AeHIN Side Meeting ICTen - Invest in Unique ID Schemes and Link CRVS and UHC - a Focus on Concrete Steps and Capacity Building October 29-30, 2015 Background As Asia-Pacific moves into the post-2015 development era, there is a growing opportunity and need for transforming personal identity and health identification systems in support of equitable access. Unique IDs are fundamental to equity and universal health coverage - from drafting new identity management policies and legal frameworks, to investing in cutting-edge ICT for ehealth and interoperability. ICTen Steps Invest in Unique ID schemes and link CRVS and UHC There are inherent connections between National identity, health identity and civil registration systems. A common practice is that the civil registration system, primarily the birth certificate serves as the basis for individual identification and for the recording of entry into and exit from population registries. The birth certificate is considered the foundational or (breeder) document for all individual identity systems and serves multiple purposes. Equally the death certificate allows for the official recording of a death in the continuous and permanent record (registry), which is important for updating electoral rolls, pensions and other social security mechanisms for the distribution of goods and services, including health and insurance. As countries modernize their civil registration systems and develop national identification systems, a key consideration is whether civil registry should also serve as the starting point for the unique identification of individuals. Civil registration plays a key role in realizing many human rights set out in United Nations declarations, covenants and resolutions, including the Convention on the Rights of the Child. Yet, advances in technology including biometrics and digital identity are shifting the boundaries between civil registration and personal identification within the National, health and insurance domains. Personal Identification typically relies on three things 1) something that a person has (i.e birth certificate, ID card, etc.); 2) something that a person knows (i.e birth date, mother s maiden name, password, etc.) and/or 3) a person s physical features (i.e fingerprints, iris scan, etc.). Biometrics are being explored and used more readily for personal identification and authentication, often in the absence of well functioning civil registration systems. Still, investments in biometrics must be measured wisely given the additional costs, capacity requirements, privacy and long-term sustainability considerations for identity management. It is worth noting that with the exception of DNA, biometrics have limited reliability for the identification of children, particularly under the age of 5. National governments have important choices surrounding the strengthening of civil registration systems, use of biometrics, National IDs and National Health Ids for health and insurance services. National Health IDs provide the mechanism for each patient to have one, unique identity within the health system. Implementing NHIDs are viewed as advantages for several reasons. In narrowing the scope to health, some of the critical implementation consideration and risks surrounding privacy, safety, ownership and human capacity become more manageable. Still, the costs and benefits must be weighed especially if a national identification mechanism already exists for non-health related government services 1. 1 UNAIDS / JC2640E (English original, June 2014) http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2014/jc2640_nationalhealthidentifiers_en.pdf 1
Currently, there are limited standards for the establishment of unique identification systems globally, including those using biometric verification techniques. And there has been limited systematic analysis of the strengths and limitations of unique ID systems, particularly in how or even if they should be linked to civil registration and population registers 2. However, the World Bank Group has recently launched the Identification for Development (ID4D) agenda to address the issues around SDG target 16.9 (by 2030, provide legal identity for all including birth registration). And the Asian Development Bank (ADB) is making unique IDs an integral part of their Health, Interoperability and UHC development agenda. These major areas are encapsulated in the ICTen recommendations, resulting from the AeHIN UHC with ICT conference held in Manila, December 2014. Open Health Information Exchange (OpenHIE) Client registry and master registry index OpenHIE provides a powerful open source architecture to support information exchange and interoperability for systems and devices to exchange data across multiple points of care and service delivery. 3 Within the OpenHIE architecture, the Client Registry (CR) and/or Enterprise Master Registry Index (EMPI) supports the unique identification and management of patient identities for who a health service was delivered. The EMPI links patient identities across healthcare providers that can often include the presence of many patient identifiers (from multiple vertical systems), limited use of standards (syntactic and semantic) in patient demographic attributes and duplicate patient records. Once a Client registry and Master index system is established linking existing ID systems in use, to a Master ID, the foundation for a person centric Health Information System that can more credibly monitor health outcomes and effectively link to CRVS for birth, death and cause of death reporting. Durable Unique IDs for disease programs, mhealth and existing systems (i.e Malaria, TB, HIV, immunization, etc.) In the near term, assigning durable ID s for the scale-up of mobile platforms (or mhealth ) and new surveillance tools that improve data management, longitudinal patient monitoring, and active case management can help address some of the fundamental challenges in managing individual-level records that have been designed and rolled out for specific diseases and vertical programs. Malaria, TB, HIV and immunization have been proving grounds for many mhealth solutions being brought to scale. Several of these efforts have implemented a durable unique id that can be merged with National Health ID/EMPI - over time. In addition, existing systems, primarily using paper can be redesigned in the short-run by assigning a durable unique ID that could be merged with a client registry/master registry and index, at a later time. Multi-country Unique ID/NHID assessment in Cambodia, Lao PRD and Myanmar, led by Asian Development Bank )ADB) in collaboration with AeHIN, WHO and UNICEF Investing in unique ID mechanisms is a substantial undertaking, with multiple opportunities and challenges, requiring sufficient planning to identify the best way forward. Advances in technology and interoperability and standards are providing unprecedented opportunities to break silos and take a quantum leap forward in delivering health care and linking to CRVS and UHC. And the cross-sectorial nature of unique identification and the existing fragmented ID landscape will require effective coordination and leadership to transform. 2 INFORMATION NOTE D, CRVS and Identity Management (www.getinthepicture.org) 3 www.openhie.org 2
