In his Budget speech on February 1, Finance Minister Arun Jaitley announced that Aadhaar-based smart cards were being introduced for senior citizens that would contain their health details. However, it seem that the finance minister has announced this health-related project without consulting the Ministry of Health and Family Welfare: even senior ministry officials have been unable to share any details about the scheme.

“A beginning will be made through a pilot in 15 districts during 2017-’18,” Jaitleysaid in this speech.

However, none of the three senior officials in the health ministry to whom spoke had any information regarding the project.

“Was this announced in this budget?” asked Dr Arun Panda, additional secretary in the health ministry. “We have to take a look at what has been stated before we can respond. Sometimes the government could think of a scheme, which we have to execute. But we wouldn’t know about it.” also spoke to Sunil Sharma, joint secretary in charge of setting up National e-Health Authority that aims to use Aadhaar-based biometric information to store health records at government facilities. Sharma said he did not have information on the project and would not be implementing it.

A senior official in the direct benefit transfer division in the cabinet secretariat said the division had no information on this new project.

Health secretary CK Mishra did not respond to SMS queries requesting information about the scheme.

Peddling Aadhaar

In the last three months, the Union government has starting using Aadhaar’s biometrics-based Unique Identity System at several health facilities across the country.

The National e-Health Authority will significantly reshape the public health system by using Aadhaar numbers as unique patient identifiers. The electronic record will include previous medical history, procedures undergone, diagnosis, drugs prescribed and which hospitals the patient visited. All this information will be accessible on a cloud-based e-application.

However, public health activists have expressed concern that using Aadhaar for health services could create barriers to accessing health facilities. Evidence from the public distribution system ration shops and from social pensions shows that the technology has not been working smoothly.

Abhay Shukla, convenor of Jan Swasthya Abhiyaan which is a network of health rights organisations, questioned the rationale of the announcement of smart cards for senior citizens. “The announcement of this scheme is a way of justifying and promoting Aadhaar,” he said.

In December 2016, the country’s premier hospital All India Institute of Medical Sciences introduced a new policy to incentivise the use of Aadhaar at the hospital. Patients who do not have an Aadhaar numbers now pay Rs 100, which is 10 times the current registration fee. Those who have registered for the national Aadhaar biometrically-verified identity scheme will have the registration fee waived.

What do senior citizens need?

Dipa Sinha, a development economist and member of the National Alliance for Maternal Health and Human Rights, said that opacity of the senior citizen’s smart card scheme was similar to the manner in which Aadhaar had earlier been linked to subsidised foodgrains benefits under the public distribution system.

“Even when the government announced the scheme converting the Public Distribution System to Aadhaar-linked direct cash transfers in 2015, the orders were coming from the Prime Minister’s Office and not going from the nodal ministry,” said Sinha.

Shukla of Jan Swastha Abhiyaan said that while the scheme sounded good on paper, the drive to digitially linked medical records could not be a priority when it comes to public health in India.

“Even when we talk of senior citizens, non-communicable diseases such as diabetes and cardiovascular problems such as hypertension are the biggest problems they face,” Shukla said. “There is a huge shortage of medicines for hypertension and diabetes in public hospitals. Making them available would have been a more useful measure than simply announcing a smart card.”

Shukla added that hospitals also need diagnostic equipments for testing hypertension and diabetes. “Or else what records are they going to store in that smart card?” he asked.