BackWhen a 43-year-old woman sought treatment for Hepatitis C eight years after her diagnosis, Dr. Sanjeev Arora was stunned. If cared for in time, Hepatitis C can be completely cured. The woman, however, succumbed to the disease. When he connected the dots – her socio-economic circumstances, lack of medical care in her community and barriers to accessing care farther away from home – he realised the right medical knowledge wasn’t reaching the right place at the right time. Especially at a time when medical knowledge was growing rapidly, he realised it takes 18 years for knowledge to move from experts to frontline health workers.
As he wondered what would enable patients to access high-quality medical care where they are, Dr. Sanjeev set up Project ECHO in 2003. With an ‘All Teach, All Learn’ model, Project ECHO enables specialists and community health workers to share expertise and insights – moving knowledge, not people. The ECHO model of connecting knowledge and people goes beyond traditional telemedicine (one provider connecting with one patient at a time) to a virtual connection between a specialist hub team and learners at multiple primary care sites, or spokes.
From delivering knowledge to distributing the ability to solve
In the initial years, the ECHO team curated the information communities needed and the experts who could teach it. As the hubs grew, they encountered a roadblock – if the ECHO team continued playing the role of matchmaker, could they really solve at scale?
They realised that to solve at scale, they needed to think differently. Could they create a space where multiple healthcare actors such as specialists, experts, frontline workers, could offer and access the right knowledge to each other without ECHO playing the matchmaker?
This shift led them to build iECHO – a digital platform to improve health outcomes for 1 billion people. Here, partners and practitioners can track programme outcomes, engage with one another and enhance their knowledge through collaborative learning and discussions from experts around the world.
iECHO enables many actors to solve by enabling collective wisdom. iECHO has a repository of knowledge from sessions, experts and on-ground contextual insights. This repository can be accessed and added to by the network of practitioners on the platform. As more healthcare practitioners engage with the iECHO platform, their insights are fed back into the system, enabling faster detection and treatment.
iECHO is designed for scale because it distributes the ability to solve. This intentional design decision comes from the belief that no one organisation or solution can address complex problems at scale. Instead, what is needed is building and enhancing the ability of key actors to solve. This ability is characterised by clarity about the role, the knowledge and skills needed to do it best, adequate time and supportive peers.
Especially in a field like medicine where a few experts hold the latest knowledge and resources, iECHO works towards democratising expertise, as well as, having participants add contextual insights for others to learn from and use – developing a pool of collective wisdom. Over time, actors beyond the ECHO team are equipped to act and solve.
As Project ECHO moved from solving context-to-context to distributing the ability of actors across the healthcare system to solve for their needs and circumstances, they realised the gap between knowledge creation and diffusion is large in domains other than healthcare as well. Could the ECHO model plug this gap?
Beyond healthcare – Enabling others to solve faster
Project ECHO began exploring what it would mean to deploy the ECHO model in other domains to distribute the ability to solve.
With INREM Foundation, they are addressing water quality issues in India. INREM uses the ECHO Model to train “Water Quality Champions” – community actors who are trained on water quality management. By leveraging the ECHO model, INREM is fostering open discussion, breaking communication barriers, and encouraging Water Quality Champions to share experiences from the field.
In education, ShikshaLokam has collaborated with Project ECHO to improve the quality of teacher training. building the capacity of school teachers, educating them on vaccinations, young girls’ health, and other essential issues.
In the US, the police department has utilised the ECHO Model to train officers in recognising the severity of threats and taking appropriate action. This training has enhanced their response capabilities by providing access to critical knowledge and expertise.
By creating a pathway for knowledge to reach the right people at the right time, Project ECHO has accelerated problem-solving across contexts. Today, many journey partners at C4EC are exploring how they can use the ECHO model to move knowledge faster in the domain / problem they are solving for, to distribute the ability to solve.
P.S. ECHO is Centre for Exponential Change’s exChange Partner – organisations that offer building blocks, as well as, help design and prototype new ideas.
