A digital health mission needs to get all the fundamentals of the ecosystem right

  • Source: The Hindu – Page no 6/editorial – A scheme before its time
  • GS 2: Polity( health)

Context: Prime Minister Narendra Modi has announced the National Digital Health Mission, the most salient aspect of which is that all citizens will have the option of voluntarily opting for a Health ID, a 14-digit health identification number that will uniquely identify every citizen and will be a repository of their medical history.


  • Complete history: Illustratively, it will contain details of every test, every disease, the doctors visited, the medicines taken and the diagnosis.
  • Easy for patient: A person will, in theory, never have to haul around their reports.
  • More informed advice: The doctor who is examining the patient can give more well-informed advice because it is possible that patients may not consider aspects of their medical history relevant to share with a doctor, or sometimes may forget about them, but which may be valuable for a better diagnosis.
  • Convenient interface: This id can be created by using a person’s basic details and mobile number or Aadhaar number, and there will presumably be an app acting as a convenient interface.

However there are various challenges that still remain: The challenge of health care in India, as decades of research and the experience with the novel coronavirus pandemic have shown, can be expressed quite simply.

  • There are various other challenges apart from digital record keeping: There is no clear justification that the immobility of medical records is an insurmountable obstacle to the provision of affordable, high-quality health care in India.
  • Inadequate Infrastructure: There are too few hospitals with trained staff to cater to all Indians. here is only 1 bed for 2046 people and 1 for 90,000 people in state-run hospitals.
  • Lack of Doctors: India has over 1 million doctors(1 doctor per 10,000 people), of which 10% work in government hospitals & only 8 Lakh are active.;
  • Out of Pocket expenditure: about 65% of expenditure on health in India is out of pocket expenditure.
  • Other Challenges: expanding the health-care system will not be easy due to
    • India’s federal structure,
    • the size of its population — and a large rural one.
    • The cost of researching, finding and buying appropriate drugs and treatment,
    • Competing systems of medicine and the very challenging nature of health itself, 
  • Privacy Issues: Absence of a privacy law and little public awareness and control over their data, could be open to misuse. There is the danger that any large private insurance company could use sophisticated algorithms across the health and other databases to construct risk-profiles for people and make access to affordable insurance difficult.
  • Exclusion of the Poor: Also, data mining can prioritise certain rich demographics for their services and direct public and private resources to people who can afford a high premium for their services rather than to those who need them but cannot pay as much.

Conclusion: For a digital health ecosystem to work, it is important that the fundamentals be fixed from the ground up. Till then a digital health id right now is really a solution looking for a problem.

The Government’s claim that the PM CARES Fund is not a public authority is unacceptable

  • GS 2: Government Policy

Context: A petitioner/lawyer, Samyak Gangwal has filed a petition seeking that the PM­CARES fund to be declared as the “State” under Article 12 of the Constitution. Currently, the PMO operates the Fund, but says it cannot supply any information about the PM CARES Fund because it is not a public authority. 

About The Prime Minister’s Citizen Assistance and Relief in Emergency Situations (PM-CARES) Fund

  • It was set up to accept donations and provide relief during the Covid-19 pandemic, and other similar emergencies.
  • It operates as a public charitable trust with the trust deed registered on March 27, 2020.
  • It can avail donations from the foreign contribution and donations to fund can also avail 100% tax exemption.
  • It is different from the Prime Minister’s National Relief Fund (PMNRF) in following ways:
 PMNRF (Prime Minister National Relief Fund)PM CARES Fund
Foundation & UseIt was established in January 1948 by the first PM, Jawaharlal Nehru to help the people displaced due to partition of India and Pakistan. It currently focuses on all kinds of natural disasters and calamities.It can also utilised for acid attack victims, cancer treatments, kidney transplants etc. PM CARES Fund was established on 27th March 2020 by PM Narendra Modi for helping people affected by COVID-19 pandemic exclusively.
MembersChairman: Prime Minister of India.Other members are from: Tata Trusts, representatives of FICCI, Congress President.Chairman: Prime Minister of India.  He has the power to nominate members.Other members: the Defence Minister, Home Minister and Finance Minister.
Donation limitMinimum donation amount: Rs 100.Allows micro donation of Rs 10.
Clarity of Use: It has been attached with all Centre and State-run hospitals and many private hospitals as well.As per reports, there is low liquidity of only 15% in the PMNRF, which makes it difficult to utilise it in case of emergency.As per reports, bulk of the corpus is invested in State Development Loans, Fixed Deposits etc. There is no clarity on its network with hospitals.There are no reports of low liquidity in PM CARES Fund, hence there won’t be constraints in using the funds. 
Who can contribute? It accepts only voluntary donations by institutions and individuals.Contributions flowing out of the balance sheets of the PSU’s or from the budgetary sources of Government are not accepted. It consists entirely of voluntary contributions from individuals or organisations and does not get any budgetary support.It can receive contributions from Public Sector Undertakings.

Problems in declaring it a part of ‘State’

  • The fund was not created by any statute or by any notification, but by the mere creation of a webpage.
  • The collection of funds does not go to the consolidated fund of India nor in the CFI.
  • Government stated that it is not a public authority.

However there still remain a few Issues in conflict

  • Tax exemption:  Those who contribute in this fund are eligible for tax exemption, for this an ordinance was passed to amend the Income tax act, 1961. Also donations to PM CARES Fund will also qualify to be counted as Corporate Social Responsibility (CSR) expenditure under the Companies Act, 2013.
    • Everything related to tax exemption is under RTI, thus this care should also come in the purview of RTI act.
  • Auditing: If the money is not going into the CFI(Consolidated fund of India) or CFI( Contingency fund of India), it means it is not audited by CAG.
  • Responsibility even as a trust: Section 19 of the Indian Trusts Act mandates the trustees to present full and accurate information of the amount and state of the trust property to the beneficiaries. Because of this statutory access, all information about the PM CARES Fund should be accessible as per Section 2(f) of RTI Act;
  • The Government advertisement says it is a pubic fund: A Government advertisement for the PM CARES Fund says: “PM announces new fund for people to donate towards Govt. fight against Coronavirus”. Another advertisement makes the claim, “MY Govt or Meri SARKAR”.
  • It receives Public money: It allows donations from PSUs.
  • It uses the government symbols: The designated symbols of the nation, the tricolour and the official ( website of the PMO, and grant tax concessions. Also all its members are government ministers.
  • Conclusion: The claim that the PM CARES Fund is not a public authority is absurd to say the least.

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