The government has made Aadhaar compulsory for tuberculosis patients and health providers seeking cash assistance under the Revised National Tuberculosis Control Programme. The nationwide programme is administered online through a web-based application called Nikshay. All government and private healthcare providers are supposed to register TB patients using Nikshay.

A notification issued by the Ministry of Health and Family Welfare on June 16 says that those eligible to receive conditional cash assistance using Nikshay will need Aadhaar, the 12-digit biometric number assigned to residents in India.

Even though the notification does not specify that TB patients must have Aadhaar to access treatment, health officials have interpreted this to mean that TB patients registering on Nikshay will need Aadhaar, regardless of whether they take cash assistance.

“We want to ensure that the patient identity number [in Nikshay] is linked with Aadhaar identity number. Otherwise, there are double or triple entries in our database of the same patient,” said Dr Sunil Khaparde, deputy director general of Central TB Division that runs the TB programme in the country. “So when the patient comes for treatment, they should come with Aadhaar.”

If patients or beneficiaries are not enrolled under Aadhaar, they must apply for Aadhaar and provide the enrollment slip along with other identity cards such as voter identity card by August 31.

Denial of treatment?

Blessina Kumar, chairperson of the Global Coalition of TB Activists expressed concern over the notification and said that the linking of Aadhaar would create yet another barrier in accessing the much needed care for TB patients.

“We have 1,400 deaths a day because of TB,” she said. “We need to be removing hurdles, not adding them.”

As per the Global TB Report 2016, an estimated 48 lakh cases new cases occur every year. However, the government has announced its intention to eliminate TB in India by 2025.

Defending the government’s decision, Khaparde said: “There is no question of denying treatment to any patient. Whoever does not have an Aadhaar can apply for it while the treatment is on too.”

Khaparde said that there is a proposal pending with the government to provide Rs 3,000 for every TB patient who seeks treatment under this programme. These patients too will have to provide Aadhaar linked bank accounts to seek benefits for the new scheme. “The Aadhaar linkage will make cash transfers more transparent,” he said.

The other beneficiaries include private healthcare providers who notify the disease with the government and Directly Observed Treatment Short-course or DOTS providers. DOTS providers may be ASHA worker, chemists or a social workers who could deliver TB medicines every alternate day to a patient.

Private doctors get Rs 100 for each notification and Rs 400 for each patient who completes treatment. A DOTS provider gets Rs 1,000 for each patient treated for simple TB and Rs 5,000 for each patient with multi-drug resistant tuberculosis. These beneficiaries will now have to provide Aadhaar-linked bank accounts.

Poorest hit hardest, again

TB affects marginalised populations of society, mostly people living in crowded urban localities, HIV patients and tribal populations.

“Any additional layer of documentation will make it more difficult for patient to access care,” said Dr Amit Sengupta, associate global coordinator of the People’s Health Movement. “In this, the poorest of people and the most in need are the most likely to be left out. We have seen this in the public distribution system (of ration).”

Often patients are migrant labourers who do not have all the documents in place. “In my experience, some patients do not even have a ration card, let alone a Aadhaar number,” said Dr Lalit Anande, chief medical officer of General TB Hospital in Mumbai, a tertiary level hospital.

Dr Yogesh Jain, one of the founder member of the nonprofit Jan Swasthya Sahyog in Bilaspur, Chhattisgarh said that government should have piloted linking Aadhaar to the TB programme in a small area to assess its impact and to see if patients are being denied treatment. “Even if we say that only a small percentage of people do not have Aadhaar, we cannot risk denying them treatment,” said Jain. “It will have an impact on the epidemiology of the disease. These people are those who can infect others or put themselves at the risk of dying.”

Reducing record duplication?

Linking the Aadhaar number with the Nikshay identity number of the patient, Khaparde said, would avoid duplication of records of patients.

“We have seen that often patients will first go to private sector, and then the public sector for TB treatment,” said Khaparde. “We will now encourage people coming to us to get Aadhaar. This way the system will be foolproof.”

The Central TB division has already informed all the state TB officers to make their patients get Aadhaar numbers, he said.

“There is a fetishisation of Aadhaar as the only means of record keeping,” said Sengupta. “There is no evidence to show that Aadhaar linkage promotes better record keeping.”

Moreover, doctors and activists said that linking Aadhaar to the national TB programme will do little to solve the basic problems of TB prevention – lack of early diagnoses and not enough access to treatment.

Corrections and clarifications: This story has been updated at 10.15 am to reflect the contents of the government notification more accurately.