Redesigning a Public Telemedicine Service

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Insights from the Field

When Systems Don’t Fit: What Telemedicine Looks Like on the Ground

Telemedicine is often positioned as a solution - efficient, scalable, and accessible. But what happens when it meets the realities of everyday healthcare systems?

Through our research, a different picture began to emerge. Not one of failure, but of friction. After spending quite some time on the field, we gathered our observations and findings and synthesized them into our research insights.

For many doctors, teleconsultations are not a priority. They’re seen as interruptions to tasks that don’t justify the time they demand. When measured against already stretched responsibilities, the incentive simply isn’t there.

At the same time, MLHPs (Mid-Level Health Providers) are caught in a system of targets. The pressure to meet numbers can sometimes come at the cost of attention - shifting focus away from the patient in front of them to the system behind them.

Patients, on the other hand, are drawn in by one of the strongest motivators: free medication. And yet, subcentres- the very access points meant to deliver this promise - are often understocked. The expectation to adopt digital systems exists alongside a lack of basic infrastructure, creating a gap between policy and practice.

Continuity of care also begins to break down. Without access to their own health records, patients are left vulnerable to repeated tests, incomplete histories, and even mistreatment over time.

Even access to teleconsultations themselves isn’t guaranteed. A randomized allocation system means not every patient gets through - introducing uncertainty into a system that is meant to improve access.

And finally, there’s the question of expertise. Specialists - arguably the most valuable resource in telemedicine - are often the least available, as they are stretched thin and used as generalists across cases.

To add to this, the subcentres are initially given targets so that they could adopt the new system and get used to this. While this is an expectation, they barely have the basic necessities like a stable internet connection to meet the targets.  

These insights point toward a larger question: Are we designing telemedicine for scale, or for the realities of the people within it? If telemedicine promises accessible healthcare, why does it still feel out of reach?

We’re now moving into the next phase - translating these tensions into opportunities for intervention. Would love to hear your thoughts, critiques, or experiences with similar systems.

If you’ve worked within layered public systems, especially in rural or resource-constrained contexts, we would love to hear your perspective. You can write to us at [email protected]. Until next time!

This blog documents the work led by three design students about an ongoing service design project exploring public healthcare and a government-led telemedicine service in India.

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Snippets from our time in remote subcentres and villages across Meghalaya; listening, observing, and understanding how care actually unfolds.

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Capture Sheets, Analysis & Putting the Pieces Together

Field notes are messy. Voices overlap. Contradictions appear. Patterns hide in plain sight.

After days of interviews, system mapping, and stakeholder conversations around e-Sanjeevani in Meghalaya, we reached the stage where everything needed to slow down.

The next step was about capture sheets.

For every interaction, we created structured capture sheets, not just to record what was said, but to decode what was meant. Each sheet helped us extract:

Who was involved

What their role in the system really is (not just on paper)

Pain points vs workarounds

Emotional signals (frustration, pride, hesitation, indifference)

Gaps between policy and practice

Some categories we focused on, for organising our data were:

Verbatim quotes

One month from now, we’d like to remember: 

Unusual / interesting observations we made

Initial thoughts/ inspirations for concepts

Patterns started emerging: • Repeated bottlenecks across different districts • Invisible labor carried by frontline workers • Digital constraints masquerading as “user error” • System-level delays that get absorbed at the human level

The most interesting part? The contradictions.

What the system assumes versus what the dashboard shows versus what the ground reality actually is.

Analysis, in this phase, wasn’t about numbers alone. It was about triangulation — aligning interview narratives, journey maps, consultation data patterns, and stakeholder structures to see where friction accumulates.

Putting the pieces together is less like solving a puzzle and more like tuning an instrument. You adjust one layer, and the whole system resonates differently. Design decisions are not made from empathy alone they are made from structured empathy. And tools like these are where structure begins.

If you’ve worked within layered public systems, especially in rural or resource-constrained contexts, we would love to hear your perspective. You can write to us at [email protected]. Until next time!

This blog documents the work led by three design students about an ongoing service design project exploring public healthcare and a government-led telemedicine service in India.

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Mapping Stakeholders & the User Journey in e-Sanjeevani

After mapping the structure of Meghalaya’s public health system, we zoomed in further to the people inside it. When we began listing stakeholders, the obvious ones came first: Patients, Doctors, Nurses 

But the map kept expanding.

