ESanjeevani: India's National Telemedicine Initiative

Policy Update

Lubina Dua

Background

India faces a structural healthcare paradox. With over 1.4 billion people, the country has a doctor-to-patient ratio far below the WHO-recommended 1:1000, and specialists remain heavily concentrated in urban centres. A patient in rural Chhattisgarh needing specialist consultation historically had two options: travel hundreds of kilometres, or go without.

eSanjeevani, India’s National Telemedicine Service, was conceived to break this barrier. Developed by the Centre for Development of Advanced Computing (C-DAC) under the Ministry of Electronics and IT, and implemented by the Ministry of Health and Family Welfare (MoHFW), eSanjeevani is India’s flagship public telemedicine platform. Its conceptual roots go back to 1999, when C-DAC began developing indigenous telemedicine technology for tele-radiology, tele-cardiology, and tele-pathology across premier institutions like AIIMS New Delhi and PGIMER Chandigarh.

The platform was formally launched in two variants: eSanjeevani AB-AAM, a provider-to-provider telemedicine system launched in November 2019; and eSanjeevani OPD, a patient-to-provider system launched in April 2020 to enable citizens to access outpatient services from their homes. The COVID-19 pandemic dramatically accelerated its adoption, with in-person visits falling and online consultations surging as lockdowns made physical access impossible.

The policy sits within the broader Ayushman Bharat ecosystem and is a key pillar of the Ayushman Bharat Digital Mission (ABDM), India’s national digital health infrastructure initiative launched in 2021.Functioning

The telemedicine platform eSanjeevani operates on a hub-and-spoke model. Health workers at the spoke-end primary health centers first complete a basic consultation for patients; if further diagnosis and treatment are required, they connect the patient to specialist physicians stationed at the hub end, which are based at medical colleges or district hospitals.

The two variants serve distinct purposes:

eSanjeevani AB-HWC (Provider-to-Provider): Health workers at Ayushman Arogya Mandirs (formerly Health and Wellness Centres) connect patients to specialists at secondary and tertiary hubs. This model accounts for over 93% of all eSanjeevani usage. It is designed to strengthen the primary care layer rather than replace it.

eSanjeevani OPD (Patient-to-Provider): Citizens can directly access doctors through an app or web portal, functioning as a “Stay Home OPD.” This model is more commonly used in urban and peri-urban settings where digital literacy is higher.

In March 2023, eSanjeevani 2.0 was launched, incorporating telediagnosis by integrating point-of-care diagnostic devices (PoCDs), further enhancing the platform’s clinical capabilities.

An important recent addition is an AI-based Clinical Decision Support System (CDSS), developed between 2022 and 2024. The AI system has supported over 282 million consultations with standardised data capture and AI-generated diagnostic recommendations, with machine learning algorithms deployed to analyse patient data patterns.

A Bhashini-integrated language translation feature is also being piloted to address the significant barrier of the platform currently operating only in English, enabling health workers to record patient histories in vernacular languages that are then transcribed for hub specialists.

Performance

As of January 2025, eSanjeevani’s scale is unmatched globally among government-run telemedicine platforms:

More than 57% of eSanjeevani beneficiaries are women and approximately 12% are senior citizens, demonstrating its reach to underserved demographic groups.

Over 33.81 crore (338 million) patients served across 1,31,069 Ayushman Arogya Mandirs (spokes), 16,872 hubs, and 691 online OPDs, supported by over 2,31,129 doctors, specialists, and health workers.

By August 2024, over 1,27,499 Health and Wellness Centres were operating as telemedicine spokes with 16,211 hubs and 477 online OPDs integrated.

State-level performance is uneven. Utilisation is highest among women and adults aged 25 to 45, with the platform supporting both acute conditions such as fever, headache, and diarrhoea, and chronic diseases, particularly diabetes and hypertension.

The platform has also registered growth in specialist integration. In September 2024, the Delhi Government integrated telemedicine across 13 medical specialties, broadening access to cardiology, dermatology, and psychiatry.

However, consultations peaked during the COVID-19 period, and recent data indicate a drop in footfall, raising concern among health policy researchers and practitioners.

Budgetary support for the programme has been channelled through the National Health Mission. Under ABDM, of which eSanjeevani is a core component, the Union Budget 2024-25 allocated Rs. 200 crores, reflecting the government’s continued prioritisation of digital health infrastructure.

Impact

eSanjeevani’s most significant impact has been on geographic equity in healthcare access. For the first time, patients in tribal districts, remote hill areas, and underserved plains can access specialist consultations without travelling. India now has approximately 820 million internet users and some of the world’s lowest data costs, making digital health delivery structurally viable at scale.

The platform has displayed measurable impact on chronic disease management, particularly for diabetes and hypertension, where continuity of care and medication refills can now happen remotely, thereby reducing the burden on secondary and tertiary facilities.

The high proportion of women beneficiaries (57%) is particularly significant, as women in India face disproportionate barriers to healthcare access, including those of mobility constraints, financialdependence, and social norms that deprioritise their health needs. eSanjeevani has been successful in partially circumventing these barriers.

