The recently released Health Data Management Policy Draft proposes the creation of a health ID to centralise data storage and expedite access to patient data across medical institutions and platforms. In theory, this ID is voluntary in nature and will help enable individuals to be integrated into the National Digital Health Ecosystem. Having said that, there are some concerns relating to the introduction of said ID.
The questionable nature of the “voluntary” feature of registering for the health ID has been brought under the scanner, especially after Prime Minister Narendra Modi highlighted the important role that the digital health ID will play as part of the Covid vaccine delivery system. This is in addition to reports of doctors and healthcare staff in the government hospitals of Chandigarh and other locations being compelled to register for the ID despite it not being mandated.
Such a situation is particularly problematic if we examine the similarly voluntary nature of Aadhaar, with the Supreme Court explicitly stating that Aadhar could not be mandatorily linked to social welfare schemes in 2018. Despite this, Aadhar has been linked with several schemes including subsidy schemes for LPG connections (Pradhan Mantri Ujjwala Yojana), housing (Pradhan Mantri Awas Yojana – Gramin) and insurance (Aam Aadmi Bima Yojana) amongst more than 20 other welfare schemes. The Economic and Political Weekly has also reported how Aadhar has been used to deny basic rights including school enrollments and emergency medical services in the past.
By linking the creation of the health ID to Aadhar as well, we will be creating a structurally problematic and exclusionary framework. This kind of linkage can lead to very troubling results, with the lack of an Aadhar ID excluding individuals from obtaining a health ID and impeding their overall access to healthcare services. While the very origin of centralised ID’s such as the health ID and Aadhar is to reduce leakages and improve access for the poor, the system has not brought the expected results so far. The government payment scheme linked to Aadhar has seen several mistakes made with regard to payments, while citizens who are disabled or residing in remote areas have failed to be integrated into the system.
Furthermore, the storage of the health ID data in a centralised database has been met with contention, considering the growing research suggesting that storing data in centralised systems poses an added security threat. In more centralized models, a single entity is given special responsibility for handling and distributing user information. This entity has privileged access to information that regular users and their devices do not. In decentralized models, on the other hand, the system doesn’t depend on a central authority with special access. A decentralized app may share data with a server, but that data is made available for everyone to see—not just whoever runs the server. While neither system is perfect, a consensus has begun emerging regarding which method provides more privacy to users. Globally, this has translated to a gradual shift towards such systems over the past few years
The digital health ID has the potential to have a positive impact on the healthcare infrastructure in the country, promoting integration and reducing leakages. The idea of a decentralised system of storage must be promoted, while the ‘voluntary’ nature of this model must be closely monitored. Scaling and implementing such a program comes with its fair share of challenges and it is imperative for citizens to realise its importance and play an active role to help ensure it is a success.
Gautam Kathuria is the Policy Analyst at The Dialogue.