IT support teams who troubleshoot failing connections. Pharmacists who interpret digital prescriptions. Supply chain actors who determine whether prescribed medicines are actually available. NHM officials managing policy and monitoring. Data operators entering consultation records. Private practitioners who remain outside the platform. Even informal providers - the local healers who compete with it.

Each actor influences the system by influencing the interactions that they bring in even if they are not visible on the screen.

The User Journey: It’s Not Just a Call

We mapped the user journeys of the major stakeholders - the doctors, the MLHPs and the patients. What looks like a 2-minute consultation is actually a multi-actor relay with not just the patient as the user but also the nurse, doctor and system operators. Designing telemedicine, then, is not about optimizing a video call. It is about aligning incentives, capabilities, and constraints across a distributed network of actors.

The more we map, the clearer it becomes - healthcare journeys are non-linear, and a lot more goes into providing healthcare that what is seen. Specifically, in the case of a state like Meghalaya, where terrain, seasons and travel are big constraints, healthcare is beyond just meeting with a professional. These journeys are navigated through availability, trust and infrastructure.

If you’ve worked within layered public systems, especially in rural or resource-constrained contexts, we would love to hear your perspective. You can write to us at [email protected]. Until next time!

This blog documents the work led by three design students about an ongoing service design project exploring public healthcare and a government-led telemedicine service in India.

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Mapping the Health System of Meghalaya: Beyond the Platform

As part of our ongoing study of e-Sanjeevani, we stepped back from individual consultations and began mapping the larger public health system of Meghalaya.

What emerged was not just a platform, but a layered, distributed structure.

At the base are Sub-Centres and Health & Wellness Centres, often staffed by MLHPs and nurses. These are the first points of contact in rural areas. Above them sit Primary Health Centres (PHCs), then Community Health Centres (CHCs), and District Hospitals.

Parallel to this runs the telemedicine layer with the hub-and-spoke network where doctors stationed at hubs consult patients located at peripheral centres.

On paper, the structure is clear. But mapping it revealed something more interesting: The system does not move in straight lines. It moves through people.

Medicines do not always arrive on time. Diagnostics are often unavailable locally. Private doctors are difficult to onboard due to cost structures. Hybrid practitioners fill gaps. Local and traditional healers remain accessible and trusted because they are present.

So patients do not simply “move up the referral chain” - they navigate availability. Simultaneously, telemedicine does not replace the physical system but overlays it and depends on it. Due to this interconnected structure, it is necessary to question what kind of a physical health system must exist for telemedicine to truly work.

If you’ve worked within layered public systems, especially in rural or resource-constrained contexts, we would love to hear your perspective. You can write to us at [email protected]. Until next time!

This blog documents the work led by three design students about an ongoing service design project exploring public healthcare and a government-led telemedicine service in India.

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Interviewing the Actors of e-Sanjeevani Day 05

On day 5, we left early in the morning to meet one of the most widely known Khasi health providers, the traditional healers. For many Khasi people, they are the first point of care, especially for bones and teeth. Fractures, body aches, persistent pains, even something like gastritis, there’s a quiet confidence in the way people speak about their ability to treat it all using traditional methods. He gave one of us a quick massage, which showcased his years of experience, expertise, and knowledge.

When we met him, he showed us a stack of certificates, some even issued by the state government, almost like a bridge between belief and formal validation. When asked about formal medicine, he said that he believes every medicine system has its value, not just his own. When he falls sick himself, he goes to a hospital without hesitation.

And yet, he holds on to one idea very firmly: medicine has to remain personal. No screens, no remote prescriptions. A doctor should see the patient in front of them; that’s non-negotiable for him.

The next day, we set out for Jongksha PHC in the East Khasi Hill region. We spoke to a staff nurse who works closely with the e-Sanjeevani system on the doctor’s side. With the medical officer often not physically present, the staff nurse takes calls on his behalf, understands the case, and relays it to the doctor over the phone, then inputs the prescription into the system. 

For him, e-Sanjeevani works best as a record-keeping tool rather than a communication platform, especially since specialists are usually contacted directly to save time. He has also built small workarounds, like recording calls to avoid miscommunication during teleconsultations. 

While he supports increasing the teleconsultation target slightly, he’s careful about where to draw the line. Pushing it too high, he feels, would end up burdening the nurses at subcentres who are already stretched. For him, the idea behind increasing the target isn’t just numbers; it’s about slowly building awareness, letting patients ease into the system, especially those who don’t have easy access to doctors or specialists.

