But many healthcare workers we interviewed also recognized that strictly enforcing the national ID requirement would result in people being denied health care, including ‘deserving’ beneficiaries. That is why most respondents reported that, although it was a requirement, they would not refuse care to a patient who did not have an NIC in their own facility. Only 7 out of 78 people who knew of the national ID requirement admitted that they were aware of its exclusionary nature. Many said that several of their patients do not have a national ID so they could not make it a strict requirement. The director of a hospital near Kampala summed this up, “it would be unfair for us to implement that system in our hospital. For example, if someone gets an accident and has lost everything, how will you ask for a national ID?” In some of the health centres we visited the column for NIN in the various health registers simply remained blank. Even the more sophisticated government hospitals reported that their electronic record systems had not yet been updated to accommodate the reporting of the NIN. One nurse in Namayingo was especially worried about the impact this policy would have on children whose parents did not have the national ID and teenage girls who were not yet 18 and thus not eligible to receive their NIC. Another told us: It’s going to make life harder for those who don’t have a national ID. They are going to get health complications including becoming anaemic like the case for young adolescent young mothers who don’t have these national IDs. Figure 23. Maternity Wing of Biiso Health Centre where its mandatory for expectant mothers to carry a national ID. Healthcare workers’ fears that the requirement would lead to people not receiving care has already materialized according to some of the women we spoke with. They recounted stories of being ‘chased away’ from health centres, both public and private, when seeking medical care for themselves or for their children. “Without an ID or clinic card for women who have been receiving antenatal care, no treatment,” one woman in Amudat told us, “many people fall sick and stay home and die.” Several women reported instances where they arrived at a health clinic only to be told that they would need to rush back home to pick up the national ID. “I took my pregnant daughter, but we left the ID at home, so we had to travel back and pick it up so as to access treatment. And the distance was far.” Not everyone was able to make such trips so they either delayed treatment, went without care, or resorted to taking herbs or buying drugs at a private drug shop. One woman in Kayunga told us: How a National Security Approach to Uganda’s National Digital ID Has Led to Wholesale Exclusion of Women and Older Persons 55

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