The government's move to bring the country's healthcare system under an integrated digital framework through the envisaged 'National e-Health Platform' is definitely a decision long time coming. Prime Minister Tarique Rahman on Saturday (August 22) directed the authorities concerned to start the platform on a pilot basis in several districts before taking it nationwide. According to reports, the pilot scheme will examine its effectiveness, possible problems, costs and feasibility. The proposed system is also expected to securely preserve patients' essential health information and make those available to authorised physicians and healthcare institutions when necessary. If implemented properly, this could save patients from carrying bundles of prescriptions, test reports and medical histories from one doctor or hospital to another.
There is hardly any argument against use of information technology to make healthcare simpler. Bangladesh has travelled far in digital connectivity. Mobile phones are everywhere and smartphones are also increasingly becoming ubiquitous. But having a phone and possessing the ability to use a digital health service are two different things. The Bangladesh Bureau of Statistics survey found internet use among rural people at 43.6 per cent, compared with 75.7 per cent in urban areas. That should be warning enough against designing the National e-Health Platform keeping only the digitally competent urban population in mind.
For the poor in rural Bangladesh, especially the elderly, women with little formal education and those who cannot comfortably operate smartphones, a sophisticated application may remain as distant as a specialised hospital in Dhaka. What is the use of putting healthcare at one's fingertips if the intended beneficiary does not know which button to press? So, the platform should not be conceived of merely as an application or website. It has to be supported by people and institutions already available at the grassroots including community clinics, union health centres and upazila health complexes. Trained health workers there should help citizens open, access and understand their digital health records. Voice-based Bangla instructions, simple menus and assisted access should be part of the system from the outset.
The National e-Health Platform will succeed only when it reaches the people who are least equipped to reach it. Digital healthcare must not create a new wall between poor patients and doctors.
In fact, there is another area where the proposed platform could play its role beyond storing medical records. That is health literacy. A large number of people have little idea about which doctor or medical facility they should approach for a particular ailment. Many patients suffering from minor conditions crowd specialised hospitals, while others with serious symptoms waste time going from one chamber or diagnostic centre to another. Worse still, people often depend on drug sellers, brokers, advertisements or advice from acquaintances to decide where to seek treatment.
Why should a national digital health platform not help address this confusion? Alongside a patient's health record, it could provide easy-to-understand information on common symptoms, preventive healthcare, maternal and child health, vaccination, diabetes, hypertension, infectious diseases and emergencies. Obviously, such information cannot replace a physician's diagnosis. But it can tell a person whether the first point of contact should be a community clinic, an upazila health complex, a district hospital or a specialised facility. It can also advise when a symptom requires immediate medical attention. The World Health Organization considers access to understandable and trustworthy information a component of health literacy. So, educating citizens should be treated as a core public-health function of the platform, not an optional extra.
However, digital guidance will be of little use if patients are ultimately directed to healthcare facilities of questionable quality. The government has since March been carrying out drives against illegal and substandard hospitals, clinics, blood banks and diagnostic centres. According to the Directorate General of Health Services, inspections were conducted at nearly 5,000 facilities during the first five months of the drive and more than 250 illegal establishments were shut down. Such actions are welcome, but experience tells us that drives against irregular healthcare establishments often gather momentum after public outrage and then lose steam.
The National e-Health Platform provides an opportunity to make regulation more systematic. The government should create and update a national database of licensed and properly inspected hospitals, clinics, diagnostic centres and other healthcare providers. More importantly, the database should classify them according to the services they are actually equipped with and authorised to provide. A patient looking for dialysis, cardiac care, maternity service, cancer treatment, eye surgery or a particular diagnostic test should be able to find the nearest verified facilities rather than search blindly on social media or depend on brokers.
Such a database would serve another purpose. Once legitimate health clinics are publicly visible on an official platform, the absence of a diagnostic clinic or hospital from the list would itself raise a red flag. Patients could check whether a clinic's licence is valid, what services it may provide and, where appropriate, whether the doctors practising there are registered. In this manner, digitisation could strengthen regulation rather than merely computerise existing mess. The recent government decision to extend private healthcare licences for two years also makes regular digital updating and inspection of records more important, not less.
Of course, storing health records of millions of citizens in one connected framework creates serious questions of privacy and security. The prime minister has rightly stressed those issues. Medical information is among the most sensitive personal data and access to it should be controlled. But security cannot become an excuse for designing a system so complicated that ordinary citizens cannot use it. The pilot stage should therefore test not only software, costs and data protection but also the experience of rural users, elderly patients, persons with disabilities and people with low literacy.
Digital technology is not a cure-all for the weaknesses of the healthcare system. It cannot create doctors where there are none, improve a substandard clinic by putting it on a computer network or ensure humane treatment through an algorithm. What it can do is connect the scattered pieces of the system, provide reliable information and make both health service providers and regulators more accountable. In the circumstances, the government should use the pilot project to build not simply an electronic repository of patients' records but a trusted national doorway to healthcare. Only then will the long-awaited e-Health Platform make technology serve health, rather than asking patients to serve technology.