It’s less about scale, more about making the system feel usable in everyday life.

If you work in public health, telemedicine, or government systems and see angles we're missing, write to us at [email protected].

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Interviewing the actors of e-Sanjeevani - day 04

After interviewing a few patients and MLHPs in sub-centres, we set out for Myriaw PHC, which works differently from other PHCs. Myriaw PHC, in collaboration with NGO Karuna Trust, has developed a distinctive healthcare model that stands out among PHCs in Meghalaya. The facility runs its own in-house laboratory for diagnostic tests that would otherwise require a visit to district hospitals, and has implemented a digital system for efficient patient record management.

Upon talking with the Medical Officer, we came across some of the most interesting insights about teleconsultation in Meghalaya.

No network, no teleconsultation - you can't digitize healthcare where the internet doesn't reach

25 consultations a month mean nothing if the system behind them is broken

Top-down doesn't work here - policies designed in boardrooms fail in the hills of Meghalaya; doctors on the ground need a seat at the table

PHC doctors are overworked and under-incentivized, juggling OPDs, emergencies, and deliveries. Without monetary recognition, teleconsultation stays last on the priority list

Linking sub-centres to PHCs first, and let PHC doctors escalate to specialists — not a randomised free-for-all

A simple appointment slot system could save hours for both patients and doctors, making teleconsultation feel less like a burden

Next, we visited Sokhrat sub-centre under Myriaw PHC and interviewed the MLHP, who painted a picture of a system failing at every touchpoint. Doctors don't show up for their shifts on the platform, medicines run out before prescriptions can even be filled, and each teleconsultation can take up to an hour just to fight network issues.

"Patients mostly come here for free medicines. Sometimes, we run out of even paracetamol." — MLHP, Sub-centre

For her, hitting 25 teleconsultations a month on eSanjeevani feels more like a burden than a goal, since the platform rarely works reliably over failing networks. She would rather switch to a simpler platform to conduct teleconsultations. Trust in screen-based consultations, too, remains low compared to in-person care.

If you work in public health, telemedicine, or government systems and see angles we're missing, write to us at [email protected].

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Trust, Targets, and the Limits of Telepresence in West Khasi Hills

On the third day of fieldwork, we moved beyond urban centres into remote villages of West Khasi Hills to understand how e-Sanjeevani functions where distance is not theoretical, but lived. Our focus was on patients, the intended beneficiaries and on how teleconsultation is embedded (or not) within everyday health-seeking behaviour.

Sub-centre Realities: When Metrics Drive Practice

At the Mawdoh Sub-Centre, the Mid-Level Health Provider (MLHP) surfaced structural tensions within teleconsultation delivery:

Target-driven utilisation: Teleconsultations are sometimes logged to meet numerical expectations rather than clinical necessity, suggesting performance metrics may be shaping behaviour more than patient need.

Temporal misalignment: Limited active hubs and restricted doctor availability (often early mornings or late evenings) rarely align with sub-centre OPD hours. As a result, teleconsultations occur opportunistically ‘when time permits’ rather than as a reliable service channel.

Stock-based prescribing: In practice, the MLHP often prescribes from available sub-centre stock instead of initiating a teleconsultation, indicating that drug availability may outweigh digital connectivity in decision-making.

Service concentration: Patient footfall is largely driven by immunisation services, raising questions about whether curative teleconsultation has meaningfully penetrated routine care-seeking patterns.

Parallel informal systems: For bone injuries and dental concerns, local healers remain primary points of contact, reinforcing the continued relevance of informal providers.

Patient Perspectives: Trust Is Interpersonal, Not Digital

Village interviews (a mother seeking immunisation services, an elderly couple, and a father of six) revealed a consistent pattern: trust in teleconsultation is mediated through trust in the MLHP, not in the technology itself.

One respondent explicitly questioned the idea of “free” care, expressing a preference for private providers who offer consultation, prescription, and medicines in one consolidated experience. This suggests that perceived value is linked to completeness and tangibility, rather than cost alone.

In effect, telemedicine does not substitute relational trust; it borrows from it.

Rambrai PHC: Infrastructure Without Institutionalisation

At Rambrai PHC, the parent facility of Mawdoh Sub-Centre, we encountered an unexpected gap: the PHC does not currently practice teleconsultation and initially assumed we were visiting to conduct training.

