The Ayushman Bharat Digital Mission (ABDM), launched in 2021, represents a significant step toward modernizing India’s healthcare system by integrating digital technologies. Following a holistic, citizen-centric approach, ABDM is working to create a national digital health ecosystem that supports universal health coverage in an efficient, accessible, inclusive, affordable, timely and safe manner by leveraging the country’s existing IT infrastructure and technologies. These span both national digital infrastructure like Aadhaar and sector-specific innovations such as electronic health records, Health Management Information Systems, Internet of Things-enabled devices and tele-consultation platforms.
Data management is a key element of these efforts, since data fragmentation in healthcare creates significant barriers, disrupting the patient’s journey by making it difficult to access and share medical records across providers. This often leads to delays, repeated diagnostics and suboptimal care. ABDM has addressed this issue by creating a unified digital health ecosystem that integrates health records and services. Through secure and interoperable digital platforms, ABDM ensures that patients and healthcare providers can seamlessly access accurate and timely health information, improving care coordination and outcomes.
This article reflects on ABDM from a health systems perspective, understanding the existing gaps (both intrinsic to ABDM and rooted in wider systemic challenges) and the strategies implemented to address bottlenecks.
the ROLE OF ABDM IN INDIA’S HEALTH SYSTEMS LANDSCAPE
Digitally integrated innovations like ABDM bridge the existing gaps between different stakeholders across the healthcare ecosystem. The transformative impact of this approach is evident in ABDM’s remarkable adoption rates. As of April, 2025, over 770 million Indians now hold a unique Ayushman Bharat Health Account (ABHA), with over 530 million health records successfully digitized and linked. The ecosystem is supported by over 392,000 verified healthcare facilities and over 608,000 healthcare professionals, underscoring ABDM’s success in creating a unified digital health infrastructure that is both scalable and accessible.
The mission’s core building blocks include several key components that work together to create a comprehensive healthcare framework.
The first component is the ABHA ID, which is a unique identification number voluntarily generated with the informed consent of the individual, to standardize their identification process and streamline the management of their health records through the ABHA application. This standardization enhances service delivery and prevents information duplication.
The subsequent components developed as core building blocks of ABDM include registries for healthcare providers and facilities, the Unified Health Interface (UHI) and an approved drug registry, all aimed at creating a trusted, accessible digital health network. The National Healthcare Providers Registry is a centralized digital database that assigns verified healthcare professionals a unique ID, enabling secure identification, service access and integration across India’s digital health ecosystem. The registry of government-verified facilities shares essential institutional details, such as facility type, services offered, contact details and operating hours. Further, the UHI — the foundational layer of ABDM — provides a digital gateway that enables secure, consent-based data exchange across platforms, reducing healthcare fragmentation. It allows patients to discover, schedule and pay for a wide range of health services, while enabling providers to expand their digital reach. It also facilitates the exchange of personal health data, enhancing continuity of care and system interoperability. The drug registry, which is still in design phase, aims to offer standardized information about drugs available in the Indian market, including clinical, regulatory and supply chain details.
These components work together to improve the health workforce’s connectivity and ensure the availability of trusted resources. By streamlining access to authorized health facilities, healthcare providers and a standardized drug registry, ABDM promotes access to quality healthcare services and medicines, while its integrated digital framework aims to optimize resource allocation, thus supporting health financing. Together, these innovations bolster leadership and governance, fostering accountability and informed policymaking.
KEY CHALLENGES OF ABDM
However, implementing this ambitious program is not without its challenges, particularly in areas like governance, adoption by healthcare providers, infrastructure and community access.
Governance-Level Challenges: Healthcare is primarily a responsibility of state government in India, and the decentralized nature of this approach represents a significant hurdle. Each state operates its own health information systems, which complicates data integration and interoperability, leading to inconsistencies in ABDM adoption. Moreover, private sector involvement remains limited compared to the government sector. ABDM has made strides in that area, with 44% of its registered health facilities being private. But these are mostly small- to mid-sized establishments that lack sufficient awareness or incentives to participate in the mission by linking patient records, using UHI services or issuing digital prescriptions. This limited engagement, coupled with a lack of standardized protocols for health data exchange, further exacerbates the challenge of achieving seamless data sharing and utilization.
