Better public health policy planning for universal health coverage

Early childhood biometrics: a tool for improving healthcare delivery

The biometrics underlying the Aadhaar system has enabled it to become the fundamental tool for identity verification in India, which has led to it being increasingly integrated into the delivery of health services by the government. However, The biometric system still does not cover anyone under the age of 5 Due to the (once considered) insurmountable challenge of accurately detecting fingerprints in childhood. However, recent technological advances mean that India must now actively consider early childhood (1-5 years of age) biometrics to improve healthcare delivery, especially for the underprivileged.

Fingerprints as a permanent mark of identification

It has been proven that children, even newborns, have fingerprints, Don't get distracted to a large extent from their fingerprints as adults. Furthermore, superficial damage to the epidermis may not change the fingerprint pattern – although Intensive physical labor can (temporarily) erase patterns while deeper, permanent marks can distort them. As a result, capturing fingerprints of young children and newborns has been a much-researched area as it offers many benefits. a stable mark of identityEspecially in developing countries, where individuals do not have access to other forms of documentation.

Obstacles to taking fingerprints of young children

However, in practice, capturing fingerprints of children under 5 years of age has been a major challenge due to problems arising from inadequate technology and child behaviour.

First, while the basic pattern of a child's fingerprint does not change over time, from an imaging perspective, major changes are observed. Given that each fingerprint contains ridges and valleys that form this unique pattern, as a child grows up, the spaces between the lines increase unevenly, making it difficult for the technology to match the new fingerprint pattern to the original recorded pattern. This challenge is further compounded by the tendency of newborns to shed their skin quickly in the weeks after birth,

Second, existing fingerprint recognition technology for adults typically uses a 'platen' (a glass surface on which the fingertip is pressed). This is problematic for young children as they may injure themselves by pressing their fingertips on a hard glass surface. Obscure some patterns due to their soft, flexible skin and poorly defined ridges.

Finally, in practical terms, it may be a challenge to motivate a young child to keep his or her finger on the plate long enough and with the proper orientation and pressure level to obtain a useful fingerprint scan. In infants, according to the report, This is further exacerbated by the early childhood grasping reflex (where they grip the objects they are in contact with) which further distorts the pattern visible on the platen.

Early childhood fingerprint technology: Making its way into the mass market

As a result, over the past few years, a lot of technological innovation has gone into developing systems that can accurately capture childhood fingerprints, especially for children under the age of five. Very high resolution scanner (500 PPI vs. 1000 PPI for adults) should be used for young children because their fingerprints are smaller and more poorly defined than those of adults. It is sometimes used with software that will correct print distortion (such as blurring or improper finger positioning).

Alternatively, to deal with the issue of distortion associated with the 'platen', emerging technologies have sought to make use of Non-contact imaging Where the image of the fingerprint is captured without pressing it against a solid surface. In these methods, Research Adjustmentdemonstrated that accurate detection of fingerprints in early childhood is possible with current technology.

Alternatively, to overcome the distortion problem associated with the 'platen', emerging technologies have sought to use non-contact imaging, where the image of the fingerprint is captured without pressing it against a solid surface.

More recently, the Japanese corporation NEC, a British startup (Simprints) and GAVI Associative form Developed a system that uses a high-resolution fingerprint scanner with software improvements Self-reported 99 percent accuracyIn September 2022, a trial was launched 4,000 children (ages 1-5 years) in Bangladesh. The fact that large development organisations are now starting trials should be a strong signal that this technology is starting to mature (with costs potentially coming down) and should prompt policy makers to reconsider.

Baal Aadhaar and Healthcare Delivery

In the Indian context, Baal Aadhaar (Aadhaar for minors) is currently Registration of fingerprint is mandatory But Age 5 and after that, an update at age 15. It is now time for the government to actively consider collecting biometrics for children beyond six months or a year of age – either by licensing existing technology (such as through GAVI) or by actively developing it through partnerships with Indian technology firms. This will not only ensure that the Aadhaar biometric scheme remains at the forefront of identity verification but will also have huge benefits for healthcare delivery.

It is time for the government to actively consider collecting biometrics of children above the age of six months or one year – either by licensing existing technology (such as through GAVI) or by actively developing it through partnerships with Indian technology firms.

Currently, the healthcare infrastructure in India (as in many countries) is extremely decentralised: a patient’s healthcare records cannot be transferred when treatment is sought at another location. As a result, There are around 600 million internal migrants in India.For many people from poor, rural backgrounds who have migrated to urban/industrial/agricultural centres for work, their children’s documents are often lost, damaged, or incomplete.

Additionally, parents/caregivers may not have the medical literacy to fully explain their child's medical history (past tests, diagnoses, prescriptions), which hinders medical management. For example, the 2022 measles outbreak in Mumbai/Thane affected primarily the urban poor and migrant populations, Disadvantages of paper records of vaccinations This negligence on the part of parents greatly hindered municipal authorities in identifying children with zero/missed doses, A study It is estimated that approximately 75 percent of children under the age of five did not have vaccination cards.

Some of these issues can be resolved to some extent. Gradual ongoing rollout Objective of U-WIN Portal Store all UIP vaccination records But A platformOne is linked to an ID proof. Similarly, Ayushman Bharat Digital Mission (ABDM) is building an app that is generating an identity card for you. Dedicated architecture for sharing medical records between healthcare facilities.

Nevertheless, these systems will be enhanced with fingerprint-based identity verification, which Better Results For Children This is more complex than electronic medical records (EMR) or document-based identity verification. For example, parents may not be aware that their child has a U-WIN ID and may register them with a different document each time (or accidentally or fraudulently create multiple Baal Aadhaars), leading to a complex web of incomplete records. This problem is further compounded by the fact that individuals (and especially children) may have different name spellings on different documents, a common problem seen in the Indian context. With biometric identification, healthcare records (such as treatment/vaccination records) can be matched to child beneficiaries with greater accuracy, enabling the provision of appropriate care.

Nevertheless, these systems will be enhanced with fingerprint-based identity verification, which yields better outcomes for children than electronic medical record (EMR) or document-based identity verification alone.

Further, documentary proof of identity also runs the risk of inadvertently excluding certain groups of society, such as adopted/abandoned children, those who are homeless and people who come from families that move frequently – as many of these individuals may lose their medical documents/vaccination cards and face difficulties in obtaining identification such as Aadhaar cards.

road ahead

Collecting biometrics for children (aged 1-5 years), including Baal Aadhaar, will aid in the process of achieving Universal Health Coverage (UHC) by providing greater access and continuity of healthcare to children from vulnerable populations, while also assisting healthcare providers/authorities who face challenges in collecting comprehensive medical history and identifying zero/missing children.

This will also have long-term benefits, as the government will be able to better identify and target child beneficiaries for welfare schemes (with less leakage), as is currently done for adults. Moreover, it will be another cornerstone towards the ultimate goal of capturing infant (0-1 year old) fingerprints within a few days of birth, allowing the government to significantly improve the accuracy of the birth registry and maintain better population data – with benefits for public health policy planning as well.

pulkit athavale She is a second year MBBS undergraduate student at Nanyang Technological University, Singapore.

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