Illustration of world globe with various headshots of people displayed on top.
MetaECHO 2023 Global Conference

A Momentous MetaECHO

Welcoming our partners for the first in-person global event since the pandemic, more than 1,000 ECHO leaders and organizers joined us in Albuquerque, New Mexico, for four days of impactful, actionable discussions, expert speakers, and community-building at the 2023 MetaECHO Conference in September.

Keynote speeches and plenary talks generated conversation around the key levers for changing our world: transformative solutions for mental health; visionary perspectives on gender equity; the latest best practices in crisis response; and a new vision for ECHO to have greater impact beyond health care.

The conference, above all, was a chance for the global ECHO community to share ideas, develop new collaborations and return to their work, inspired.

We look forward to continued momentum, and connections, at our next conference in 2025.

Support Project ECHO

How ECHO Works

Message from Dr. Arora

Dear Friends,

When we first developed the ECHO Model in 2003, I couldn’t have imagined the catalytic power Project ECHO would unleash.

Starting with a single hepatitis-C program, today more than 1,200 partners are running ECHO programs with attendees in nearly 200 countries. More than 2 million people have attended ECHO sessions, and more than 500 peer-reviewed articles demonstrating ECHO’s efficacy have been published. We estimate, conservatively, that more than 200 million patients around the world have benefited.

I’m grateful to everyone who has participated in ECHO sessions, started ECHO programs to solve a problem in their community, and funded this work. It is all of you who have made this impact a reality.

People sometimes ask, what’s so special about the ECHO Model?

At its core, the ECHO Model is a simple but potent recipe for holding an ongoing conversation with a virtual community, using cased-based learning and implementation of best practices as the basis for problem solving and learning. In the beginning, we focused on solving the problems of individual patients—how to reduce their high blood pressure, treat their complex diabetes, or get them appropriate addiction services.

Over time, we have learned that the model works just as well to support systems change, whether that is helping clinics improve patient access to care; HIV programs target outreach; or nursing homes reduce use of anti-psychotics and the spread of infections. In every case, ECHO is ensuring equitable access for all.

Because it’s virtual, the ECHO Model delivers results much more effectively and efficiently than traditional face-to-face trainings, which can be prohibitively expensive. A study by the Kenya Ministry of Health AIDS and STI Control Programme found that, while their traditional in-person trainings cost about $800 per person, ECHO training and mentoring—a low dose, high frequency approach—was far less expensive (at $21 per person), and just as effective.

More than a protocol for creating a robust community of practice, the ECHO Model is based on trust, mutual respect, and—dare I say—love; principles that I believe are core to its power and success.

  • ECHO grows out of a core commitment to equity and a culture of co-creation: “all teach, all learn.” Since everyone is learning and sharing together, this culture helps to reduce the hierarchy that can often exist between experts and students.
  • The model is based on the fundamental idea that knowledge grows with sharing. Unlike material things, knowledge doesn’t diminish when we give it away. If you share your expertise with me, I am enriched by your knowledge and I can contribute my own background and experiences. By sharing our cumulative knowledge and expertise with each other, our impact grows and we create more contextually relevant solutions.
  • As participants become more and more expert over time, they are empowered to act as advocates in their organizations and local communities. We have seen this individual transformation happen again and again, creating agents of change in communities that need timely, relevant and actionable solutions.

Experts around the world use ECHO in creative ways to solve a wide range of challenges. We have seen ECHO programs ranging from addiction to kidney disease, diabetes, and even rare diseases, such as Ehlers-Danlos syndrome.

ECHO programs have also been developed to support schoolteachers, farmers, and even workers building clean water infrastructure. The ECHO Model has proven to be effective in supporting frontline professionals in many different domains, wherever problems are complex and local workers need ongoing guidance and mentorship.

The world is falling short on the 2030 United Nations Sustainable Development Goals.

This past year, our team has been pushed to think deeply about how the ECHO Model might be able to help partners globally reach the UN Sustainable Development Goals—the 17 commitments the global community has made to build a more just and sustainable world by 2030.

As we pass the halfway point for reaching those goals, governments, NGOs and grassroots organizations alike are grappling with how to accelerate and focus those their efforts. What’s on the line is our commitment to billions of those most vulnerable to help raise them out of poverty and provide a better future for their children.

How can the ECHO Model help the global community reach the 2030 goals?