Healthcare Provider-Level Challenges: For healthcare providers, the transition to digital systems is complex. While digital solutions aim to streamline operations, they can inadvertently add to providers’ workloads, especially if they are not well-integrated with existing practices. Many providers already face high workload pressures, and the lack of phased integration of digital tools exacerbates this issue. Additionally, addressing low digital literacy among healthcare staff — mostly front-line workers such as Accredited Social Health Activists or nursing professionals — requires ongoing training and support. Changing longstanding practices, such as the use of manual prescriptions, to digital methods also demands a significant behavioral shift, making adoption a challenge — especially in busy healthcare settings.
Infrastructure Challenges: Infrastructure remains a critical concern, particularly in rural areas that lack the necessary IT networks and secure data facilities. Financial constraints further impede smaller facilities from investing in digital infrastructure, as many correctly perceive it as a recurring cost rather than a one-time investment, due to the ongoing demands of staff training, workflow integration and time commitments — even in cases where basic systems like Health Management Information Systems or digital support are already in place. This perception limits their willingness to adopt and sustain digital solutions. These regional disparities in digital readiness, combined with complex data governance requirements, impact the mission.
Community-Level Challenges: A lack of digital literacy among local communities is another key barrier to ABDM’s success. Many patients — especially senior citizens and women — struggle to use digital platforms, creating “intervention-generated inequality,” a phenomenon in which well-intended initiatives unintentionally exacerbate disparities in healthcare access. Additionally, awareness of ABDM’s services is low among the public. Without proper understanding, many patients remain unaware of how to obtain ABHA ID numbers or use digital health services, limiting the mission’s reach and impact.
INITIATIVES TO ADDRESS ABDM’S CHALLENGES
Despite these obstacles, ABDM holds promise for transforming healthcare delivery in India through secure data sharing, standardization and public-private coordination aimed at improving healthcare accessibility. Recognizing these challenges, the government has implemented several strategic initiatives to strengthen the digital health ecosystem, with ABDM serving as the cornerstone of a comprehensive response strategy.
The mission is complemented by various targeted initiatives that work together to address specific barriers, with a focus on:
- Developing a robust digital health ecosystem that addresses operational challenges and encourages cross-sector collaboration.
- Establishing data hubs, standardized protocols for health service delivery and regulatory frameworks, supported by a structured institutional foundation for implementation — i.e., a formal governance structure led by the National Health Authority and implemented through State Health Agencies.
- Implementing the National Digital Health Blueprint to ensure interoperability standards, facilitating seamless data exchange across platforms.
ABDM’s integration with other digital health platforms has enhanced accessibility and efficiency, by:
- Developing tele-consultation platforms such as eSanjeevani, which has evolved into a large-scale model offering tele-consultation at Health and Wellness Centres, facilitating doctor-patient connections that link providers based in district hospitals or urban health facilities with communities in remote areas, thus bridging accessibility gaps.
- Streamlining hospital workflows and data management through e-Hospital and Health Management Information Systems.
These programs enable healthcare workers to integrate digital technologies into their daily routines, improving service delivery across health centres. The government’s broader Digital India campaign has organized training workshops and literacy programs, equipping healthcare staff to effectively use digital health tools and ensuring that patients can navigate digital services. Tools like Aarogya Setu — a government-developed mobile app that now serves as the National Health App under ABDM — are enabling access to lab results, telemedicine, appointment scheduling and digital health records.
At the state level, several innovative implementation approaches have demonstrated ABDM’s potential. Kerala established coordinated state and district committees, and published user manuals in the local language, Malayalam. The committees were formed to oversee implementation and stakeholder coordination at multiple levels, while the manuals served as training resources to help healthcare providers adopt and navigate ABDM’s digital tools. Andhra Pradesh integrated ABHA adoption with its non-communicable disease screening programs through unified health apps. Uttar Pradesh emerged as a leader in scan-and-share technology, processing over 2.7 million digital Outpatient Department tokens — i.e., digital registration slips generated when a patient checks in at a health facility — across 533 facilities through its state health repository, “UP ke Swasthya Kendra.” In this model, patients scan a QR code at the registration desk when they check in, enabling the provider to access ABHA-linked demographic details, streamlining Outpatient Department registration and linking visits to their digital health records.
