India’s New National Digital Health Mission: A Trojan Horse for Privatization

TECHNOLOGY & HUMAN RIGHTS

India’s New National Digital Health Mission: A Trojan Horse for Privatization

Through the national Digital Health ID, India’s Modi government is implementing techno-solutionist and market-based reforms to further entrench the centrality of the private sector in healthcare. This has serious consequences for all Indians, but most of all, for its vulnerable populations.

On August 15, 2021, India’s Prime Minister Narendra Modi launched the National Digital Health Mission (NDHM), under which every Indian citizen is to be provided with a unique digital health ID. This ID will contain patients’ health records—including prescriptions, diagnostic reports, and medical histories—and will enable easy access for both patients and health service providers. The aim of the NDHM is to allow patients to seamlessly switch between health service providers by facilitating their access to patients’ health data and enabling insurance providers to quickly verify and process claims. Accessible registries of health master data will also be created. But this digital health ID program is emblematic of a larger problem in India—the government’s steady withdrawal from healthcare, both as welfare and as a public service.

The digital health ID is a crucial part of Modi’s plans to create a new digital health infrastructure called the National Health Stack. This will form the health component of the existing India Stack, which is defined as “a set of digital public goods” that are intended to make it easy for innovators to introduce digital services in India across different sectors. The India Stack is built on the existing foundational user-base provided by Aadhaar digital ID numbers. A “Unified Health Interface” will be created as a digital platform to manage healthcare-related transactions. It will be administered by the National Health Authority (NHA), which is also responsible for administering the flagship public health insurance scheme, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), providing health coverage for around 500 million poor Indians.

The Modi government proclaims that the NDHM and digital health ID will revolutionize the Indian healthcare system through technology-driven solutions. But this glosses over the government’s real motive, which is to incentivize the private sector to participate in and rescue India’s ailing healthcare system. Rather than invest more funds in public health infrastructure, the Indian government has decided to outsource healthcare services to private healthcare providers and insurance companies, using access to vast troves of health data as the proverbial carrot.
Indeed, the benefits of the NDHM for the private healthcare sector are numerous. It will provide valuable, interoperable data in the form of “health registries” which link data silos and act as a “single source of truth” for all healthcare stakeholders. This will enable quicker processing of claims and payments to health service providers. In an op-ed lauding the NDHM, the head of a major Indian hospital chain noted that the NDHM will “reduce administrative burden related to doctor onboarding, regulatory approvals and renewals, and hospital or payer empanelment.”
The government appears to have learned its lessons from the implementation of the AB-PMJAY, which allowed people below the poverty line to purchase healthcare services through state-funded health insurance. Although the scheme included both private and public hospitals, it relied heavily on private hospitals, as public hospitals lacked sufficient facilities. However, not enough private hospitals onboarded because rates were non-competitive as compared to the market, and because the scheme was plagued by long delays in insurance payments and insurance fraud. But, instead of building up public healthcare and reducing dependency on the private sector, the government is eager to fix this problem by providing better incentives to private providers through the NDHM.

Meanwhile, it is unclear what the benefits to the public will be. Digitizing the healthcare system and making it easier for insurance companies to pay private hospitals for services does not solve more urgent and serious problems, such as the lack of healthcare facilities in rural areas. The COVID-19 pandemic saw public hospitals playing a dominant role in treatment and vaccination, while private hospitals took a backseat. Given this, increasing the reliance placed on the private healthcare system through the NDHM is counterintuitive.

This growing reliance on the private sector is also likely to further disadvantage people living in poverty. The lack of suitable government hospitals forces people into private hospitals, and they are often required to pay more than the amount covered by the government-funded AB-PMJAY. Further, India’s National Human Rights Commission has taken the position that denial of care by private service providers is outside its ambit, notwithstanding their enrollment into state-funded insurance schemes like AB-PMJAY. Also, as the digital health ID will enable insurance companies’ access to sensitive health data, they may deny insurance or charge higher premiums to those most in need, thereby further entrenching discrimination and inequalities. Getting coverage with a genetic disorder, for instance, is already extremely difficult in India, something a digital health ID could worsen because insurance companies could access this information, rendering premiums prohibitively expensive for millions who need it. Digitization also renders highly-personal health records susceptible to breaches: such privacy concerns led many persons living with HIV to drop out of treatment programs when antiretroviral therapy centers began collecting Aadhaar details from patients.

Not having a digital health ID could lead to exclusion from vital healthcare. This is not a hypothetical. The government had to issue a clarification that no one should be denied COVID-19 vaccines or oxygen for lack of Aadhaar after numerous concerning reports, including allegations that a patient died after two hospitals demanded Aadhaar details which he did not have.

Nonetheless, plans are speeding ahead as the “usual suspects” of India’s techno-solutionist projects turn their efforts to healthcare. RS Sharma, the ex-Director General of the government agency responsible for Aadhaar, is the current CEO of the NHA. The National Health Stack was reportedly developed in consultation with i-SPIRT, a group of so-called “volunteers” with private sector backgrounds who act as a go-between between the Indian government and the tech sector and played a vital role in embedding Aadhaar in society through private companies. A committee set up to examine the merits of the National Health Stack was headed by another former UIDAI chairman.

Steered by individuals with an endless faith in the power of technology and in the private sector’s entrepreneurial drive to save the Indian government and governance, India is determinedly marching forward with its technology-driven and market-based reforms in public services and welfare. This is all underlined by a heavy tendency towards privatization and is in turn inspired by the private sector. The NDHM, for instance, is guided by the tagline “Think Big, Start Small, Scale Fast,” a business philosophy for start-ups.

Perhaps most concerningly, the neoliberal withdrawal of government from crucial public services to make space for the private sector has resulted in the rationing of those goods and services, with fewer people having access to them. Having a digital health ID is not likely to change this for India’s health sector, and is allowing for this privatization by stealth.

December 14, 2021. Sharngan Aravindakshan, LL.M. program, NYU School of Law; Human Rights Scholar with the Digital Welfare State & Human Rights Project in 2021-22. He previously worked for the Centre for Communication Governance in India.