Most ideas worth implementing are complex and need to be adapted to local context, politics, and culture. We believe the ECHO Model provides an effective and adaptable tool to help scale best practice implementation in many areas.

A 2020 study by a leading global consulting firm showed that simply by ensuring that people across the globe had access to the existing best practices, we could reduce the global disease burden by 40% over the next two decades. This is low-hanging fruit and a way we believe Project ECHO can make a huge difference.

We know this is possible because the ECHO Model has been used to quickly scale up and strengthen best practice care, leading to significant increases in the number of people treated and the reduced burden of seemingly intractable diseases.

  • When the state of Bihar in India faced a significant and sudden increase in the number of people seeking treatment for alcohol addiction, there were very few trained specialists to address the crisis. After a year of working with India’s National Institute of Mental Health and Neurosciences to train district medical officers on addiction medicine, the 22 district officers who participated in an ECHO program treated more than 23,000 patients, greatly improving access to addiction support across Bihar.
  • In Namibia, where HIV/AIDS is a leading cause of death, the Ministry of Health launched ECHO programs across the country to teach nurses, physicians and pharmacists about HIV medications that reduce the risk of transmission, among other topics. Health care professionals’ knowledge on HIV improved, and providers collaborated with peers and asked questions, helping them feel less alone and more confident in their work. To date, more than 140,000 Namibians living with HIV have been impacted by Project ECHO.

Providing a helpful roadmap, the Copenhagen Consensus outlines key strategic interventions the global community can make to optimize our ability to reach key SDGs. For example, with relatively modest additional investment, the global community can greatly expand access to tuberculosis treatment, saving millions of lives.

The ECHO Model can play a key catalytic role in this area—ensuring frontline providers have the latest government protocols for treatment, and the most effective strategies to identify hard-to-reach or difficult-to-treat patients. We are already doing this in India, working with state and national government leaders to scale their programs and train thousands of TB workers across the country.

Education is another area where focused investment on teaching reading and basic math can make a significant difference. Our recent programming in education demonstrates that ECHO’s robust system of ongoing mentorship and support is a cost-effective way to up-skill classroom teachers and administrators. This is critical because we know that teacher quality is key to student success.

Should ECHO reach beyond health care?

Believe me, I have asked myself this question more than once. But, encouraged by friends and mentors, we have become convinced that we can contribute an important voice to the broader SDG conversation and community.

As we take a bold step on our journey to bring best practices to everyone in need, I invite you to work with us and join the global community working to secure the SDGs by 2030. Together, we can make a meaningful difference.

Warm regards,

Dr. Sanjeev Arora

ECHO Supports Nine United Nations Sustainable Development Goals

3: Good health and well-being.
3: Good health and well-being.
4: Quality education.
13: Climate action.
5: Gender equality.
3: Good health and well-being.
3: Good health and well-being.
10: Reduced inequalities.
17: Partnerships for the goals.

ECHO by the Numbers 2023

Icon indicating attendance.

1,044,084 ECHO Session Attendances

Icon indicating hubs launched.

220 ECHO Hubs Launched + 2 Superhubs

Icon indicating hubs.

New ECHO Programs Launched

Icon of magnifying glass.

58New Peer-Reviewed Publications Validating the ECHO Model


*Data may vary year to year based on manual reconciliation between collection platforms

Don Berwick headshot

Project ECHO’s unique model is impacting millions of people around the world and has the potential to improve the health and well-being of billions more – quickly, at scale, and at very low cost. We’re proud to support Project ECHO and invite you to join the journey ahead.”

Rohini and Nandan Nilekani

Nilekani Philanthropies, Bangalore, India

ECHO Around the World

global map showing ECHO attendances and global hub and superhub locations
Autumn Along the River with Mountain Background

New Mexico

Tackling Our State’s Most Urgent Health and Education Priorities

Older woman talking to a younger woman.

United States

Working Toward Systems-Change for Sustainable Impact

Global South: Local Leaders Creating Change​

2023: A year of committed progress

As health care systems in low- and middle-income countries, particularly in the Global South, build back from the COVID-19 pandemic, they face significant challenges —many of which cannot be solved without growing and strengthening the health care workforce.

We worked with ECHO partners, ministries of health and other key constituents in 35 countries to identify the greatest needs and ECHO-focused solutions that can be implemented quickly, cost-effectively and at scale.

