The Digital Divide: Addressing the inaccessibility of essential medical aid in rural India
Health in India is a state subject. Rural communities have long struggled to maintain access to quality healthcare services. And access to healthcare services is critical to good health, yet rural residents face a variety of access barriers. The public health system in the country persists to face formidable challenges even though the implementation of the National Rural Health Mission has been made since 2005.
Now, “Digitalization” adds a thick layer of EXCLUSION. As healthcare continues to lean on technological innovations, a new social determinant of health is sprouting out: the Digital Divide. The digital divide is the breach between those who have access to technologies and the digital literacy to work them and those who don’t.
With people hunkering down due to COVID-19, more and more services are being offered online — healthcare being one of them. Telemedicine has become a popular alternative to traditional doctor appointments as health facilities seek to minimize in-person visits. While this virtual method of care has expanded access for some, there is a wide range of the population to whom it has been shut, especially the rural population.
Government makes policies and thinks the entire country runs on apps. But only the privileged, educated and urban population benefits from this. This Digital Divide is hampering especially during the vaccine drives today. The Cowin portal, which was opened for registration for the 18–44 age group on May 1, has come under the scanner for its potential to exclude those on the other side of the digital divide given that registration is mandatory. Digitally illiterate, mainly in the rural population have been left out of this new vaccination process. This disconnectivity between India’s reality and the government’s scheme has prompted criticism widely.
Some describe the big modern-day hospitals as “monuments to disease”. As long as the hospitals function as institutions only for ‘Curative Care’ that is detached from the larger social, economic, cultural, and political context of the people’s which mainly determines their health. Even this Curative Care is unfortunately unaffordable to many of the common people, especially today, where the private hospitals are much unaffordable for COVID-19 treatments.
The government’s policy and its execution from its procurement, pricing, supply, and access to the vaccine itself is an inequity. India’s vaccination plans are missing detailed district plans and social mobilization strategies to reach vulnerable communities.
Hearing a suo motu case recently, the Supreme Court asked the government to “wake up and smell the coffee”, stressing a ‘digital divide’ causing unequal access to COVID-19 vaccines in India.
Table 1 shows the socio-economic group of smartphone users between the age group 18 to 44 years, where unsurprisingly, the rich, the urban and the urban upper castes and the men are more likely to own Internet-enabled smartphones as compared to women and the poor castes and poor class people.
Table 2 shows a state-wise comparison of smartphone users in the 18 to 44 age group with the proportion of those vaccinated with at least one dose as of June 1, i.e. exactly a month since the inclusion of this age group.
Digital connectivity is key to ensuring that nobody is left behind in COVID-19 vaccine delivery efforts. As an immediate step, the country embarking on the vaccine rollout should assess the connectivity needs in health clinics, schools, and other community facilities that will house, manage, and distribute vaccines to the local population. Implementation of rapid connectivity solutions for key facilities and community centres in rural areas should be done, as Governments, in partnership with private sector operators, should consider a range of policy options to expand broadband access and capacities like a temporary release of the frequency spectrum and a review of the rules governing the use of Universal Service Fund (USF) to address connectivity gaps, particularly in rural communities.
Today, a sizeable population of India is struggling to get a shot of the life-saving vaccine — some in the absence of an Internet-enabled smartphone, some due to ignorance of the registration process, some for not knowing the only language (English) the portal is available in, and the rest, in navigating through the complex multi-step journey on the portal for freeing a slot despite having the means.
Beyond the emergency response for equitable COVID-19 vaccine delivery and treatments, the country can grip this opportunity to strengthen the key underlying pillars of the digital economy, including digital infrastructure and skills across various sectors and applications, such as telehealth, digital government systems, online learning, and e-commerce, forging flexibility to future shocks.
In the meantime, it is also necessary to make progress towards digital equality within the country between different age groups, genders, and urban-rural communities, among others. Ultimately, investment in digital skills and literacy is an essential part of efforts to expand broadband access and usage.
By Nimmy Mathew Nimmy Mathew