Project ECHO is a global healthcare intervention that uses videoconferencing for telementoring programs that build capacity for screening, diagnosing, and providing complex care to patients in underserved areas. ECHO addresses disparities in care by moving specialized medical knowledge from medical universities and tertiary care centres to primary care practices serving resource- constrained communities.

Sanjeev Arora, MD, founded ECHO in 2003 and remains director of this innovative model. ECHO operates in 45+ countries, covering 70+ complex medical conditions, providing education, training, and software to support replication initiatives worldwide. This guided-practice model reduces health disparities in underserved areas with a goal to reach 1 billion lives by 2025.

Under the leadership of Dr. Kumud Rai as Chairman and Dr. Sunil Anand as Executive Director, ECHO India has completed more than 280 programs with 89 in progress. These cover over 25 areas including cancer screening, palliative care, mental health, liver disease, and tuberculosis. Begun as a healthcare initiative ECHO serves other disciplines, including mentoring and training teachers and journalists and addressing the air pollution problem in Delhi NCR.

ECHO’s design moves specialized knowledge from academic and tertiary care centres (hubs) to community-based healthcare clinics (spokes) using case-based learning and guided practice, increasing the capacity of healthcare providers over time.

Teams of experts at ECHO hubs co-manage patient cases and promote an all teach, all learn strategy using group discussion to help participants increase knowledge. Best practices are shared as rural providers educate hub teams and peers on resource constraints, cultural barriers, and patient outcomes based on the hub team’s recommendations. ECHO’s multidirectional teaching and learning culture creates virtual communities of practice where participants seek additional mentoring and share innovations.

Figure 1. The ECHO hub-and-spoke model encourages an all teach, all learn approach to knowledge sharing.

As of November, 76 active hubs are serving 20 states in India. Some of the most respected research institutes in India serve as hub teams, including the National Institute for Mental Health and Neurosciences (NIMHANS), the National Institute of Cancer Prevention and Research (NICPR), and the National Institute of Tuberculosis and Respiratory Diseases (NITRD).

ECHO India Mobilizes for Covid-19

ECHO was uniquely suited to quickly mobilize a geographically disparate workforce for detecting and treating COVID-19 and to disseminate best practices. In early 2020, 54 of the 56 existing ECHO hubs immediately suspended training on their regular topic to train regional providers on COVID-19 prevention, treatment, and containment. Between March and April 2020, the number of participating spokes climbed from 12,377 to over 227,942 spokes.

ECHO has been a pipeline to help public health officials communicate updates and guidelines to clinicians attending remotely throughout the pandemic. During the first six months, ECHO hubs trained 400,000+ clinicians on COVID-19 topics, from public health and epidemiological considerations to clinical guidelines and vaccination updates. Included among these participants is a network of community health workers who have undertaken the work of going door-to-door in villages to educate residents on preventing COVID and proper self-isolation procedures for symptomatic individuals. In addition, ECHO India’s team and partners have provided 3300+ COVID- 19 training sessions to healthcare providers, many of whom lacked access to quality training due to geographic isolation.

In September 2020, one ECHO session on ventilator safety hosted by ECHO India, the Ministry of Health, and AIIMS trained providers at 1000 spokes in a single day.

ECHO also works with palliative care experts to train providers to offer quality end-of-life care and alleviate suffering for patients and their families. On Palliative Care for Healthcare Providers Treating People (Pallicovid ECHO) is a collaborative effort by Pallium India and PalliCovid Kerala. In addition to palliative care services, Pallicovid ECHO addresses feelings of helplessness among attending staff, improving work satisfaction and morale.

ECHO India will continue to build its partnership with the Government of India’s Ministry of Health and Family Welfare to educate healthcare providers on topics identified as health priorities by the national government, including eradicating tuberculosis and hepatitis C and increasing access to mental and behavioral health and addiction services.

Project ECHO is efficient, equitable, and sustainable. It will continue to learn from COVID-19 experiences to prepare for the next public health emergency while building workforce capacity to cure diseases we already know how to treat and improve health outcomes for those in India who need it most.

Image source: ECHO India