Through our collaborative approach, we produced a report highlighting dozens of ready-made solutions for some of the world’s most challenging problems.

Large group of people posing for a photo.


Co-Creating Scalable and Affordable Solutions

Two woman talking at a table.


Strengthening Health Care Systems Since 2008

People wearing masks and lab coats in a lab.


Impact at Scale Through Government Partnerships

People posing on steps holding up certificates.

Latin America

Local Leaders Paving the Way

Nancy Barrand.

As a WHO Collaborating Centre, Project ECHO’s experience and expertise in delivering complex public health knowledge rapidly, at scale, and at low cost not only helps advance WHO objectives but helps ensure our member states are prepared for the next crisis.”

Heini Utunen

Unit Head, Learning and Capacity Development for Health Emergencies,
World Health Organization
Geneva, Switzerland

ECHO Strategic Initiatives


Four Cross-Cutting, Impactful Initiatives

Every year, we identify initiatives where we can focus efforts to make the most impact—whether that’s strategies for partnering with other organizations in particular disease states and practices, or evaluating our own processes to improve outcomes, as we’ve done with gender equity. This year we looked both externally and internally to create greater impact in the some of the world’s most pressing problems.

Learn more about our 2023 strategic initiatives: emergency preparedness and response, gender equity, infectious diseases and noncommunicable diseases.

People in lab coats and masks in a lab.
Woman having mammogram

Emergency Preparedness and Response

Managing Global Health Emergencies

pregnant woman at doctor's office

Gender Equity

An Amplified Focus on Women and Girls

People in lab coats and masks in a lab.

Infectious Diseases

Uniquely Positioned to Prevent, Screen and Treat in the Global South

African child getting COVID vaccine

Non-Communicable Diseases

Systemic Interventions for Best Practice Care

Two women, one looking through a microscope.


Giving Educators the Tools to Meet Challenges and Build More Equitable Classrooms

To accelerate the global adoption of ECHO for Education programs, the ECHO Institute
launched the Partner Assistance for Launch Support ECHO Program, which helps potential education partners learn the ECHO Model by experiencing it firsthand.

We also held our first-ever education focused partner launch training in French, to better
support new partners in French-speaking Africa and welcomed our first African
education ECHO programs in Nigeria, South Africa and Cote D’Ivoire.

Paving the way for new types of ECHO education programs, our Indian partners
launched the first program devoted to increasing gender equity in middle school

As ECHO for Education continues to evolve, we see significant opportunity to impact
many of the challenges facing governments, school leaders and teachers worldwide –
including literacy, social and emotional learning and early childhood development.

Now I feel confident in my ability to find solutions for struggling readers. It makes a difference – my students have gone from barely writing one or two complete sentences to understanding how to write three-sentence paragraphs.”

Arlene Marquez

Special Education teacher
ECHO participant, Structured Literacy for the Classroom Grants, New Mexico

Research and Evaluation

2023 Research Highlights

The immense body of research highlighting ECHO’s effectiveness for improving outcomes continued to grow in 2023. More ECHO partners in the Global South are producing significant peer-reviewed research publications that illustrate the impact of their work on patients and communities worldwide.

ECHO Providers Successfully Support Rural Diabetic Patients

When looking at the effectiveness of the New Mexico Endocrinology ECHO Program, a weekly telementoring program for primary-care physicians and community health workers in 10 rural clinics, they found patients of the rural ECHO providers experienced positive results: a significantly greater reduction in their average blood sugar level (HbA1c), and they were significantly more likely to achieve a blood sugar level of less than 8% on the A1C test when compared to patients of The University of New Mexico’s Diabetes Specialty Clinic.

Bouchonville et al. (2023)

Leveraging the ECHO Model to Treat Opioid Use Disorder

Buprenorphine is an opioid prescription drug taken as a replacement in the treatment of heroin or other opioid dependence. It is considered particularly useful to expand treatment access, especially in rural areas, because it can be prescribed in a typical office-based setting, rather than inpatient at a hospital.

Six months after participating in the Medication for Opioid Use Disorder ECHO Program, providers who attended more ECHO sessions were significantly more likely to begin prescribing buprenorphine and to prescribe the drug to additional patients than providers who attended fewer ECHO sessions.

