Anjali Jha watched her two-month old daughter with a smile. But, a month and a half ago, there was just anxiety writ large on her face as her newborn faced serious health complications.

Ever since she was born, the baby was unable to feed on her mother’s milk. With no paediatrician at hand to advise them, the family, that lives in Jemco in East Singhbhum district of Jharkhand, were at their wits’ end and had to depend on home remedies to bring relief to the baby who cried all day.

Fortunately, the baby’s grandmother, Sunita Jha had heard ofe-Sanjeevani, which offered telemedicine services at the Health and Wellness Centre (HWC) at Sundarnagar, about 10 kilometres from Sunita’s house. The baby was taken there and with the help of Navita Kumari, the Community Health Officer (CHO), the family connected with a doctor virtually who prescribed treatment. The baby has since recovered and the family is relieved.

Sunita said she was immensely grateful to the tele-medicine service. “The mother was unable to feed the baby but after visiting the wellness centre, all is well. I am thankful to this free online service that brought a smile to my granddaughter’s face,” the grandmother told Gaon Connection.

Naxal hit villages like Dumaria where patients were unable to visit government hospitals due to lack of direct transportation are greatly helped by this.

 Bringing medical services closer home

Many people such as Anjali Devi in the predominantly tribal state of Jharkhand are seeking recourse to e-Sanjeevani, started by the Union ministry of health and family welfare to provide expert medical consultation to people in far flung areas through video conferencing and online chatting.

Two medical colleges and over 230 doctors across the state are empaneled for the service. Transforming Rural India Foundation (TRIF), a grassroots organisation, is providing technical service and conducting training at 1,100 HWCs in Jharkhand.

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Over 30,000 consultations have been recorded in Jharkhand since the project was started in the state in August 2021 through the HWC model. The community health officer at each HWC is supposed to ensure consultation to at least two patients daily.

According to Navita Kumari, the community health officer at Sundarnagar, patients needing medical help are connected to the relevant doctors through the e-Sanjeevani app, right at their doorstep. The wellness centre then provides medicines, as prescribed by the doctor over the app, she explained to Gaon Connection.

There are 19 anganwadis covering around 25,000 inhabitants that come under her jurisdiction, she said.

“So far, at least ten consultations a day happen ever since the service was started in East Singhbhum in August 2021,” the community health officer said. She added that most of those who sought help were women and children.

These health officers fill the patient’s details on the app along with their medical history, details of blood pressure, sugar, oxygen, weight, etc. Then they identify the doctor relevant to the medical condition and start the video conference with the patient.

TRIF is helping out in the process of ID creation of doctors and community health officers for running the service smoothly.

After an online examination, the doctor writes prescriptions and the community health officers give the patients free medicines. They also write down the prescription for the patients in case the medicines are not available at the health centre and the patient has to purchase it outside.

“Patients are happy with the telemedicine services and we are also learning about advanced treatment with the help of specialists as the teleconference happens in our presence,” Navita Kumari said.

Benefits of audio-visual consultation

The audio-visual consultations have provided patients in remote areas a great respite, said Sukanta Sheet, medical officer in charge of the Community Health Centre at Potka in East Singhbhum. “Living in remote villages, poverty and lack of transport, come in the way of many people here from seeking medical help,” he pointed out.

Sheet himself is empanelled as a doctor in the East Singhbhum doctors’ pool for e-Sanjeevani and he meets at least five to six patients each day through tele-consultation, he said.

“I feel happy I can do this for needy patients who have so far been deprived of specialised treatment,” Sheet told Gaon Connection. He added that it was the women, children and the elderly who mostly sought this service.

Deepak Giri is the nodal officer of e-Sanjeevani in East Singhbhum. According to the doctor in February 22 this year, there have been 749 tele-consultations in the district.

“Altogether 99 HWC have e-Sanjeevani since August 2021 in the district. Twenty doctors are empaneled in the district hub for the services including gynaecologists, paediatricians and general practitioners,” Giri explained to Gaon Connection. “We ensure that generic medicines are available at each of the HWC so that patients do not have to purchase them from outside,” he added.

The outcome of the tele-consultations have been multipronged. “It reduces the rush in district level hospitals allowing the doctors to work more efficiently, and saves patients the money as well as valuable time that they would otherwise have to spend if they had to physically visit hospitals,” Nirmal Das Kumar, district project manager in Seraikela-Kharsawan, told Gaon Connection.

A wide network of doctors and medical practitioners

Shyamal Santra, Jharkhand state head of TRIF, said the service (without the HWC method) was first started in 2020, when the COVID-19 pandemic was at its peak in the country.

“The state government ensures smooth implementation of e-Sanjeevani, while TRIF provides technical support and training to the concerned stakeholders,” Santra told Gaon Connection.

Initially, the consultations on e-Sanjeevani were only through eSanjeevani-OPD method, which is patient to doctor connection through android app or by any web browser. The consultation at the HWC began from May 2021 which is done by the CHOs through a browser based service called as eSanjeevani-HWC method. Both the methods support online video consultation.

While there are two state level hubs for doctors, each district also has its own doctors’ hub. There are 40 specialist doctors from the Rajendra Institute of Medical Sciences (RIMS) in Ranchi, 23 from All India Institute of Medical Sciences (AIMS) in Deoghar, and several medical consultants in each of Jharkhand’s 24 districts. They are available for consultation between 11 am and 2 pm every day.

According to Praveer Mahato of TRIF, the health minister reviewed the services frequently, while the state level Non Communicable Diseases cell and Comprehensive Primary Health Care Cell monitored and coordinated with districts for the project. TRIF is helping out in the process of ID creation of doctors and community health officers for running the service smoothly, he added.

Recently, Ramesh Gholap, managing director of National Health mission (NHM) in Jharkhand called for a meeting in Ranchi where he directed civil surgeons to ensure at least two consultations at each HWC daily through e-Sanjeevani. There are 1,158 active HWC out of the total 1,640 in Jharkhand that have been tagged.

Forest and Naxal-hit villages benefit too

Inhabitants of villages in Saranda forest area in West Singhbhum district are also benefiting from the tele-medicine services. Till a few years ago the district did not have a specialised doctor even at the district level Sadar Hospital in Chaibasa. Now, the villagers in the area have the option to consult a specialist online within 10 to 30 minutes of visiting an HWC, having an e-Sanjeevani facility.

Naxal hit villages like Dumaria where patients were unable to visit government hospitals due to lack of direct transportation are greatly helped by this.

Doctors as well as patients, especially from rural areas in Jharkhand, are hopeful that the government will further improve the e-Sanjeevani service so that more patients can receive timely and quality treatment at their doorstep. Rural tribal residents of Santhal Pargana are also taking advantage of the specialised treatment facility that they had been deprived of earlier.

Residents and para medical staff of several villages in East Singhbhum, where the teleconferencing service is yet to be implemented due to technical reasons, are eagerly waiting for the start of e-Sanjeevani there.

“A population of about 5,600 are hopeful that the telemedicine services will start soon,” Pushpa Rani MahatoSah, staff at the HWC in Lupungdih village under Hurlung panchayat in East Singhbhum, told Gaon Connection.

This story has been done as part of a collaboration with the Transforming Rural India Foundation.