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Dr. Kumud Rai
Director, Vascular Surgery, Max Hospital; Chairman, ECHO India

Dr. Kumud Rai, Chairman, ECHO India, discusses the importance of listening to frontline healthcare professionals to meet community medical needs more effectively.

All teach, all learn.

This philosophy is the heart of Project ECHO, the global collaborative learning and practice model that has become integral to building the capacity of healthcare workers in India.

At ECHO India, we have learned that our healthcare programs’ success often depends on seeking out, listening to, and learning from the experiences and insights of on-the-ground community health workers—especially in rural areas, where access to basic healthcare is limited or non-existent.

The context shared by Farmeena, a community health care worker from new Delhi, is a perfect example.

Farmeena told a story at a weekly ECHO session of a patient who refused a tuberculosis test. Sharing that story led to a fundamental change in tuberculosis testing—and an improvement in tuberculosis healthcare—in many parts of India.

Farmeena’s patient, a daily wage laborer, had been treated for tuberculosis but still had symptoms. Suspecting a relapse, Farmeena instructed the patient to get tested at a hospital. The patient refused, endangering herself, her family, and her community.

Exploring the issue further, Farmeena learned that social stigma and the woman’s fear of losing her livelihood stopped her from being tested again.

The ECHO session of the Indian government’s tuberculosis program where Farmeena shared her story with other health workers—called “ASHAs” (Accredited Social Health Activists)—led to a discussion about the challenges of tuberculosis testing in rural villages. The group discovered that, in addition to social stigma associated with testing, people are reluctant or unable to travel to hospitals and clinics conducting tests.

These trained female ASHAs are learners and teachers on the front lines of healthcare in India. They work in villages to connect residents with health information, resources, and basic services. Often, they are patients’ first—and sometimes only—point of contact for health-related issues. ASHAs are from and of the communities they serve. Residents place abiding trust in them.


ASHAs at work in their community in New Delhi, India

ASHAs at work in their community in New Delhi, India.


For ECHO India, ASHAs are a crucial point of community engagement and a source of deep wisdom and practical insights.

The ASHAs’ observations about tuberculosis testing were a revelation to program leaders. They realized that for their testing program to succeed, they needed to change it.

Today, instead of sending patients to hospitals or clinics for tuberculosis testing, the ASHAs, trained by ECHO India, collect sputum samples from patients in the patients’ homes.

It is a telling example of how essential community engagement is to Project ECHO. Without that deep regard for what is happening at the community level, we at ECHO India would lack the crucial understanding of what best-practice care means in those places. And we would be unable to deliver it there.

Moving forward with work proposed in our 100&Change project, and our pivot to training a COVID-19 vaccination workforce, it will be critical to maintain our community focus. To reach populations with the least access to healthcare, we need to hear from frontline health workers, learn from their experiences, and facilitate a change for the better.


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