My Thoughts and Expressions
Kiran Mazumdar Shaw

Thursday, 5 May 2016

A Collaborative Approach to Healthcare Delivery

Courtesy: TOI



The highest attainable standard of health is a fundamental right of every human being. In this context, universal access to healthcare assumes prime importance. However, healthcare delivery poses a significant challenge for policymakers in India.

A severe lack of resources means that there is only one doctor per 1,700 citizens in India, well below the minimum ratio of 1:1,000 stipulated by the WHO. There are also only 1.3 beds per 1,000 population, significantly lower than the other BRIC economies and the WHO guideline of 3.5 beds per 1,000 population. In rural areas and smaller towns of India, even basic health services remain inaccessible. Given the sorry state of affairs it is no surprise then that India continues to lag behind poorer neighbors like Bangladesh, Sri Lanka and Nepal in terms of child mortality. For every 1,000 children born in India between 2011 and 2015, 48 died on average every year before reaching the age of five, according to the World Bank. Equally alarming is the fact that a quarter of the world’s neonatal deaths and 15% of maternal deaths happen in India.

It is pertinent to note here that despite the fairly rapid pace of economic growth that India has experienced in the last 20 years, public health spending in the country is only about 1% of GDP. This compares to 3% in China, 4.1% in Brazil and 8.3% in the US.

Inadequate government spending on healthcare and lack of access to health insurance pushes almost 3% of India’s population into indebtedness and bankruptcy every year. To address this situation, the government needs to come forward and take proactive steps to implement a universal healthcare program that ensures basic healthcare services for everyone with minimum financial burden being passed on to the patient. 

India needs a universal healthcare program that hinges on affordability and access. This calls for existing public health infrastructure to be revitalized, new medical centres built and modern ICT-based telemedicine technology to be leveraged for addressing the demand-supply gaps in terms of doctors and health facilities. There is an urgent need therefore for public health spending in India to be raised to at least 2.5% of GDP as well as Public Private Partnership (PPP) models in healthcare to be promoted.   

PARTNERING TO MAKE HEALTHCARE ACCESSIBLE

The government alone cannot meet the healthcare infrastructure and capacity gaps in Tier II and Tier III cities as well as rural areas, and this makes private participation a must. While it’s true that some PPP projects attempted earlier have failed, clear policy guidelines can ensure the successful implementation and sustainability of healthcare PPP models in future.

The prerequisites should include agreed upon scope of work, legal and regulatory framework, resources pooling and management, transparency and accountability, suitable policies and a commitment to public good. It is necessary that PPPs ensure that government services are delivered in an economical, effective and efficient manner. The role of the government should be proactive and it should identify areas in National Health Programs, diagnostic and curative services where partnerships are possible. The government should also develop working guidelines based on successful experiences of different states besides framing quality guidelines with professional help from organizations that already have experience in preparing quality assurance tools. Lastly, smart business models need to be put in place without which it will be difficult for private players to achieve reasonable returns on investment.

It is encouraging to see that the NDA government is looking seriously at PPP models for improving healthcare access to the country’s 1.2 billion people and lessen the healthcare burden on the common man. At a time when the federal government is examining ways to implement healthcare initiatives under the PPP model in a time bound manner, states like Rajasthan have already set the ball rolling.

THE RAJASTHAN EXPERIENCE

The Vasundhara Raje government in Rajasthan has partnered with the private sector for running Primary Health Centres (PHCs) and sub-centres across the state. Rajasthan, which is geographically the largest state in India, has over 500 Community Health Centres, over 2,000 PHCs and over 13,000 sub-centres. Several PHCs, which are located in remote areas, are now being run on a PPP model. The terms of the PPP engagement are simple. While the state government will provide the necessary infrastructure, medicines, equipment and operational costs, the private operator would provide doctors, paramedics and other staff, free outpatient services and 24-hour emergency services. These PHCs are already reporting encouraging results as the improvement in cleanliness and availability of staff and medicines  have led to a jump in the number of patients being treated.

The Rajasthan government has also launched a health insurance scheme to provide medical coverage of up to Rs 3 lakhs to each citizen and is expected to cover nearly 70% of the state’s population.

