Telemedicine in India: is the government’s eSanjeevani platform living up to its potential?

eSanjeevani: India's National Telemedicine Service, revolutionizing healthcare access with virtual consultations and innovative technology.

On a hot day earlier this year, a 30-year-old from far-flung Aangamoozhy in Pathanamthitta district in Kerala arrived at a primary health centre (PHC) to check out a patch of discolouration on his skin. The medical officer at the PHC thought that the lesion looked suspicious and suggested a dermatology consult.

“If I had sent him off with a referral to the specialist at the Konni Medical College nearly 50 km away, he would never have gone: he would lose a day’s work in travelling back and forth, plus there would be a long waiting line at the medical college hospital. Our nurse put him on a telemedicine consult through the government’s eSanjeevani portal the next day, and uploaded a picture of the skin patch. And just like that, we had picked up a case of leprosy!” the medical officer said. 

Instances such as this abound in experiences with eSanjeevani, the National Telemedicine Service of India, which will complete five years next month.

Telemedicine in India has been evolving over the past two decades, after the first telemedicine pilot project was set up in 2001, with the help of the Indian Space Research Organisation (ISRO), linking Chennai’s Apollo Hospital with the Apollo Rural Hospital at Aragonda village in Chittoor district of Andhra Pradesh.

In 2005, the National Telemedicine Taskforce was set up by the Union Ministry of Health. Telemedicine grew through several public-private partnerships until 2019, when the Covid-19 pandemic changed the entire scenario. In March 2020, the Government of India released the Telemedicine Practice Guidelines.

eSanjeevani, the National Teleconsultation Service, launched by the Health Ministry in November 2019, turned out to be a crucial service during the pandemic, offering a range of outpatient consultations to people, when physical access to the hospitals became severely restricted. Part of the broader Ayushman Bharat programme, eSanjeevani has an OPD (outpatient department) model which enables direct patient-to-doctor consultations and a hub-and-spoke model or the eSanjeevani Ayushman Bharat Health and Wellness Centre (AB-HWC) model, facilitating Doctor-to-Doctor (D2D) consultations.

Subcentres and PHCs serve as spokes, while district hospitals and medical colleges (specialist centres) act as the hubs. In March 2023, the enhanced eSanjeevani 2.0 was introduced, incorporating telediagnosis by integrating point-of-care diagnostic devices (PoCDs).