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The digital health ID hack 📲

The Indian government has found a way to slip in a digital health ID when you are not looking

This is edition 379 of Beyond The First Order, a premium daily newsletter that demystifies the hidden models, incentives and consequences of the most significant events across India and Southeast Asia

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Good morning,

In India, the making of a digital health ID is definitely not as easy as it seems. Back in 2020, everyone thought WhatsApp Pay will, for sure, dominate the payments market. But, it turns out, it barely scratched the surface. The education board is going on the blockchain train, but how far can it go?

A marriage of unequals

Lines are getting blurred between a welfare scheme for the poor and a voluntary project cutting across classes.

On 27 September, India’s Prime Minister Narendra Modi presided over yet another renaming ceremony for the National Health Digital Mission (NDHM). Now, it is called Ayushman Bharat Digital Mission (ABDM).

It is not merely a case of changing nomenclatures. There is more than what meets the eye. In February, The Ken reported that the National Health Authority (NHA) machinery was working to marry the government-run cashless health insurance scheme for the poor—popularly referred to as ‘Ayushman Bharat’—with NDHM (or ABDM).

ABDM is being sold as a concept that will help any citizen of India access their digital health records at their fingertips. But this journey will be long. It will require numerous health players like laboratories, hospitals, and clinics to come and board and link all their patient records with newly minted, unique health IDs. They’ll also have to present the patient with a repository of their healthcare data.

In the future, it will pave the way for opening up findings from such data to the market, as hinted in the National Digital Blueprint. For now, just 12 public and private providers have been integrated with ADBM, including labs like Dr Lal Pathlabs, SRL Diagnostics, and an insurance company, Bajaj Finserv Health.

The Ayushman Bharat scheme, on the other hand, with 22 million beneficiaries, is a treasure house of data believed to be used to accelerate the wheels of ABDM. Officials in NHA have been working fervently in the background over the past seven months to enrol as many beneficiaries as possible for the cashless health insurance scheme. Two officials confirmed to The Ken that every beneficiary who has an Aadhaar linkage will get assigned a unique ID at the back end, which will then be used to make a digital health ID (with consent) under ABDM.

And while the scheme will have substantial beneficiaries cornered through this route, it is also urging the citizens who are financially well off and don’t fall under the purview of receiving the state’s cashless treatment to register under ABDM.

“Like UPI, ultimately, the patient/user needs to consent to all movement of records. So, the success of the mission will depend on that. Merely driving up numbers won’t help anyone,” an industry executive involved in the mission told The Ken. 

India envisions providing a unique health ID to every citizen, so that their health records are stored electronically. But getting a unique health ID requires a citizen to be properly counselled. It also requires the citizen to give specific consent to this end. But NHA rode on the back of the Covid vaccination wave to randomly issue unique health IDs to vaccinated individuals through the CoWIN portal route in the past. Don’t be surprised if you glance at your vaccine certificate and find out that you have already been issued one.

Source: The author’s vaccination certificate

While Ayushman Bharat is a welfare scheme, which empowers the government to mandate the use of Aadhaar to access welfare benefits, under the Aadhaar Act 2016, ABDM is a voluntary mission, which cannot mandate the use of Aadhaar.

However, ABDM aims to be the digital backbone for all healthcare services in India (public as well as private). And to that end, increasingly, Aadhaar is being notified as a preferred ID proof for Covid vaccinations, accruing welfare scheme benefits, and making a unique health ID.

For now, a complicated marriage is being worked out. To what end will cutting corners like surreptitiously slipping in unique health IDs while patients go in to seek other health services like vaccinations or cashless health insurance, remains to be seen.

CBSE marksheets are now on-chain

The Central Board of Secondary Education (CBSE), a national-level board of education in India for public and private schools, is moving class 10 and 12 marksheets to an oddly-titled blockchain platform, the Academic {BlockChain} Documents (ABCD).

