Surveillance medicine 2.0: digital monitoring of community health workers in India.

Abstract

This paper examines a digital platform used in the primary health sector in a state in Eastern India. Within a 'regime of tactility,' it is supposed to redefine the state's presence in rural areas, not only by attending to patients but also by screening the population and establishing health databases. While the health workers who operate the digital platform represent the state in 'the peripheries,' the state itself exhibits mistrust towards them and monitors their performance through the platform. Based on long-term ethnographic research, the manuscript analyses the use of digital health technologies as technologies of accountability. The competitive nature of monitoring techniques leads to an ever-higher number of digital consultations, which projects the image of a caring and efficient state. However, the paper also explores the unintended consequences of this politics by display on the provision of healthcare. Even though digital technologies and the managerial form of governance they engender promise to touch people's lives, they lead to intangible forms of care while leaving untouched pressing structural issues that India's health sector has been facing for decades.