On 3 March 2025, the Chief Minister of Kerala officially launched Kerala CARE, the state's Palliative Care Grid. It was the beginning of statewide rollout for a digital backbone designed to support community-based palliative care across government, local self-government, and health-system teams.
The launch was a public milestone, but the work that followed was the real test. CARE had to move quickly from ceremony to daily use: facilities had to be created, users had to be trained, Medical Officers in Charge had to be assigned, nurses had to register patients, and home visits had to be recorded digitally across districts.
Training NHM teams for statewide use
Immediately after the launch, the team executed a comprehensive training program for National Health Mission teams.
On 6 and 7 March, district-level NHM nurses, doctors, and palliative district coordinators were trained in Trivandrum. The sessions included hands-on CARE training, and staging credentials were shared so users could test workflows and become familiar with the platform before using it in production.
From 10 March onward, district-level training began across all 14 districts of Kerala. The Pupilfirst team physically handled training in six districts and remotely trained eight districts. This split mattered because the rollout was statewide, but the implementation team was lean. The training model had to combine in-person handholding with remote scale.
Separate sessions were also conducted for District Medical Officers. These sessions focused on role setup: creating Medical Officer in Charge roles within districts and configuring home care teams inside each facility.
Training LSGD and local body teams
The Palliative Care Grid depends not only on health staff but also on local self-government structures. March therefore included a second training track for LSGD teams.
A state-level session introduced district-level LSGD directors to the overall flow of the Grid and the user creation process. The Information Kerala Mission team, an autonomous body under LSGD, received physical state-level training so it could provide technical support. District-level training followed for LSGD secretaries across panchayat, municipality, corporation, district, and state levels.
This was crucial because LSGD teams were responsible for creating healthcare facilities and supporting the local operating structure. A digital grid only works if the administrative hierarchy behind it is correctly represented.
Operationalizing the Grid
During March, the Grid moved into active operation.
LSGD teams began creating healthcare facilities across Kerala and assigning Medical Officers in Charge. NHM nurses started registering patients and recording home care visits. The implementation team provided on-ground and remote support, resolving issues and answering user queries in real time.
Frequent reviews with NHM and LSGD helped keep the rollout aligned. The team also held weekly review calls with the State Palliative Care Grid Coordinator and reviewed implementation progress with officials across health and local self-government.
The ABDM registration process for the Kerala CARE instance also progressed and was awaiting NHA approval, linking the deployment to India's broader digital health infrastructure direction.
Malayalam localization and field-led refinement
March confirmed that localization and usability were not optional. The platform's Malayalam localization was completed, making CARE more accessible for primary-level healthcare workers and local teams.
Ground-level exposure also led to significant UI, UX, and functional improvements. Primary care nurses often had limited prior exposure to digital tools, and many field users worked on older or lower-performance mobile devices. The team had to respond with practical changes, not abstract design preferences.
This is one of the most important lessons from the launch month: a statewide digital health system improves through field contact. Live usage exposed training gaps, mobile performance issues, workflow confusion, and paper-to-digital resistance. Each of those became product and implementation input.
Handover to NHM
One of the most significant March milestones was the official handover of the Kerala CARE Grid to the NHM team. The platform, tools, and credentials were handed over so NHM could independently manage and operate the Grid statewide.
That handover changed the meaning of the deployment. CARE was not being held as a vendor-controlled application. It was being embedded into a public health operating model, with government ownership and responsibility.
For digital public infrastructure, this distinction matters. Long-term sustainability depends on whether the public system can operate the infrastructure, not merely whether a technical team can demonstrate it.
The human implementation challenge
The launch also made the constraints visible.
The team had to manage multiple training sessions in parallel across the state with limited staffing. Travel logistics were demanding. Field support volume was high, and many users preferred calling for help despite documentation and training materials. Some staff were hesitant to move away from pen-and-paper practices. Outdated mobile devices affected speed and user satisfaction.
The absence of a dedicated implementation support team meant the core product team had to handle training, field support, issue resolution, and product development simultaneously. This slowed some HMIS work and made prioritization harder.
These challenges are not footnotes. They are the reality of public health technology implementation. A system succeeds when it has enough operational humility to handle them.
A wider ecosystem of builders
March also saw the launch of the GDC AI Workforce Internship Program in Kerala by the Higher Education Minister, Prof. R. Bindu. More than 4,600 students applied and began coursework through Kerala Technical University channels.
While this initiative was separate from the Palliative Care Grid deliverable, it reflected a wider ecosystem-building ambition around CARE: train more people, create contributor pathways, and connect public-good software to young technical talent.
From launch event to operating model
March 2025 converted CARE from a pilot-backed platform into an operating model for statewide palliative care.
The statewide launch, training across all 14 districts, Malayalam localization, NHM handover, and live patient registration created a new responsibility structure around the software. CARE was no longer only a platform under development. It had become a live digital backbone for Kerala's palliative care network.
That operating model included government ownership, district-level training, local facility creation, Medical Officer assignment, field support, and continuous product correction from frontline usage.
The launch was the visible part. The durable achievement was the handover of a working system into the hands of the public health teams who would run it.