Abstract
Birth registration is a critical element of newborn care. Increasing the coverage of birth registration is an essential part of the strategy to improve newborn survival globally, and is central to achieving greater health, social, and economic equity as defined under the United Nations Sustainable Development Goals. Parts of Eastern and Southern Africa have some of the lowest birth registration rates in the world. Mobile technologies have been used successfully with mothers and health workers in Africa to increase coverage of essential newborn care, including birth registration. However, mounting concerns about data ownership and data protection in the digital age are driving the search for scalable, user-centered, privacy protecting identity solutions. There is increasing interest in understanding if a self-sovereign identity (SSI) approach can help lower the barriers to birth registration by empowering families with a smartphone based process while providing high levels of data privacy and security in populations where birth registration rates are low. The process of birth registration and the barriers experienced by stakeholders are highly contextual. There is currently a gap in the literature with regard to modeling birth registration using SSI technology. This paper describes the development of a smartphone-based prototype system that allows interaction between families and health workers to carry out the initial steps of birth registration and linkage of mothers-baby pairs in an urban Kenyan setting using verifiable credentials, decentralized identifiers, and the emerging standards for their implementation in identity systems. The goal of the project was to develop a high fidelity prototype that could be used to obtain end-user feedback related to the feasibility and acceptability of an SSI approach in a particular Kenyan healthcare context. This paper will focus on how this technology was adapted for the specific context and implications for future research.
Highlights
The Sustainable Development Goals agenda (UN General Assembly, 2015), launched by the United Nations in 2015, spurred renewed focus on the high rates of neonatal mortality and low rates of birth registration in low and middle-income countries (LMICs)
Some of the highest rates of neonatal mortality and lowest rates of birth registration can be found in parts of Sub-Saharan Africa
The project team de-risked delivery, by adding a simulation mode to the prototype, which used representations of transitions between the applications to present pre-loaded credentials to the user of the guardian application. This has proven to be useful, as the COVID-19 pandemic resulted in an unexpected delay for the planned participatory design and user feedback activities in Kenya
Summary
The Sustainable Development Goals agenda (UN General Assembly, 2015), launched by the United Nations in 2015, spurred renewed focus on the high rates of neonatal mortality and low rates of birth registration in low and middle-income countries (LMICs). Low rates of birth registration, the lack of a reliable system for vital statistics reporting and tracking of mother-baby pairs contribute to the problem of excess neonatal mortality by preventing health care systems from effectively delivering crucial evidence-based interventions (Hereward et al, 2019). In LMICs, where many births take place in the home, about 1 in 4 children under age five are not registered. Of the children who are registered, an estimated 237 million children under age five globally do not have proof of registration in the form of a birth certificate (Selim, 2019). A lack of adequate data governance infrastructure across nations threatens the ability of identity technologies to protect the personal identifying data of both children and guardians (Privacy International, 2018; World Bank, 2018; Hug et al, 2019; Schoemaker et al, 2019)
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