Nothing is Inevitable! Main Takeaways from an Event on “Techno-Racism and Human Rights: A Conversation with the UN Special Rapporteur on Racism”

TECHNOLOGY & HUMAN RIGHTS

Nothing is Inevitable! Main Takeaways from an Event on “Techno-Racism and Human Rights: A Conversation with the UN Special Rapporteur on Racism”

On July 23, 2020, the Digital Welfare State and Human Rights Project hosted a virtual event on techno-racism and human rights. The immediate reason for organizing this conversation was a recent report to the Human Rights Council by the United Nations Special Rapporteur on Racism, Tendayi Achiume, on the racist impacts of emerging technologies. The event sought to further explore these impacts and to question the role of international human rights norms and accountability mechanisms in efforts to address these. Christiaan van Veen moderated the conversation between the Special Rapporteur, Mutale Nkonde, CEO of AI for the People, and Nanjala Nyabola, author of Digital Democracy, Analogue Politics.

This event and Tendayi’s report come at a moment of multiple international crises, including a global wave of protests and activism against police brutality and systemic racism after the killing of George Floyd, and a pandemic which, among many other tragic impacts, has laid bare how deeply embedded inequality, racism, xenophobia, and intolerance are within our societies. Just last month, as Tendayi explained during the event, the Human Rights Council held a historic urgent debate on systemic racism and police brutality in the United States and elsewhere, which would have been inconceivable just a few months ago.

The starting point for the conversation was an attempt to define techno-racism and provide varied examples from across the globe. This global dimension was especially important as so many discussions on techno-racism remain US-centric. Speakers were also asked to discuss not only private use of technology or government use within the criminal justice area, but to address often-overlooked technological innovation within welfare states, from social security to health care and education.

Nanjala started the conversation by defining techno-racism as the use of technology to lock in power disparities that are predicated on race. Such techno-racism can occur within states: Mutale discussed algorithmic hiring decisions and facial recognition technologies used in housing in the United States, while Tendayi mentioned racist digital employment systems in South America. But techno-racism also has a transnational dimension: technologies entrench power disparities between States that are building technologies and States that are buying them; Nanjala called this “digital colonialism.”

The speakers all agreed that emerging technologies are consistently presented as agnostic and neutral, despite being loaded with the assumptions of their builders (disproportionately white males educated at elite universities) about how society works. For example, the technologies increasingly used in welfare states are designed with the idea that people living in poverty are constantly attempting to defraud the government; Christiaan and Nanjala discussed an algorithmic benefit fraud detection tool used in the Netherlands, which was found by a Dutch court to be exclusively targeting neighborhoods with low-income and minority residents, as an excellent example of this.

Nanjala also mentioned the ‘Huduma Namba’ digital ID system in Kenya as a powerful example of the politics and complexity underneath technology. She explained the racist history of ID systems in Kenya – designed by colonial authorities to enable the criminalization of black people and the protection of white property – and argued that digitalizing a system that was intended to discriminate “will only make the discrimination more efficient”. This exacerbation of discrimination is also visible within India’s ‘Aadhaar’ digital ID system, through which existing exclusions have been formalized, entrenched, and anesthetized, enabling those in power to claim that exclusion, such as the removal of hundreds of thousands of people from food distribution lists, simply results from the operation of the system rather than from political choices.

Tendayi explained that she wrote her report in part to address her “deep frustration” with the fact that race and non-discrimination analyses are often absent from debates on technology and human rights at the UN. Though she named a report by the Center Faculty Director Philip Alston, prepared in cooperation with the Digital Welfare State and Human Rights Project, as one of few exceptions, discussions within the international human rights field remain focused upon privacy and freedom of expression and marginalize questions of equality. But techno-racism should not be an afterthought in these discussions, especially as emerging technologies often exacerbate pre-existing racism and enable a completely different scale of discrimination.

Given the centrality of Tendayi’s Human Rights Council report to the conversation, Christiaan asked the speakers whether and how international human rights frameworks and norms can help us evaluate the implications of techno-racism, and what potential advantages global human rights accountability mechanisms can bring relative to domestic legal remedies. Mutale expressed that we need to ask, “who is human in human rights?” She noted that the racist design of these technologies arises from the notion that Black people are not human. Tendayi argued that there is, therefore, also a pressing need to change existing ways of thinking about who violates human rights. During the aforementioned urgent debate in the Human Rights Council, for example, European States and Australia had worked to water down a powerful draft resolution and blocked the establishment of a Commission of Inquiry to investigate systemic racism specifically in the United States, on the grounds that it is a liberal democracy. Mutale described this as another indication that police brutality against Black people in a Western country like the United States is too easily dismissed as not of international concern.

Tendayi concurred and expressed her misgivings about the UN’s human rights system. She explained that the human rights framework is deeply implicated in transnational racially discriminatory projects of the past, including colonialism and slavery, and noted that powerful institutions (including governments, the UN, and international human rights bodies) are often “ground zero” for systemic racism. Mutale echoed this and urged the audience to consider how international human rights organs like the Human Rights Council may constitute a political body for sustaining white supremacy as a power system across borders.

Nanjala also expressed concerns with the human rights regime and its history, but identified three potential benefits of the human rights framework in addressing techno-racism. First, the human rights regime provides another pathway outside domestic law for demanding accountability and seeking redress. Second, it translates local rights violations into international discourse, thus creating potential for a global accountability movement and giving victims around the world a powerful and shared rights-based language. Third, because of its relative stability since the 1940s, human rights legal discourse helps advocates develop genealogies of rights violations, document repeated institutional failures, and establish patterns of rights violations over time, allowing advocates to amplify domestic and international pressure for accountability. Tendayi added that she is “invested in a future that is fundamentally different from the present,” and that human rights can potentially contribute to transforming political institutions and undoing structures of injustice around the world.

