Improved Public Health Policy Planning for Universal Health Coverage

The Aadhaar system in India, which uses biometric data for identity verification, has become a key tool in delivering government healthcare services. However, it currently does not include children under the age of 5 due to the difficulty of accurately capturing young children’s fingerprints. Recent technological advancements suggest that India should now consider including biometrics for children aged 1-5 to improve healthcare delivery, especially for underserved populations.

Fingerprints as a Reliable Identity Marker

Research has shown that children’s fingerprints, even those of newborns, remain largely unchanged as they grow into adults. While superficial skin damage does not alter fingerprint patterns, intense manual labor can temporarily wear them away, and deep scars can permanently disrupt them. Capturing young children’s fingerprints has been a focus of research because it offers a stable form of identity, particularly in developing countries where other forms of documentation may be lacking.

Challenges in Capturing Young Children’s Fingerprints

Capturing fingerprints of children under 5 has been challenging due to technological limitations and infant behavior. Although the basic patterns of a child’s fingerprints remain the same, the spaces between the ridges change as the child grows, making it difficult for technology to match new patterns with the original ones. Additionally, newborns often experience quick skin peeling, complicating the process further.

Existing fingerprint technology for adults uses a glass surface, or ‘platen,’ which is problematic for young children. Their soft, malleable skin and poorly-defined ridges can obscure the patterns when pressed against the hard surface. Moreover, getting young children to keep their fingers on the platen long enough and with the right pressure is difficult due to their natural grasp reflex, which distorts the fingerprint.

Advances in Early Childhood Fingerprint Technology

Over the years, significant technological innovations have been made to accurately capture fingerprints of children under 5. High-resolution scanners and software that corrects for print distortion are now used. Non-contact imaging technology, which captures fingerprints without pressing them against a solid surface, has also shown promise in research settings.

Recently, companies like NEC, Simprints, and GAVI have developed a high-resolution fingerprint scanner with software correction, boasting a 99 percent accuracy rate. A trial involving 4,000 children aged 1-5 in Bangladesh began in September 2022, indicating that this technology is maturing and becoming more affordable, warranting attention from policymakers.

Baal Aadhaar and Healthcare Delivery

In India, the Baal Aadhaar currently requires fingerprint registration at age 5 and an update at age 15. The government should now consider collecting biometrics for children older than six months or a year, either by licensing existing technology or developing it in-house through partnerships with Indian tech firms. This would enhance the Aadhaar biometric scheme and significantly benefit healthcare delivery.

India’s healthcare infrastructure is highly decentralized, making it difficult to transfer patient records when treatment is sought at different locations. For the approximately 600 million internal migrants, many from poor, rural backgrounds, paper records for their children are often lost, damaged, or incomplete. Parents may also lack the medical literacy to fully explain their child’s medical history, hindering effective medical management.

For example, during the 2022 measles outbreak in Mumbai/Thane, the loss of paper vaccination records by parents made it difficult for authorities to identify unvaccinated children. The ongoing rollout of the U-WIN portal aims to store all vaccination records on one platform linked to an ID proof, and the Ayushman Bharat Digital Mission (ABDM) is creating a system for sharing medical records between healthcare facilities. These systems would be more effective with fingerprint-based identity verification, which offers better outcomes than electronic medical records or document-based verification alone.

Documentary proof of identity can exclude certain groups, such as abandoned children, the homeless, and those from frequently moving families, who may lose medical documents and face difficulties acquiring identification like Aadhaar cards.

The Way Forward

Including biometrics for children aged 1-5 in the Baal Aadhaar will help achieve Universal Health Coverage by providing better access and continuity of healthcare for vulnerable children. It will also aid healthcare providers in collecting comprehensive medical histories and identifying unvaccinated children. In the long term, this will help the government better target child beneficiaries for welfare schemes and improve the accuracy of birth registries, benefiting public health policy planning.

Pulkit Athavle is a 2nd year MBBS undergraduate student at Nanyang Technological University, Singapore.

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