Is India Ready For Digitization Of Services?

"The digital space has evolved in leaps and bounds in the last two decades. After the pandemic, the digital space became an inescapable part of everyone’s lives. From many urban businesses being Google listed to online shopping, buying groceries, and online banking, the presence of the internet has been prominent. This has resulted in India experiencing the largest number of real-time transactions in 2021 (48.6 billion). Technology has therefore enabled knowledge and information sharing, has brought markets to our fingertips, and increased access to basic services. Yet this is just one side of the story—of the privileged who have gadgets and uninterrupted internet connection at their homes and on their smartphones to reap the benefits of being online.” - India Inequality Report 2022: Digital Divide, Oxfam India

India is taking giant leaps in digitizing health systems with the introduction of the Ayushman Bharat Digital System (previously named National Digital Health Mission). The digital revolution in the health sector is intended to help resolve the existing disparities in the delivery of services. India is a country with a diverse population with multi-layered inequalities related to gender, social and economic status, geographical location, and, most importantly in this context, digital literacy. Therefore, we need to ponder whether the need for digitization is uniform and if it will really address existing inequities. 

The India Story is quite ironic. We have huge disparities existing within the digital realm -  rural and urban; privileged and marginalized. The digital literacy rates in most the metropolitan cities are over 61%,  which is at par with some of the most developed countries. But predominantly rural states like Bihar and Orissa are worse off than several of the least-developed countries with only 25% of people being digitally literate.

According to the National Sample Survey Office (NSSO) 75th round, only one-fifth of India’s population can operate a computer or use the internet.  Among the poorest one-fifth of households, only 2.7% have access to a computer and 8.9% to internet facilities. On the contrary, among the richest one-fifth of households, 27.6% have access to a computer and 50.5% to internet facilities.

The Oxfam India Digital Inequality Report 2022 refers to the digital divide as “the gap between individuals, households, businesses, and geographic areas at different socio-economic levels with regard to both their opportunities to access information and communication technologies (ICTs) and to their use of the internet for a wide variety of activities.” It reflects differences among and within countries. 

“It is not just about people who have access and those that do not; it is not just about haves and have-nots. It is about people becoming knowers and know-nots; and doers and do-nots; those who can communicate with the rest of the world and those that cannot.” - Sumanjeet Singh, Associate Professor in the Department of Commerce, Ramjas College, University of Delhi, writes in his paper on the digital divide in India.

In a recent talk titled “Digital Divide: A Perspective From the Other Side,” Dr. John Cherian Oommen from Christian Hospital, Bissamcuttack emphasized how digitalization has excluded the underprivileged and widened the gap of the existing inequalities. He cited the example of the Cowin portal. The COVID-19 vaccine was made available through appointments through the digital platform. This deprived the digitally poor of accessing a life-saving vaccine. 

Citing another example from the same community, he highlighted how online education during the COVID-19 pandemic had failed to consider people from his remote community. He rightly pointed out how most solutions (existing policies and schemes) that are introduced or formed are affected by “Capitalitis”, a term he invented. He describes Capitilitis as “an ophthalmic disease that prevents one from seeing beyond the capital.” Through the talk, Dr. Johny instilled the need of enlarging the viewpoint of policymakers, and public health professionals beyond the four walls of the capital.

 “Our understanding of reality depends on where we are looking from.”-Dr. John Oommen

The effects of the digital divide were classified by Dewan and Riggings into two groups. First-order effects include inequalities due to differential access to technology and second-order effects include inequalities due to the difference in the ability to use the technology among those who have access to them. These two effects need to be considered before digitizing anything in the country.

The Oxfam India Inequality Report 2022 on the Digital divide has extensively covered and discussed the existing disparities in various fields including health. The Government has been trying to digitalize schemes to increase accessibility. 

“Often the beneficiaries of the government belong to the economically backward and socially marginalized sections of the society. Evidence suggests that they have remained digitally disconnected. As such, when compulsory digital methods are used to provide government benefits and services, it fails the very people it intends to serve”. - India Inequality Report 2022: Digital Divide, Oxfam India

For instance, let’s look at the initiatives that mandate an Aadhar card. The One Nation One Card (ONORC) launched in August 2019, made it mandatory for individuals to get their Aadhar Card linked with the Ration Card to avail benefits of this scheme. Though the deadline to link the card was extended twice, officials in many states immediately started insisting on linkage and denied ration to those who could not. 

For many with the linkage, the ration is denied since the thumbprint could not be authenticated as in the case of fading thumbprints in the elderly and finger deformities in people with leprosy. At a village in Jharkhand, it was reported that an 11-year-old died after months of starving as the administration stopped giving her family subsidized food. This is just one story among others, many of which go unreported or are brushed under the carpet. Similarly, pension was also denied to people whose identity was lost due to missing fingerprints.

Another case is that of the Mahatma Gandhi National Rural Employment Guarantee Act (NREGA) which is an Indian job guarantee scheme. The scheme guarantees 100 days of employment in every financial year to willing adult members of any rural household at the statutory minimum wage of Rs 100 per day. From January 1st onwards, the National Mobile Monitoring System (NMMS) digital attendance application was made compulsory for the workers across the country. 

The Application requires two “time-stamped and geo-tagged” photographs of the laborers before the attendance can be uploaded onto the server. Many times due to poor network issues or lack of access to digital technologies, the photos do not get registered on time. From February 1, 2023, the Ministry of Rural Development made it mandatory that all payments to the Mahatma Gandhi NREGA beneficiaries would be made through Aadhaar Based Payment System only. According to the Ministry of Rural Development’s report, currently, only 43% of NREGA workers are eligible for the Aadhar Based Payment System. This means that more than half of the workers are not getting paid even though they are working.

The above examples clearly show that digitization has not helped in addressing the inequity but made it worse. Before digitizing any existing process the officials should consider the following questions - Does the community have the necessary skills and technologies needed to effectively survive digitization? Are the internet download and upload speeds sufficient for the needs of the users? How does the cost of using digital devices compare to the cost of essential goods? What percentage of a person’s income will be spent on making the process accessible? Are there mobile applications available in the local language relevant to the people in the community?

Health experts insist that broadband internet access must be recognized as a social determinant for health. We need to build an inclusive, resilient, and sustainable digital environment. However, to achieve this goal and bridge the existing digital divide in India we need to bring in more inclusive solutions that consider all socio-economic aspects of the most vulnerable groups.

Edited by Parth Sharma.