These coordinated efforts across the national and state levels showcase how systematic approaches and local innovations can effectively address implementation challenges while advancing ABDM’s goals of improved healthcare accessibility and standardization.
WAYS TO FURTHER STRENGTHEN ABDM
Strengthening ABDM has the potential to foster a resilient health system that integrates public and private sector data, facilities service delivery, and enhances the interoperability of health information. To achieve this, a focus on clear and enforceable data policies is essential, as are efforts to ensure data privacy and support platform connectivity. Establishing sustainable public-private partnerships and innovative solutions will further support the long-term success of digital health initiatives. Some of these solutions include:
Successfully Implementing the Digital Personal Data Protection Act: The effective implementation of this Act can contribute to increased awareness of the ABDM by establishing a legal framework for the secure and ethical handling of personal health data. The Act mandates the protection of personal health data, aligning with ABDM’s objective of facilitating the secure exchange of health information. By emphasizing data privacy, consent management and accountability, the Act fosters stakeholder confidence and encourages broader engagement with ABDM initiatives, with the goal of ultimately advancing digital health adoption in India’s healthcare ecosystem.
Fully Implementing a Federated Data Architecture: The use of a federated data architecture — a foundational principle of ABDM — aims to significantly enhance awareness and adoption of the program by addressing data privacy concerns, ensuring scalability and promoting inclusivity across diverse healthcare settings. In a federated system like ABDM, health data is shared across different healthcare facilities, but remains distributed and stored within individual facilities or regional repositories rather than being centralized. This decentralized approach supports data privacy and local autonomy while enabling interoperability, aligning with the principles of the Digital Personal Data Protection Act, and reassuring healthcare providers and patients that their sensitive health data remains under local control.
Strengthening the Virtual Private Cloud: Supporting the federated architecture is the use of Virtual Private Clouds — i.e., secure, logically isolated environments within public cloud platforms. Virtual Private Clouds allow ABDM to host digital health applications and registries in controlled environments with encrypted data exchange, customizable network configurations and stringent access management. This ensures that sensitive health information remains private, consent-based and accessible only to authorized stakeholders. Strengthening this infrastructure through standardized security protocols and continuous monitoring will further enhance ABDM’s capacity to deliver trusted, scalable and privacy-preserving digital health services across India.
Additionally, ongoing investments in training programs are crucial to equip healthcare workers at all levels with the necessary digital skills, enabling them to adapt swiftly to evolving technologies. While several initiatives have been introduced, there is continued need to strengthen data management practices with stringent privacy protections, along with a need for accessible interfaces that will encourage public engagement, promoting familiarity and trust in digital platforms. The mission’s effectiveness can also benefit from regular monitoring, evaluation and adaptive strategies, to ensure that it stays aligned with its core objectives, and that its goals are met and refined as needed over time.
Conclusion
ABDM has marked a significant milestone in India’s healthcare journey, addressing challenges such as fragmentation, limited accessibility and lack of interoperability. Its success depends on factors like clear data policies with strong privacy protections, sustainable public-private partnerships, capacity building, regular monitoring and adaptive strategies.
By providing digital health identifiers (ABHA IDs), a unified health registry and streamlined digital infrastructure, ABDM lays the foundation for a transformative, patient-centric healthcare system. Together with initiatives like e-Sanjeevani and e-Hospital, ABDM strengthens the delivery, coordination and governance of healthcare services across India, laying the foundation for an integrated, secure and patient-centric digital health ecosystem. Through innovation and collaboration among stakeholders, ABDM can bridge gaps in digital literacy, infrastructure and data security, fostering a resilient digital health ecosystem that supports universal health coverage.
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