Why National Health ID Without Laws Is Another ‘Aadhaar Fiasco’

Govt claims that the National Health ID is critical to providing universal healthcare to Indians. But at what cost?

Image used for representational purposes.

(Photo: Erum Gour / The Quint)

The National Health Authority has invited consultations as part of the National Digital Health Mission for the National Health Data Management Policy. This policy essentially asserts the government's intent to promote the newly announced National Health ID along with the National Health Stack.

While the policy talks extensively about the Health ID and how data will be shared and regulated, it is no law. In April 2018, the Ministry of Health and Family Welfare even carried out public consultations for a law Digital Information Security in Healthcare Act (DISHA). This new draft policy undermines the parliament’s role of law making while ignoring past consultations and judgments of the Supreme Court.

‘Private Interests’ Of New National Health ID

According to the government, the National Health ID is critical to providing universal healthcare to Indians, and it will be done by creating a digital health industry around it. The government claims to be implementing the National Digital Health Blueprint in building this digital health ecosystem. Multiple Supreme Court judgments have orders that require the government to pass laws to issue an ID.

The answer to why the government is then ignoring Supreme Court orders – and is keen on promoting new digital systems – lies in the private interests of this new National Health ID.

To understand the National Health ID and the National Digital Health Mission, one needs to look closely at National Health Stack. The National Health Stack intends to replicate IndiaStack, a set of APIs of Aadhaar, eKYC, eSign, UPI, DigitalLocker.

HealthStack is termed as another layer on top of Jan Dhan-Aadhaar-Mobile or IndiaStack for Healthcare.

IndiaStack, as a brand, is promoted by Indian Software Products Industry Roundtable (iSPIRT), which includes Aadhaar volunteers with Nandan Nilekani as advisor/mentor. iSPIRT claims to be a think tank, but should be considered more as a lobby group which represents business interests for the Indian IT industry.

• According to the government, the National Health ID is critical to providing universal healthcare to Indians, and it will be done by creating a digital health industry around it.
• The government claims to be implementing the National Digital Health Blueprint in building this digital health ecosystem.
• Multiple Supreme Court judgments have orders that require the government to pass laws to issue an ID.
• The answer to why the government is then ignoring Supreme Court orders lies in the private interests of this new National Health ID.
• It is the Indian IT industry – and not the healthcare industry – that is pushing the government to build giant health databases and information-sharing infrastructures to collect health data of citizens.

Implications Of Linking Aadhaar With Existing Health Schemes

The current version of Health Stack has a few sub systems like a health data repository, a consent manager to share health data, doctor registry, healthcare facility registry and an insurance claims system for Ayushman Bharat. The National Health ID is a key element for sharing data from health repositories to hospitals. The policy on National Health Data Management is just a codification of this Health Stack architecture.

A law regulating this system, unlike a policy, will hamper Health Stack’s capacity for experimentation or more widely regarded as innovation by the industry and government. Something that was common with Aadhaar.

The usage of Aadhaar inside healthcare was something Nandan Nilekani promoted at UIDAI. Starting with the promotion of Aadhaar for usage in healthcare schemes, promoting Aadhaar linkages with health information systems, the groundwork for Health Stack was set long back.

By linking Aadhaar to existing health schemes, the government has already linked a significant amount of health data. This information can help the private sector monetise it in the guise of innovation.

The government is now enabling this data sharing with the National Health Stack.

Who’s Pushing The Govt To Build Giant Health Databases & Why?

It is the Indian IT industry – and not the healthcare industry – that is pushing the government to build giant health databases and information sharing infrastructures to collect the health data of citizens. These information infrastructures or centralised data infrastructure are a direct result of the shift that India took post-Aadhaar because of Nandan Nilekani’s vision of an information economy.

The National Health Stack is part of that vision, where the IT sector aims to use these learnings for profit and to export them abroad. But they do come at a cost to citizens who are being forced to be part of these systems without laws.

The first proposal to create a National Health Stack was made in 2017 by iSPIRT. This proposal came out as an official document from NITI Aayog in 2018, of the government’s interest to build Health Stack. After consultations for Health Stack by NITI in 2018, the idea was further evolved into the National Digital Health Blueprint in 2019, with its own further consultations by the Ministry of Health and Family Welfare.

There were a wide range of issues that emerged during these consultations, but all of them remain an issue with no data protection law.

Yet another consultation and policy to build these systems is to buy time to experiment and scale it before a law regulates this upcoming industry.

Policy For National Health Data Management: Why Is This Being Pushed Without A Law?

The policy for National Health Data Management is just another exercise inside the government to promote a new industry for the private sector. The main question to ask about the policy is why is this being pushed without a law? iSPIRT not only proposed the health stack, but has privately raised money from private investors to build it for the government. All of this without any formal agreement with the government and under the name of welfare. This is a similar tactic how Aadhaar was pushed onto every citizen without any law. Instead of public welfare, Aadhaar became an important asset for the Fintech industry. Similarly the private interests of Health ID are concerning without a law restricting its usage from the start.

(Srinivas Kodali is an independent researcher working on data, governance and the internet. He tweets @digitaldutta. This is an opinion piece, and the views expressed are the author’s own. The Quint neither endorses nor is responsible for them.)