Impact of pandemic

• The novel coronavirus pandemic has accelerated the use of digital technologies in India, even for essential services such as health and education, where access to them might be poor.
• Economic inequality has increased: people whose jobs and salaries are protected, face no economic fallout.
• Well-recognised channels of economic and social mobility — education and health — are getting rejigged in ways that make access more inequitable in an already unequal society.

Growing inequality in access to education

• According to National Sample Survey data from 2017, only 6% rural households and 25% urban households have a computer.
• Access to Internet facilities is not universal either: 17% in rural areas and 42% in urban areas.
• Surveys by the National Council of Educational Research and Training (NCERT), the Azim Premji Foundation, ASER and Oxfam suggest that between 27% and 60% could not access online classes for a range of reasons: lack of devices, shared devices, inability to buy “data packs”, etc.
• Further, lack of stable connectivity jeopardises their evaluations.
• Besides this, many lack a learning environment at home.
• Peer learning has also suffered.

Inequality in access to health care

•  India’s public spending on health is barely 1% of GDP.
• Partly as a result, the share of ‘out of pocket’ (OOP) health expenditure (of total health spending) in India was over 60% in 2018.
• Even in a highly privatised health system such as the United States, OOP was merely 10%.
• Moreover, the private health sector in India is poorly regulated in practice.
• Both put the poor at a disadvantage in accessing good health care.
• Right now, the focus is on the shortage of essentials: drugs, hospital beds, oxygen, vaccines.
• In several instances, developing an app is being seen as a solution for allocation of various health services. 
• Digital “solutions” create additional bureaucracy for all sick persons in search of these services without disciplining the culprits.
• Platform- and app-based solutions can exclude the poor entirely, or squeeze their access to scarce health services further.
• In other spheres (e.g., vaccination) too, digital technologies are creating extra hurdles.
• The use of CoWIN to book a slot makes it that much harder for those without phones, computers and the Internet. 

Issues with the creation of centralised database

• The digital health ID project is being pushed during the pandemic when its merits cannot be adequately debated.
• Electronic and interoperable health records are the purported benefits.
• For patients, interoperability i.e., you do not have to lug your x-rays, past medication and investigations can be achieved by decentralising digital storage say, on smart cards as France and Taiwan have done.
• Given that we lack a data privacy law in India, it is very likely that our health records will end up with private entities without our consent, even weaponised against us.
• For example, a private insurance companies may use health record to deny poor people an insurance policy or charge a higher premium.
• There are worries that the government is using the vaccination drive to populate the digital health ID database.

Way forward

• Unless health expenditure on basic health services (ward staff, nurses, doctors, laboratory technicians, medicines, beds, oxygen, ventilators) is increased, apps such as Aarogya Setu, Aadhaar and digital health IDs can improve little.
• Unless laws against medical malpractices are enforced strictly, digital solutions will obfuscate and distract us from the real problem.
• We need political, not technocratic, solutions.

Conclusion

Today, there is greater understanding that the harms from Aadhaar and its cousins fall disproportionately on the vulnerable. Hopefully, the pandemic will teach us to be more discerning about which digital technologies we embrace.

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