The Indian government’s telemedicine platform eSanjeevani, which completed 300,000 consults in early September, has been allotted over Rs 100 crore for the current financial year. This was disclosed by the Health Ministry in Parliament on Friday.

Three states account for nearly half of the allotment: Karnataka (Rs 21.87 crore), Madhya Pradesh (Rs 15.13 crore), and Haryana (Rs 10.69 crore), total to Rs 47 crore. eSanjeevani, which began scaling up as the pandemic hit, is implemented at a state-level under the National Health Mission. NHM has provided implementation guidelines for matters such as the IT infrastructure needed at hubs & spokes, and personnel needed to conduct telemedicine. States accordingly request financial support from the centre under the NHM.

As of early September, the platform had been rolled out in 23 states, wherein Tamil Nadu accounted for nearly a third of the 300,000 consults completed. This was followed by Uttar Pradesh, and Himachal Pradesh & Andhra Pradesh, and then Kerala.

eSanjeevani was developed by the Mohali branch of Centre for Developmof Advanced Computing (CDAC), an attached office of the IT Ministry. It offers two kinds of consults: doctor-to-doctor and doctor-to-patient. The former was launched in November 2019, and patient consults began after the central government notified guidelines for practicing telemedicine in late March.

The Health Ministry disclosed the information in Lok Sabha in response to question by BJP MP Nalin Kumar Kateel, who is also the  BJP Karnataka state president.

The eSanjeevani application has been modelled on EHR guidelines issued by MoHFW, GoI. The application is compatible with advance technologies like Internet-of-Things (IoT) and bluetooth enabled diagnostic devices. The whole architecture of eSanjeevani is based on the agileframework and utilizes cloud services for hosting. — Health Ministry in Parliament

A hub-and-spoke model

eSanjeevani is being rolled out in a ‘hub and spoke model’, wherein consults flow from an anchor hospital (a hub) to district and primary health centres (spokes) spread across the state. For instance, Karnataka provides teleconsults via 11 hubs, which are secondary or tertiary care hospitals, including Mysore Institute of Medical Sciences and Rajiv Gandhi Institute of Chest Diseases. These 11 hubs provides consults to 160 smaller health care centres across Karnataka. The platform has been implemented in 3,000 such centers nationwide.

CDAC has been providing regular technical assistance to states for “training, handholding and for ensuring uninterrupted operations”. The government is also examining whether and how tele-cardiology and tele-radiology can be integrated with eSanjeevani.

The coronavirus pandemic has become a watershed for telemedicine. It spurred the government to identify a burgeoning industry and regulate what had operated in a regulatory grey area for years. Now, one of the main components of the Indian government’s National Digital Health Mission will be teleconsultations.

No funding for Kerala, Uttarakhand, J&K has small allotment

It’s worth noting that Kerala does not have any allotment for eSanjeevani, even though it had completed 28,000 consults as of early September. Among the states, Manipur has no allotment; Uttarakhand, which has at least one hub and spoke, also has no allotment. Surprisingly, Jammu & Kashmir, which has no high-speed internet access except in two districts on a trial basis, has been allotted Rs 1.59 crore to implement eSanjeevani.

eSanjeevani OPD was among the five teleconsultation services which was available on the now-defunct Aarogya Setu Mitr portal. Launched as an ancillary service on the Indian government’s contact-tracing app Aarogya Setu, the portal aggregated government and private entities offering COVID-19 teleconsultations, delivery of medicines, and home sample collection for lab tests. It was launched as a public-private partnership facilitated by the government’s Principal Scientific Advisor and NITI Aayog, with “voluntary participation” from organisations, industry coalitions, and startups.

However, in response to a writ petition filed by Delhi-based South Chemists & Distributors Association, the central government suspended the Aarogya Setu Mitr portal in June. The association had alleged that the website acted as a marketing tool for only e-pharmacies, and did not mention the local brick-and-mortar pharmacies. It had sought direction that the name “Aarogya Setu” not be misused to sponsor the commercial interests of “arbitrarily hand-picked entities”.