Put simply, blockchains are a way to record information, transactional or otherwise, in a way that makes it difficult to change, hack, or cheat the system. Instead of being stored in one on-premise or cloud server, blockchains use a network of computers to distribute and duplicate information across the entire network, thereby eliminating single points of weakness.

The CBSE has uploaded academic documents for class 10 and 12 from 2019-2021 to the network. It has plans to add documents from previous years, too. The distributed repository has been integrated with the cloud-based Digital Locker service and has operational nodes (re: group of computers to run a blockchain) in Pune, Bengaluru, and Jaipur.

In addition to the marksheets, the blockchain repository will also store migration certificates and pass certificates.

While blockchains offer a higher level of security and make it easier to cross-check information, operating one can also come with significant costs. While the details are scant on how much the government shelled out on building the three nodes, The Ken has reported in the past that similar distributed record-keeping mechanisms used in the banking sector can cost anywhere between Rs 30-40 lakh (US$40,000-55,000) per node.

“This will serve as a single source [of] truthful data for verification for students going for higher education or employment,” Antriksh Joshi, director of information technology at CBSE, told news agency ANI.

While the CBSE has boarded the train with what seems to be a custom-built blockchain managed by the National Informatics Center (NIC), state governments in Maharashtra and Karnataka have been using similar document verifications services built atop the Ethereum blockchain and provided by a firm called LegitDoc.

Going by the headlines that appear now and then in national dailies—such as recent ones from Punjab and Uttar Pradesh—the CBSE’s offering could help resolve pain points. But telling people about it and getting them to use it could be a taller order.

India is no country for distribution (alone)

If sheer distribution strength could make a business, by now, WhatsApp Pay should have joined the league of top payments apps in India. Everyone—including the National Payments Corporation of India (NPCI), which manages retail payments, and I—believed that Whatsapp entering payments would be a runaway hit. The NPCI in 2020 even said WhatsApp Pay could only launch in a graded manner, starting with a maximum user base of 20 million, and cannot be rolled out to all users.

That caution came from the fact that WhatsApp had nearly 400 million users. It had the potential to walk away with the largest market share.

Cut to 2021 August and where are Whatsapp payments?

It recorded some 500,000 transactions in August, out of the total 3.55 billion UPI transactions that month. That’s even less than what India Post Payments Bank’s app or IndusInd bank’s app—companies that are not famous for their tech—registered in the same month. WhatsApp continues to lurk at the bottom of the UPI charts.

How does it get out of this funk? If WABetaInfo is anything to go by, the answer seems to be cashbacks.

The website, which reports on WhatsApp features in the works, said that the company submitted a new update through the Google Play Beta Program last week, which includes a plan to roll out cashbacks.


WABetaInfo’s report notes that the current code hints towards a one-time cashback of just ₹10 ($0.14)— which is very low compared to what other apps like Google Pay offered at launch — but it could change during the rollout. Plus, you’ll get the cashback 48 hours after you’ve made the payment. The reward could also be only for the people transacting through WhatsApp Pay for the first time, so if you’ve already used it, you might be out of luck. WhatsApp payments might soon earn you cash back, The Next Web

This plan could change, but the fact that WhatsApp is considering cashbacks shows that it realises distribution alone doesn’t guarantee success. The argument that regulatory forces kept WhatsApp from dominating payments also won’t fly anymore. Because Amazon Pay, a late starter in the payments game, is cranking up volumes. It saw 60 million transactions in August 2021.

Seems like the lesson for Whatsapp is: when in Rome, do as Romans do; and when in India, give cashback.

Unofficial Sources: How will smallcase win the millennial investing turf war?

When smallcase began operations in 2015, it took the retail investment world in India by storm. Investors flocked to the service for their intuitive and idea-based stock bundling options. Now, smallcase finds itself at the top of the market that has only grown in popularity, but the environment around it is changing. With new competitors gaining momentum, partnerships changing faces and the imminent threat of a price war, what will smallcase do to maintain its lead in the space it has created?

Listen to the latest episode of our podcast here:

That’s all for today. We’ll be back tomorrow.


Ka Kay

[email protected]

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