Page 100 - The Digital Financial Services (DFS) Ecosystem

ITU-T Focus Group Digital Financial Services
Ecosystem

can present challenges to children receiving health care and to government’s ability to track births, marriages,
deaths (UNICEF, 2013).

Many of the ID programs profiled in this paper function primarily as voter cards or national IDs that are issued
at later stages in life and therefore do not aim to register children. However, 38 percent of the registries that
underpin ID programs do incorporate children before age 11 (Figure 10). Colombia’s Registraduria Nacional
del Estado Civil has a three-tiered system of documentation from birth to age 18. It issues birth certificates
to newborns, an identity card to minors at age seven, and its “citizen card” to adults at 18 (Immigration and
Refugee Board – Colombia, 2007). India has set its registration age at five, but beginning in May 2015 the state
of Haryana began enrolling newborn babies into the Aadhaar program, issuing each unique ID numbers. The
goal of such early enrollment is related to both health and education, as it enables the government to centrally
track immunization rates and also school admission during adolescence (Economic Times of India, 2015a).

Figure 11 illustrates what health services are linked to national ID programs. In six cases, IDs are necessary in
order to access hospital or other health care system services (Iraq, Mali, Peru, Philippines, Romania, Sudan).
Four programs track services and treatment using national identifications registries. India and Pakistan track
immunizations, and Thailand and Uganda’s national ID’s facilitate patient management and tracking at hospitals.
Four countries (Cambodia, India, Thailand, Uganda) are using ID registries to verify eligibility for particular
health insurance coverage or for medical benefits. For example, Thailand’s national ID synchronizes with its
universal health coverage to automatically separate citizens into one of three possible public health insurance
schemes: “a) the civil servant medical benefit scheme for government employees, spouses, and dependents
under 20 years old, their parents and government retirees; b) the Social Health Insurance Scheme for private
sector employees, excluding their spouses and dependents, and; c) the Universal Coverage Scheme for the
76 percent of the population not covered by a or b” (JointLearningNetwork, n.d.).

Figure 11 – Health Connections of ID Programs

Despite the potential usefulness of national ID programs in centralizing information to inform public health
decisions, our literature review failed to return high numbers of demonstrated health links. One possible
explanation for low integration of national IDs and health may be that many existing, separate health cards
already exist. We found evidence of separate health IDs in five countries (Cote D’Ivoire, Ghana, Indonesia,
Kenya, and Mozambique). As discussed in the interoperability challenges section, we find evidence of instances
in which government agencies engage in ID turf wars in order to preserve existing powers or oversight (India,
Nigeria, Pakistan). This may prevent separate “health card” schemes from folding into overarching national ID
programs. In addition, for health agencies, maintaining status-quo operations may be more convenient given
the political will and effort that can be required to overhaul existing systems.

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