Knowing what should happen is not the same as making it happen. Identifying a need and then having nobody to act on it produces a very well organised list that helps nobody.
Why it matters
If a system like this worked, it would surface an enormous number of outstanding needs at once. The binding constraint would immediately stop being information and start being people: clinician hours, health centre throughput, diagnostic capacity, medicine supply.
That changes the design. It makes deciding what not to surface as important as deciding what to surface, which is a rationing question with real ethical weight that we should not pretend is merely technical.
Where our thinking currently sits
India's community health workforce is roughly a million ASHAs, plus ANMs, Anganwadi workers and an extensive primary care network. That is among the largest in the world.
Rwanda has shown that community health workers plus good coordination can produce results at national scale. We think the interesting possibility is not that technology replaces these workers, but that it makes each of them considerably more effective. Something like: here are the six people who need you today, here is why, here is who is most at risk.
If that is right, it reframes the whole thing. The missing piece is not the workers. India has those. The missing piece is the layer that tells each of them who needs attention today.
What we are worried about
Measuring a health worker on unresolved items would turn them into a target rather than someone being supported. Any system that assigns work has to be designed against that from the start, not retrofitted once it has happened.
What would count as an answer
- A realistic picture of current workload and capacity, not the establishment figures
- Evidence on what actually helps a frontline worker versus what adds reporting burden
- A defensible approach to prioritisation when there is more need than capacity
Help us with this
ASHAs, ANMs, Anganwadi workers, supervisors, and anyone who has run community health programmes: you know things about this that are not written down anywhere. Please tell us.