Before dawn, an ASHA worker checks her mobile phone. Notifications include performance alerts, missing entries, and pending uploads. A computerised quiz infrastructure has already evaluated her productivity before she begins her house visits. Despite India’s health-tech revolution being based on dashboards and algorithms, it is the women who knock on doors who form its backbone. Over 10 lakh ASHA workers and over 13 lakh Anganwadi workers provide last-mile healthcare in India, making it one of the world’s largest community health networks. The COVID-19 vaccine programme, TB surveillance, and childhood immunisation efforts have all relied on them. With today’s digitised government, their position is being repurposed, not lessened, but enlarged without recognition. When a dashboard replaces patients Over 65 crore health data documents have been linked and over 80 crore health IDs have been issued by the Ayushman Bharat Digital Mission.Over 39 crore teleconsultations have been conducted by the national telemedicine program, eSanjeevani. Pregnancy, diet, immunisations, and disease monitoring are all tracked using mobile applications. Artificial Intelligence (AI) is being used to forecast resource allocation and hazards. The characteristic of the policy is efficiency. On the ground, however, this means more effort. Instead of eradicating paperwork, digitisation has multiplied it. In addition to entering data into different apps, ASHAs maintain physical registers. Problems with connectivity push digital labor into the late hours of the night. Despite the effort, late entries might lead to warnings or loss of incentives. Ultimately, the system compensates for data input rather than care. A metropolitan environment—constant electrical supply, dependable internet, and English literacy—is the foundation of the app’s design. But in vast swathes of the country, this is not the reality. Frontline workers are held accountable when technology malfunctions, not app developers or administrators. Though accurate, the digital state lacks accountability. This gap is widened even further by AI. . It could mark a region as “underperforming,”but it is unable to discern caste issues, migratory trends, or mistrust of public institutions. Once more, the least powerful person — the woman ASHA worker — is left with the burden of explanation. Digital State, unpaid women The change that the embedding of technology into the delivery of community care has brought about is largely shouldered by women. Officially classified as volunteers, ASHAs and Anganwadi staff typically pay for their own smartphones, internet, and energy. Notwithstanding the progressively greater range of duties, the not-to-exceed fixed monthly honorarium, including incentives, remains at around ₹3,500 even after the adjustment in 2025. What this means is that the State is using informal labour to digitise healthcare. India is also gathering previously unheard-of volumes of health data, but employees at the lowest levels are unaware of how this data is being updated or used. Where reform is needed Technology is not the issue: in certain States, digital payments have improved transparency, while telemedicine has expanded access. The issue is dashboard governance, where objectives replace trust and measurement replaces engagement. Reform must begin with labour if the goal of digital health is to succeed: cut down on unnecessary registrations, pay for digital labour, offer ongoing training, and make AI choices contestable. Otherwise, digitisation turns into extraction, when women’s unpaid labor is used to mine data from the impoverished. The success of the Indian health system can be attributed to its reliance on reliable middlemen between the government and its citizens. If that trust is betrayed, the system will fail, but the data will remain intact. The issue is not if India will have digital healthcare, but rather if it will have the medical professionals to put it into practice. The future of public health, from ASHA to AI, will rely on political will rather than technological prowess: efficiency, or dignity and efficiency. (Abhilasha Semwal is deputy director, programs and process, ASIA and assistant professor of law, faculty of law at SGT University, Gurgaon. abhilasha@advancedstudy.asia) Published – March 27, 2026 12:19 pm IST Share this: Click to share on WhatsApp (Opens in new window) WhatsApp Click to share on Facebook (Opens in new window) Facebook Click to share on Threads (Opens in new window) Threads Click to share on X (Opens in new window) X Click to share on Telegram (Opens in new window) Telegram Click to share on LinkedIn (Opens in new window) LinkedIn Click to share on Pinterest (Opens in new window) Pinterest Click to email a link to a friend (Opens in new window) Email More Click to print (Opens in new window) Print Click to share on Reddit (Opens in new window) Reddit Click to share on Tumblr (Opens in new window) Tumblr Click to share on Pocket (Opens in new window) Pocket Click to share on Mastodon (Opens in new window) Mastodon Click to share on Nextdoor (Opens in new window) Nextdoor Click to share on Bluesky (Opens in new window) Bluesky Like this:Like Loading... 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