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Paper short abstract

This paper examines AIdriven digital health platforms in India as contested spaces where digital citizenship expands agency and rights, while digital authoritarian practices—surveillance, exclusion, and algorithmic bias—constrain freedoms. Cases highlight co-production of capabilities and unfreedoms

Paper long abstract

This paper explores AI-powered digital health platforms in India as contested arenas where digital citizenship and digital authoritarianism co-produce human development outcomes. Platforms such as the Ayushman Bharat Digital Mission (ABDM), AI-enabled telemedicine, and clinical decision support systems offer opportunities to expand citizens’ capabilities, improve health access, and exercise agency. Yet, these same platforms also expose users to algorithmic exclusion, state surveillance, biased decision-making, and digital marginalization, constraining freedoms and reproducing inequalities.

Drawing on Sen’s capability approach, the paper analyzes how real freedoms in health—the ability to access care, exercise informed choice, and participate in decision-making—are mediated by digital infrastructures. Case studies highlight citizen and civil society responses: the Internet Freedom Foundation’s petitions demanding ethical use of health data, NGO-led monitoring of telemedicine programs in Odisha and Tamil Nadu, and advocacy during COVID-19 AI-based triage implementations in Maharashtra and Karnataka. These interventions demonstrate how digital citizenship practices can resist authoritarian encroachments and expand agency.

The paper argues that human development in AI-driven health systems emerges from the tension between empowering digital citizenship and constraining digital authoritarian practices. By foregrounding resistance, advocacy, and community-led oversight, the paper shows that digital health platforms can become sites where capabilities, rights, and freedoms are actively negotiated, highlighting lessons for designing equitable, accountable, and citizen-centric digital health infrastructures in India and the Global South.