Legal identity remains a fundamental prerequisite for accessing formal health systems, yet nearly half a billion people worldwide - disproportionately concentrated in Africa, lack official proof of who they are. Stateless populations, refugees, and displaced persons (including internally displaced persons or IDPs), face compounding vulnerabilities. Forced migration, conflict, and administrative exclusion strip them of birth certificates, national IDs, and civil registry records. This documentation gap translates directly into health inequity, barring individuals from routine immunizations, health insurance enrollment, and continuity of chronic disease management. As protracted displacement crises intensify across the Sahel, Horn of Africa, and Great Lakes region, it is the considered opinion of this writer, that health systems should no longer apply legal identity as a precondition for care. This article examines emerging biometric, digital, and community-based alternatives that decouple health access from citizenship status.
HALF OF ONE BILLION PEOPLE
The World Bank estimates that half of the one billion people globally – about twice the population of Nigeria and one-third the population of Africa, who lack official proof of identity live in Africa. For stateless populations, refugees, and internally displaced persons (IDPs), this legal invisibility constitutes a critical health systems barrier. Without formal citizenship documentation, millions are routinely excluded from essential vaccinations, health insurance schemes, and emergency medical care. To strengthen health systems and achieve long-term development impacts, public health practitioners must decouple the right to health from state-issued legal identity. Emerging alternative identification mechanisms bridge this gap, ensuring health equity in low-resource contexts.
BIOMETRIC HEALTH RECORDS
Biometric technology offers a secure, unalterable mechanism to establish patient continuity without requiring a national passport. The United Nations High Commissioner for Refugees (UNHCR) utilizes the Biometric Identity Management System (BIMS) across multiple African nations. BIMS captures fingerprint and iris scans to establish unique, global identities for over 37 million displaced individuals. In clinical settings, these biometric anchors prevent duplicate patient records, track childhood immunization schedules accurately, and facilitate cross-border medical referrals without relying on domestic civil registries.
MOBILE HEALTH PASSPORTS
Decentralized, patient-controlled mobile platforms provide highly portable medical histories. Emerging digital initiatives leverage time-limited QR codes and Fast Healthcare Interoperability Resources (FHIR) data standards to ensure offline accessibility. These digital tools allow highly mobile populations to carry verified records of chronic treatments, such as Antiretroviral Therapy (ART), across international borders. Maintaining this strict continuity of care mitigates the risk of drug resistance and reduces emergency department surges within underfunded host community facilities.
COMMUNITY-BASED HEALTH REGISTRIES
When digital infrastructure is entirely absent, localized data collection provides an essential safety net. In Uganda, the deployment of the Electronic Community Health Information System (eCHIS) empowers Village Health Teams to digitally register households and track disease trends in real time. By relying on trusted community verification rather than state documentation, these registries successfully integrate marginalized groups into national malaria, pneumonia, and diarrheal disease control campaigns.
POLICY LESSONS FOR SUSTAINABILITY
To ensure structural sustainability, these technical innovations must be integrated directly into national Health Management Information Systems (HMIS) rather than operating as isolated humanitarian silos. Furthermore, African states must establish robust data protection legal frameworks to prevent the weaponization of biometric or locational data against vulnerable populations. True health system resilience requires inclusive national policy frameworks that formally recognize alternative identifiers within public clinical spaces.
CONCLUSION
Achieving universal health coverage across Africa demands a fundamental reimagining of identity within health systems, to recognise biometric anchors, mobile health passports, and community verification as legitimate substitutes for state documentation. Biometric Identity Management Systems, FHIR-enabled digital records, and Village Health Team registries collectively demonstrate that continuity of care, immunization tracking, and disease surveillance are achievable without formal citizenship papers. However, technical innovation alone is insufficient; sustainability requires deliberate integration into national Health Management Information Systems and robust data protection legislation safeguarding vulnerable populations from surveillance misuse. Policymakers, donors, and public health practitioners must prioritize inclusive frameworks that formally institutionalize alternative identifiers, ensuring that stateless persons, refugees, and IDPs are never again rendered invisible to the health systems meant to protect everyone, including them.
BIBLIOGRAPHY
African Digital Rights Network. (2025). Biometric digital-ID in Africa: Progress and challenges to date - Ten country case studies. Institute of Development Studies. https://doi.org/10.19088/IDS.2025.051
Malaria Consortium. (2024). Pioneering solutions for community health: Africa’s trailblazers [Blog post]. Malaria Consortium. https://www.malariaconsortium.org
UNHCR. (2003). Handbook for registration: Provisional release. United Nations High Commissioner for Refugees. https://www.unhcr.org/publications
World Health Organization. (2025, December 18). Advancing health equity for people on the move [News release]. https://www.who.int/news/item/18-12-2025-advancing-health-equity-for-peo...
“Technological tools, including computers, search engines, statistical software, AI, and other digital applications routinely employed in contemporary scholarship, assisted in the preparation of this work. However, the conceptualization, analysis, interpretation, verification of information, conclusions, and responsibility for the content remain solely those of the author.” - Dr. Uzodinma Adirieje; CEO/Programmes Director, Afrihealth Optonet Association (AHOA), and President, African Refugees Council (ARC).
HIFA profile: Dr. Uzodinma Adirieje is a leading voice in health education, community health, and advocacy, with decades of experience advancing people-centered development across Africa and beyond. His approach to health education emphasizes participatory learning, knowledge transfer, and behavior change communication, ensuring that individuals and communities gain the skills and awareness to make informed decisions about their health. He develops and delivers innovative health promotion strategies tailored to local realities, particularly in resource-limited settings. In community health, Dr. Adirieje has championed integrated primary health care, preventive medicine, and grassroots health initiatives. Through Afrihealth Optonet Association (AHOA), which he leads, he connects civil society, community groups, and health institutions to strengthen healthcare delivery, tackle health inequities, and improve access to essential services for vulnerable populations. His work addresses infectious diseases, maternal and child health, nutrition, climate and health, environmental health, and emerging public health challenges. As a passionate advocate, Dr. Adirieje works with governments, NGOs, and international organizations to influence health policy, mobilize resources, and promote sustainable development goals (SDGs). He amplifies community voices, ensuring that health systems are inclusive, accountable, and responsive. His advocacy extends beyond health to governance, environment, and social justice, positioning him as a multidisciplinary leader shaping healthier and more equitable societies. afrepton AT gmail.com