Health insurance is an area where PPP arrangements have been successful. The Yeshasvini Co-operative Farmer’s Healthcare Scheme, a PPP scheme involving Narayana Health and the Karnataka government, offers coverage of over 800 surgical procedures to farmers and their family members. Yeshasvini is one of the largest self-funded healthcare insurance schemes in the country. Neighboring Andhra Pradesh runs the Arogya Raksha Scheme in collaboration with the New India Assurance Company and with private clinics. The scheme, which is fully funded by the government, provides hospitalization benefits and personal accident benefits to citizens below the poverty line.

TOWARDS A HEALTHIER FUTURE

The new Companies Act of 2013 mandates corporates to spend 2% of their profits on CSR activities. The government can take this opportunity to partner with the private sector for taking healthcare delivery to the next level. It will lead to a huge improvement in healthcare delivery in India through a combination of good infrastructure, latest technology and the best available medical expertise. If PPPs are need based and customized to local circumstances, they clearly have the potential to drastically change the healthcare landscape in India.


PPPs can thus be a 'win-win' arrangement in which diverse actors with varied motivations and philosophies work together to contribute to the health of the people and the development of the country.

This piece was first published in the print version of TImes of India on May 5th, 2016

Friday, 25 March 2016

What Price Philanthropy?

                                                       Courtesy: Google Images
Over the past month, I have been a silent spectator, witnessing a miserable drama unfold in Bangalore. This is regarding a remarkable project to safeguard an important art collection through the upkeep and modernisation of an ailing state gallery the Venkatappa Art Gallery (VAG), by turning it into a new museum for the city. These plans were to be made possible through local corporate philanthropy. Sadly, the plans are currently in jeopardy as they are being protested by a group of ‘artist activists’ operating under the banner of the ‘VAG Forum’.

Tuesday, 8 March 2016

Breaking the Stereotype

Courtesy: Google Images


Today’s Indian woman is making a mark across diverse fields – from business and politics to sports and social work – breaking stereotypes and smashing glass ceilings along the way. It is interesting to note that 6 of the Top 10 Banks in India are headed by women and 12% of India’s 5,100 pilots are women. Likewise, there is a huge surge in women-led start-ups in IT & Biotechnology. Witnessing this change is exciting and energizing as there is a newfound confidence among Indian women, a sense of self-belief that they can excel in any domain, compete with their male counterparts on a level-playing field, attain leadership positions and become role models for all.

Thursday, 3 March 2016

Innovation, not price control is the answer to affordable Bt cotton technology

Courtesy: TOI


The biggest threat to cotton farmers is the bollworm, because of its ability to cause extraordinary damage to crops and livelihoods. In the 1990s, pesticides were the only weapon farmers had against the bollworm. Half of all the pesticide consumption in India was accounted for by just one crop – cotton.

Tuesday, 1 March 2016

A ‘People’s Budget’ to Spur Inclusive Economic Growth


Budget 2016 can be described as a ‘people’s budget’ that is aimed at spurring inclusive economic growth through measures that will drive rural development, relieve agricultural stress and boost farmers’ welfare. The Budget however has missed out on outlining innovative policies to spur India’s manufacturing sector to drive growth at a time when the economic scenario appears challenging, both externally and internally.

Monday, 22 February 2016

Can healthcare costs in India come down further?

Courtesy - Google Images
When you can’t tax the rich, tax the less well-off. This is exactly what the Karnataka government did by notifying all hospitals to collect 8% luxury tax from every patient in an intensive care unit (ICU).

Friday, 5 February 2016

Pharma & Biotech Sector Must Get Its Due This Budget

Courtesy: The Hindu


Finance Minister Arun Jaitley has a challenging task at hand to present a Budget for FY17 that spurs India’s growth at a time when the economic scenario appears challenging, both externally and internally. The global economy is expected to slow down further in 2016 pulled down by weakness in major emerging economies like China, Brazil and Russia. These global trends as well as weak investment sentiments at home are likely to impact India's GDP for FY16 and growth prospects for FY17.

Mr Jaitley’s last two Budgets belied hopes of ‘Big Bang’ reforms. Instead, he opted a path of gradual reforms aimed at addressing both the corporate and social sectors. This time there are expectations that the Budget will provide more specifics on Prime Minister Modi’s ‘Make in India’ campaign. Given that biotechnology is one of the key sectors identified by the government as part of ‘Make in India,’ it is imperative that the upcoming Budget provides an enabling and facilitating framework for preparing the Indian biotech industry to meet its aspirational target of US$100 billion by 2025.