In addressing an audience question about technological responses to COVID-19, Mutale described how an algorithm designed to assign scarce medical equipment such as ventilators systematically discounted black patient viability. Noting that health outcomes around the world are consistently correlated with poverty and life experiences (including the “weathering effects” suffered by racial and ethnic minorities), she warned that, by feeding algorithms data from past hospitalizations and health outcomes, “we are training these AI systems to deem that black lives are not viable.” Tendayi echoed this, suggesting that our “baseline assumption” should be that new technologies will have discriminatory impacts simply because of how they are made and the assumptions that inform their design.
In response to an audience member’s concern that governments and private actors will adopt racist technologies regardless, Nanjala countered that “nothing is inevitable” and “everything is a function of human action and agency.” San Francisco’s decision to ban the use of facial recognition software by municipal authorities, for example, demonstrates that the use of these technologies is not inevitable, even in Silicon Valley. Tendayi, in her final remarks, noted that “worlds are being made and remade all of the time” and that it is vital to listen to voices, such as those of Mutale, Nanjala, and the Center’s Digital Welfare State Project, which are “helping us to think differently.” “Mainstreaming” the idea of techno-racism can help erode the presumption of “tech neutrality” that has made political change related to technology so difficult to achieve in the past. Tendayi concluded that this is why it is so vital to have conversations like these.

We couldn’t agree more!

To reflect that this was an informal conversation, first names are used in this story. 

July 29, 2020. Victoria Adelmant, and Adam Ray. 

Adam Ray, JD program, NYU School of Law; Human Rights Scholar with the Digital Welfare State & Human Rights Project in 2020. He holds a Masters degree from Yale University and previously worked as the CFO of Songkick.

Victoria Adelmant, Director of the Digital Welfare State & Human Rights Project at the Center for Human Rights and Global Justice at NYU School of Law. 

 

‘Chased Away and Left to Die’: New human rights report finds that Uganda’s national digital ID system leads to mass exclusion

TECHNOLOGY & HUMAN RIGHTS

‘Chased Away and Left to Die’: New human rights report finds that Uganda’s national digital ID system leads to mass exclusion

Uganda’s national digital ID system, a government showpiece that is of major importance for how individuals in Uganda access their social rights, leads to mass exclusion. This is the key finding in a new report titled Chased Away and Left to Die, published today by a collective of human rights organizations. The report is the outcome of 7 months of in-depth interviews with a multitude of victims, health workers, welfare workers, government officials and other experts on the national ID, referred to by Ugandans as Ndaga Muntu.

Report cover featuring an interviewee holding documents and being photographed on a phone.

The report argues that the Ugandan government has sacrificed the potential of digital ID for social inclusion and the realization of human rights at the altar of national security. “Ndaga Muntu is primarily a national security weapon built with the help of Uganda’s powerful military and not the ‘unrivaled success’ that the World Bank and others have claimed it is,” said Christiaan van Veen, one of the authors of the report and based at the Center for Human Rights and Global Justice at New York University School of Law.

Obtaining a national digital ID is described as “a nightmare” in the report. Based on official sources, the report estimates that as many as one third (33%) of Uganda’s adult population has not yet received a National Identity Card (NIC), a number that may even be rising. Many others in the country have errors on their card or are unable to replace lost or stolen IDs.

Since Ndaga Muntu is mandatory to access health care, social benefits, to vote, get a bank account, obtain a mobile phone or travel, the national ID has become a critical gateway to access these human rights. As one individual in Nebbi in Northern Uganda, put it succinctly in the report: “Ndaga Muntu is like a key to my door; without it, I can’t enter.” This can literally mean the difference between life and death. A woman in Amudat, in Northern Uganda, described the consequences of not having the national ID for access to health care: “Without an ID […] no treatment. Many people fall sick and stay home and die.”

The report urges the Ugandan government to immediately stop requiring the national digital ID to access social rights. “Government has to go back to the drawing table and rethink the use of Ndaga Muntu,” said Angella Nabwowe of the Initiative for Social and Economic Rights, “especially when it comes to tagging it to service delivery, because many people are being left out.”

Researchers focused their fieldwork in various parts of Uganda on documenting evidence of exclusion of women and older persons from health services and the Senior Citizens’ Grant (SCG) tied to Ndaga Muntu. Since 2019, patients are required to show the national ID to access public health centers. The report details how women, including pregnant women, are ‘chased away’ by health care workers for failure to show their ID. Previously, there was no single, rigid ID requirement to access health care in Uganda.

In March, the Ugandan government also announced its intention to require the national digital ID for access to Covid-19 vaccines. But a lawsuit based on this research by two organizations that co-authored the report, the Initiative for Social and Economic Rights and Unwanted Witness, led to a quick reversal of that policy by the government.

The impact of Ndaga Muntu on the elderly in Uganda is equally heart-wrenching. The report recounts the story of Okye, an 88-year old man from Namayingo in Eastern Uganda whose date of birth was registered incorrectly, ‘making’ him 79-years old instead. The result for Okye is that he is not eligible for the life-saving government cash transfer for persons over 80 (SCG). Okye is not an exception. Senior sources confirmed to the authors of the report that at least 50,000 Ugandans over 80 have similar mistakes on their national ID that make them ineligible for government assistance or do not have a national ID at all. That number is almost certainly an undercount and points to mass exclusion among Uganda’s 200,000 older persons over 80.
The consequences of not having a national ID for older persons can be tragic. Nakaddu, an 87-year old woman in Kayunga district in Central Uganda told researchers that she did not get the cash grant for the elderly: “I don’t get the money, but I don’t know what to do. […] I can no longer dig. My arm is not okay. I cook for myself. Those ones [pointing to the neighbours] give me some food.”

The report blames the struggles and failures of the National Identification and Registration Authority (NIRA) for many of the exclusionary problems with Ndaga Muntu. NIRA has faced criticism for its failure to enroll a larger part of the population, problems with issuing ID cards, high rates of errors, high costs imposed on individuals and allegations of bribery and corruption.
Perhaps NIRA’s biggest failure, however, has been the neglect of its responsibility for registering births. By prioritizing the registration of adults for the national ID over birth registration, the birth registration rate may have plummeted to as low as 13% of children under 1 years old. Meanwhile, the percentage of adults excluded from the national ID may be rising even as NIRA appears unable to keep up with the growing number of young people who turn 18 and become eligible for the national ID card.

