Current Project

On August 15, 2020, the prime minister of India announced the pilot launch of the National Digital Health Mission (NDHM) across various union territories of the country. The Mission seeks to make the entire ecosystem of existing health infrastructure available to citizens across different states by facilitating the digital storage, portability and interoperability of heath data and creating an updated registry of health facilities and service providers. One of the principal features of this e-infrastructure is the generation of unique Health IDs for every individual, which the architects of the Mission expect to unleash a range of digital potentialities. The NDHM also entails new configurations of participating actors, whereby the Indian government moves from being a healthcare provider to becoming a mere architect of technological standards – known as “common digital public goods” – that private players can utilize to produce relevant digital products.
The Indian state has been reconfiguring the ways of knowing, seeing, servicing populations through the processes of digitization and databasing. A pantheon of Digital India initiatives has sought to unleash neoliberal development by digitally syncing individuals into banking networks, identity databases, and mobile data connectivity. New networked infrastructures have come to pervade people’s everyday activities by digitally mediating access to welfare goods, banking services, jobs, mobile connections, and even cooking gas. The NDHM is a latest invocation in this digital utopia. However, India’s management of the Covid-19 pandemic in 2020 exposed multiple frictions underlying the promise of digital health governmentalities. Digital data infrastructures were characterized by leakages, duplications, and errors as they were incorporated into local configurations of the health bureaucracy, decentralized administrative decisions, infrastructural challenges, data-flow pathways, and data-entry labor.
In this project, I seek to understand the NDHM as emerging e-infrastructure that aims to intervene into health and illness management in a medical landscape of flawed disease-control programs, welfare programs, and informal and formal healthcare providers. I am particularly interested in understanding how the NDHM is spatialized across existing bureaucratic hierarchies, technological systems, and the geographical distribution of health facilities to manifest the vision of seamless management of patients and their data.
Drawing together both utopian visions and real-world frictions, this project explores the nation-wide impetus for databasing, data integration and data interoperability as a form of digital governmentality that supplants the care of population for the care of data and its productive capacities. The research explores the NDHM as emerging e-infrastructure and focuses on the interactions this infrastructural vision entails: between citizens and institutions, bodies and technologies, new software provision and existing technological systems, and health-seeking and health-provisioning. Tracing the inroads NDHM is making into the political economy of digital technology, I analyze how citizen-patients are construed as data subjects, how data is put to use, and how digitized systems mediate or disrupt care as they increasingly encompass the myriad interactions between medical staff and patients in hospitals. My ethnography analyzes the implementation of digital health projects in hospital settings, where there are ongoing attempts to digitize all paper-based medical work, from the admission to the discharge of patients. Moreover, the project explores how governments “see” populations as they plan to integrate multiple sources of data – disease surveillance programs, insurance beneficiary data, patient health IDs – into unified health interfaces.
This project adds to recent scholarship on large-scale e-infrastructures in Information Systems (IS) and Science, Technology and Society (STS) that dwell on configural politics of infrastructure. Drawing on the anthropology of infrastructures, I focus on how large-scale information technology systems are piled onto existing bureaucratic settings and data environments. What are the socio-material challenges that emerge as siloed data systems are recalibrated to create a “lively” interactive platform that will capture every digital trace generated by patient-users and health security beneficiaries? Finally, I engage with medical anthropological literature on illness experiences and therapy management to probe whether this new infrastructure may miss more than it captures about how health is done, between medical staff, patients, and their attendants in a hospital setting.