Interviews with a dentist and a nurse highlighted several institutional constraints:

Absence of formal telemedicine training, resulting in low adoption despite infrastructural availability.

Nurses as trust intermediaries, translating medical terminology, reassuring patients, and mitigating communication barriers.

Preference for physically available providers, including informal practitioners, due to immediacy and familiarity.

Need for outreach-based care, particularly for pregnant women, elderly patients, and palliative cases contexts where teleconsultation alone is insufficient.

Emerging Themes

Across sites, three structural insights emerge:

Incentive–practice mismatch: Quantitative targets may incentivise usage reporting rather than meaningful integration.

Temporal and operational misalignment: Doctor availability, OPD timings, and workflow realities are poorly synchronised.

Trust as infrastructure: Human intermediaries, not digital platforms, remain the core enablers of adoption.

Telemedicine, in this context, appears less as a replacement for physical care and more as an overlay, its effectiveness contingent on local actors, stock availability, and relational credibility.

If you’ve worked within public health systems, telemedicine, or government healthcare programs or if you see blind spots in our interpretation—we would value your perspective. Write to us at [email protected].

Until next time.

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Interfacing Trust, Incentives, and Infrastructure

Insights from UPHC-Level Teleconsultation

On Day 2 of fieldwork, we studied two Urban Primary Health Centres (UPHCs) in Shillong to understand how e-Sanjeevani operates at the last mile. Rather than recounting events chronologically, this reflection synthesises patterns emerging across interviews with nurses, pharmacists, and patients.

1. Teleconsultation as a Trust-Embedded Service

At Nongthymmai UPHC, e-Sanjeevani has averaged 5–6 teleconsultations daily since 2024 often for serious conditions. Telemedicine here is not a convenience layer; it is a trusted alternative to tertiary hospitals.

Patients prefer the UPHC for:

Shorter queues

Geographic proximity

Emotional familiarity

As one nurse put it: “They cooperate because they believe in us.”

Operationally, the nurse is the system. She conducts screening, structures case histories, and anchors patient confidence. The specialist interaction lasts 1–3 minutes; the full journey spans 10–15.

Clinical labour is redistributed:

Screening & contextualisation → Local nurse

Diagnosis & prescription → Remote doctor

Monitoring → Local nurse

The interface may appear central, but relational capital drives uptake.

However, specialist unavailability, particularly psychiatrists, exposes a structural vulnerability. Telemedicine depends not just on connectivity, but on specialist supply elasticity.

2. Comfort as Access

A patient described the UPHC as his “second home.” Compared to prior experiences at public hospitals, he valued attentiveness and dignity.

Telemedicine here reduces not only physical distance but psychological distance from care. The UPHC becomes an intermediary space — less intimidating than hospitals, yet digitally connected.

e-Sanjeevani functions as a social equaliser only when embedded within a trusted local node.

3. The Hybrid Health-Seeking Pattern

At Umsohsun UPHC, most patients are from BPL families. Many consult private doctors for diagnosis but rely on the UPHC for:

Free medicines

Diagnostics

Subsidised NCD tests

This reveals a hybrid model: Private consultation + Public subsidy

Trust appears bifurcated:

Confidence in private clinical judgement

Dependence on public financial protection

Meanwhile, delays in lab logistics reportedly affect test reliability demonstrating how backend fragility erodes frontline credibility.

4. Metrics and Incentives

One centre reported the highest teleconsultation volumes at times logging patients who did not consult online. Meanwhile, genuine follow-ups remained difficult.

This raises structural questions:

Are centres incentivised for volume over continuity?

Do reporting targets shape behaviour more than outcomes?

Is performance measured by numbers logged or health improvements achieved?

When quantitative metrics dominate evaluation, gaming becomes rational.

5. Institutional Frustration

A pharmacist remarked: “If poor people die, nothing will happen. If the rich die, then they care.”

Emotionally charged, yes but indicative of deeper systemic distrust. These reflections point toward:

Perceived weak accountability

Inequitable responsiveness

Broken feedback loops between policy and practice

Emerging Tensions

Across both centres, five structural tensions surfaced:

Trust vs Infrastructure — Adoption is relational before technology.

Volume vs Continuity — Metrics may undermine longitudinal care.

Private Confidence vs Public Dependence — Patients optimise across systems.

Backend Fragility — Logistics and specialist shortages weaken delivery.

Frontline Disillusionment — Institutional trust is eroding from within.