“It is quite absurd to invest in registering the adult population for a national ID and forget about the next generation. It is as if NIRA’s left hand does not know, and does not care, what its right hand is doing,” said Dorothy Mukasa, Team leader at Unwanted Witness.
Digital ID systems have been widely hailed by international development organizations and private actors as ways to foster social inclusion and development and promise poor African nations the ability to ‘leapfrog’ towards becoming modern, digital economies. The report by the collective of human rights organizations shows a much darker picture of exclusion, missed opportunities, and significant financial costs.

Not only does the report estimate that the Ugandan government has already spent more than USD 200 million on its digital ID system in the past decade, comparable to the total budget of its Ministry of Gender, Labour and Social Development in that same period. But international organizations and bilateral donors have also poured many millions into Uganda’s health and social protection programs that are now risking to exclude millions from their reach because of Ndaga Muntu’s dysfunction. In an ironic twist, some of those same development partners, like the World Bank, are among the foremost champions of digital ID systems in Africa and have also funded NIRA.

Equally tragic is the fact that many of the benefits of digitalization are missed in this digital ID system. While NIRA maintains air-conditioned servers to house its National Identity Register in Kampala, Uganda’s capital, health care workers still register patients’ national identity information in paper booklets provided by NIRA. And the promised benefits of biometric verification are missed because many remote areas do not have fingerprint scanners or the internet and electricity to make them usable. And when modern biometric equipment worked, many older Ugandans, whose fingerprints have been worn away after many years of manual labor, were, as victims told us, “refused by those machines.”

The report recounts one macabre result of these missed digital opportunities, when an old and sick man was forced by officials to personally travel to a cash transfer distribution point to verify his fingerprints and receive his social benefit. The man set out on a boda boda motorcycle taxi and died on his way there. The last payment due to a deceased beneficiary will customarily be given to family members. Therefore, officials proceeded to take the dead man’s fingerprints.

A short documentary on the impact of Ndaga Muntu on women and older persons can be found here.

This post was initially published as a press release on June 8, 2021.

‘Chased Away and Left to Die’

TECHNOLOGY & HUMAN RIGHTS

Chased Away and Left to Die

How a National Security Approach to Uganda’s National ID Has Led to Wholesale Exclusion of Women and Older Persons

The Ugandan government launched a new national digital ID system in 2014, promising to issue all Ugandans with a national ID number and national ID card, while also building a large central database of identity information, including personal biographic information and digitized biometric information such as fingerprints and facial photographs. This 2020 report documents the continuing wholesale exclusion of large swaths of the Ugandan population from this national digital ID system, known as Ndaga Muntu. Based on 7 months of research together with our Ugandan partners the Initiative for Social and Economic Rights (ISER) and Unwanted Witness, the report takes an in-depth look at the implications of this exclusion for pregnant women and older persons attempting to access their rights to health and social protection.

The report begins with a thoroughly researched overview of the origins and design of the national digital ID system, which was originally described by a prominent government Minister as a “national security weapon.” Although it was strongly linked to national security priorities of the government, the national ID system was also intended to serve a wide variety of uses, including identification and authentication for access to social services and healthcare. However, the implementation of this ambitious system has been filled with challenges—with the result that up to one-third of the adult population remains excluded. Despite robust political support and several waves of mass registration, progress in increasing coverage in the system continues to be frustrated by implementation challenges including budget shortfalls, as well as physical, financial, technological, and administrative barriers to access. All of these challenges have been exacerbated by an environment marked by inequality and discrimination. 

This has led to severe human rights consequences, especially for vulnerable groups such as older persons and women, who have been denied access to lifesaving social services. The report describes how Ndaga Muntu has now become a mandatory requirement to access both government and private services. This includes access to health care and social pensions, as well as the ability to vote, get a bank account, and obtain a mobile phone. In short, exclusion from the national digital ID has become a life and death matter for many people in Uganda. The report draws on focus group conversations and individual interviews with affected persons, as well as discussions with numerous government administrators and scholars, to share deeply contextualized personal accounts of how this mandatory requirement has had an impact on individual lives. 

Based on these extremely concerning accounts of exclusion, discrimination, and violations of economic and social rights, the report concludes with a series of actionable recommendations to mitigate the most pressing human rights concerns. This includes the need to ensure that the mandatory national ID requirement does not continue to lead to exclusion from fundamental rights and services, for instance by allowing for the use of alternative forms of ID. It also emphasizes the need to re-examine whether a national ID system designed to be a national security tool is fit for the purposes of inclusion and human rights. 

“Leapfrogging” to Digital Financial Inclusion through “Moonshot” Initiatives

TECHNOLOGY & HUMAN RIGHTS

“Leapfrogging” to Digital Financial Inclusion through “Moonshot” Initiatives

The notion that new technological solutions can overcome entrenched exclusion from banking services and fair credit is quickly gaining widespread acceptance. But tech-based “fixes” often funnel low-income groups into separate, inferior systems and create new tech-driven divisions.

In July 2021, the New York City Mayor’s Office of the Chief Technology Officer launched the NYC[x] Moonshot: Financial Inclusion Challenge. This initiative seeks to deploy digital solutions to address inequalities in access to financial institutions. As the Chief Technology Officer stated, “Too many people have been left out of the financial system for too long. This disparity means that financial transactions … end up costing more for those who can least afford it.”

One in ten Americans are “unbanked,” meaning that they do not have a bank account. People of color are disproportionately excluded from traditional financial institutions. Banks consistently operate fewer branches in Black, Native American, and Latinx communities, creating “banking deserts,” while the practice of redlining continues. Poorly-regulated predatory financial institutions such as payday lenders, which impose higher costs than banks and trap customers in cycles of debt, are highly concentrated in these communities and take advantage of financial exclusion. In New York’s borough of the Bronx, over 49% of households are unbanked and high-cost lenders significantly outnumber banks.

Unequal access to banking means unequal access to fair credit. This compounds inequalities, as a poor credit record increasingly determines crucial outcomes, including higher interest rates on loans, higher insurance premiums, and difficulty obtaining employment or housing.

