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Task-shifting, Technology, and Training (3T) in Healthcare

The inception of the 3T project coincided with the announcement of “Ayushman Bharat” or the National Health Protection Scheme (2018) by NITI Aayog that extends insurance coverage to over 500 million Indians. To promote affordable preventive healthcare, 1.5 lakh (or 150,000) Health and Wellness Centers (HWCs) are proposed to be set up by 2022. The project identifies this period to be crucial for building and seeding India’s digital health data ecosystem in order to realize the full potential of health data application for advancing clinical care, scientific discovery, and healthcare access. Through a vast network of public and private partners in India, the 3T Project is working on multiple nodes to develop local capacity, with a focus on building and augmenting India’s digital health data ecosystem.

Principal Investigator
Satchit Balsari, Assistant Professor in Emergency Medicine, Harvard Medical School


Over the last few years, the project has provided the evidence base for policymakers to design their own framework in a way that respects the rights of individuals
and uses the most advanced technology to implement
these plans.



When it comes to health information in India, the majority of recorded data are stored and transferred on paper, causing significant overlap and making the validity of such data questionable, while also presenting a substantial challenge toward a seamless and effective exchange of health information. The 3T project is building scientifically proven clinical pathways that are aimed at optimizing digital tech and achieve the ideal combination of task-shifting, technology, and training in the Indian setting.

Informing National Policy:

While the original 3T project set out to develop the “model” prototype for a primary care center, the launch of HWCs, and Ayushman Bharat’s invitation to the team to join a Working Group, and the collaboration with Social Alpha positions the project uniquely to scale its ideas at a national level. The project built rich partnerships with the public and private sector at the state level as well, allowing to leave behind a team that will maintain and continue to develop the prototypes to ensure sustainability.

Success with Bahmni (open source EHR developed by ThoughtWorks)

Based on the implementation instance at Community Health & Training Center (CHTC) Mugalur, recommendations were provided to the St. John’s Hospital Management to use Bahmni EHR to digitize records at newly started St. John’s Health Center at Kanakapura. Bahmni was implemented & customized in the Kanakapura health center from March to September 2020, applying implementation lessons from the past years.

Pandemic Response

In July 2020, the 3T team provided technical guidance for incorporation of the telemedicine options into the Bahmni EHR, which are now available at all institutions using Bahmni, since September 2020. In early 2021, the project provided technical assistance to ThoughtWorks to incorporate Vaccine Record Management in the latest release of Bahmni update. Recognizing the need for community-based vulnerability mapping, during the pandemic, the 3T team provided technical guidance from May 2020 to January 2021 for a household-based survey targeting 20,000 persons across 7000 households in 35 villages. In addition to creating a baselined record health conditions in the community, the survey allowed ascertainment of the prevalence of disability in the locality, to design and provide rehabilitation services. Read More

Media and Resources


The team has published a wealth of academic output pushing for the advancement of easy-to-access standardized, contextually relevant (Indian) protocols for primary care.


The robust research activities undertaken by the team at India Digital Health Net, and supported under the 3T Project, has yielded a mass of resources relevant to health practitioners and policy makers in India.

We essentially were looking in Year Three, as the pandemic started, at three key contributions to the digital health ecosystem in India. The inclusion, more specifically of the term “machine readable” in the Data Protection Bill, which lays out the stage for health data interoperability. The concept of the personal health record as opposed to a hospital-based electronic medical record that then becomes the organizing core for India’s digital health ecosystem. And finally, the inclusion of records in the national digital health mission that allows for a testing environment for the 3T vision. In Year Three, we finally pivoted because of the pandemic to apply some of these learnings to telemedicine services at St. John’s Research Institution for their patients whose care was interrupted because of COVID.

Satchit Balsari

Assistant Professor in Emergency Medicine, Harvard Medical School