During COVID-19, eSanjeevani served as a critical public health infrastructure, demonstrating the state’s capacity to pivot to digital delivery during a crisis. This lesson has wider implications for disaster preparedness and pandemic response planning.

Emerging Issues

1. Target-driven consultations are distorting data quality. Health workers are reportedly logging into the system, sometimes in the complete absence of a patient, to meet referral targets assigned by authorities to boost eSanjeevani statistics. This “ghost consultation” phenomenon inflates numbers while eroding the platform’s clinical value and patient trust. Suggestion: Replace quantity-based targets with quality metrics such as resolution rates and patient satisfaction scores.

2. Inadequate triage and referral quality. Problems include sub-optimal integration of general practitioners within the tele-referral pathway, inadequate training of health workers leading to inappropriate consultations, outdated technological support, absence of mechanisms for re-referrals, and lack of feedback loops. Many referral requests consist of a single word, such as “pain” or “headache,” making it impossible for hub specialists to provide meaningful guidance.

Suggestion: Mandate structured referral templates and minimum standards for referral notes.

3. Language barriers The platform currently operates only in English, disadvantaging health workers and patients in non-English-speaking regions.

Suggestion: Accelerate the integration of the Bhashini speech-to-speech translation tool across all eSanjeevani variants.

4. Connectivity and infrastructure gaps Users report system glitches, slow platform response, connectivity failures, and interface difficulties. Rural HWCs operating with poor internet bandwidth experience frequent call drops mid-consultation, undermining both clinical quality and patient confidence.

Suggestion: Condition eSanjeevani hub/spoke designation on verified minimum connectivity benchmarks.

5. Low awareness and digital literacy. About 21.3% of surveyed users were unaware that the service was even continuing, indicating a significant awareness deficit.

Suggestion: Integrate eSanjeevani awareness into ASHA and Anganwadi worker training programmes.

6. Dropping footfall post-COVID Recent reports of dropping footfall have raised questions about eSanjeevani’s potential to bridge service provision gaps now that in-person care has resumed. The platform risks reverting to niche usage unless it builds compelling, habitual use cases.Suggestion: Introduce continuity-of-care pathways by linking eSanjeevani consultations to ABHA records so patients have a longitudinal, portable health record that incentivises return use.

Way Forward

eSanjeevani is the world’s largest government-run telemedicine programme. It has reached 338 million consultations, predominantly serving women, the rural poor, and the elderly. This achievement represents a real structural shift in how healthcare can be delivered in a country as huge and diverse as ours.

Still, the platform is in a tight spot. The post-COVID drop in footfall, the emergence of target-driven ghost consultations, and persistent gaps in triage quality suggest that hat a system focused mainly on hitting higher numbers is beginning to fail. The next phase must prioritise quality, clinical integration, and longitudinal care.

The integration with ABDM’s ABHA health records, the deployment of the AI-based CDSS, and the Bhashini language translation pilot together represent a promising technological roadmap. But technology alone will not sustain this platform. What is needed is a fundamental shift in how performance is measured, how health workers are trained, and how patients are made to see eSanjeevani not as a one-time transaction but as their regular, trusted doctor at a distance.

The real promise of eSanjeevani is not just in the consultations it has already conducted, but in the chronic disease crises it can prevent, the maternal deaths it can avert, and the specialist care it can democratise, if its quality can be made to match its scale.

References

Ministry of Health and Family Welfare (2025). Rajya Sabha Unstarred Question No. 304: Status of eSanjeevani National Telemedicine Services, answered 04.02.2025. Sansad.in

Mishra, U.S., Yadav, S., and Joe, W. (2024). The Ayushman Bharat Digital Mission of India: An Assessment. Health Systems Reform. DOI: 10.1080/23288604.2024.2392290

Ghosh Dastidar, B. (2024). Reimagining India’s National Telemedicine Service to improve access to care. The Lancet Regional Health, South-East Asia. PMC11422547

Arora, S., Huda, R.K., Verma, S., Khetan, M., and Sangwan, R.K. (2024). Challenges, Barriers, and Facilitators in Telemedicine Implementation in India: A Scoping Review. Cureus. PMC11414145

Oxford Open Digital Health (2025). Adoption and utilization of India’s eSanjeevani national telemedicine service. DOI: 10.1093/oodh/oqaf025

Rosh, P.S.N. et al. (2025). Current pattern of use and barriers to implementation of eSanjeevani telemedicine services in Kerala, India. International Journal of Community Medicine and Public Health. ijcmph.com

Ghosh Dastidar, B. (2024). Ayushman Bharat vs eSanjeevani: Contrasting Healthcare Outcomes. MediaNama. medianama.com

eSanjeevani Official Platform, Ministry of Health and Family Welfare: esanjeevani.mohfw.gov.in

ABDM Official Portal: abdm.gov.in

About the Contributor: Lubina Dua is a Research Intern at IMPRI. An Optometry graduate with a strong interest in public policy and governance, she has represented India at the Harvard Conference on Asian and International Relations (HPAIR) and participated in the World Bank Youth Summit.

Acknowledgement

The author extends sincere thanks to the IMPRI team for their guidance.

Reviewed by: Sneha Sharma, Gautham Shine