NYC is pursuing technology-based solutions to address these issues. The Moonshot initiative, which seeks proposalsutilizing breakthrough financial inclusion technology” to bring the unbanked into the financial system, follows previous tech-driven schemes. A recent initiative involved IDNYC, the city’s official identification card launched in 2015. This ID scheme had sought to facilitate access to banking by providing government-issued IDs to groups previously unable to open bank accounts for want of official identification; the ID is explicitly available to undocumented immigrants. However, shortly after its launch, the city’s largest banks dealt a blow to the IDNYC scheme by refusing to accept it as sufficient identification to open accounts. In response, the Mayor’s Office turned to technology. In 2018, it solicited proposals from financial firms to introduce electronic chips—the same smartcards used in debit cards—into the ID cards. This would allow IDNYC cardholders to load money onto their ID cards and make payments using these cards. Such reloadable cards are known as prepaid cards.

This proposed integration of identification and payment functions was not unique. In the U.S., the city of Oakland’s municipal identification scheme enabled cardholders to have their welfare benefits deposited onto the ID card and make payments with it. Also in California, the city of Richmond’s ID similarly functions as a prepaid card. In 2020, MasterCard’s “City Key” card, which combines official identification and payments, was distributed to low-income residents in Honolulu. Outside of the U.S., MasterCard was involved in adding electronic chips to national ID cards in Nigeria, and the Malaysian national ID also functions as a reloadable debit card.

But the proposal to incorporate smartcards into IDNYC was abandoned. Dozens of immigrants’ rights organizations warned that the integration of payment functions increased immigrant cardholders’ risk of surveillance and profiling. Adding the chip would lead to “massive data collection” by the financial technology firm brought into IDNYC and, because such firms are legally required to retain information about cardholders, undocumented immigrants’ data could be subpoenaed by the Trump administration. The Mayor’s Office accepted that these risks were fundamentally in conflict with the inclusionary goals of IDNYC and withdrew the plan.

While the proposal was abandoned, the narratives and driving forces behind it have intensified. Turning to a prepaid card system to “eliminate banking deserts” in NYC followed a well-established script that promises to “leapfrog” over deeply-rooted social problems using new technologies. The Gates Foundation, McKinsey, MasterCard, and others have long furthered this narrative that groups left behind by traditional financial institutions can be reached through innovative technological solutions which “leapfrog” banks. Bill Gates was famously quoted saying, “banking is necessary but banks are not”—and today, actors which are not banks, such as payment technology companies and telecommunications firms, are increasingly offering “financially-inclusive” services such as mobile money and smartcard solutions in explicit efforts “to ‘disrupt’… traditional banking services.” Prepaid cards especially seek to bypass banks: by their very design they operate without any link to bank accounts.

As such, these technological solutions funnel unbanked groups into a separate, “parallel banking system.” Prepaid cards do not provide access to bank accounts, so cardholders remain unbanked. This is an inferior banking product; cardholders do not gain the same access to the services and fairer credit that bank accounts enable. Financial inclusion persists, but the unbanked now have smartcards.

Further, the companies “disrupting” banking are usually not subject to the same legal obligations as banks, nor do they provide the same financial protections. Within these separate, technology-enabled payment systems for the unbanked, the extractivism and predatory practices that financial inclusion efforts are supposed to address re-emerge. NYC’s Chief Technology Officer had lamented that financial exclusion means that transactions cost “more for those who can least afford it”—but when Oakland launched its smartcard ID, the company running the prepaid function levied countless fees on cardholders, including $0.75 per transaction, $1 per reloading of funds, and a $2.99 monthly fee. The fees were higher than those of banks. Further, the insistence that electronic payments will solve financial exclusion is motivated by a desire to monetize new customers’ transaction data. Companies are racing to “capture the data of the newly ‘included’” and uncover the “financial lives of the poor” as a new market segment.

As the Immigrant Defense Project and others argued, turning IDNYC into a prepaid card would therefore “be perpetuating, not resolving, inequality in our banking system.” Within our work outside the U.S., we see the same technological solutions being embraced, all while they siphon low-income groups toward less-regulated, separate systems. For example, in South Africa and Australia, recipients of state benefits are forced onto prepaid cards not linked to traditional bank accounts. Still, “digital financial inclusion” through these technologies is being hailed as the solution to financial exclusion.

The 2021 Moonshot initiative appears to be based on the same ideals. The very notion of a “moonshot” is solutionist—it connotes a monumental (technologically-driven) effort to achieve a lofty goal. Official “launch” documents state that technology can “help solve the most pressing issues of people’s lives.” Rather than seeking to work with banks, the scheme turns to developers: the unbanked need “new options.” This focus on technology can obscure the root causes of financial exclusion—namely racism, discrimination, and predatory financial practices. “New options” will too often mean separate, inferior systems; and eschewing attempts to resolve inequalities within the “old options” leaves harmful practices—such as the linking of everything from housing to insurance with credit reports, continuing redlining, and the closing of bank branches without regard for those left behind—unaddressed. 

September 21, 2021. Victoria Adelmant, Director of the Digital Welfare State & Human Rights Project at the Center for Human Rights and Global Justice at NYU School of Law. 

Wrong Prescription: The Impact of Privatizing Healthcare in Kenya

INEQUALITIES

Wrong Prescription: The Impact of Privatizing Healthcare in Kenya

A collaboration between The Economic and Social Rights Centre-Hakijamii and the Center for Human Rights and Global Justice at New York University School of Law.

The 49-page report draws from more than 180 interviews with healthcare users and providers, government officials, and experts, and finds that the government-backed expansion of the private healthcare sector in Kenya is leading to exclusion and setting back the country’s goal of universal health coverage. 

The report documents how policies designed to increase private sector participation in health, in combination with chronic underinvestment in the public healthcare system, have led to a rapid increase in the role of for-profit private actors and undermined the right to health. Privatizing healthcare has proven costly for individuals and the government, and pushed Kenyans into poverty and crushing debt. While the wealthy may be able to access high-quality private care, for many, particularly in lower-income areas, the private sector offers low-quality services that may be inadequate or unsafe. The report concludes with a call to prioritize the public healthcare system.

Everyone Counts! Ensuring that the human rights of all are respected in digital ID systems

TECHNOLOGY & HUMAN RIGHTS

Everyone Counts! Ensuring that the human rights of all are respected in digital ID systems

The Everyone Counts! initiative was launched in the fall of 2020 with a firm commitment to a simple principle: the digital transformation of the state can only qualify as a success if everyone’s human rights are respected. Nowhere is this more urgent than in the context of so-called digital ID systems.

