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Healthcare: Challenge and promise

At the 12th annual convocation of the International Institute of Information Technology, Hyderabad, on October 26 2013, Guest of Honour, Sangita Reddy, Executive Director (Operations), Apollo Hospitals Group, addressed the challenges of delivering healthcare to India's billion plus population -- and how technology helps.

We bring you extracts from her convocation address.

Dr. Prathap Chandra Reddy, the man who founded India’s first corporate hospital took a decision four decades ago and transformed India and the way in which healthcare is delivered in this country. It was deep discontent with the healthcare scenario in India that inspired him to accelerate positive change. Management Gurus have repeatedly said that discontent isn't a negative emotion and that it can be a powerful catalyst for positive change. Discontent can be used to question status quo, accelerate change, experiment with new opportunities and find solutions for social good. To illustrate this aspect, I would draw upon the recent history of my industry. In the seventies, Indian healthcare was characterized by a huge infrastructure gap. At that time, there was an almost complete dominance of public healthcare in the medical landscape of India, and this fell woefully short of the country’s healthcare needs.

Access to healthcare was a huge challenge and the nation was chained by two seemingly insurmountable bottlenecks – the problem of geographical access and the problem of financial access. Funding too was an unheard of concept. Banks did not even recognize a hospital as an entity that could be funded. Then there was the problem of quality of healthcare. The concept of clinical excellence was far from popular and the common understanding was that if you wanted quality healthcare, you would most likely have to make a trip overseas.

 

Research was a largely ignored area, as there was simply no time or resource to dedicate to research. Manpower was under par – both in terms of absolute numbers as well as in expertise. Finally, when so much of effort was in being reactive and trying to play catch, the long term was often sacrificed for the short term. The long term benefits of managing the demand of healthcare, through preventive healthcare, comprehensive immunization were greatly ignored. Ever since the birth of the corporate healthcare sector, it has been three transformational decades and each has brought with it, its own share of cherished memories and catalyzed innovations across the country. It is said that innovation is the hallmark of entrepreneurship. Over the years thousands of compassionate entrepreneurs have come aboard to address the healthcare challenges of India and are participating in making India a truly inclusive nation. An innovation to bridge financial access, the rupee a day health insurance that witnessed its beginnings in Aragonda has grown to take shape as the unparalleled community health insurance schemes prevalent in India. An example would be the national Rashtriya Swasthiya BhimaYojana which provides protection to Below Poverty Line households from financial liabilities arising out of medical illnesses that involve hospitalization. RSBY has issued over 30 million smart cards and has taken care of over 60 lac cases involving hospitalization.

 

The miracle of telemedicine is bridging the rural-urban divide in terms of medical facilities, extending low-cost consultation and diagnostic facilities to the remotest of areas via high-speed internet and telecommunication. Major hospitals like AIIMS, Narayana Hrudayalaya, Mohan Diabetes, Shankar Netrayalaya, Apollo Hospitals and many others have adopted telemedicine services and are using it to take medical care and education not just across India but even to the underserved African continent and other nations. India is today the largest provider of telemedicine in the world. Encouraged by the Indian Government’s progressive tax policies, super specialty hospital groups are setting up state of the art hospitals and healthcare services in tier-II and tier-III cities, Increasingly technology is transforming healthcare. It sounds like science fiction, but today, a doctor can see his patient’s progress on his iPad and a family can see their loved one inside the ICU over the internet. In the past, even a simple gall bladder surgery meant several days of hospitalization. Today, minimally invasive surgeries have made the concept of day surgeries a reality and a person does not need to get admitted or spend even a single night at the medical centre. Electronic medical records make an individual’s medical details available to a physician anywhere in the world while ensuring total privacy and confidentiality. Today the Indian healthcare industry, which comprises hospitals, medical infrastructure, medical devices, clinical trials, outsourcing, telemedicine, health insurance and medical equipment, is expected to reach US$ 160 billion by 2017 and employ over 10 lac people.

Undoubtedly, a lot has been done, but a lot more is needed.

Not just India but the world at large today is facing unprecedented healthcare challenges. Billions lack access to healthcare systems. While communicable and infectious diseases still remain a challenge, 36 million deaths each year are caused by non-communicable diseases and amount to almost two-thirds of all deaths worldwide. Over 7.5 million children die from malnutrition and preventable diseases every year. Diseases kill more people each year than all conflicts and natural or man-made catastrophes put together. The health issues facing India are equally pandemic. India is now well over a billion people in population, with vital health challenges that need to be addressed. This will entail a significant increase in access, awareness and affordability of healthcare for our large population. Addressing these challenges at scale will require break-through innovation across healthcare provisioning, financing and in the enabling environment, involve participation from multiple constituencies in the private and public sectors.

I am of the firm view that India should develop the definitive way forward with an action plan to impact the future of healthcare. The solutions that we develop could not only favorably impact health in India, but also serve as a unique model for addressing health challenges globally; i.e. the notion of reverse innovation in healthcare out of India. Do bear in mind that the impact of innovation goes well beyond an individual organization. It impacts the community and helps the company in providing a strong shoulder to the nation. My first lesson in management from my mentor was that the challenges of the nation belong to business leaders just as much as they do to the administrators.