Salvador et al. (2023)

ECHO Primary Care Physicians Effectively Diagnose Autism

Diagnosing autism in the primary-care setting may lead to earlier diagnosis and quicker connection to evidence-based therapies and interventions. PCPs trained in diagnosing children through the ECHO Autism STAT (Screening Tool for Autism in Toddlers and Young Children) Program were able to diagnose autism almost as effectively as ASD specialists, with a 95% confirmed diagnosis rate.

Sohl et al. (2023)

Reducing the Mental Health Treatment Gap in Rural India

With the hope of reducing the “treatment gap” for mental health and substance-use disorders in rural India, the National Institute of Mental Health and Neurosciences used the ECHO Model to train community health workers for 18 months on how to identify and provide treatment referrals to individuals in need. The study noted a “significant decrease” in the treatment gap for severe mental health and substance use disorders.

Gakkhar et al. (2023)

In Indonesia, a country made up of tens of thousands of islands and archipelagos that are spread across thousands of miles of ocean, Project ECHO provides a solution for improving care in the hardest to reach places.
Through our partnership with Project ECHO, we have a solution to accelerate training of thousands of nurses and doctors in best practice cancer care, improving the lives of millions of people in every part of the country.”

Dr. R. Soeko Werdi Nindito D.

President Director, Dharmais National Cancer Center
Jakarta, Indonesia


2023 Funders

American Society of Addiction Medicine
Association of State and Territorial Health Officials
Board of Trustees of The Leland Stanford Junior University
Bristol Myers Squibb
Bristol Myers Squibb Foundation, Inc.
Centers for Disease Control and Prevention
Chronic Liver Disease Foundation, Inc.
Clinton Health Access Initiative
Dallas County Hospital District
ECMC Foundation
Elizabeth Glaser Pediatric AIDS Foundation
F. Hoffmann-La Roche Ltd
Family Health Centers of San Diego, Inc.
Family Health International
Fort Defiant Indian Hospital Board, Inc.

Foundation for Opioid Response Efforts
GE Foundation
Genentech, Inc
Gilead Sciences, Inc.
HHS Agency for Healthcare Research and Quality
HHS Assistant Secretary for Preparedness and Response
HHS Health Resources and Services Administration
Indian Health Service Navajo Area
JHPIEGO Corporation
Johnson & Johnson Services, Inc.
Laura and John Arnold Foundation
Leona M. and Harry B. Helmsley Charitable Trust
Los Alamos National Laboratory Foundation
Medscape, LLC
Merck Foundation
Ministry of Health of the Republic of Armenia
National Center for Chronic Disease Prev
National Foundation for the Centers for Disease Control and Prevention, Inc.
National Philanthropic Trust
New Mexico Corrections Department
New Mexico Department of Finance & Administration
New Mexico Department of Health
New Mexico Early Childhood Education and Care Department
New Mexico Public Education Department
New Venture Fund
Northwest Portland Area Indian Health Board
Northwest Regional Education Cooperative
Pennsylvania State University
Pfizer, Inc
Regents of the University of California
Reginald S. Lourie Center for Infants and Young Children, Inc.
Robert Wood Johnson Foundation
Schmidt Initiative for Long Covid, LLC
Silicon Valley Community Foundation
Southcentral Foundation
The Audacious Project
The University of New Mexico, College of Population Health
The World Bank
UBS Optimus Foundation
United States Department of Agriculture
United States Department of the Interior
Valhalla Charitable Foundation
W.K. Kellogg Foundation
World Health Organization

Support Project ECHO

Join Us in Saving and Improving the Lives of Millions Around the World.

Your generosity makes a difference. Join Project ECHO in getting the right knowledge to the right places at the right time so we can bring best-practice health care and education to everyone, helping them achieve their full potential. Backed by a solid body of research, Project ECHO’s potential is unprecedented. Put simply, we are changing the way knowledge is shared to advance human health and well-being. The result looks different in every community, but the impact is always profound.

Olivia Leland.

With ECHO’s telementoring, a primary care provider at a rural clinic becomes a resource for the other providers and other staff of that clinic. It’s great for a rural system […] that doesn’t have a lot of specialists. These frontline primary folks in a lot of rural, small clinics can have access to real mentoring with ECHO.”

Dr. Alithea Gabrellas

Infectious Disease Specialist, Gallup Indian Medical Center, U.S. Indian Health Service
Gallup, New Mexico