Research, litigation and broader advocacy on digital ID in countries like India and Kenya has already revealed the dangers of exclusion from digital ID for ethnic minority groups[1] and for people living in poverty.[2] However, a significant gap still exists between the magnitude of the human rights risks involved and the urgency of research and action on digital ID in many countries. Despite their active promotion and use by governments, international organizations and the private sector, in many cases we simply do not know how these digital ID systems lead to social exclusion and human rights violations, especially for the poorest and most marginalized.

Therefore, the Everyone Counts! initiative aims to engage in both research and action to address social exclusion and related human rights violations that are facilitated by government-sponsored digital ID systems.

Does the emperor have new clothes? The yawning evidence gap on digital ID

The common narrative behind the rush towards digital ID systems, especially in the Global South, is by now familiar: “As many as 1 billion people across the world do not have basic proof of identity, which is essential for protecting their rights and enabling access to services and opportunities.”[3] Digital ID is presented as a key solution to this problem, while simultaneously promising lower income countries the opportunity to “leapfrog” years of development via digital systems that assist in “improving governance and service delivery, increasing financial inclusion, reducing gender inequalities by empowering women and girls, and increasing access to health services and social safety nets for the poor.”[4]

This perspective, for which the World Bank and its Identification for Development (ID4D) Initiative have become the official “anchor” internationally, presents digital ID systems as a force for good. The Bank acknowledges that exclusionary issues may arise, but is confident that such issues may be overcome through good intentions and safeguards. Digging underneath the surface of these confident assertions, however, one finds that there appears to be remarkably little research into the overall impact of digital ID systems on social exclusion and a range of related human rights. For instance, after entering the digital ID space in 2014, publishing prolifically, and guiding billions of development dollars into furthering this agenda, the World Bank’s ID4D team concedes in its 2020 Annual Report that “given that this topic is relatively new to the development agenda, empirical research that rigorously evaluates the impact of ID systems on development outcomes and the effectiveness of strategies to mitigate risks has been limited.”[5] In other words, despite warning signs from several countries around the world, including chilling stories of people who have died because they were shut out of biometric ID systems,[6] the digital ID agenda moves full steam ahead without full understanding of its exclusionary potential.

Making sure that everyone truly counts

While the Everyone Counts! initiative only has a fraction of the resources of ID4D, we hope to inject some much needed reality into this discourse through our work. We will do this by undertaking–together with research partners in different countries–empirical human rights research that investigates how the introduction of a digital ID system leads to or exacerbates social exclusion. For example, we are currently undertaking a joint research project with Ugandan research partners focused on Uganda’s digital ID system, Ndaga Muntu, and its impact on poor women’s right to health, and older persons’ right to social assistance.

Our presence at a leading university and law school underlines our commitment to high quality and cutting-edge research, but we are not in the business of knowledge accumulation purely for its own sake. We will aim to transform our research into action. This could come in the form of strategic litigation and advocacy, such as the work by our partners described below, or in the form of network building and information sharing. For instance, together with co-sponsors like the UN Economic Commission for Africa (UNECA) and the Open Society Justice Initiative (OSJI), we are hosting a workshop series for African civil society organizations on digital ID and exclusion. The series creates a space where activists hoping to resist the exclusion associated with digital ID can come together, gain access to tools, information and networks, and form a community of practice that facilitates further activism.

Ensuring non-discriminatory access to vaccines: An early case study 

A recent example from Uganda demonstrates just how effective targeted action against digital ID systems can be. The government began rollout of its national digital ID system Ndaga Muntu as early as 2015, and it has gradually become a mandatory requirement to access a range of social services in Uganda.

To address the threat of COVID-19, the Ugandan government recently began a free, national vaccine program. One of the groups eligible to receive the vaccine would be all adults over the age of 50. On March 2, however, the Ugandan Minister of Health announced that only those Ugandan citizens who could produce a Ndaga Muntucard, or at least a national ID number (NIN), would be able to receive the vaccine. Conservative estimates suggest that over 7 million eligible Ugandans have not yet received their national ID card.

Our research partners, the Initiative for Social and Economic Rights (ISER) and Unwanted Witness (UW), sued the Ugandan government on March 5 to challenge the mandatory requirement of the Ndaga Muntu.[7] They argued that not only would the requirement of the national ID in exclude millions of eligible older persons from receiving the vaccine, but also that it would set a dangerous precedent that would allow for further discrimination in other areas of social services.[8]

On March 9, the Ministry of Health announced that it would change the national ID requirement so that alternative forms of identification documents, which are much more accessible to poor Ugandans, could be used to access the COVID-19 vaccine.[9] This was a critical victory for the millions of Ugandans who seek access to the life-saving vaccine–but it is also a warning sign of the subtle and pernicious ways that the digital ID system may be used to exclude.

Humans first, not systems first

The Ugandan case study shows the urgent need for the human rights movement to engage in discussions about digital transformation so that fundamental rights are not lost in the rush to build a “modern, digital state.” In our work on this initiative, we will remain similarly committed to prioritizing how individual human beings are affected by digital ID systems. Listening to their stories, understanding the harms they experience, and channeling their anger and frustration to other, more privileged and powerful audiences, is our core purpose.

Digital transformation is a field prone to a utilitarian logic: “if 99% of the population is able to register for a digital ID system, we should celebrate it as a success.” Our qualitative work does not only challenge the supposed benefits for these 99%, but emphasizes that the remaining 1% equals a multitude of individual human beings who may be victimized. Our research so far has only confirmed our intuition that digital ID systems can deliver significant harms, particularly for those who are poorest, most vulnerable, and least powerful in society. These excluded voices deserve to be heard and to become a decisive factor in deciding the shape of our digital future.

April 6, 2021. Christiaan van Veen and Katelyn Cioffi.

Christiaan van Veen, Director of the Digital Welfare State and Human Rights Project (2019-2022) at the Center for Human Rights and Global Justice at NYU School of Law. 

