By Lisa Wirthman, Contributor
Although technology holds great promise for solving global issues, it’s not a remedy for all challenges. The right partnerships, however, can greatly magnify the scale and impact of innovative digital solutions.
In India, two-thirds of the country’s 1.4 billion citizens live in rural communities with limited access to preventive healthcare—a national scale problem that is only heightened by the COVID-19 pandemic.
Dell Technologies’ Digital LifeCare platform has built a custom platform leveraging cloud technology and mobile apps to help the Government of India tackle this challenge, says Jeremy Ford, vice president of Dell Giving. The platform, which leverages mobile, cloud, and analytics applications, helps healthcare workers screen and treat non-communicable diseases (NCDs) like diabetes, hypertension, and cancer. But technology is only one part of the solution.
Even more vital is the collaboration with the government, healthcare, technology, and research organizations that helped design, create, and deploy the platform, Ford says. Part of a national population-based screening program launched by Indian Prime Minister Narendra Modi in 2018, Digital LifeCare aspires to improve access to healthcare services for more than 800 million individuals living in India’s rural communities.
“We are proactively looking at some of the most challenging issues facing humans and working together with a number of people inside and outside of Dell to understand where our technology can have an impact,” Ford says. “Our partnerships are really important to this goal.”
In India, citizens have relied for decades on a cohort of about 200,000 auxiliary nurse midwives to provide care primarily focused on maternal and child health, as well as infectious diseases, says Dr. Rajani R. Ved, executive director of India’s National Health Systems Resource Centre (NHSRC).
With limited resources, the country prioritized infectious diseases and maternal and child health, the health issues with the highest death rates, rather than lifelong preventive care. For example, “a woman may get pregnant multiple times, but her care is done when the baby is born,” says Ved. “The baby then gets vaccines in its first year and fifth year, and then it’s out of the health system.”
In recent years, however, the Government of India has broadened its national healthcare agenda to include the prevention and treatment of NCDs for adults over the age of 30.
The change in scope came after India’s Ministry of Health and Family Welfare found that while the country’s morbidity rate from infectious diseases such as tuberculosis and leprosy had dropped by half from 1990 to 2016, there was a nearly equal rise in morbidity from NCDs over that same time period.
“The country as a whole has seen a decisive shift in its disease burden over the last 25 years,” says HSD Srinivas, project director of health systems at Tata Trusts. “Two thirds of morbidity and mortality in India today are caused by NCDs.” As the program implementation partner for Digital LifeCare, Tata Trusts trains health workers and improves adoption of the platform.
It’s important to provide early screenings for NCDs, adds Digital LifeCare Director Sunita Nadhamuni, because the diseases have few symptoms until they are in the advanced stages. They are also chronic conditions that require lifelong treatment and disproportionately impact the poor, who have limited access to care.
Solving the Pain
Leveraging its army of nurse midwives, the government tasked its frontline workers with offering preventative screenings and treatment for NCDs to individuals over the age of 30. However, with each health worker responsible for an average caseload of about 5,000 people, the mandate added another layer of paperwork to an already onerous paper-based system.
Dell and its partners aimed to solve that pain point by creating Digital LifeCare, says Nadhamuni. Her team helped develop a suite of applications that enables India’s nurse midwives to create a digital health record for every patient, which can then be synced and stored in a government-run cloud to provide a continuum of care for individuals over time.
“It was necessary to have a robust IT system to be able to enroll people in the health system and track them across their lifespans, across geographies and across levels of care.”
—Dr. Rajani R. Ved, executive director, National Health Systems Resource Centre
“It was necessary to have a robust IT system to be able to enroll people in the health system and track them across their lifespans, across geographies and across levels of care,” says Dr. Ved.
To help healthcare workers learn how to diagnose and treat NCDs, Digital LifeCare also includes an Android app with interactive training modules for providing care. Tata Trusts then deployed personnel across the country to conduct about 4,000 training sessions, says Srinivas. Doctors using the LifeCare portal during patient examinations are given recommendations for diagnosis and treatment, enabling more standardized care. LifeCare also prompts health workers and doctors to follow up with vulnerable patients whose conditions might otherwise be overlooked
“Each of us contributes to the value of the program in our own way,” he says. “But this would not have been possible if all of us did not share the same vision.”
Nadhamuni cautions that while technology plays a vital role in implementing the shared vision of improved access to care, it’s not a standalone cure for such a complex societal issue.
“Technology is not the silver bullet that will solve the problem,” she says. Dell’s LifeCare platform supports the key players who are working on the solution by increasing the productivity of local health workers and enabling health care administrators and government officials to get a clear and reliable picture of how the initiative is progressing.
Partnering for Impact
While the format of the Digital LifeCare platform hasn’t significantly changed over time, the number of participants—and partners—has grown.
At the end of 2018, about 58,000 people were enrolled in the program, according to Dell. Today, enrollment tops 60 million. In addition to its support of the Ministry of Health and Family Welfare, Digital LifeCare counts among its partners the NHSRC, the All India Institutes of Medical Sciences (AIIMS), Tata Trusts, the National Institute of Cancer Prevention and Research (NICPR), the National Centre for Disease Informatics and Research (NCDIR), WHO India, and the National Informatics Center (NIC). Research partners Harvard University, St. John’s Research Institute, and the India Stack team at iSPIRT are also engaged.
The strong ecosystem of partners “is not just important, it is essential to the program’s success,” says Dr. Nikhil Tandon, the head of endocrinology at AIIMS, a group of public medical colleges funded by the central government.
“We are doing this so that human beings who are suffering from ailments can benefit. That has to be the delivery endpoint,” Dr. Tandon says.
“I’m a medical professional. I may have a thought in my mind, but I cannot translate that into efficient software. My collaborators at Dell are exceptional IT professionals, but they’re not equipped to understand the nuances of clinical medicine. The program administrators may not know information technology or medicine, but they understand deployment and how to manage resources in a more efficient way,” he adds. “We need all the stakeholders.”
Dr. Ved says it’s also important to include input from those who use the platform daily. “We have learned so much from our front-line workers who actually use the app and are able to tell us in great detail how it benefits them,” as well as where improvements can be made, she says.
As it continues to evolve over the next decade as a crucial piece in Dell’s Progress Made Real program, the Digital LifeCare platform can potentially expand to track all of India’s comprehensive primary healthcare, Nadhamuni says.
“We want to provide an integrated view of the individual for the health care workers so they can look at all of the patient’s health care information in one place.”
—Sunita Nadhamuni, director, Digital LifeCare
“We want to provide an integrated view of the individual for the health care workers so they can look at all of the patient’s health care information in one place,” she says. The LifeCare platform also has performance-based dashboards for health workers to help them monitor their screening and treatment numbers.
The partners are also working to help health workers identify and proactively reach out to current LifeCare users who may be at higher risk for COVID-19-related complications, according to Dr. Ved.
“As we go forward, our vision is that every individual, from birth through the different life cycles, is registered in a health system that is able to reach out to them and support them as they navigate life,” she says.