India’s free-to-use National Telemedicine Service, eSanjeevani, has provided over 276 million consultations and shown promise to reduce systemic inequalities in access to care. However, recent reports of dropping footfall have raised questions about the potential of eSanjeevani to bridge service provision gaps in India. We reveal important problems linked to the design and practice of triage and tele-referral nationally within eSanjeevani, corroborated by the experience of one of the …