Scaling Telemedicine for a Billion: Lessons from India’s eSanjeevani Platform
When eSanjeevani was launched in 2019, it began as a small pilot to determine if digital consultations could reach patients within India’s public health system. Few imagined it would grow into one of the world’s largest telemedicine systems. The concept was straightforward: if distance kept patients from doctors, digital channels could close that gap. Over time, what began as a controlled experiment has evolved into an essential component of India’s healthcare delivery system, particularly for those residing in rural areas far from urban centers.
The platform functions through two interlinked models. One, eSanjeevaniAB-HWC, connects frontline workers at Health and Wellness Centres with remote specialists. The other, eSanjeevaniOPD, launched during the pandemic, lets citizens consult doctors directly using a smartphone or computer. Together, these models combine human facilitation with digital access, a mix that has made remote consultations workable in areas where health staff are scarce and transportation is limited.
By 2025, official figures show that more than 418 million consultations had taken place on the platform. Over 2.28 lakh medical professionals were registered, serving users across all 36 states and union territories. Tamil Nadu, Uttar Pradesh, and Karnataka lead in total consultations. Their progress shows how steady internet access, active local health systems, and supportive governance help drive uptake.
The platform is hosted on NIC’s MeghRaj cloud, a national digital infrastructure designed to handle large volumes of simultaneous users. Its setup ensures that consultations run smoothly even during peak hours. To keep patient information secure, the system uses encrypted connections and verified logins. The Health Ministry monitors activity through a central dashboard that highlights which regions are using the service effectively and where additional support may be needed. eSanjeevani is also linked to the Ayushman Bharat Digital Mission, so that patients can automatically create an ABHA ID and access digital health records when required. These steps make data follow the patient, not the other way around.
What has made eSanjeevani workable, though, is how it fits into existing systems. A community health officer or Auxiliary Nurse Midwife (ANM) often initiates the session, sets up the video call, and helps patients interpret the doctor’s guidance. This blended model has prevented the technology from becoming impersonal. In villages where connectivity or literacy is low, having a familiar intermediary ensures the consultation remains accessible.
The outcomes are beginning to show. According to the Ministry’s internal monitoring, average wait times have dropped by nearly 75 percent, and patients spend significantly less on travel. For daily wage earners, avoiding a long trip to a city hospital often means not losing a day’s income. Several states also report reduced crowding at outpatient departments, freeing up doctors for more complex cases.
There are still gaps that need attention. Internet coverage in rural belts is patchy, and power cuts interrupt sessions more often than expected. For doctors trained in traditional clinical settings, adapting to a virtual format takes time. Writing notes digitally, managing multiple calls, or judging symptoms through a screen can be challenging in the beginning. Regular orientation sessions and follow-up audits will be key to keeping service quality consistent and ensuring that both patients and doctors remain confident using the system.
Work on system upgrades has already started. Teams from the Health Ministry and NIC are experimenting with tools that can automatically sort patient queries or suggest next steps for routine cases. Efforts are also being made to include regional language support so that consultations are not restricted by English or Hindi interfaces. Another important step being explored is linking eSanjeevani with real-time disease surveillance, something that could help detect local health trends faster and improve preventive response.
The larger lesson is that digital health cannot exist on its own. Telemedicine has to grow within public health systems, not outside them. India’s experience suggests that scaling remote healthcare depends as much on training, logistics, and policy design as on the software itself. eSanjeevani is now evolving from a lockdown innovation into a standard service, one that extends rather than replaces physical care.
In a country of more than a billion, universal access is always the hardest promise to deliver. But platforms like eSanjeevani show that, when designed with local capacity in mind, digital systems can bridge the distance between patients and providers and bring primary healthcare a step closer to every household.
References
- Ministry of Health and Family Welfare
- eSanjeevani Portal
- Press Information Bureau, “eSanjeevani Crosses 180 Million Consultations,” 2024
- NIC MeghRaj Cloud Infrastructure – Overview
- NITI Aayog, Digital Health Blueprint for India, 2023
- Ayushman Bharat Digital Mission (ABDM) – Interoperability Standards
Raj Kashyap Das – Knowledge & Insights Coordinator, Sambodhi