Katelyn Cioffi, Senior Research Scholar, Digital Welfare State & Human Rights Project at the Center for Human Rights and Global Justice at NYU School of Law.

Prominent human rights expert admitted as amicus curiae in groundbreaking legal challenge to Ugandan national digital ID system

TECHNOLOGY & HUMAN RIGHTS

Prominent human rights expert admitted as amicus curiae in groundbreaking legal challenge to Ugandan national digital ID system

Today, at the High Court of Uganda in Kampala, the Hon. Justice Boniface Wamala issued a decision to admit the application of Professor Philip Alston of New York University School of Law to participate as amicus curiae, or ‘friend of the court’, in a petition for the enforcement of human rights challenging the use of the country’s national digital ID system as a pre-condition to access to public services.

The admission of the amicus application is a critical development in this groundbreaking litigation, the latest in a series of legal challenges that have raised concerns about national digital ID systems in countries including India, Kenya, and Jamaica. This case is one of the first globally to center concerns around social and economic rights. The applicants, three Ugandan civil society organizations, argue that the national digital ID system suffers from persistent and severe gaps in coverage, and its integration with the country’s social welfare programs has resulted in the exclusion of vulnerable and marginalized individuals from fundamental services such as social protection and healthcare.

“Given the importance of the national digital ID system and its mandatory usage, it is imperative that it is fully inclusive. All Ugandans, regardless of age or economic status, must be able to access their social welfare benefits,” said Professor Alston. “Today’s decision by the High Court is an important and welcome step in that direction.”

In a 32-page brief, Professor Alston seeks to assist the court in analyzing some of the novel legal questions at the heart of the case. He calls attention to the obligations of the Government of Uganda under international human rights law, the serious consequences that digital and non-digital barriers to public services may have on the enjoyment of rights, and the high burden of proof that falls on the government to justify any measure that leads to exclusion. The brief also emphasizes the need to ensure equal treatment and non-discrimination in the enjoyment of these rights, particularly given the high risk that any negative impacts of the digital ID system will continue to fall disproportionately on poor and marginalized groups.

“As many governments turn to digital ID systems to mediate access to essential public services, there is an urgent need for courts to ensure the protection of economic and social rights,” said Professor Alston.

Setting aside the objections of the two government respondents, the Attorney General and the National Identification & Registration Authority, Judge Boniface Wamala stated that the “positive benefits of the intervention as amicus curiae outweighs any possible opposition from the parties in the main cause. It is in public interest, the interest of justice, the protection and progressive development of human rights and socio-economic reform that the leave sought in the application is granted.”

“The court and by extension the multitude of Ugandans whose human rights the main petition is fighting to protect shall benefit from the input and expertise that Prof. Philip shall contribute in its adjudication,” said Counsel Elijah Enyimu, who represented Professor Alston. “The contents of the amicus brief shall be elucidatory on the standards and protections necessary for the realization of ESCR in Uganda.”

The Applicants and Respondents will be back in court to argue their cases on April 5, 2023. In the meantime, those who have missed out on social protection payments or been turned away from health centers due to their inability to access the national digital ID will continue to wait for a judicial decision.

This post was originally published as a press statement on March 24, 2023. 

The World Bank and co. may be paving a ‘Digital Road to Hell’ with support for dangerous digital ID

TECHNOLOGY & HUMAN RIGHTS

The World Bank and co. may be paving a ‘Digital Road to Hell’ with support for dangerous digital ID

Global actors, led by the World Bank, are energetically promoting biometric and other digital ID systems that are increasingly linked to large-scale human rights violations, especially in the Global South. A report by researchers at New York University warns that these systems, promoted in the name of development and inclusion, might be achieving neither. Rather than the equitable digital future envisioned by the World Bank and its Identification for Development (ID4D) Initiative, the report argues that “despite undoubted good intentions on the part of some, [these systems] may well be paving a digital road to hell.”

Report cover: Paving a digital road to hell?

The report, at over 100 pages, is intended to be a “carefully researched primer as well as a call to action to all of those with an interest in safeguarding human rights to set their gaze more firmly on the multidimensional dangers associated with digital ID systems.” Governments around the world have been investing heavily in digital identification systems, often with biometric components (digital ID). The rapid proliferation of such systems is driven by a new development consensus, packaged and promoted by key global actors like the World Bank, but also by governments, foundations, vendors and consulting firms. This new ‘manufactured consensus’ holds that digital ID can contribute to inclusive and sustainable development—and is even a prerequisite for the realization of human rights.

Drawing inspiration from the Aadhaar system in India, the dangerous digital ID model that is being promoted prioritizes what the primer refers to as an ‘economic identity’.  The goal of such systems is primarily to establish ‘uniqueness’ of individuals, commonly with the help of biometric technologies. The ultimate objective of such digital ID systems is to facilitate economic transactions and private sector service delivery while also bringing new, poorer, individuals into formal economies and ‘unlocking’ their behavioral data. As the Executive Chairman of the influential ID4Africa, a platform where African governments and major companies in the digital ID market meet, put it at the start of its 2022 Annual Meeting earlier this week, digital ID is no longer about identity alone but “enables and interacts with authentication platforms, payments systems, digital signatures, data sharing, KYC systems, consent management and sectoral delivery platforms.”

Unlike ‘traditional systems’ of civil registration, such as birth registration, this new model of economic identity commonly sidesteps difficult questions about the legal status of those it registers and the rights associated with that status. The promises of inclusion and flourishing digital economies might appear attractive on paper, but digital ID systems have consistently failed to deliver on these promises in real world situations, especially for the most marginalized. In fact, evidence is emerging from many countries, most notably the mega digital ID project Aadhaar in India, of the severe and large-scale human rights violations linked to this model. These systems may in fact exacerbate pre-existing forms of exclusion and discrimination in public and private services. The use of new technologies may furthermore lead to novel forms of harm, including biometric exclusion, discrimination, and the many harms associated with “surveillance capitalism.”

Meanwhile, the benefits of digital ID remain ill-defined and poorly documented. From what evidence does exist, it seems that those who stand to benefit most may not be those “left behind”,but instead a small group of companies and governments. After all, where digital ID systems have tended to excel is in generating lucrative contracts for biometrics companies and enhancing the surveillance and migration-control capabilities of governments.

