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Accepted Paper:
Governing (through) healthcare: digital health infrastructure as a global public good
Sandra Baernreuther
(University of Lucerne)
Smriti Sharma
(University of Lucerne, Switzerland)
Sreya Dutta Chowdhury
(Universität Leipzig)
In 2020, the Indian state launched the Ayushman Bharat Digital Mission (ABDM). Part of this infrastructure has been declared as Digital Public Goods. Based on ethnographic research, we follow the creation of the ABDM infrastructure and discuss its implication for healthcare provisioning.
Long abstract:
In recent years, the Indian state has promoted the digitalization of healthcare services. On August 15, 2020, at the height of the COVID-19 pandemic, India launched the National Digital Health Mission as part of its Universal Health Coverage program. Now renamed the Ayushman Bharat Digital Mission (ABDM), it is conceived as an open, modular ecosystem, facilitating the participation of both public and private actors. In the ABDM, the government provides health building blocks, which have been declared as Digital Public Goods (DPGs). These health building blocks collect and converge basic health system data on doctors, institutions, and patients. In doing so, the ABDM envisages bridging the gap between different stakeholders through a smoother exchange of data. Based on ethnographic research in three different sites and states in India, we follow the creation of the ABDM infrastructure and discuss its implication for healthcare provisioning. Although built on principles of openness and compliance, we examine how these DPGs often lead to inconsistencies and center-state conflicts. We also point to the dangers of conceptualizing digital infrastructure itself (rather than medical services) as public goods.