Government of Maharashtra | Project PRAGATI
Concept Note: Digital Health and Diagnostics Component
Primary Healthcare Reimagined with Advanced Governance and Accessible Technology Integration (PRAGATI), ADB-supported.
Draft for discussion | Prepared October 13, 2026
Background and Rationale
The Maharashtra state cabinet has approved PRAGATI, an estimated INR 4,250 crore initiative to add 1,600 hospital beds across five districts over 2026 to 2031. The programme gives special priority to the prevention, screening, diagnosis and treatment of non-communicable diseases (NCDs), including diabetes, hypertension, heart disease, chronic kidney disease, COPD, stroke, mental health, diabetic retinopathy and fatty liver, and strengthens screening for breast, cervical and oral cancers. Around 70% of funding is expected through an Asian Development Bank loan, with 30% from the state government.
Physical capacity alone will not improve outcomes. The Digital Health and Diagnostics component addresses the gap between facilities and timely, coordinated care: patients are screened late, diagnostic reports do not reach clinicians on time, records are fragmented across facilities, and specialist capacity is concentrated in a few centres. This component makes digital records, diagnostics and telemedicine the connective tissue of the PRAGATI network.
Budget (Indicative)
The overall PRAGATI programme is estimated at INR 4,250 crore, with the 70/30 funding split as follows:
| Funding | Amount (indicative) |
|---|---|
| ADB loan (approximately 70%) | INR 2,975 crore |
| State government share (approximately 30%) | INR 1,275 crore |
| Total | INR 4,250 crore |
Note:Indicative split for discussion; final allocation is subject to project appraisal.
Objectives
- Establish a unified electronic health record (EHR) for every PRAGATI patient, linked to the Maharashtra Health Technology Mission and the national health stack.
- Digitise diagnostic workflows (laboratory, radiology, imaging and screening) with results routed to the treating clinician in near real time.
- Scale telemedicine and tele-diagnostics so district and sub-district facilities can access specialist opinions from the Kolhapur, Nanded, Latur, Nagpur and Pune hospitals.
- Enable population-level NCD and cancer screening registries that drive call-recall, follow-up and outcome tracking.
- Provide real-time governance dashboards for the state, district and facility levels, supporting ADB reporting and results-based monitoring.
Scope of Component
| Area | Proposed scope | Primary users |
|---|---|---|
| Digital health records | Patient registry, unique health ID, longitudinal EHR, consent management | Clinicians, record staff, patients |
| Diagnostics | LIMS and PACS integration, digital reporting, sample tracking, teleradiology and telepathology | Lab and radiology staff, specialists |
| Screening programmes | NCD and cancer screening registers, camp data capture, referral and recall workflow | Community health workers, PHC and district teams |
| Telemedicine | Video consultations, store-and-forward imaging, hub-and-spoke specialist support | Facilities, specialists, patients |
| Governance and analytics | Dashboards, KPIs, data warehouse, audit trail, ADB results framework reporting | State and district administration, PMU |
System Architecture
The architecture is a layered, interoperable design built on open standards (HL7 FHIR, DICOM, LOINC, SNOMED CT and ICD-11) so that systems can exchange data with the Ayushman Bharat Digital Mission (ABDM) and state platforms. Components are hosted in a state data centre with a disaster recovery site, and deployment follows the Government of India data protection and cybersecurity norms.
Layers
| Layer | Components | Function |
|---|---|---|
| Access channels | Clinician web and tablet apps, mobile app for CHWs, patient portal and SMS/IVR, kiosks at camps | Entry points for all user groups, with offline-capable data capture |
| Application services | EHR and OPD module, screening registry, LIMS, PACS/RIS, telemedicine, referral engine, pharmacy and inventory | Core clinical and diagnostic workflows |
| Integration layer | API gateway, HL7 FHIR interoperability engine, message queue, master data and terminology service | Standards-based exchange with ABDM, state systems and devices |
| Data platform | Operational data store, data warehouse, analytics and AI/decision-support modules, de-identified research data set | Reporting, population health analytics and clinical decision support |
| Infrastructure and security | State data centre, cloud burst capacity, identity and access management (role-based), encryption, audit logging, backup and DR | Availability, confidentiality, integrity and compliance |
Key design principles
- Interoperability first: every system publishes and consumes FHIR resources and uses the health ID as the common key.
- Hub-and-spoke model: diagnostics and specialist reads are centralised at the regional hospitals and served to spoke facilities.
- Resilience for low-connectivity sites: local caching and store-and-forward synchronisation.
- Privacy by design: consent-based access, pseudonymised analytics and compliance with the Digital Personal Data Protection Act, 2023.
Implementation Approach
Phased Rollout 2026 - 2031
| Phase | Timeline (indicative) | Key outputs |
|---|---|---|
| Phase 1: Foundation | Year 1 | Governance set-up, data standards, health ID linkage, EHR pilot in two districts, network and data-centre readiness |
| Phase 2: Scale-up | Years 2 to 3 | Full rollout across five districts, LIMS/PACS integration at hospitals, telemedicine hub operational, screening registries live |
| Phase 3: Optimise | Years 4 to 5 | Analytics and decision support, interoperability with national registries, sustainment and handover to state operations |
Governance (Indicative)
A Project Management Unit (PMU) would own day-to-day delivery across the five districts, coordinating vendors, standards and reporting. Oversight would sit at three levels: the state (Health Department and the Maharashtra Health Technology Mission), the district administration and facility leadership, each using the governance dashboards for results-based monitoring against ADB reporting requirements.
Note:Indicative structure for discussion; not part of the approved scope.
Expected Outcomes and Indicators
- Share of PRAGATI patients with a unique health ID and digital record (target to be fixed at appraisal).
- Turnaround time for diagnostic reports, from sample collection to clinician review.
- Number of people screened for NCDs and breast, cervical and oral cancers, and proportion referred and followed up.
- Number of teleconsultations and tele-diagnostic reads per month across the hub-and-spoke network.
Note:Baseline values and numerical targets are to be established during project preparation and are not specified in this note.
Key Risks and Mitigation
| Risk | Mitigation |
|---|---|
| Fragmented legacy systems and data quality | Data cleansing and standards mandate; phased migration; master data governance |
| Limited digital skills at facility level | Role-based training, digital champions, helpdesk, simple user interfaces |
| Connectivity gaps in rural areas | Offline-first apps, local caching, satellite or fibre backup links |
| Data privacy and cybersecurity | Consent framework, encryption, audit trails, periodic security audits, DPDP Act compliance |
| Sustainability after loan period | Budgeted O&M from state funds, vendor transition plan, in-house capacity building |
Next Steps
- Validate the scope and architecture with the Health Department, the Maharashtra Health Technology Mission and the PRAGATI Project Management Unit.
- Complete a baseline digital readiness assessment of the five districts and the four hospital sites.
- Finalise procurement modality, cost estimates and results framework for inclusion in the ADB project documents.
Source Note
Source note: Digital Health News, “PRAGATI Initiative to Add 1,600 Hospital Beds Across Five Maharashtra Districts,” updated September 11, 2026 (digitalhealthnews.com). Architecture, scope and timelines are indicative proposals for discussion.