Ayushman Bharat Digital Mission (ABDM)- 2020

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Policy Update
Riya Singh


Background

The Ayushman Bharat Digital Mission (ABDM) is an initiative that was introduced by the Government of India as a historic move to establish a national digital health infrastructure. It is a continuation of the former National Digital Health Blueprint and the National Digital Health Mission. The objective is to create a national health ecosystem through federated architecture and interoperable digital public goods, which connects patients, providers, health professionals and facilities regardless of geography and organisational silos.

The driver of the Mission was various: disjointed health-data systems, high out-of-pocket spending, the necessity of real-time information to facilitate care coordination, and the aim of India to achieve universal health coverage. It was announced that it would roll out nationally on 27 September 2021 when the pilot started on 15 August 2020 in six Union Territories. 

The essence of ABDM is that all citizens will have a special health ID (ABHA – Ayushman Bharat Health Account), all health practitioners will have a registry record, all facilities will have a registry, and standardised digital transactional aids will support smooth care across environments. 

Functioning

The major building blocks of ABDM include: (i) ABHA (Ayushman Bharat Health Account) of individual citizens; (ii) Health Professional Registry (HPR); (iii) Health Facility Registry (HFR); (iv) Unified Health Interface (UHI); and (v) interoperable electronic health/medical records standards. 

The Mission is run through a nodal implementation agency, National Health Authority (NHA). States and Union Territories have to balance their health-IT systems, make the facilities/professionals register, and promote the digital ecosystem at the point of service. Assisted or offline forms of ABHA registration can be used in centres to cover the areas with substandard connectivity.

At the user level, a citizen may enroll in an ABHA through the ABDM portal or mobile application, connect his health records with the participating providers, and give consent to data sharing, as well as receive digital consultations, e-prescriptions, diagnostics and longitudinal health records. The ecosystem aims at minimizing loss of paper records, repetition of investigation, and lack of continuity of care. 

The Mission puts more emphasis on open-source, standards-based architecture (Digital Public Goods) and federated data exchange as opposed to centralised data storage. This enables various states, hospitals and clinics to be connected to the architecture without compromising on privacy, security and user-consent mechanisms.

Performance 

ABDM has achieved great milestones since its national implementation which began in late 2021. As of February 2022, over 15 crore (150 million) ABHA IDs were already created. According to academics, the system had registered approximately 400 million beneficiaries and 273 million connected health records by June 3, 2023. 

Such figures denote high adoption but also highlight the youthfulness of longitudinal record-linkage and the use of the entire digital ecosystem. The degree of implementation differs among states, though more hospitals and primary care establishments are becoming members of the Health Facility Registry (HFR)  and Unified Health Interface (UHI) platforms. Studies show that the Mission is a landmark move in the quest to make India a single, citizen-oriented health ecosystem. 

In addition to this, introducing modes of assisted registration, offline systems and reinforcing infrastructure in under-served regions are included in the performance curve. Nevertheless, enduring results, including decrease in redundancy, cost reduction, better health care results, are not fully demonstrated.

Impact

Over 67 crore Ayushman Bharat Health Accounts (ABHA) have been created. More than 42 crore health records have been linked to ABHA. Over 1.3 lakh facilities are ABDM-enabled, including more than 17,000 private facilities. 3.3 lakh health facilities and 4.7 lakh healthcare professionals have been successfully registered in the National Healthcare Providers Registry

The ABDM has the transformational potential of the Indian health system. The Mission minimizes the discontinuity and fragmentation of health care by allowing citizens to have their health history with them when they move across facilities. It has enhanced access to health-services data, enhanced portability, made telehealth possible and preconditions data-driven health-policy making. It is perceived by scholars as consistent with Sustainable Development Goal 3 (Good Health & Well-being) and SDG 9 (Industry, Innovation & Infrastructure). 

Practically, it allows healthcare providers to get access to shared records, improved coordination, reduced redundant investigations as well as the possibility of reduced out-of-pocket costs. To the citizens living in remote or under-served regions, ABHA IDs provide identity within the digital health ecosystem, the digital equivalent of a master patient index in IT terms. 

The data layer, in the wider meaning of governance, allows health administrators and policymakers to track disease burdens, service use and outcomes in near real-time – in support of India’s drive to universal health coverage and evidence-based policy.

Emerging Issues

Although there is a great momentum, some challenges still persist:

  • Interoperability gaps: Some state health IT systems lack full alignment and compatibility resulting in the incomplete data flow.
  • Digital divide: In rural/ tribal, there is poor infrastructure (internet, power, devices) which is a hindrance to uptake of ABHA and digital services.
  • Privacy and consent issues: Massive collection of health data presents the problem of user consent, data security, risk of misuse and regulation.
  • Provider adoption: Not all small clinics and providers have adopted the ABDM ecosystem, which prevents network effects.
  • Fairness in use: Mere registration (ABHA) does not imply meaningful use- sidelined citizens might still be a barrier to digital health services.
  • Outcome measurement: As the inputs (IDs, registries) are increasing, evidence of health outcomes improvement, cost savings and reduced fragmentation is yet to be seen.
  • Governance & accountability: The accountability of the state level, monitoring and redressal of grievances to the users and the quality of data capture is still weak in some aspects of the system.

Way Forward

The following measures are essential in order to achieve the maximum potential of ABDM:

  • Quickly integrate at the state level through technical assistance, funding and capacity-building to bring legacy systems up to standards of ABDM.
  • Close the digital divide in rural, tribal and remote communities with connection initiatives, access to devices and community health workers (digital).
  • Enhance privacy, consent and data governance systems, such as effective regulations, publicity audit systems and awareness initiatives.
  • Encourage provider adoption and incentives to smaller clinics, diagnostic centres and primary care to access the ecosystem.
  • Develop equity and usability, whereby ABHA and digital health services should be modeled after vulnerable populations (elderly, low literacy, differently abled).
  • Establish outcome-monitoring systems that will monitor cost-saving, duplication prevention, health-outcome and user-satisfaction, not raw-registration statistics.
  • Promote innovation and local solutions: apply AI/ analytics to the digital health infrastructure to predictive care, early intervention and disease surveillance.
  • The ABDM can be the backbone of digital-public-health infrastructure in India in case it is effectively implemented, and it transforms primary care, referral systems, health analytics, emergency response, and universal health coverage.

Conclusion

The Ayushman Bharat Digital Mission represents a bold step in India’s health-policy journey-the shift from episodic, facility-based care toward a continuous, citizen-centric, digitally-enabled health ecosystem. While the early numbers on ABHA registrations and health-professional/facility registries signal momentum, the true test lies in translating this infrastructure into better health outcomes, greater equity, and lower out-of-pocket burdens, especially for India’s vast underserved populations. The next phase demands a pivot from “scale” to “quality of use”-from IDs issued to improved lives; from registries launched to meaningful health journeys enabled. In doing so, ABDM may not only underpin India’s move to Universal Health Coverage, but also position the country as a global exemplar of digital-public-health infrastructure.

References

About the Contributor:

Riya Singh is a Research Intern at IMPRI. She is a student of the Master of Arts in Public Policy and Governance at the Tata Institute of Social Science, Hyderabad and holds a bachelor’s degree in Political Science from the University of Delhi. Her research interests lie in government policy and data analysis.

Acknowledgement:  The author sincerely thanks Ms. Aasthaba Jadeja, Ms. Bhaktiba Jadeja and the IMPRI team for their valuable support. 

Disclaimer: All views expressed in the article belong solely to the author and not necessarily to the organisation.

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