Background:
Recently, the government of jharkhand has adopted a web-based comprehensive telemedicine platform – named esanjeevani-- to provide specialist healthcare consultations in rural areas. Under this program, rural health and wellness centers (hwcs) are upgraded to enable teleconsultations by connecting patients to remote doctors through audio or video calls.

Objective:
To identify processes and enablers of improving outcomes of telemedicine services under esanjeevani with respect to patient-reported outcomes, acceptability of telemedicine among providers and clients, and their perceptions on service delivery.

Methods:
A mixed method approach was used combining cross-sectional surveys and qualitative interviews with clients and providers. 500 clients and 119 health providers across five districts were surveyed, and in-depth qualitative interviews were conducted with 10 health providers and 20 clients.➠The analysis is guided by the implementation research framework suggested by the medical research council to identify processes and facilitators integral to shaping outcomes.

Findings:
The findings indicate that esanjeevani is perceived as an affordable and easily accessible health service delivery platform – with clients emphasizing a reduction in health expenditure and improved provider availability. Overall, we estimate that⟴elemedicine saved 21.59 km in distance traveled and inr 941.51 per health visit.⟣ommunity health officers and frontline workers were identified as the primary drivers of the intervention. providers also reported a high level of acceptability in terms of perceived usefulness and ease of use and highlighted the need for continued capacity building and behavior change to increase the adoption of the platform.

Conclusion:
The esanjeevani program has been effective in providing affordable quality specialist consultation to patients in rural communities, especially women. However, there are a few challenges such as the need for improvement in reducing over-referrals, creating community demand, capacity building of the telemedicine workforce, and challenges related to deficits in digital infrastructure in rural contexts.