Day 2 revealed e-Sanjeevani not as a standalone platform, but as a layered socio-technical system operating within pre-existing trust hierarchies and incentive structures.

If you work in public health systems, telemedicine, or government healthcare programs, how do performance metrics, trust, and accountability intersect in your experience? Write your questions and feedback to us at: [email protected]

Until next time :)

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Interviewing the actors of e-Sanjeevani - Day 01

We started our first interview with 3 doctors who regularly consult on e-sanjeevani to get a narrower- in detail perspective of how it works. Our main goal was to understand how the doctors define and practice health, how trust is built in telemedicine, what makes telemedicine feel sufficient and insufficient and lastly how the patients seek care through the platform.

The doctors working in this network have never met the nurses, the MLHPs- who stand in for them at the sub-centres. Yet their diagnoses depend entirely on these nurses’ observations. The nurse becomes the doctor’s eyes, ears, and hands.

A usual consultation is brief- mostly 2 minutes, sometimes 5. The doctor begins with patient history. For women, there are questions about menstrual cycles or contraception. 

The examination is “head to toe” but specific to the complaint. 

One doctor mentioned that “60% of sickness is cured psychologically,” emphasizing how reassurance, counselling, and trust often play such important roles in the process.

The doctor instructs. The nurse observes. Information travels back. Diagnosis follows. It is objective, structured, and relay-based. One doctor admitted that this might not be the “ideal” way to consult, but also added, “something is better than nothing.”

In cases of tech failure, the consultation does not stop, the professionals find workarounds like WhatsApp, phone calls or texting to connect with the nurses. This made us wonder - are they really relying on the e-Sanjeevani platform?Later that day, while talking to one of the officials of NHM Meghalaya, we understood that e-Sanjeevani operates on a hub-and-spoke model with 53 doctors (11 dedicated, rest juggling OPDs), but faces significant friction from undertrained/busy hybrid practitioners, erratic medicine and equipment supply chains, no local diagnostic labs, and an inability to onboard private doctors due to cost, pushing locals toward more available quacks. 

If you’ve worked within public health systems, telemedicine, or government healthcare programs or have perspectives we should be considering we’d love to hear from you. You can write to us at [email protected].

Until next time <3    :)

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Mapping e-Sanjeevani in Meghalaya: Structure, People, and On-Ground Realities

This post documents our first day at the Health Department in Shillong, Meghalaya. As with earlier entries, this is a record of what we were told and what we observed, not an evaluation or a set of conclusions.

By the time we arrived in Meghalaya, we already knew that e-Sanjeevani functions very differently across states. What we wanted to understand here was how it is structured, who makes it work, and why it seems to function with relative consistency despite limited resources.

Understanding the Hierarchy

We began by mapping out the administrative and operational structure through conversations at the department.

The hierarchy broadly looks like this:

→ District Centre (NHM Office)→ Doctor Hubs→ Sub-centres (Nurses & CHOs)

This structure sets the foundation for how care flows across the state.

Doctors who are part of these hubs are not exclusively assigned to e-Sanjeevani. On a daily basis, they are expected to manage:

OPD

IPD

Their own in-person consultations

e-Sanjeevani consultations

Because of this overlap, availability is often a constraint. We were told that doctors at PHCs are sometimes unavailable for teleconsultations simply because they are occupied with physical OPD duties. This creates a constant balancing act rather than a fixed workflow.

Importantly, there are no separate hiring panels for e-Sanjeevani. All government doctors are automatically listed on the platform.

As one official put it:

“If it is done as it should be done, it really helps.” ~ Madam Carol, on e-Sanjeevani

The Dedicated e-Sanjeevani Team in Meghalaya

One of the most striking things we learnt was that Meghalaya operates with a small but dedicated team focused solely on e-Sanjeevani.

The team consists of:

3 specialists

8 medical officers

11 people in total, serving the entire state

This team is paid a fixed monthly salary, regardless of how many consultations they complete. There are no daily targets tied to their pay.

For regular government doctors (who are not part of this dedicated team), incentives are structured differently:

Around ₹500 for every 10 e-Sanjeevani consultations

This hybrid model, some salaried, some incentive-based, stood out to us, especially when compared to what we had heard about other states.

“We’re Obsessed With Numbers”

During our conversations, a contrast kept coming up between Meghalaya and other states.

In many places, success is measured primarily through daily consultation numbers. Targets, dashboards, and quotas dominate how performance is discussed.

