Identity Project

How efficient is Aadhaar? There's no way to know since the government won't tell

The UIDAI has received 331 crore authentication requests since 2012 but declined to reveal how many of them failed.

From the inception of the unique identity project, the government has claimed that one of the biggest advantages of Aadhaar – a biometrics-based 12-digit identity number for Indian residents – is that it helps identify beneficiaries of social schemes accurately and ensures the benefits go only to the deserving.

In March, the government notified that Aadhaar, or at least proof of enrolment in Aadhaar, was mandatory for several vulnerable groups to continue to receive government benefits. These groups included women rescued from trafficking, workers engaged in forced labour, schoolchildren between six and 14 years of age, and people with disabilities. Schoolchildren, for instance, will not be served mid-day meals from June if they cannot present their Aadhaar numbers.

All recent notifications state that the use of Aadhaar as a document of identification will bring in “transparency and efficiency”.

But is Aadhaar really making it easier for people to access welfare programmes? How accurate are the claims of greater efficiency? There are no answers to these questions, it seems, as Scroll.in’s requests for information under the Right to Information Act revealed.

Aadhaar authentication

An Aadhaar number is generated after the collection of demographic information and biometrics (fingerprints and iris scans). The number can be used by either the government or a private entity to authenticate a person carrying out a transaction that requires them to establish their identity. The database now has over a billion people enrolled in it.

One way of biometric authentication is through fingerprints. For example, several states such as Delhi, Rajasthan and Andhra Pradesh have made Aadhaar biometric authentication mandatory for those who wish to avail of foodgrains under the public distribution system. These beneficiaries must, therefore, place their fingers on the point-of-sale devices at fair price shops. The devices use the internet to verify the fingerprints with the data stored in the Aadhaar servers.

Besides fingerprint authentication, the Unique Identification Authority of India – the agency that manages the database – lists five other authentication techniques:

  • Matching the Aadhaar number and demographic attributes of residents.
  • Through a one-time password sent to the resident’s mobile number/email shared in the central identities database.
  • Using one of the biometric modalities – fingerprints or iris.
  • A two-factor authentication using one of the biometrics (iris, fingerprints), and a one-time password.
  • Using a one-time password, fingerprints and iris for authentication.

Lack of transparency

To monitor the efficacy of Aadhaar, the Authority is supposed to regularly collect this authentication data along with information on how many authentication requests were received, and how many failed or succeeded.

After the Aadhaar (Targeted Delivery of Financial and Other Subsidies, Benefits, and Services) Act was passed last year, Business Standard asked the Authority’s chief executive officer, ABP Pandey, in the course of an interview on March 22, 2016, about the system’s efficacy:

“Is there a system already in place for monitoring the efficacy of Aadhaar? Say, if I came to you six months down the line and asked how is the biometric system working? Would you be able to provide that authentication worked in 85% of cases or not? Are you regularly collecting this kind of data?

We monitor this. Say in one day, say, we get 2 million requests. Out of that we naturally have the information that so many have failed or so many has passed. The failure could be because of various reasons. Someone could have tried to falsify an identity, it could be a finger print failure. We also try to monitor the failure rate.”

Pandey also stated in the interview that “in some places where biometric is being used, like in Rajasthan for public distribution system, the rate of failure of fingerprint authentication is much higher than expected”. He added that it was not clear how much of the data on authentication failure would be put in the public domain, and what independent audit process would be adopted to monitor if the authentication was going on efficiently.

After the Aadhaar regulations were notified in September, this reporter submitted several right-to-information applications to the Authority seeking data related to authentication requests – as part of Scroll.in’s ongoing Identity Project series on the implementation of Aadhaar. The period for which information was sought was from September 2010, when the first Aadhaar number was issued, till October 31, 2016. Most of the replies from the Authority’s regional offices were received in December and January, with a final response coming in on March 1.

Replying to Scroll.in’s query, the Authority stated that it maintains month-wise data on how many authentication requests were received since September 2012. It does not maintain this data state-wise.

The Authority shared the total number of authentication requests received between September 2012 and October 2016 through five modes – fingerprint, iris, demographic, one-time password, and “other” – which came to a total of over 331 crore requests.

But it declined to share how many of these requests had failed or succeeded. To a question on how many times the Authority had returned a negative reply to the authentication requests, with a number for each of the five authentication modes, it stated that this data “is not readily available”.

UIDAI stated that the data on authentication requests cannot be shared as it is not
UIDAI stated that the data on authentication requests cannot be shared as it is not "readily available."
UIDAI stated that it received 331,02,44401 (over 331 crore) authentication requests between September 2012 and October 2016.
UIDAI stated that it received 331,02,44401 (over 331 crore) authentication requests between September 2012 and October 2016.

No accountability

Government data and interviews with scheme beneficiaries show that individuals in some states, such as Rajasthan, have faced glitches and fingerprint authentication errors on a massive scale since Aadhaar was made mandatory to access food rations in 2015-’16. Thousands of households could not access their legal food entitlements and pensions because of this.

The beneficiaries are being denied for various reasons: if they do not have an Aadhaar number, if there are data entry errors in the details linked to or seeded in the public distribution database, if the fingerprint authentication does not work for many who do manual work or for the elderly. Also, electricity and internet connectivity problems, especially in remote villages, often mean that beneficiaries have to make multiple trips to the fair price shops, which in turn means losing a day’s wage for many of them.

Play

One of the first blueprints to be published for Aadhaar in welfare delivery was on the public distribution system.

“The Aadhaar number would be a foundation, over which the government can build more effective public distribution system processes,” the Unique Identification Authority of India stated in a 2010 policy document.

The paper envisioned that using Aadhaar would allow for “real-time identity verification at the fair price shop”, real-time streamlining for inventory management, and real-time tracking of beneficiaries’ claims by civil society activists.

In a sub-section titled “Community participation in monitoring” (page 11), the Authority stated:

“Aadhaar-based authentication and Management Information Systems would bring transparency to a currently opaque system. Clear accountability through Aadhaar authentication, as well as the use of electronic records, would make data more available for community monitoring, and would strengthen the use of right to information in the public distribution system.”

It added that an Aadhaar-enabled information technology grievance system “would ensure that complaints are visible publicly and across different levels of government”.

But that’s all on paper. Six years on, the process for tracking those who have been denied their legal entitlements, such as subsidised foodgrains under the National Food Security Act, and why remains as opaque as ever, say social activists.

“The biometric authentication technology claim is failing on a large scale in villages,” said Nikhil Dey, an activist with the Mazdoor Kisan Shakti Sangathan. “Yet, in three recent meetings, Rajasthan government has refused to share data with us on how many beneficiaries have been wrongly rejected, how many times, after how many authentication attempts.”

He added: “Why does the government want our information, while it keeps important public data such as these a secret?”

We welcome your comments at letters@scroll.in.
Sponsored Content BY 

What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

At the Emory University Hospital in Atlanta, visitors don’t have to worry about navigating their way across the complex hospital premises. All they need to do is download wayfinding tools from the installed digital signage onto their smartphone and get step by step directions. Other hospitals have digital signage in surgical waiting rooms that share surgery updates with the anxious families waiting outside, or offer general information to visitors in waiting rooms. Many others use digital registration tools to reduce check-in time or have Smart TVs in patient rooms that serve educational and anxiety alleviating content.

Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the Scroll.in marketing team and not by the Scroll.in editorial staff.