All teach, all learn
Catalysing Interactions is the core of the ECHO model, which aims to foster vibrant learning communities to solve societal problems. But doing so at population scale needed us to reimagine how to distribute the act of solving to others and how to restore the agency of the community to be active participants in their learning journey.
Catalysing Interactions in an ECHO clinic
Doctors and healthcare workers treating multidrug-resistant tuberculosis (MDR-TB) are witnessing increasing instances of psychiatric issues in patients on treatment. An expert from National Institute of Tuberculosis and Respiratory Diseases (NITRD) came across a tuberculosis patient with suicidal thoughts and he needed a way to best advise his patient. Meanwhile, Malti, a community health worker working in a slum in Delhi, had a patient who had gone into a shell and stopped taking the medicine. She had figured out a way to persuade the patient to restart the medicine regime and also seek psychiatric help.
Both of them presented their cases at our ECHO clinic that brought them together with mental health experts from National Institute of Mental Health and Neuro Sciences (NIMHANS). They both learnt from the experts, and from each other, about the similarities of the patients and the right care they need.
This is a testament to the ECHO model’s potential. By catalysing interaction between doctors and healthcare workers, our model moves the right knowledge faster.
The ECHO Model
Project ECHO was started by Dr. Sanjeev Arora in 2003. A senior gastroenterologist specialising in treating Hepatitis C, there was always an 8-month-long wait for patients to see him. Inspired to ensure equitable access to treatment for all, he started Project ECHO to build the capacity of frontline health workers in a unique ‘All teach, All learn’ telementoring model.
ECHO’s model has a hub and spoke structure, where multidisciplinary experts based at a regional academic medical centre (hub) engage with local healthcare workers (spokes) over video-conferencing for telementoring.
Today ECHO’s global footprint covers 93% of the world, with hubs in 59 countries and spokes in 185 countries. In two decades, Project ECHO has seen 3,450,000 attendances from healthcare workers globally.
Phase I: Growing what works
The existing infrastructure of hubs and spokes made it possible for us to mobilise massive capacity during the COVID pandemic, in India and around the world. A classic ECHO session, pre-pandemic, comprised a cohort of 20-40 participants. However, in its contingent response to COVID pandemic, ECHO India was hosting webinars that could accommodate 10,000+ participants. Our training series covered a wide range of topics, from infection prevention and control, vaccine advocacy, COVID care guidelines, ventilator management to mental health support, laboratory guidance and diagnostics. At our first training, a thousand participant slots got filled in less than five minutes! To match the demand, we expanded our hub network in India from 50 to more than 200 in a little more than two years, and our COVID programmes saw more than 700,000 attendances in urban and rural areas alike.
The pandemic was a defining moment for us. It made us move faster than we’d ever imagined and, as we did, it revealed some structural cracks:
What works may not work at scale: In the hub-and-spoke replication model, our team does the heavy-lifting of identifying what information communities need and who can provide it, onboarding partners as well as communities and conducting sessions. Doing so for 150 new hubs made us realise we were becoming a bottleneck in our own scale journey.
Quality may suffer with massive growth: As we grew at a rapid rate, ECHO became a broadcaster. As a result, maintaining the learning quality standards set for classic ECHO sessions became difficult. While it was easy to catalyse interactions in classic ECHO clinics, doing so at scale was challenging.
What communities want Vs what we think they want: A lot of ECHO’s programmes are designed according to our perception of what communities want. Although this is successful most of the time, it is vital for ECHO to be a conduit for the community to become decision makers in their own wellbeing.
400 million people, so little time! We knew it was time for a transformed approach. This led us to the second phase of our journey: finding out what works at scale.
Phase II: What works at scale
Project ECHO and ECHO India have embarked on an ambitious plan to establish a robust digital infrastructure called iECHO. This is the result of many deliberations on reimagining our role, the roles of our partners and most importantly, the role played by healthcare workers themselves. Answering the question ‘How do we move from being a tool to an infrastructure?’ led us to dig deep into the core interaction we are trying to solve and what will help us do so faster, efficiently and at scale.
iECHO is designed as a cloud-based, multi-lingual, cross-device digital platform to turn ECHO into a movement. It aims to accelerate adoption and the launch of new ECHOs, amplify the impact of operations and increase productivity as well as build and empower the community. It makes it easier for hubs to onboard themselves and their spokes to the ECHO platform, and build and operate multiple programmes. All programme data can be accessed in one place with ways to manage multiple programs, see details of attendance, get data analytics on participation, conduct assessments and issue certifications to participants.
iECHO is built with open-source and interoperable architecture that is easy to adapt, build upon and scale.
By design, iECHO restores the agency of participants to choose what they want to learn and when, and build communities of support.
We see our role evolving from solving the problem ourselves to distributing the ability to solve to the community, including superhubs, hubs and even participants. Our role will be to ensure that there is an enabling technological infrastructure, defined standards and a proper governance model to support and protect all participants.
Democratised data is powerful for ECHO, our partners and participants. It is a tool for everyone in our ecosystem to see, sense and solve the problems we face.
iECHO is redefining the ECHO platform as an integrated technology infrastructure that will power the ECHO movement to positively impact 1 billion lives by 2025. In fact, our model can be tapped into across sectors and geographies to catalyse interactions between experts and communities.
Come, join the ECHO movement!