With such powerful backing, digital ID has taken on the guise of an unstoppable juggernaut and inevitable hallmark of modernity and development in the 21st century, and the dissenting voices of civil society have been written off as Luddites and barriers to progress. Nevertheless, the report calls on human rights organizations, other civil society organizations, and advocates who may have been on the sidelines of these debates to get more involved.  The actual and potential human rights violations arising from this model of digital ID can be severe and potentially irreversible. The human rights community can play an important role in ensuring that such transformational changes are not rushed and are based on serious evidence and analysis. It can also ensure that there is sufficient public debate, with full transparency and involving all relevant stakeholders, not in the least the most marginalized and most affected individuals. Where necessary to safeguard human rights, such dangerous digital ID systems should be stopped altogether.

This post was originally published as a press release on June 17, 2022.

False Promises and Multiple Exclusion: Summary of Our RightsCon Event on Uganda’s National Digital ID System

TECHNOLOGY & HUMAN RIGHTS

False Promises and Multiple Exclusion: Summary of Our RightsCon Event on Uganda’s National Digital ID System 

Despite its promotion as a tool for social inclusion and development, Uganda’s National Digital ID System is motivated primarily by national security concerns. As a result, the ID system has generated both direct and indirect exclusion, particularly affecting women and older persons.

On June 10, 2021, the Center for Human Rights and Global Justife at NYU School of Law co-hosted the panel “Digital ID: what is it good for? Lessons from our research on Uganda’s identity system and access to social services” as part of RightsCon, the leading summit on human rights in the digital age. The panelists included Salima Namusobya, Executive Director of the Initiative for Social and Economic Rights (ISER), Dorothy Mukasa, Team Leader of Unwanted Witness, Grace Mutung’u, Research Fellow at the Centre for IP and IT Law at Strathmore University, and Christiaan van Veen, Director of the Digital Welfare State & Human Rights Project at the Center . This blog summarizes highlights of the panel discussion. A recording and transcript of the conversation, as well as additional readings, can be found below.

Uganda’s national digital ID system, known as Ndaga Muntu, was introduced in 2014 through a mass registration campaign. The government aimed to collect the biographic and biometric information including photographs and fingerprints of every adult in the country, to record this data in a centralized database known as the National Identity Register, and to issue a national ID card and unique ID number to each adult. Since its introduction, having a national ID has become a prerequisite to access a whole host of services, from registering for a SIM card and opening a bank account, to accessing health services and social protection schemes.

This linkage of Ndaga Muntu to public services has raised significant human rights concerns and is serving to lock millions of people in Uganda out of critical services. Seven years from its inception, it is clear that the national digital ID is a tool for exclusion rather than for inclusion. Drawing on the joint report by the Center , ISER, and Unwanted Witness, this event made clear that Ndaga Muntu was grounded in false promises and is resulting in multiple forms of exclusion.

The False Promise of Inclusion

The Ugandan government argued that this digital ID system would enhance social inclusion by allowing Ugandans to prove their identity more easily. Having this proof of identity would facilitate access to public services such as healthcare, enable people to sign up for private services such as bank accounts, and allow people to move freely throughout Uganda. The same rhetoric of inclusion was used to sell Aadhaar, India’s digital ID system, to the Indian public.

But for many Ugandans this was a false promise. From the very outset, Ndaga Muntu was developed chiefly as a tool for national security. The powerful Ugandan military had long pushed for the collection of sensitive identity information and biometric data: in the context of a volatile region, a centralized information database is appealing because of its ability to verify identity and indicate who is “really Ugandan” and who is not. Therefore, the national ID project was housed in the Ministry of Internal Affairs, overseen by prominent members of the Ugandan People’s Defense Force, and designed to serve only those who succeeded in completing a rigorous citizenship verification process.

The panelist from Kenya, Grace Mutung’u, shared how Kenya’s hundred-year-old national identification system was similarly rooted in a colonial regime that focused on national security and exclusion. Those design principles created a system that sought only to “empower the already empowered” and not to extend benefits beyond already-privileged constituencies. The result in both Kenya and Uganda was the same: digital ID systems that are designed to ensure that certain individuals and groups remain excluded from political, economic, and social life.

Proliferating Forms of Exclusion

Beyond the fact that Ndaga Muntu was designed to directly exclude anyone not entitled to access public services, those who are entitled are also being excluded in the millions. For ordinary Ugandans, accessing Ndaga Muntu is a nightmarish process rife with problems every step of the way. These problems, such as corruption, incorrect data entry, and technical errors, have impeded Ugandans’ access to the ID. Vulnerable populations who rely on social protection programs that require proof of ID bear the brunt of such errors. For example, one older woman was told that the national ID registration system could not capture her picture because of her grey hair. Other elderly Ugandans have had trouble with fingerprint scanners that could not capture fingerprints worn away from years of manual labor.

The many individuals who have not succeeded in registering for Ndaga Muntu are therefore being left out of the critical services which are increasingly linked to the ID. At least 50,000 of the 200,000 eligible persons over the age of 80 in Uganda were unable to access potentially lifesaving benefits such as the Senior Citizens’ Grant cash transfer program. Women have been similarly disproportionately impacted by the national ID requirement; for instance, pregnant women have been refused services by healthcare workers for failing to provide ID. To make matters worse, ID requirements are increasingly ubiquitous in Uganda: proof of ID is often required to book transportation, to vote, to access educational services, healthcare, social protection grants, and food donations. Having a national ID has become necessary for basic survival, especially for those who live in extreme poverty.

Digital ID systems should not prohibit people from living their lives and utilizing basic services that should be universally accessible, particularly when they are justified on the basis that they will improve access to services. Not only was the promise of inclusion for Ndaga Muntu false, but the rollout of the system has also been incompetent and faulty, leading to even greater exclusion. The profound impact of this double discrimination in Uganda demonstrates that such digital ID systems and their impacts on social and economic rights warrant greater and urgent attention from the human rights community at large.

June 12, 2021. Madeleine Matsui, JD program, Harvard Law School; intern with the Digital Welfare State and Human Rights.