Dr. Piyush Singla
India’s digital health ambitions are both timely and necessary. The Ayushman Bharat Digital Mission (ABDM) has laid the foundation for a national digital health ecosystem through unique health identifiers (Ayushman Bharat Health Account, or ABHA), registries of health facilities and professionals, consent-based data sharing, and interoperable health records. These are significant building blocks. As the system scales, now is an appropriate moment to reflect on what kind of digital health system India is consciously building-and to consider how early design choices can maximize long-term public value.
As India’s digital health stack evolves, its ability to deliver efficiency, equity, and affordability will depend on whether its core digital foundations remain open, interoperable, and publicly governed. To realize its full potential, the health stack must be designed, financed, and governed as a public good-much like essential physical infrastructure or core public utilities.
In economic terms, a public good is non-excludable and designed to maximize collective benefit. Applied to digital health, this means foundational elements-such as health identifiers, registries, consent frameworks, and interoperability standards-remain openly accessible, publicly governed, and insulated from commercial capture.
This approach is not theoretical. India has already demonstrated its effectiveness through digital public infrastructure such as Aadhaar and UPI, where open standards and public stewardship have enabled innovation, competition, and inclusion at scale. A similar design philosophy in health can unlock comparable system-wide gains.
The early momentum of ABDM is encouraging. Millions of health records are being generated and linked, hospitals are adopting digital workflows, and citizens are becoming familiar with digital health identifiers. Scale is an important first step, but the next phase must focus on translating this momentum into sustained value.
For many patients, health care still begins with a familiar ritual: carrying thick paper files from one hospital to another. These files often contain old prescriptions folded at the corners, fading laboratory reports, and handwritten notes whose meaning is often lost over time. Each visit requires retelling the same medical history, repeating tests because previous records are unavailable, and hoping that a critical detail has not been misplaced. A well-designed digital health stack can replace this burden with continuity-meaning a patient’s records follow the person rather than the file-reducing repetition, cost, and anxiety.
Ultimately, what matters is whether the system reduces duplicative tests, shortens patient journeys, improves continuity of care, lowers out-of-pocket expenses, and strengthens public health planning. These outcomes depend less on technology itself and more on how the system is designed and governed.
There are four reasons why a public good approach is essential. First, equity and inclusion: Health care delivery in India is highly heterogeneous, ranging from tertiary hospitals to small clinics and primary health centres in remote areas. If participation in the digital ecosystem depends on expensive proprietary software or closed platforms, smaller providers and vulnerable populations risk exclusion. Public funding of core digital infrastructure and open APIs ensures that participation is possible regardless of size or location, allowing innovation to occur at the edges without creating barriers at the centre.
Second, system efficiency and interoperability: Fragmented digital systems are costly. When hospitals, laboratories, insurers, and public programmes operate on incompatible platforms, the result is repeated diagnostics, delayed referrals, and administrative inefficiency. A publicly governed, interoperable stack enables seamless data exchange, reduces transaction costs, and supports continuity of care across all levels of the health system. International guidance-including from the World Health Organization-has consistently emphasized the importance of common standards and interoperability for safe, scalable digital health.
Third, long-term cost control and avoidance of vendor lock-in: Health systems are durable institutions, and digital choices made today will shape costs for decades. Proprietary systems can create dependence, making future upgrades expensive and complex. An open, standards-based public stack lowers switching costs, preserves institutional flexibility, and encourages a competitive market of solutions built on common foundations rather than in isolated silos.
Fourth, trust, privacy, and legitimacy: Health data is widely regarded as among the most sensitive forms of personal information. Countries that have successfully scaled digital health systems have typically done so with clear legal and institutional safeguards-such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States-that define permissible data use, ensure accountability, and establish penalties. In India, the Digital Personal Data Protection Act, 2023 (DPDP Act) provides a necessary baseline. However, a national digital health system will also require sector-specific operational rules, privacy-by-design architecture, and independent oversight to translate legal intent into sustained public trust. Such trust will be central to deepening adoption and ensuring long-term success.
Designing the digital health stack as a public good is an ongoing process that requires deliberate and coordinated policy choices. Core components such as ABHA, the Health Facility Registry, and the Healthcare Professional Registry should be explicitly recognized as national digital public infrastructure, supported by stable public funding for operations and maintenance. Open and well-documented APIs must remain the default, allowing multiple vendors and solutions to coexist while ensuring interoperability and data portability.
It is equally important to enable participation across the health system. Many public facilities and small private providers lack the resources or skills to adopt digital systems. Targeted financial support, shared digital services, and structured capacity building can bridge this gap. When combined with certification mechanisms that ensure compliance with national standards, such support protects public investments while expanding the ecosystem.
Governance is the other critical pillar. A multi-stakeholder digital health governance framework-bringing together the Centre, states, clinicians, technologists, privacy experts, and patient representatives-can provide oversight, monitor performance, and ensure accountability. Transparent reporting on uptime, data protection, interoperability compliance, and user outcomes would shift attention from headline enrolment numbers to the system’s real value.
Finally, success must be measured by outcomes rather than enrolments. Indicators such as reduced patient waiting times, fewer duplicate tests, faster insurance claims, improved referral completion, and lower out-of-pocket spending offer a more meaningful assessment of impact. Public dashboards tracking such metrics would strengthen accountability and guide iterative improvement.
Encouragingly, the financial implications of this approach are modest relative to the potential gains. Redirecting a small portion of existing digital health budgets towards sustaining core infrastructure, supporting facility digitisation, and strengthening governance could yield substantial efficiency dividends. In health economics, investments that reduce transaction costs and information asymmetry can deliver returns that exceed their upfront costs.
India is at a promising stage in the evolution of its digital health architecture. Like any large-scale public digital infrastructure initiative, the health stack is a work in progress. Decisions taken now will determine whether early gains consolidate into a shared national asset or fragment over time. By treating the digital health stack as a public good-open, inclusive, interoperable, and trusted-India can ensure that digital transformation steadily translates into tangible health system gains. India’s earlier digital public infrastructure initiatives suggest that when the foundations are public, innovation can flourish and citizens can benefit.
The author is an IAS officer and an MPH (Master of Public Health) alumnus of Johns Hopkins University, USA
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