Each one you here today is a business leader or one in the making and therefore the nation’s challenges should be your challenges. And they are many - be it the dichotomies that plague rural India, the social angst in urban India or the healthcare challenges of the country. Each is a mountain to climb, each has repercussions, and each will demand your unwavering focus. I would also add that my focus on health and healthcare not just because I work in the sector, but more because the subject of health is unique. Health is a responsibility that rests on both the individual and the collective. Each one of us needs to make an effort to stay well and also encourage all in our own family at home and at work to embrace a culture of wellness and wellbeing.An acute need is to inculcate an attitude of staying healthy amongst one’s own team and peers. Most in corporate India have mandated pre-employment medical checks and that is a good start. But a pity is that this focus fizzles away soon after, in most organizations. You would be dismayed that according to a large-scale government study released earlier in the month, 20% of India’s population in the metros and above the age of 30 years of age suffer from the deadly duo of diabetes and high blood pressure. Over 40 million people from across the country screened under the Government's National Programme for Prevention and Control of Cancer, Diabetes, Cardio-vascular Diseases and Stroke and it has revealed that 6.34 per cent of the population is suspected to be suffering from diabetes and over 6 per cent are hypertensive.

Furthermore, a recent study by the World Economic Forum had concluded that between 2013 and 2030, the cumulative cost of healthcare and loss in economic productivity due to illness, largely attributable to cardiovascular diseases, cancers, chronic pulmonary diseases and diabetes would be about US$ 30 trillion. And quite a significant portion of that would be because of India. Quite often, we are unaware that health costs so much. India's health care system has traditionally targeted short-term acute health problems rather than focus on curbing the root causes such as lifestyle risks factors. In a way of giving back to the community and as societal responsibility, business managers need to participate in addressing the causes of illness. Your business acumen in optimizing limited resources would be valuable in this march. A nation is defined by its people and it’s distressing that India has the lowest health indicators amongst BRIC nations. Due to an acute shortage of hospital beds, India has the lowest rates of institutional delivery. To reach the world average of 2.6 hospital beds per 1000 population, India would need another 1.7 million beds. This situation is further compounded by a huge shortfall of health human resources. India needs double the number of doctors, triple the nurse and quadruple the number paramedics to meet the World Health organization’s mandate of population to medical personnel recommendations.

We need to bear in mind that a healthy India is a prosperous India, a powerful India. There is conclusive evidence from the world over that firmly establishes that improved health leads to better economic performance and prosperity. Sadly, till date, it has never really been understood or accepted that health impacts the economy positively or negatively even by policy makers. The economic future of India is in the hands of its citizens, and its time India realizes that an unhealthy population would just not have the ability or wherewithal to up the momentum. For a nation with 40 percent population at the median age of 25 -30 years, health has to be our priority to maximize productivity.

As corporate India, just as we focus on bottom lines and top lines, we should also keep an eye on waistlines. As I had said earlier, health is a collective responsibility and therefore as business managers of the future, as responsible citizens you too should need to raise your voice in encouraging the Indian government to increase government expenditure on healthcare, provide transparency of public health schemes and do away with taxation on aspects that could discourage one from staying healthy. The healthcare sector has been vociferous in its demand for a Budget announcement that would reform the healthcare agenda of the nation. This demand has not been just for the sector’s benefit, but more for the country as the lack of an environment fostering the growth of healthcare underlines a lassitude to building an inclusive nation.

In March 2013, I was heartened when I heard the Union Budget announcements which said that by the end of the 12th five-year plan, India would allocate 2.5 percent of the GDP on public health services. To provide greater perspective on allocations, at an average OECD countries devote 9.6% of their GDP to health spending. The United States spends 16 – 18% of GDP on health. Netherlands and France typically allocate about 12.0% and at a lower level, nations like Korea and Mexico allocate 3.1 to 4% of GDP on this vital priority.

India needs to invest in education and skill development as that alone can address the bane of unemployment and nurture innovation in the long term. With the right impetus, healthcare could well be the employment engine for India. There are bright minds sitting in this room today. And while Indian healthcare would have loved each of you talented people to be lobbying for its betterment and advancement, I do know that many of would you have other plans for your careers.

However whatever your plans in life are and wherever they take you I have two small requests for you on a very personal level. Both are entirely in your hands.

The first is to staying healthy. The day you cannot touch your toes is the day you are breaking the promise you made to me today.

The second is being open- minded. In the organizations that you join and build, focus on nurturing a culture of innovation. Remember that an organization’s culture can drive strategy or sadly even drag strategy.

I would conclude my address today by narrating an extract of William Ernest Henley’s famous poem Invictus. 

"Out of the night that covers me,
Black as the pit from pole to pole,
I thank whatever gods may be
For my unconquerable soul

....
It matters not how strait the gate,
How charged with punishments the scroll,
I am the master of my fate:
I am the captain of my soul."


Nelson Mandela, the anti-apartheid global icon had famously proclaimed that it was this very poem which was his constant source of inspiration when he was imprisoned for 27 years. When he was freed from prison and assumed the Presidency of South Africa he used the same poem to address the unrest in the rainbow nation, and sow the seeds of unity. Today racial discrimination is becoming a thing of the past in contemporary society and nothing is more emblematic of the fact that we have turned a full circle as we have seen Barak Obama stride his way into the White House, on two consecutive terms!

To me personally, Invictus has always resonated with one powerful message –‘the tomorrow we live, is the tomorrow we build with our hands, today!’ 




    


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