Up to a third of adults in Uganda have been excluded from vital healthcare and social services because they do not have national ID cards, according to a report.
Women and elderly people have been particularly affected by the introduction of the digital identity cards, which are required to access government and private sector healthcare, to claim social benefits, to vote and to open bank accounts or buy sim cards.
Many services that require IDs are funded by donors, including the UK and Ireland, which finance grants for older people, and the World Bank, which supports birth registrations.
The report, published by three human rights organisations, estimates that between 23% and 33% of Uganda’s adult population do not have ID cards, which were introduced by the National Identification and Registration Authority (Nira) in 2015.
Many of the cards issued include errors, said the report. Correcting mistakes or replacing lost or stolen cards costs at least 50,000 Ugandan shillings (£10). More than 40% of Uganda’s population live on less than £1.30 a day.
One of the nurses interviewed said ID cards should not prevent access to healthcare, which was “a matter of life and death”.
The report called on the government to stop requiring ID cards to access essential services. Its authors also called on the World Bank, UN agencies and donors to urge the Ugandan government to “do everything in its power to prevent further wholesale exclusion and related human rights violations” that result from the mandatory use of the cards, referred to as “Ndaga Muntu”.
Angella Nabwowe, of the Initiative for Social and Economic Rights, one of the organisations that produced the report, said: “Government has to go back to the drawing table and rethink the use of Ndaga Muntu, especially when it comes to tagging it to service delivery, because many people are being left out.”
The report details how women and older people had been particularly affected by the ID scheme.
“Without an ID […], no treatment,” said a woman from Amudat, in northern Uganda. “Many people fall sick and stay home and die.”
“I was chased [for ID] two times. When they chased me, I just went back home. What could I do? I came [back] home and used herbs,” said a mother from Kayunga, in central Uganda, recalling a time she tried to access health services. “But if they chase you and you go back in a critical condition, they will say you are lying and that you were never there before.”
A pregnant mother told researchers: “The nurse asked me for a national ID and I said I didn’t have one. She [the nurse] threw the book at me and said she will not attend to me.”
Researchers found errors on ID cards have left thousands of people aged 80 and over unable to receive monthly grants of 25,000 Ugandan shillings (£5), under the Social Assistance Grants for Empowerment (Sage) programme, which is supported by the UK government.
Okye, an 88-year-old man from Namayingo, eastern Uganda, told researchers that his card stated his age as 79. “This has made me miss out on the Sage benefits because as per the National ID, I am yet to clock 80 years,” he said.
According to the report, at least 50,000 people over 80 have similar mistakes on their ID cards or do not have a national ID at all, making them ineligible for government assistance.
The report was also critical of the Nira’s failure to register births and deaths. Recent estimates show that only 13% of children under one had their births registered.
“Among other things, this means that as Uganda’s young population reaches adulthood and becomes eligible to register for Ndaga Muntu, a majority of them will be unable to prove their identity and age because they have no birth certificate,” said the report.
“It is quite absurd to invest in registering the adult population for a national ID and forget about the next generation. It is as if Nira’s left hand does not know, and does not care, what its right hand is doing,” said Dorothy Mukasa of Unwanted Witness, which co-authored the report.
Rosemary Kisembo, Nira’s executive director, told the Guardian: “The management and staff of Nira are deeply saddened by the pain our clients are experiencing in accessing our services and enjoying their statutory rights.
“We acknowledge the urgent need for improvement. In the next six months, we will create mobile teams to reach the rural areas at parish and sub-county levels and in the urban congested areas. These mobile units will prioritise the elderly and disabled.
“We shall train health practitioners at health facilities, duty bearers and village health teams to help rural populations register birth and death in communities or during immunisation or hospital visits,” she said.