Between Flow and Friction: Regulating Health Data Flows in India’s National Digital Health Ecosystem

Abstract

Digital health infrastructures, such as India’s National Digital Health Ecosystem (NDHE), are touted as the panacea for improving universal healthcare, particularly in the Global South. Central to this infrastructure is the generation and circulation of health data, i.e. digital data relating to any facet of health. This article offers two critical analyses of the NDHE – first, the centrality of the ‘flow’ of health data to enable monetisation of these data flows by commercial actors (and consequently, the commercialisation of health), and second, the ways in which this market-driven imaginary of the NDHE reshapes principles of data governance such as informed consent and impact assessments into negative frictions for health data flows. Finally, this article instead offers suggestions on how to implement these legal principles through friction-in-design regulations, to engineer a necessary ‘drag’ to limit the commodification of health data flows in the NDHE.