Redefining Public Health Governance: India’s Digital Leap with CoWIN, eSanjeevani, and ABDM

India’s healthcare governance is undergoing a seismic shift, propelled by technology, inclusion, and innovation. At the heart of this transformation are three game-changing government-led platforms: CoWIN, eSanjeevani, and the Ayushman Bharat Digital Mission (ABDM).

These digital tools are not mere stopgaps but foundational instruments of a new governance model that values data, decentralization, and citizen empowerment. Together, they mark the evolution from a reactive, fragmented system to a proactive, integrated, and real-time healthcare architecture—one that could serve as a global template.

ABDM: The Backbone of India’s Digital Health Ecosystem

Launched in 2021, the Ayushman Bharat Digital Mission (ABDM) was envisioned as a federated digital ecosystem connecting citizens, health professionals, and health facilities nationwide. Unlike centralized systems, ABDM allows decentralized data ownership, giving citizens control over their health records while enabling seamless provider interoperability.

As of February 2025, the digital infrastructure under ABDM has achieved scale at a historic pace:

Notably, 49.15% of all ABHA account holders are women, and services are offered in multilingual formats, along with assisted and offline creation modes to bridge digital access gaps in rural and low-connectivity regions.

eSanjeevani: Mainstreaming Telemedicine as Public Policy

The national telemedicine platform, eSanjeevani, has redefined healthcare accessibility, particularly in remote and underserved regions. Launched by the Ministry of Health and Family Welfare, the platform includes:

• eSanjeevani OPD – enabling doctor-to-patient remote consultations
• eSanjeevani AB-HWC – linking Health and Wellness Centers (HWCs) with specialists

As of January 2025, the platform has facilitated over 14 crore consultations, with more than 80,000 daily users across 36 states and UTs.

What sets eSanjeevani apart is its integration with ABDM, ensuring that every virtual consultation gets automatically recorded in the patient’s ABHA-linked personal health record, enabling longitudinal, portable, and secure medical histories.

CoWIN and U-WIN: Vaccination Governance at Population Scale

CoWIN, originally launched for COVID-19 vaccination rollout, emerged as a landmark in digital health infrastructure. It enabled real-time appointment booking, inventory tracking, and universal vaccine certification. Building on its success, the government launched U-WIN in October 2024 to digitize India’s Universal Immunization Programme (UIP).

Here’s what U-WIN has accomplished as of November 2024:

The platform allows parents to self-register for immunization services, receive SMS alerts, generate QR-coded vaccination certificates, and even create Child ABHA IDs for lifelong recordkeeping.

The Unified Health Gateway: Aarogya Setu’s Second Life

Initially launched as a COVID contact tracing app, Aarogya Setu has now evolved into a full-fledged National Health App, allowing users to:

• Register for ABHA

• Access digital prescriptions and lab reports

• Schedule eSanjeevani consultations

• Download COVID and routine immunization certificates

This convergence of services under a single interface represents a citizen-first digital health gateway, with added features for offline access, real-time updates, and multilingual navigation.

Mental Health and Hospital Digitization: Expanding the Scope

Digital public health governance in India is not limited to physical health.

• Under the National Tele Mental Health Programme (Tele-MANAS), launched in October 2022, over 17.6 lakh calls have been handled across 53 centers in 36 States/UTs, providing mental health support via toll-free helplines.

• Simultaneously, platforms like e-Hospital, part of the Digital India initiative, provide hospital management systems to over 600 hospitals, covering appointment booking, diagnostics, and online patient services—all integrated with ABHA.
  

Policy as Infrastructure: What Makes This Governance Model Unique

India’s new governance model is powered not just by platforms but by enabling policies:

• The Health Data Management Policy under ABDM ensures citizen data ownership, informed consent, and data anonymization.

• The Digital Health Incentive Scheme (DHIS) offers monetary incentives to hospitals and providers who adopt ABDM-integrated digital systems. Partnerships, like the NHA-IIT Kanpur collaboration for federated AI learning, bring academia into governance innovation.

Challenges and the Road Ahead

Conclusion: India’s Model for the World

India’s journey with CoWIN, eSanjeevani, and ABDM represents more than service modernization—it signifies a reimagined model of healthcare governance. A model that is inclusive, data-driven, patient-centric, and scalable. It shows that citizen-focused design, strong public infrastructure, and ethical governance can converge to create a sustainable health ecosystem.

“Healthcare will no longer be about where you live, but how well you're digitally connected.”

As India continues to digitize its public health services, it stands not only to benefit its 1.4 billion citizens but to inspire a global shift in how nations govern health in the 21st century.

Despite rapid adoption, certain challenges remain. Digital literacy, especially in rural and tribal areas, must be prioritized. As the volume of health data grows, cybersecurity will require robust legal and technical safeguards. Skilling frontline health workers for digital platforms is critical to ensuring inclusivity in implementation.

Yet, India’s approach already offers a blueprint for the Global South: invest in digital public goods, prioritize inclusion, and embed trust through policy.

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