Aarogya Setu – What more could this bridge connect? by Dr. Senthil, @drsenthilp & Jai Ganesh

Is the Novel Corona Virus here to stay? The opinion is different among the experts! In the absence of a vaccine to prevent or medicine to cure, how effective are the lockdown and social distancing going to be in flattening the curve? While the world waits for answers, COVID19 has become one of the biggest mystery humankind has encountered in recent time. Lives of more than half of the world’s population have suddenly become uncertain.

Aarogya Setu, India’s flagship COVID app has become the most downloaded contact tracing app in the world. Should an app with such a tremendous reach be limited in terms of its utility only for the current crisis – the COVID? Or, do we extend its use for an e-healthy connect with citizens?

Unabated lockdown is disastrous for the global economy; people across countries are raring to get out, go to work and move as before. As governments are exploring an extension of lockdown, it will have dissents and implementation hitches. Social distancing is expected to become the new normal.

Mobile technology has emerged as the new hope in containing the spread. Resultantly, hundreds of COVID related mobile applications and web portals have been developed globally in the last two months alone. Majority of such applications focus on contact tracing, a pivotal step to localize and contain the spread.  

A study by Oxford University’s Nuffield Department of Medicine found that a contact tracing app could help stop the spread of coronavirus if around 60 per cent of the whole population and 80 per cent of those with a smartphone used the software alongside other interventions. The research suggests wide adoption of the app and speed of use are crucial factors in effectively slowing the spread of the virus and has the potential to substantially reduce the number of new coronavirus cases, hospitalizations and ICU admissions. [1]

Quality of the data from principal sources and their analysis is quintessential for such effectiveness. However, the present thrust on contact tracing does let us think whether our confidence in the single measure is leading to a limitation of thoughts and processes. A national emergency like COVID will require considerable interdepartmental and multisectoral coordination (including the private sector) and real-time exchange of data/information between them. 

Among the COVID related applications launched in the recent times, Aarogya Setu, India’s flagship COVID app has become the most downloaded contact-tracing app in the world, even as it is not yet mandatory for citizens. The app developed by the Ministry of Electronics and Information Technology (MeitY), Government of India, is available for Android as well as iOS and has recorded more than 75 million downloads as we write this [2, 3]. Aarogya Setu (Health Bridge) had, in fact, replaced another app again from MeitY known as Corona Kavach (Corona Shield). Development of the app itself is a successful public-private partnership (PPP) with volunteer engineers from the private sector, including some of the start-ups working together with MeitY towards this national cause [4, 5]. 

Aarogya Setu apt to its name is more comprehensive in terms of scope and aims to inform the users regarding risks, best practices and relevant advisories about the containment of COVID-19. Apart from contact tracing the app seems to be aimed at augmenting the initiatives of the Government of India, particularly the Department of Health, in proactively reaching out to the citizens. 

Presently, the three COVID dedicated health facilities designated as COVID Care Center (CCC), Dedicated COVID Health Centre (DCHC), Dedicated COVID Hospital (DCH) [6], the labs/test centres are connected via the Integrated Disease Surveillance Programme (IDSP) under the oversight of National Center for Disease Control, Government of India. Under IDSP data is collected on three specified reporting formats, namely “S” (suspected cases), “P” (presumptive cases) and “L” (laboratory-confirmed cases) filled by Health Workers, Clinicians and Laboratory staff respectively. [7] As we have the necessary infrastructure and systems in place, further broader integration will help us implement a coordinated interdepartmental and multisectoral approach that is in line with the government’s vision and objectives. Further, we may like that the app empowers citizens and health volunteers to report suspect cases proactively.

Such flow of information from citizens and facilities may be connected to IDSP and the Ministry of Health and Family Welfare. It is also imperative that local administrative departments are also connected for necessary real-time information and swift action. We believe fostering such real-time communication and flow of information will take us to the next level of COVID management, ahead of most countries. 

Thanks to the efforts of the Government, Aarogya Setu is today, known to almost one-sixth of the global population. Should an app with such a tremendous reach be limited in terms of its utility only for the current crisis – the COVID? 

We are hugely optimistic about the utility of Aarogya Setu beyond its current scope. While the focus of the app right now is on the current emergency, we wish and hope that the awareness, reach and potential of this app can be leveraged in terms of extending the e-healthy connect with the citizens further.

Mindmap – Aarogya Setu

Mindmap – Aarogya Setu – Authors: Dr. Senthil & Jai Ganesh

Aarogya Setu Bridging Health Services for Citizens by Dr. Senthil, @drsenthilp and Jai Ganesh

Conclusion

We have a dream for Aarogya Setu in being the gateway for the evolution of a National Digital Health Eco‐system (NDHE). As rightly pointed out in the final report of the National Digital Health Blueprint (NDHB), omni‐channel access/delivery are an important capability required in the NDHE. The NDHB with its alignment to the vision of National Health Policy (NHP) 2017 as well as the SDG’s relating to the health sector recommends a pragmatic agenda to start with, adopting the principle of ‘Think Big, Start Small, Scale Fast’ [8].

Given the significant reach of smartphones and the potential for their further spread, the NDHB emphasizes the ‘mobile first’ principle for delivery of majority of stakeholder‐facing services. Annexure VII of NDHB mentions an illustrative list of digital services to be provided for the citizens/patients. We hereby present a mind map for the next avatar of Aarogya Setu with the wish that it spans a wide spectrum of citizen-centric healthcare services. The list of digital health services projected in the mind map is merely indicative and by no means exhaustive. We believe the implementation of the NDHB might shape the future scope and prospects for Aarogya Setu.

References:

1. Coronavirus: contact tracing app could stop spread if 80 per cent use it https://www.sciencefocus.com/news/coronavirus-contact-tracing-app-could-stop-spread-if-80-per-cent-use-it/(Accessed 25 April 2020)

2. Aarogya Setu app crosses 75 million downloads link (Accessed 25 April 2020) 

3. Aarogya Setu tops charts with 75 million downloads https://www.business-standard.com/article/current-affairs/covid-tracker-aarogya-setu-recommended-but-not-mandatory-clarifies-govt-120042401721_1.html (Accessed 25 April 2020)

4. Aarogya Setu is ahead of anyone else in privacy https://www.rediff.com/news/interview/coronavirus-in-india-he-helped-developed-the-aarogya-setu-app/20200421.htm (Accessed 25 April 2020)

5. What you could do with Aarogya Setu app https://www.rediff.com/news/interview/coronavirus-in-india-what-you-could-do-with-aarogya-setu-app-/20200423.htm (Accessed 25 April 2020)

6. Guidance document on appropriate management of suspect/confirmed cases of COVID-19 – Types of Covid-19 dedicated facilities link (Accessed 25 April 2020)

7. Integrated Disease Surveillance Project (IDSP) https://idsp.nic.in/index4.php?lang=1&level=0&linkid=313&lid=1592 (Accessed 25 April 2020)
8. National Digital Health Blueprint. Final Report dated 8^th November 2019, MoHFW, Government of India. (MoHFW NDHB Document – Final)
9. Guidelines for Home Isolation of very mild/pre-symptomatic COVID-19 cases from the MoHFW – [PDF Link]

Authors

---