In the interest of better understanding the current landscape for unique identifications systems, ADB in collaboration with UNICEF, WHO, and AeHIN, is conducting a multi-country assessment under the RECAP mission in Cambodia, Laos and Myanmar. The assessment is currently on-going and is drawing on emerging best practices (i.e digital identity management, biometrics, interoperability, CRVS strengthening (i.e uniquely identifying children, the hard to reach), etc. to help countries avoid early missteps and develop effective and efficient Unique ID management strategies. Another major focus of the assessment is health financing schemes where population coverage is typically very low but unique identification mechanisms have been put in place. Questions remain about how to effectively integrate these systems with NHID. In addition, the assessment will provide key recommendations for national consultations that will enable countries to develop step-wise roadmaps for the implementation of unique IDs including NHID, linked to CRVS and population registries. AeHIN & the Interoperability Lab building capacity in the region As investments in UHC, ehealth, Interoperability and CRVS grow throughout the region, there is recognition that human capacity will have one greatest impacts on the success of these efforts. In response, AeHIN is expanding it s efforts surrounding capacity building by forming the AeHIN Regional Community of Interoperability Laboratories. The Labs will allow AeHIN member countries to have first- hand experience on the policies, processes, and capacity-building approaches that are required to establish the foundations of a national health information system, and at the same time, allow for regional interoperability. 4 An important area of capacity building will focus on unique identifiers, NHID and Client Registry and Master index. During the recent Interoperability lab consultation in Manila, participants identified a capacity building curriculum for unique identifiers and Client registry around two parallel tracks including Policy/ Human interoperability and Technical/System interoperability. Further, data privacy and security was identified as an important part of the curriculum deserving of particular attention. The data centric nature of unique identification including the collection and retention of personal information can create real or perceived threats to privacy. In order to protect privacy, an effective Identity management program has to institute strong measures, including, but not limited to, appropriate legislation, oversight, data protection and privacy (e.g. an individuals right to consent, public notices), and the effective enforcement of privacy/it security policies and regulations, among others. The curriculum will be explored during the workshop and implemented in select countries throughout Asia. Purpose The workshop will expand National level understanding and capacity surrounding some of the key opportunities and challenges for the adoption of Unique IDs, linked to CRVS and UHC. Objectives Provide a foundation for countries to develop step-wise roadmaps for the Implementation of Unique IDs, NHID and Client Registry and Master Person Index (MPI) Support countries in identifying specific technical assistance and human capacity building needs surrounding the implementation of unique IDs Output(s) Brief guideline on important steps, key considerations and human capacity development needs for each country to progress towards implementation of Unique Ids 2 AeHIN Regional Interoperability Lab Terms of Reference 2015 3
Provisional Agenda 29-30 October 2015 Time Thursday, 29 Oct 2015: ICTen - Invest in Unique ID Schemes and Link CRVS and UHC Opportunities and Challenges 14:00 Welcome - National IDs Linked to CRVS and UHC Thailand s Experience Dr Boonchai Kijsanayotin, Co-Chair, Asia ehealth Information Network (AeHIN) 14:30 Workshop Objectives and Participant Introductions Ms Lori Thorell, UNICEF 14:45 Identity Management, Digital Identity and National Health IDs: On-going Efforts Opportunities and Challenges Dr Susan Roth, ADB 15:15 Identification for Development (ID4D) agenda and SDG target 16.9 (provide legal identity for all including birth registration, by 2030) Mr Sam Mills, World Bank Group 15:30 National Strategic Plan for Identity Management in the Kingdom of Cambodia (2015-2024) Excellency Yin Malyna 15:45 Break 16:00 Biometrics Investing in biometrics, assessing, cost, capacity, privacy and long-term sustainability - an identity management system assessment tool How biometrics are being used to uniquely identify individual in the absence of well functioning civil registration system and official birth certificates Biometrics and children reliability and ethical considerations Dr Mia Harbitz, World Bank Group 16:30 Data Privacy and System Security - Universal issues for personal identification and data sharing - assessing and managing the risks Mr Tom Hutton 4
17:00 OpenHIE a focus on Client Registry and Master Person Index Durable Unique IDs for disease programs, mhealth and existing systems (i.e Malaria, TB, HIV, immunization, etc.) Mr Mark Landry, WHO SEARO Engr Derek Ritz Health Infrastructure, Unique Ids and Immunization registry an entry point for a shared Person electronic health record 17:45 End of day - Wrap-up Time Friday, 30 Oct 2015: ICTen - Invest in Unique ID Schemes and Link CRVS and UHC Opportunities and Challenges 08:30 09:30 Unique ID/NHID Assessment in Laos, Cambodia and Myanmar - Initial Findings and Recommendations to Date Mr Michael Stahl, ADB Consultant Country Group Work Implementing Unique IDs, NHID and Identity Management Policy/Human Interoperability Capacity Building and Curriculum Development Exercise Facilitators: Michael Stahl, Lori Thorell, Derek Ritz, Mark Landry and Susann Roth 10:30 Break 11:00 Group-work Feedback and Discussion All participants 12:00 Lunch 13:00 13:30 AeHIN & the Interoperability Lab - Building Capacity in the Region for Client Registry and Unique IDs Dr Alvin Marcelo, Chair AeHIN Country Group Work--Implementing Unique IDs, NHID and Identity Management Capacity Building Needs and Curriculum Development Exercise Facilitators: Michael Stahl, Lori Thorell, Derek Ritz, Mark Landry, Susann Roth 5
15:00 Break 15:30 Group-work Feedback and Discussion All participants 16:30 Wrap-up and closing 6