As one official bluntly put it:

“We’re obsessed with numbers.”

We also know that in some states, consultations lasting as little as 30 seconds get counted in official data. These inflate numbers but don’t always reflect meaningful care.

In Meghalaya, the system relies far less on heavy auditing. According to the officials we spoke to, one of the reasons this works is trust.

“The main reason why e-Sanjeevani works here is because people are honest.”

This honesty, of doctors, nurses, and patients, was repeatedly mentioned as an invisible but critical factor.

How Consultations Are Conducted in Meghalaya

e-Sanjeevani can function in two ways:

OPD model – patients directly connect with a doctor from anywhere

Hub & Spoke model – patients connect to doctors through a nurse or CHO from a physical touch point

Meghalaya follows only the Hub & Spoke model.

Here, the nurse or CHO is not just a facilitator but an active participant in every consultation. No patient directly connects to a doctor without going through them.

Consultations currently happen in two fixed shifts:

9:00 am – 1:00 pm

2:00 pm – 6:00 pm

We were also told that most users of the service are women.

When we asked about this imbalance, the response was candid:

“Men are hiding.”“Men don’t get sick.”

Whether said jokingly or seriously, it pointed to deeper gendered patterns in health-seeking behaviour.

Geography Matters

Over 80% of Meghalaya is rural, and this shapes how consultations are conducted.

We were told that:

Khasi Hills and Jaintia Hills have fairly similar healthcare setups

Garo Hills operate differently, since they speak an entirely different language 

This reinforced something we had already begun to sense: even within one state, e-Sanjeevani is not a single, uniform service. It adapts to terrain, infrastructure, and local practices.

Stepping Back

Day one at the Health Department gave us a system-level view we hadn’t had before. We began to see e-Sanjeevani less as a “website” and more as a negotiated service held together by people, incentives, trust, and constant adjustment.

In the next posts, we’ll move closer to the ground again looking at how this structure translates into lived experiences at sub-centres and during actual consultations.

If you’ve worked within public health systems, telemedicine, or government healthcare programs or have perspectives we should be considering we’d love to hear from you. You can write to us at [email protected].

Until next time!

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Studying e-Sanjeevani: Service Design Exploration in Meghalaya

We’re a team of three design students - Anushka, Koyena, and Anbu, currently researching and redesigning e-Sanjeevani, India’s public telemedicine service. This blog is our work-in-progress log, documenting insights from the field, conversations with healthcare providers, and ongoing service design explorations.

We have an exciting update. Through extensive secondary research and conversations with doctors across multiple Indian states, we began to see a clear pattern: the way telemedicine services function and succeed varies significantly from state to state.

One of the states where e-Sanjeevani is functioning particularly well is the state of Meghalaya. Given its cultural and linguistic diversity, challenging terrain, limited accessibility in certain regions, and extreme seasonal conditions, we identified Meghalaya as an “extreme case” for our study. In service design research, designing for extremes often leads to more inclusive and resilient systems overall.

As a result, we are temporarily based in Meghalaya, conducting on-ground research to better understand how public telemedicine operates within these unique constraints.

If you have perspectives we should be considering, we’d be glad to learn from you. You can write to us at [email protected]. Until next time!

This blog documents the work led by three design students about an ongoing service design project exploring public healthcare and a government-led telemedicine service in India.

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The Tag Board: Visualising Insights from Public Healthcare Research

After multiple inputs from observing people, talking to them, and reviewing public telemedicine services like e-Sanjeevani, we knew we had to visualise all the information as a whole.

We pinned up photos (clicked with consent) from our visits and interviews and put up notes with captions about the photos and key insights. This helped sort, clearly look at the insights and make connections. We started to understand the deeper questions we needed the answers to and the topics we needed to truly understand. 

The tag board is a shared reference point for us to revisit and process all that we have learnt. 

Starting from the left, we have some statistics and diagrams from the secondary research, the field visit to the government hospital in Ahmedabad, the visit to the Ayushman Arogya Mandir, the service promotions, and interviews with the doctors.

If you’ve interacted with e-Sanjeevani, worked in public healthcare, telemedicine, or government digital services, or have perspectives we should be considering, we’d be glad to learn from you. You can write to us at [email protected]. Until next time!

This blog documents the work led by three design students about an ongoing service design project exploring public healthcare and a government-led telemedicine service in India. 

