India is embarking on an massive, arduous program aimed at addressing a simple problem with complex ramifications, a task that has implications for the rest of the world. India’s Unique Identification Project, also known as Aadhaar, (which means “the foundation”) is a large scale biometrics project.
Its goal is to issue identification numbers linked to the fingerprints and iris scans of every single person in India.
There are 1.2 billion people in India, speaking more than 300 languages and dialects. The biometrics and the Aadhaar identification number will serve as a verifiable, portable, national ID. According to the webstie, it is by far the biggest and most technologically complicated biometrics program ever attempted. And given this scale, its impact could potentially spread to healthcare in very interesting ways.
This program is critical in India, where services and programs are only given out if the identity of the person can be verified. Bank accounts, jobs, insurance and governement services all require identification, much in the same way that we would use our social security number or driver’s license to obtain services. Aadhaar is a key piece of the Indian government’s campaign for “financial inclusion.” Without proper identification you are pretty much locked out of the formal economy.
When the Indian Parliment was deciding how to undertake such a massive project, they tapped an important local resouce, billionaire Nandan Nilekani, who is known as the the “Bill Gates of Bangalore.”
Aadhaar launched last September, just 14 months after Nilekani took the job, and officials armed with iris and fingerprint scanners, digital cameras, and laptops began registering the first few villagers and Delhi slum dwellers. More than 16 million people have since been enrolled, and the pace is accelerating. By the end of 2011, the agency expects to be signing up 1 million Indians a day, and by 2014, it should have 600 million people in its database.
The implications for this biometric database goes beyond being able to access a bank account – what this kind of program does is help get people on the margins of society back in. Once people can be linked to available government programs, they suddenly have access to food subsidies, basic medicine, housing programs – all critical elements to maintaining health. Admittedly, these benefits may only be realized in places like India and China with booming economies, poor infrastructure, and income disparities potentially amenable to some degree of redistribution. Also, it will take much more work than just an ID to make all of these impacts–but its a start.
The potential benefits to medicine are also significant. Take vaccination programs, which are often centrally administered but locally delivered. Here a single worker travelling to a remote village with even just a smartphone, a few peripherals, and supplies could become so much more powerful. This worker could record everyone who has received vaccines and upload to a central IT hub. When he or she encounters someone in need of a particular health intervention, say a young woman with small children, they could receive a flag with that information and arrange for the needed care. Similarly, if linked to a centralized EHR, this provider could immediately know the person’s medical history.
That’s just one example and I am certain there are many more. This all assumes a fairly sophisticated IT infrastructure behind the program, but when you’re talking about a program on this scale that is already storing biometric and identification data, I suspect it is already fairly sophisticated. And when this kind of national program exists already, it can serve as a nexus for others – say a centralized EHR. Part of the reason that has proven so elusive in the United States is that the market was already heavily fragmented when the move to centralize information was made. Here, the Indian government is already implementing a large IT program from the top-down.
One concern that is certainly obvious to us is privacy and protection of health information. HIPAA doesn’t apply in the subcontinent and in a nation with a legacy of heavy class separation and discrimination, this kind of system is going to be prone to abuse. Corruption and the potential for abuse will likely be the biggest weakness of this program.
The ambitions of the Aadhaar identification number program are great and I’m certain I’m being idealistic and perhaps even a bit naive in imagining is potential. But its a novel solution to a simple problem – identifying yourself. There’s no DMV that requires 8 different forms of other government ID before issuing a card covered in holograms. And that card – or in this case a person’s biometric tags – are how they access many essential services. Much like growth of mobile telecommunications in resource-poor areas, this program gets around the lack of effective infrastructure. It will be interesting to see how much of its potential is realized.
Cory Schultz contributed on this article.