Healthcare: Mediated Care Chains and the Role of Human Intermediaries

Abstract

This chapter examines India’s digital healthcare platforms through the framework of ‘mediated care chains’, using the hypothetical Swasa-Net platform to illustrate how technology creates multi-layered care relationships while reproducing societal inequities. The analysis demonstrates three mechanisms shaping these chains: substitution (replacing traditional intermediaries), supplementation (adding layers like community health workers) and subsidization (enabling cross-class financial support). Through contrasting illustrative narratives of rural healthcare worker Kasthuri and urban professional Ramesh, the chapter reveals how platforms simultaneously bridge and deepen divides along class, geographic and gender lines. While offering urban convenience and lifesaving access in rural areas, profit-driven innovation prioritizes AI diagnostics over essential rural needs, such as offline functionality and regional language support. Community health workers emerge as critical but often uncompensated intermediaries, bridging trust and access gaps for marginalized women. The analysis concludes that achieving equitable digital health requires systemic interventions addressing technological, social and institutional factors, including inclusive platform design, equitable feedback loops and recognition of intermediary labour beyond mere technological solutions.