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A Doctor’s Perspective: Understanding Telemedicine

Since the service we are researching is the public telemedicine platform e-Sanjeevani, it is essential to understand the points of view of medical advisors and advice seekers. When we spoke to a few doctors from our contacts about telemedicine and platforms that enable it, a bunch of interesting points came up.

For doctors practising telemedicine (independently, not through any platform), building trust with the patients is the top priority. The doctors spend a lot of quality time with the patients, over phone calls, reassuring and counselling them and not sticking solely to the medical case. The consultation is conversational in nature.

Some doctors brought up the aspect of training medical professionals before they can join telemedicine platforms to equip them with the soft skills needed to carry out online consultations

Doctors mentioned how telemedicine was used primarily for non-emergent or lifestyle diseases which can be managed from a distance (life diabetes, running a mild fever and so on)

Some doctors questioned the ethicality of telemedicine

Doctors mentioned how they preferred going through multiple photos and videos and reports before diagnosing.

These conversations sensitised us to how fragile the entire concept of healthcare is and how many aspects go into ensuring that all the users experience the best of the service. 

If you’ve interacted with e-Sanjeevani, worked in public healthcare, telemedicine, or government digital services, or have perspectives we should be considering, we’d be glad to learn from you. You can write to us at [email protected]. Until next time!

This blog documents the work led by three design students about an ongoing service design project exploring public healthcare and a government-led telemedicine service in India.

[esanjeevani-servicedesign]

Service Promotion as an Experiment: Understanding e-Sanjeevani

We carried out the first part of our field research in Ahmedabad, Gujarat where we did not see much awareness about the scheme. So the next step was to carry out a small experiment. 

We knew that there were a bunch of primary healthcare centres, Arogya Mandirs and Urban Wellness Centres - all physical touchpoints of e-Sanjeevani. Hence, the question about the low adoption of e-Sanjeevani in the state, despite the availability of infrastructure, tickled our brains. 

Before we could find the answer to why people are not using this platform, we thought it would be fundamental to answer if people even knew about this platform and if they would be willing to try it out. We made a very simple pamphlet in 2 languages - English and Gujarati - with a QR code to download the app and very visual information on how to use the platform with short, simple captions. 

We started our experiment on a bright morning where the three of us approached the people in the neighbourhood and struck a conversation with them. What was interesting was us learning, conversation after conversation about how to approach people and talk to them about a healthcare platform with ease, to get the most valuable insights from them. 

Some of the observations we made were:

A lot of people who used a smartphone did not necessarily know how to scan a QR code. 

There was a fear that creating an account would be a paid process, and people did not want to pay for a platform they did not trust yet

Account creation involved generating multiple OTPs, making people ore cautious about the process

A lot of users might not specifically know what an OPD means or what specific department they’re supposed to consult with.

For those who did not want to disclose their Aadhaar or ABHA details, an email id was mandatory for account creation - which again, most people did not have.

In case of groups, people showed more openness to finding out about the platform, if 1-2 members showed interest or trust - live example of social proof

People who understood the concept were willing to try it out at their convenience, (not with us present with them) and believed that since it is a government scheme, it would definitely be a good one. 

A lot of people were scared of being scammed and hence refused to hear us out

We also realised that this platform benefits people in multiple ways - in case one has fallen sick and cannot move physically, or is alone, or has to wait for too long to get an appointment or see a doctor. But most users these days have their own trusted, family doctors they would seek advice from. These doctors might be friends or relatives and just one call away. So this platform would be especially useful for the underserved, informal and economically weak share of the population.

It was now crystal clear that the service runs on trust - trust on the physical, digital and the virtual aspects of the platform. How the service was introduced also shaped how it would be trusted. It was less about promotion and more about orientation. 

What is next? Looking at the service from the doctors’ point of view. 

If you’ve interacted with e-Sanjeevani, worked in public healthcare, telemedicine, or government digital services, or have perspectives we should be considering, we’d be glad to learn from you. You can write to us at [email protected]. Until next time!

This blog documents the work led by three design students about an ongoing service design project exploring public healthcare and a government-led telemedicine service in India. 

[esanjeevani-servicedesign]

Reflections from Field Visits: What Research and Reality Reveal About e-Sanjeevani

Our field visits gave us a first-hand view of how public healthcare is accessed and navigated.But observation alone isn’t enough especially when working within a large, national service like e-Sanjeevani.

Alongside fieldwork, we reviewed credible policy documents, government reports, peer-reviewed studies, and independent analyses to understand how telemedicine has been framed, implemented, and evaluated over time.

