Strategic Integration of Artificial Intelligence in Public Health System: Direction Toward a Paradigm Shift

INTRODUCTION India’s Ministry of Health and Family Welfare implements national health programs to prevent, control, and manage major public health challenges using evidence-based outcome-oriented strategies, although achieving universal health coverage persists as a major challenge. Existing Indian health programs, while comprehensive, require enhancements for optimal efficiency. Barriers to effective implementation of health programs include limited community participation, communication gaps, inequitable resource allocation, and ambiguous stakeholder roles.[1–3] The evaluation system needs to be robust with integrated accountability, community engagement, and inclusivity. This necessitates a paradigm shift, leveraging innovative methods and advancements to improve program planning, execution and thereby, outcomes. Emerging technologies, particularly artificial intelligence (AI) and machine learning (ML), are increasingly utilized in healthcare. The evolution of AI in public health, from early expert systems to contemporary predictive modeling and spatial analysis, represents a transformative advancement with limitless possibilities. India is slowly initiating the integration of AI into its public healthcare system, like in disease predictions and virtual chatbots, but it is yet to be integrated in planning and management of public health programs. CURRENT CHALLENGES The central and state health departments of India have been working toward improving health services, building an enormous infrastructure of publicly funded medical services, medical education facilities, high-quality laboratories, and research institutions. Various public health programs currently available to address the above health system verticals run into various challenges such as human resource challenge, accountability, fragmentation, monitoring, and ineffective patient education. How can AI help achieve this paradigm shift? AI and ML methods can be integrated and utilized at several stages of health programs in India. A strategic framework to integrate AI into the national health programs has been summarized in Figure 1, appended at the end.Figure 1: Strategic framework to integrate artificial intelligence in national health programsThe five key areas essential for the effective use of AI in implementing public health programs are: Data governance: Establishing clear and responsible policies for managing data. Upgrading data infrastructure: Investing in modern systems and tools to handle AI-driven analysis. Addressing workforce skills: Closing the gap in expertise needed to work with AI technologies. Fostering collaborative partnerships: Building strong alliances to amplify AI’s impact. Ensuring transparency and reliability: Utilization of validated and accurate AI models. Considering the abovementioned areas, the Indian government has undertaken measures to incorporate AI into the public healthcare system as follows: Designation of selected medical institutions as centers of excellence to promote AI based research and healthcare.[4] National Tuberculosis Elimination Program has collaborated with Wadhwani AI[5] to integrate AI-assisted TB-specific healthcare that includes screening for TB using cough sounds (cough against TB application), Interpretation of LPA results and in prediction of loss to follow-up. Media Disease Surveillance under Integrated Disease Surveillance Program is contributing to surveillance of infectious diseases by monitoring the updates on print media and electronic media.[6] The national telemedicine service of India has been using AI-based clinical decision support system in eSanjeevani platform.[7] EMPIRICAL ILLUSTRATIONS There are several case studies where AI has been used in community settings. Breast cancer is one of the most prevalent forms of cancer among women in India and has emerged as a significant public health concern. A promising thermography-based AI screening called Thermalytix has been developed.[8,9] Another simple yet reliable smartphone-based AI platform has been used for the detection of oral (potentially) malignant disorders in community settings.[10] It utilizes photographic images that can be taken by trained community health workers. However, these technologies can only be incorporated after being validated on larger cohorts and different demographics. Telemedicine is already being practiced in India.[7,11] AI can help in improving the accountability framework at various levels of health programs. One such framework is ASTA (ASHA self-tracking application), which is specifically designed for performance monitoring of ASHA workers.[12] The ethical dilemma and other challenges The use of AI in public health programs presents a significant ethical dilemma, balancing the potential for improved health outcomes against concerns about privacy, equity, and accountability. Ethical issues regarding the use of health data are a major concern in healthcare. The government needs to establish strict data protection regulations. A committee can be established for preparing the guidelines specifically for “public health decision making using AI.” Addressing generalizability: AI models may suffer from the issues of generalizability. A comprehensive algorithm that includes a maximum number of relevant factors related to the disease and has equitable representation of all communities, making it suitable for universal application. Accuracy: Regulatory mechanisms must ensure that AI tools are validated, accurate, and reliable. Such studies can form reliable evidence for AI-mediated policy making. In this context, the National Health Authority has signed a Memorandum of Understanding with IIT Kanpur for comparison and validation of AI models.[13] Operational challenges: The health system is likely to face several problems in the real world before these methods start running smoothly in the existing system. Implementation research on AI and ML methods shall identify these practical problems and barriers. CONCLUSION India is a rapidly advancing economic and technical power, and there are rapid strides in technology development in all fields. This development when complemented by healthy population would have synergistic effect on the national growth. To achieve optimum population health, there is a need to leverage these advancements in the management of health services. AI is being successfully used in healthcare service delivery and can be used in planning, evaluation and monitoring of national health programs through IT collaboration. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.