Ethical challenges of digital health technologies: Aadhaar, India

PROBLEM: The proliferation of information and communication technologies in India has enabled the emergence of health-related digital applications, from which important ethical issues arise. APPROACH: The Aadhaar identification system provides each resident in India with a 12-digit unique identification number, linked to demographic and biometric data. Identification by Aadhaar in welfare programmes has the important advantage of ensuring targeted benefits reach the intended recipients. LOCAL SETTING: Some of the major issues faced by the public health sector in India are inadequate funding and inefficient utilization of the funds allocated. The enhancement of currently available digital health records will greatly increase the efficiency of the health care services. RELEVANT CHANGES: The Aadhaar identification system has been linked to several health programmes since 2013. Success was achieved in a programme encouraging pregnant women to undergo delivery at a health facility, as use of Aadhaar number ensured that cash incentives reached the correct recipient. However, interruptions in the treatment of patients with tuberculosis and acquired immunodeficiency syndrome have been reported in other health programmes, due to patients fearing a breach of their confidentiality. LESSONS LEARNT: Although the proposed merging of the Aadhaar identification system with digital health care records could enable greater efficiency in monitoring public health and welfare programmes, important ethical issues of privacy and data ownership and use must be considered. In joining the digital revolution, low- and middle-income countries must also develop strict legal regulation to protect data and avoid information technology companies exploiting such databases for profit.