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:
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.
“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.
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 â‚ą500 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:
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.
Over 80% of Meghalaya is rural, and this shapes how consultations are conducted.
Khasi Hills and Jaintia Hills have fairly similar healthcare setups
Garo Hills operate differently, since they speak an entirely different languageÂ
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.
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].
