Eight doors, one person

The obvious way to give every patient an identity is to use the one the state already issues. A national ID number, one per citizen, the key to the record. It is obvious, and it is wrong, because the people who need a health identity most are the people a national ID serves worst.

The day laborer who never collected his card. The woman whose ID lists a husband she has left. The migrant whose papers are in a drawer in a labor camp two thousand kilometers away. The Rohingya refugee who has no national ID and for whom a government-linked record is a danger, not a key. The newborn with a birth certificate and nothing else yet. Build identity on a single document and every one of them falls through, which means the system fails exactly where the need is sharpest.

So identity here is anchored from many directions at once. A national ID where it exists. A passport. A pre-departure registration for the worker going abroad. An embassy attestation for the man whose papers are unreachable. A birth certificate for the newborn. A vouching by a trusted institution for the person who has none of these. A patient's identity is assembled from whichever anchors they have, checked against each other, and strengthened as more arrive.

The important property is that the thread does not break while it is incomplete. A worker who starts with a passport and a pre-departure record holds a real, usable identity that day. When he adds a national ID a year later, it attaches to the same thread. He does not start over. The record he built in the meantime is still his, still verifiable, now anchored a little more firmly.

Every credential also carries the provenance of its anchor, so a verifier always knows what was actually checked. A prescription signed against a council-confirmed registration weighs more than one signed against a self-asserted number, and the credential says which it is. Nobody has to pretend a weak anchor is a strong one. The system states what it knows and how it knows it, and lets the verifier decide.

This is the difference between identity as exclusion and identity as inclusion. A single-document system draws one line and sorts the country into the inside and the outside. A multi-anchor system has many doors, and the test is not which document you hold but whether enough can be assembled to tell, with stated confidence, that you are the same person who was here before. For most people that is easy. For the person with one fragile document, or none, it is the whole point.

An identity layer that only works for the fully documented is not infrastructure for Bangladesh. It is infrastructure for the half of Bangladesh that was already easy to serve. The eight doors exist because the other half is the half a health system keeps losing.