India is currently in the throes of a catastrophic second wave of the Covid-19 pandemic, which has exposed the severe lack of our health infrastructure. Since March 2021, we have seen the situation spiral out of control to the extent that people are now left with no choice but to crowdsource life-saving drugs, oxygen cylinders and hospital beds on the internet.
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Technology is serving us during this crisis and it is natural for it to be viewed as a measure for vaccination. Here, the principal response has been through the CoWin portal that has been launched by the Government of India to digitise the vaccination drive. It is, however, resulting in vaccine exclusion and a lack of privacy.
The most obvious criticism of the portal is its mandatory nature for vaccination in the 18-44 age group. CoWin, which on May 1 opened for registration of individuals ranging from 18-44 years of age, has come under criticism for its propensity to exclude people who are still on the other side of the digital divide as well as for its inherent design issues.
According to the Indian Telecom Services Performance Indicator Report for October-December, 2020, released on April 27, 2021, the percentage of the rural population that subscribes to the internet is 34.60 per cent. It even conflicts with the early-stage learnings from CoWin’s own dashboard. On April 28, the dashboard showed that for the 45-plus age group, out of a total 14,42,10,652 vaccination registrations, only 2,52,96,511 were through CoWin.
In the absence of the internet and without knowledge of how the portal functions, the majority of India’s rural population is being discriminated against and a form of technical rationing is being implemented by CoWin based on broadband connectivity and digital literacy.
This is anecdotally reinforced even in high connectivity areas. A report in this paper (IE, May 12) carries a self-explanatory headline, “In Delhi’s slums, barriers to vaccination: Few smartphones, English-only website”.
The second area of concern is that of data protection and cyber security. At present, vaccination slots on the portal are being released without any notice or schedule, and are being snatched up within seconds of being released by whoever is lucky enough to be checking the portal at the time, turning the vaccination drive into a game of “fastest finger first”.
Even this metaphor is inaccurate as either through its official API or automated scripts, a range of functionality is available for people to automate functions ranging from notification to even slot reservation. These exist in multiple variations and risk exposure of medical healthcare data through third-party providers.
It would be appropriate for the National Health Authority to issue an advisory or change the technical flow of CoWin to prevent such automation, which compounds exclusion and also risks the privacy of Indians.
However, CoWin’s own record speaks poorly on privacy. The CoWin website has no privacy policy even while India lacks a data protection law. While the Union Minister of State for Health, Ashwini Choubey, has provided, in a response to Parliament, an undertaking that the Data Privacy Policy of the National Health Mission would cover CoWin, on a finer reading of the policy, its applicability is not specifically defined.
This is contrary to the Supreme Court’s right to privacy judgment but also to the departmental guidelines of the Government of India for official websites. The departmental guidelines clearly state that government websites when collecting personal data, “must incorporate a prominently displayed privacy statement…”.
In an interview on April 6, 2021, R S Sharma, the current CEO of the National Health Authority, revealed a pilot study stating that “Aadhaar-based facial recognition system could soon replace biometric fingerprint or iris scan machines at Covid-19 vaccination centres across the country in order to avoid infections.”
Following criticism from public health and digital rights organisations, Sharma claimed that, “the process involves face authentication and not facial recognition”. This change in nomenclature means little. Facial recognition bundles within it the process of authentication and can match against a person’s own biometrics (as has been claimed) for identity authentication, or against the general population, which is a wider body of data, for surveillance and security. While the privacy risk in the latter is more significant, the former continues to erode rights.
Use of Aadhaar-based facial authentication for access to vaccines creates further technical barriers for universalisation of vaccination with a worrying prospect of false negative results. The available technical studies consistently demonstrate high error rates in facial authentication.
Environmental factors as opposed to ideal laboratory conditions will further contribute to operational complexity. The technology is not mature enough for deployment and a pandemic is an inappropriate time for experimentation. Again, facial authentication is being piloted in a legal vacuum of a data protection law, where the facial recognition data that will be layered with medical healthcare data can be stored, captured and shared without any legal limits or practical safeguards.
The technocratic approach in using digital systems has prioritised data collection and efficiency over vaccine equity. It disregards the experience of public healthcare and digital rights experts. The present deployment of CoWin, rather than augmenting the right to health, is undermining it.
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- In the Large States category (overall), Chhattisgarh ranks 1st, followed by Odisha and Telangana, whereas, towards the bottom are Maharashtra at 16th, Assam at 17th and Gujarat at 18th. Gujarat is one State that has seen startling performance ranking 5th in the PAI 2021 Index outperforming traditionally good performing States like Andhra Pradesh and Karnataka, but ranks last in terms of Delta
- In the Small States category (overall), Nagaland tops, followed by Mizoram and Tripura. Towards the tail end of the overall Delta ranking is Uttarakhand (9th), Arunachal Pradesh (10th) and Meghalaya (11th). Nagaland despite being a poor performer in the PAI 2021 Index has come out to be the top performer in Delta, similarly, Mizoram’s performance in Delta is also reflected in it’s ranking in the PAI 2021 Index
- In terms of Equity, in the Large States category, Chhattisgarh has the best Delta rate on Equity indicators, this is also reflected in the performance of Chhattisgarh in the Equity Pillar where it ranks 4th. Following Chhattisgarh is Odisha ranking 2nd in Delta-Equity ranking, but ranks 17th in the Equity Pillar of PAI 2021. Telangana ranks 3rd in Delta-Equity ranking even though it is not a top performer in this Pillar in the overall PAI 2021 Index. Jharkhand (16th), Uttar Pradesh (17th) and Assam (18th) rank at the bottom with Uttar Pradesh’s performance in line with the PAI 2021 Index
- Odisha and Nagaland have shown the best year-on-year improvement under 12 Key Development indicators.