It was interesting to notice how field insights not only confirmed the research but also quietly complicated it. We went through multiple statistics and realised that the success of this service varied from state to state due to multiple reasons.

Some screenshots from the papers we read

This helped us realise some of the bigger questions we were starting to chase - the true meaning of health, trust, efficacy and awareness.

Much of the secondary research highlights e-Sanjeevani’s rapid scale and adoption. On the ground, however, scale translated into complex coordination, increased dependency on staff mediation, and handovers between physical and digital systems. 

Across hospitals, Arogya Mandirs, and Health & Wellness Centres, the involvement of people eased the entire process more than the interface alone. This aligned with research that pointed out that there was dependence on facilitation and uneven readiness across facilities. We were surprised to see the extent of invisibility of the labour in these kind of narratives.

Policy guidelines and implementation frameworks describe clear roles and flows. Field reality showed constant improvisation staff adapting processes in real time to make care accessible. This gap between designed workflows and lived workflows stood out.

What Shifted for Us

Together, the field visits and secondary research reframed our understanding of e-Sanjeevani. e-Sanjeevani is not a standalone digital platform. Instead it is a service whose success relies not only on the digital teleconsultation aspect of it, but also on the pre and post consultation experience - both physical and digital. 

We carried out our first part of field research in Ahmedabad, Gujarat where we did not see much awareness about the scheme. So our next step was to carry out a small experiment. 

If you’ve interacted with e-Sanjeevani, worked in public healthcare, telemedicine, or government digital services, and have perspectives we should be considering, we’d be glad to learn from you. You can write to us at [email protected]. Until next time!

This blog documents the work led by three design students about an ongoing service design project exploring public healthcare and a government-led telemedicine service in India. 

[esanjeevani-servicedesign]

What Initial Field Visits Revealed About India’s Public Healthcare System

Why Field Visits Matter in Service Design

Research is a key step in any design process, and ethnography is one way to start. Ethnography involves a bunch of sub-processes - we started with field visits, small informal conversations and intercepts. The visits allowed us to validate/invalidate pre-listed assumptions and capture how people navigate care, especially when bound by time, pressure and uncertainty.

Before engaging with e-Sanjeevani as a digital service, we wanted to understand the physical healthcare ecosystem it operates within since public digital services are shaped by spaces, workflows, staff capacity, patient behaviour and interfaces.

Our initial field visit included three public healthcare touchpoints:

A Government Hospital

An Arogya Mandir

A Health & Wellness Centre (HWC) that supports multiple Arogya Mandirs

The purpose of these visits was to review the existing experience of government healthcare, to verify the need for a telemedicine service and to observe how care is accessed, navigated, and delivered in real conditions.

Government Hospital

The government hospital we visited represented a rather chaotic environment.

We observed:

A time and distance intensive procedure to register as a new patient and avail a “chopdi” or a case file

A long waiting queue and communal checkups happening parallely, in the same consultation room

Quick check ups with provision for diagnostic tests at close proximity and negligible expense

Staff to help navigate and manage patients

Movement relied on informal systems - patients following others, staff verbally redirecting people, and repeated clarification at counters.

Arogya Mandir

The Arogya Mandir was a physical touchpoint of the e-Sanjeevani platform

We observed:

The presence of a medical officer, class 4 healthcare worker and a medical assistant

A setup for a teleconsult via e-Sanjeevani with human tech assistance

Health & Wellness Centre (HWC)

The Health & Wellness Centre acted as a hub, supporting several Arogya Mandirs.

We observed:

Better infrastructure 

More healthcare professionals 

Bigger physical touchpoint of the e-Sanjeevani platform running parallel in person consultations 

Across All Three Sites

Healthcare access involved multiple steps before consultation

Patients relied on staff or other patients for clarity

Potential for gaps in information

Staff acted as critical intermediaries between the system and patients

These visits provided essential context for understanding how any digital health service, including e-Sanjeevani, fits into the broader public healthcare experience.

In the next post, we reflect on what these observations challenged, confirmed, and changed in how we think about designing for public digital healthcare services.

If you’ve interacted with e-Sanjeevani, worked in public healthcare, telemedicine, or government digital services, and have perspectives we should be considering, we’d be glad to learn from you. You can write to us at [email protected]

This blog documents the work led by three design students about an ongoing service design project exploring public healthcare and a government-led telemedicine service in India.