Article Text

Driving digital transformation of comprehensive primary health services at scale in India: an enterprise architecture framework
  1. Sunita Nadhamuni1,
  2. Oommen John2,
  3. Mallari Kulkarni1,
  4. Eshan Nanda1,
  5. Sethuraman Venkatraman3,
  6. Devesh Varma4,
  7. Satchit Balsari5,6,
  8. Nachiket Gudi7,
  9. Shantidev Samantaray1,
  10. Haritha Reddy8,
  11. Vikas Sheel9
  1. 1Digital LifeCare, Dell Technologies, Bengaluru, Karnataka, India
  2. 2The George Institute for Global Health, University of New South Wales, New Delhi, Delhi, India
  3. 3Argusoft, Gandhinagar, Gujarat, India
  4. 4Piramal Swasthya Management and Research Institute, Hyderabad, Telangana, India
  5. 5Emergency Medicine, Beth Israel Deaconess, Harvard Medical School, Boston, Massachusetts, USA
  6. 6Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  7. 7The George Institute for Global Health, New Delhi, Delhi, India
  8. 8BeeHyv Software Solutions, Hyderabad, Telangana, India
  9. 9Ministry of Health and Family Welfare, New Delhi, India
  1. Correspondence to Sunita Nadhamuni; sunita.nadhamuni{at}


In its commitment towards Sustainable Development Goals, India envisages comprehensive primary health services as a key pillar in achieving universal health coverage. Embedded in siloed vertical programmes, their lack of interoperability and standardisation limits sustainability and hence their benefits have not been realised yet. We propose an enterprise architecture framework that overcomes these challenges and outline a robust futuristic digital health infrastructure for delivery of efficient and effective comprehensive primary healthcare. Core principles of an enterprise platform architecture covering four platform levers to facilitate seamless service delivery, monitor programmatic performance and facilitate research in the context of primary healthcare are listed. A federated architecture supports the custom needs of states and health programmes through standardisation and decentralisation techniques. Interoperability design principles enable integration between disparate information technology systems to ensure continuum of care across referral pathways. A responsive data architecture meets high volume and quality requirements of data accessibility in compliance with regulatory requirements. Security and privacy by design underscore the importance of building trust through role-based access, strong user authentication mechanisms, robust data management practices and consent. The proposed framework will empower programme managers with a ready reference toolkit for designing, implementing and evaluating primary care platforms for large-scale deployment. In the context of health and wellness centres, building a responsive, resilient and reliable enterprise architecture would be a fundamental path towards strengthening health systems leveraging digital health interventions. An enterprise architecture for primary care is the foundational building block for an efficient national digital health ecosystem. As citizens take ownership of their health, futuristic digital infrastructure at the primary care level will determine the health-seeking behaviour and utilisation trajectory of the nation.

  • health systems
  • public health

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  • Handling editor Seye Abimbola

  • Twitter @oommen_john, @satchit_balsari

  • Contributors SN, OJ, MK, EN and SS conceptualised the paper. MK, EN, SV, DV and SS analysed the frameworks. SN, OJ, MK, EN, SV, DV, SS, HR and NG drafted and revised the paper. SB and VS provided critical feedback and revised the paper. All authors read and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.