take time to get refined and attain some level of maturity. In the initial stages, there will be numerous attempts by entrenched vested interests to destabilise and game the new system. An implementation which does not double down with quick reactive follow-up will be certain to set the system for failure.
Besides, the use of digital technologies in health come with risks of security and privacy, with implications far higher than those associated with even financial transactions. In case of the latter, at worst, you lose some money. However, in case of the former, the individual's entire health history is compromised with all its attendant life-long consequences. The systems to mitigate these risks therefore assume great significance.
Much the same is happening now with the institutional ingredients of the Insolvency and Bankruptcy Code (IBC). Much before the pandemic brought things to standstill, the load of cases had already started to strain the fledgling bankruptcy process. Apart from the bottlenecks from numbers, there have also been growing allegations of questionable practices and questions about the competence of important stakeholders like the Insolvency Professionals (IPs). Institutional practices take time to stabilise.
The point is not to argue against such innovations and reforms. There cannot be any doubt that they are not only required but are very important steps, in case of NDHM, in enhancing the effectiveness of the country's health care system. But it is important to understand the implementation challenges and limitations of such reforms. Its importance lies foremost in the ability to take measures to address some of the associated emergent problems in course of implementation, which would ensure the success of these reform initiatives.
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