- In the 60:40 division States, the top three performers are Kerala, Goa and Tamil Nadu and, the bottom three performers are Uttar Pradesh, Jharkhand and Bihar.
- In the 90:10 division States, the top three performers were Himachal Pradesh, Sikkim and Mizoram; and, the bottom three performers are Manipur, Assam and Meghalaya.
- Among the 60:40 division States, Orissa, Chhattisgarh and Madhya Pradesh are the top three performers and Tamil Nadu, Telangana and Delhi appear as the bottom three performers.
- Among the 90:10 division States, the top three performers are Manipur, Arunachal Pradesh and Nagaland; and, the bottom three performers are Jammu and Kashmir, Uttarakhand and Himachal Pradesh
- Among the 60:40 division States, Goa, West Bengal and Delhi appear as the top three performers and Andhra Pradesh, Telangana and Bihar appear as the bottom three performers.
- Among the 90:10 division States, Mizoram, Himachal Pradesh and Tripura were the top three performers and Jammu & Kashmir, Nagaland and Arunachal Pradesh were the bottom three performers
- West Bengal, Bihar and Tamil Nadu were the top three States amongst the 60:40 division States; while Haryana, Punjab and Rajasthan appeared as the bottom three performers
- In the case of 90:10 division States, Mizoram, Assam and Tripura were the top three performers and Nagaland, Jammu & Kashmir and Uttarakhand featured as the bottom three
- Among the 60:40 division States, the top three performers are Kerala, Andhra Pradesh and Orissa and the bottom three performers are Madhya Pradesh, Jharkhand and Goa
- In the 90:10 division States, the top three performers are Mizoram, Sikkim and Nagaland and the bottom three performers are Manipur and Assam
In a diverse country like India, where each State is socially, culturally, economically, and politically distinct, measuring Governance becomes increasingly tricky. The Public Affairs Index (PAI 2021) is a scientifically rigorous, data-based framework that measures the quality of governance at the Sub-national level and ranks the States and Union Territories (UTs) of India on a Composite Index (CI).
States are classified into two categories – Large and Small – using population as the criteria.
In PAI 2021, PAC defined three significant pillars that embody Governance – Growth, Equity, and Sustainability. Each of the three Pillars is circumscribed by five governance praxis Themes.
The themes include – Voice and Accountability, Government Effectiveness, Rule of Law, Regulatory Quality and Control of Corruption.
At the bottom of the pyramid, 43 component indicators are mapped to 14 Sustainable Development Goals (SDGs) that are relevant to the States and UTs.
This forms the foundation of the conceptual framework of PAI 2021. The choice of the 43 indicators that go into the calculation of the CI were dictated by the objective of uncovering the complexity and multidimensional character of development governance
The Equity Principle
The Equity Pillar of the PAI 2021 Index analyses the inclusiveness impact at the Sub-national level in the country; inclusiveness in terms of the welfare of a society that depends primarily on establishing that all people feel that they have a say in the governance and are not excluded from the mainstream policy framework.
This requires all individuals and communities, but particularly the most vulnerable, to have an opportunity to improve or maintain their wellbeing. This chapter of PAI 2021 reflects the performance of States and UTs during the pandemic and questions the governance infrastructure in the country, analysing the effectiveness of schemes and the general livelihood of the people in terms of Equity.
Growth and its Discontents
Growth in its multidimensional form encompasses the essence of access to and the availability and optimal utilisation of resources. By resources, PAI 2021 refer to human resources, infrastructure and the budgetary allocations. Capacity building of an economy cannot take place if all the key players of growth do not drive development. The multiplier effects of better health care, improved educational outcomes, increased capital accumulation and lower unemployment levels contribute magnificently in the growth and development of the States.
The Pursuit Of Sustainability
The Sustainability Pillar analyses the access to and usage of resources that has an impact on environment, economy and humankind. The Pillar subsumes two themes and uses seven indicators to measure the effectiveness of government efforts with regards to Sustainability.
The Curious Case Of The Delta
The Delta Analysis presents the results on the State performance on year-on-year improvement. The rankings are measured as the Delta value over the last five to 10 years of data available for 12 Key Development Indicators (KDI). In PAI 2021, 12 indicators across the three Pillars of Equity (five indicators), Growth (five indicators) and Sustainability (two indicators). These KDIs are the outcome indicators crucial to assess Human Development. The Performance in the Delta Analysis is then compared to the Overall PAI 2021 Index.
Key Findings:-
In the Scheme of Things
The Scheme Analysis adds an additional dimension to ranking of the States on their governance. It attempts to complement the Governance Model by trying to understand the developmental activities undertaken by State Governments in the form of schemes. It also tries to understand whether better performance of States in schemes reflect in better governance.
The Centrally Sponsored schemes that were analysed are National Health Mission (NHM), Umbrella Integrated Child Development Services scheme (ICDS), Mahatma Gandh National Rural Employment Guarantee Scheme (MGNREGS), Samagra Shiksha Abhiyan (SmSA) and MidDay Meal Scheme (MDMS).
National Health Mission (NHM)
INTEGRATED CHILD DEVELOPMENT SERVICES (ICDS)
MID- DAY MEAL SCHEME (MDMS)
SAMAGRA SHIKSHA ABHIYAN (SMSA)
MAHATMA GANDHI NATIONAL RURAL EMPLOYMENT GUARANTEE SCHEME (MGNREGS)