eSanjeevani has evolved from a hub-and-spoke telemedicine model into population-scale digital public infrastructure. Critically examine its role in achieving equitable access to healthcare in India.

eSanjeevani is India's National Telemedicine Service. It is run by MoHFW and was built by C-DAC. In September 2026 it crossed 50 crore teleconsultations across all 36 States/UTs [1]. It began in 2019 as a doctor-to-doctor hub-and-spoke service and is now population-scale DPI. It has advanced equitable access a great deal, but the job is not finished.

Role in advancing equitable access

• Gender and age equity: women account for 57.14% of consultations and senior citizens for 16.25%. This suggests that barriers of mobility and travel have come down [1].
• Geographic reach: more than 1.42 lakh Ayushman Arogya Mandir spokes are linked to 19,473 hubs. This brings scarce specialists to rural and remote areas [1].
• Affordability and last mile: the OPD service is free, and 3.74 lakh Common Service Centres give assisted access to people with low digital literacy [2].
• Continuum of care: specialist OPDs at AIIMS Jodhpur, Jammu and Patna, a link to ERSS-112 and an award-winning AI-CDSS connect primary, tertiary and emergency care [1].
• Interoperability: eSanjeevani OPD can create ABHA IDs, which link it to ABDM health records [5].

Limitations and concerns

• Volume is not outcomes: 2.5–3 lakh consultations a day across more than 1.42 lakh spokes is only about two per centre per day. There is no data on referrals completed or patients who recovered [1].
• Digital divide: the Parliamentary Standing Committee on Health (175th–177th Reports) called for rural broadband in "mission mode" and digital training for ASHAs [3]. WHO warns that gaps in connectivity and digital literacy "risk widening health inequities" [4].
• Fading awareness: the Committee noted that telemedicine use "often diminishes without sustained public awareness" [3].
• Federal variation: health is a State subject, so hub staffing and waiting times differ from State to State.
• AI accountability: the Telemedicine Practice Guidelines (2020) were written before AI-CDSS existed [2]. It is unclear who is liable for wrong advice given with the AI's help.

In short, eSanjeevani has turned telemedicine from a pandemic stopgap into lasting DPI that reaches women, older people and rural India. To build on this, the government should publish outcome metrics, connect every spoke to broadband, run sustained IEC campaigns [3], and update the guidelines for AI in line with the DPDP Act, 2023. With these steps, eSanjeevani can complement, not replace, physical health infrastructure. It can then help India move towards Universal Health Coverage (SDG 3.8) and the right to health under Article 21.