Even as Obamacare rings in ‘affordable healthcare’ as a buzzword worldwide, it has been doing the rounds in India for quite some time, with the Indian government having constituted a high level expert group to put together the plan for universal health coverage. Private sector efforts along with public private partnerships, entrepreneurs and NGOs have pushed the cause a notch further. However, there are lessons to be learnt, including going back to the drawing board, brainstorming ideas and coming up with unique solutions that address the equally challenging needs that a country such as India presents. It was with this in mind that the Omidyar Network and The Indus Entrepreneurs (TiE) organised the ‘Affordable Healthcare Summit’ in New Delhi that brought together various stakeholders from the industry, academia, entrepreneurs and Government to ponder, rethink, debate and share their opinions and learnings.
The Government’s role
Opening the session, Sanjeev Bhikchandani, Founder and Vice Chairman Naukri.com and President of the Delhi chapter of TiE, revealed that TiE no longer represents only IT entrepreneurs, healthcare is an emerging domain. He lauded Omidyar for its model of being a for profit and doing social good, a role traditionally left to non-profits. “My personal belief is to really build a scalable model, you have to be a for-profit, otherwise you are constantly seeking funds from outside,” he added. Jayant Sinha, Partner, Omidyar Network, then gave the audience a background of the networks activities and its inception. An initiative of eBay founder Pierre Omidyar, the network has invested $600 million in the last eight years since its inception across both for profits and not-for-profits out of which $100 million have been so far invested in India. He stressed on a sector-based approach and how it can be used to take healthcare to a completely new trajectory.
Following this, Arun Maira, Member, Planning Commission cited healthcare as a next big opportunity where innovation and new solutions could change the game altogether. Health is a fundamental right that even the poor should have access to and hence the need to find solutions specific to the needs of the country, is imperative, he stressed. Talking about the government’s role in healthcare, he added that innovations are needed on the process side to have efficient healthcare delivery mechanisms that ensure both healthcare providers and provisions being accessible, new medicines and devices on the product side and also newer ways of providing insurance to people. While advocating the role of regulations in the medical devices, Maira was optimistic about the sector, which has a huge potential for growth. He urged for ‘People Public Private’ solutions and models that bring together the government, industry and civil societies keeping the needs of the common man in mind. “So let’s work together to see what each of our roles is in devising the process of continuing to learn together, because we won’t get the innovation right the first time,” he concluded.
Representing the Medtech industry, Ajay Pitre, Managing Director, Sushrut Surgicals, stressed the need for the right regulations, citing them as fundamental for those in the industry. However, there needs to be prioritisation and then sensitisation to these along with an influx of investment and adequate technology, he added. “The industry needs to put in a huge input in terms of training and development which requires an all rounded approach from all stakeholders, some of whom currently undermine the relevance of the sector,” he opined. This in turn would help enhance medtech outcomes and directly benefit the end user. Talking about Department of Biotechnology’s innovative schemes, which although help develop IP, do not fund it, he praised DBT’s open-mindedness to suggestions to improve the same. Pitre outlined the role of the Indian medical device sector when he said, “Medtech is about contribution and not about profit.”
Nachiket Mor, Chairman of the Boards of Directors, Sughavazhvu Health Care, on an optimistic note for the role of the private sector, said, “Unlike other sectors, the government is a small player in healthcare and therein lies an opportunity for us.” He stressed the need to find out ways the Government can mobilise funds currently being utilised in secondary and tertiary centres, towards primary healthcare centres. This needs to be followed with evidence-based screening alongwith guidelines and protocols behind it, he added. Drawing from his experience at Sughavazhvu Health Care which is trying to make healthcare accessible to the rural poor in Tanjore, Tamil Nadu, Mor added that the Government should commission a group giving them a set of problems and then direct them to solutions. “There is a need for clarity for vision. For instance, what do we need to do at primary healthcare level, build capacity there to deal with emergencies then and there.” Even the Government-run Rashtriya Swasthya Bima Yojana (RSBY) scheme has its challenges, he said, facing them and learning from them is the road ahead. “If we do not address the disease burden it will show up sooner or later, thus also increasing the utilisation of resources at the ground level vis-a-vis the projected figures. Hence, the Government needs to give the vision and leave the execution to the private sector,” he concluded.
Rethinking access
This session had an interesting mix of panelists, sharing their experiences on how to make healthcare accessible to the populace. Zeena Johar, President, IKP Centre for Technologies in Public Health (ICTPH), the research arm behind Tamil Nadu-based Sughavazhvu Health Care expressed the excitement and challenges of starting the venture six years back. “Initially we started out thinking that if we systemise the supply side, we will be able to create a good business model. However, during the course of time, we learnt that demand side generation is even more important.” A systematic understanding of the community they operate in, its requirements and sustained efforts to make a difference in the lives of these people were some of the driving factors behind Sughavazhvu which has a user fee driven model till now.
Rajat Goyal, Co Founder, and CEO of EyeQ, a chain of eye care hospitals in Tier-II and III cities, echoed Johar’s thoughts restating that it takes initial years to breakdown the problem, understand it and then automate the process. He talked about the opportunities that lie for secondary models to be created in rural areas. Building the patients trust, understanding their needs while taking care of infrastructure, training and manpower were some of his learnings. The impact of the company can be gauged by the fact that 40 per cent of EyeQ’s patients come from households with income less than R`s 10,000 per annum and 30 per cent of the total surgeries performed are done for less than ` 5000. Sheena Chabbra Chief of the Health Systems Division, USAID, pointed out that the limited role donor agencies can play given that less than one per cent of the funding in healthcare comes from them. A total market approach then is the best way, she suggested.
Commenting on the role of NGOs, Alkesh Wadhwani, Deputy Director, Avahan, an initiative from the Bill and Melinda Gates Foundation, highlighted that scalability is a challenge for non-profits as they drive towards self-sustenance. Most of the large agencies in the field will continue to be foreign civil society NGOs. The panelists agreed on use of technology to increasing access. To this effect, android-based platforms, open source technologies and aggregation of such solutions and deploying them to the end user was suggested.
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Ruchi Dass, CEO, Healthcursor Consulting Group emphasised on funding more models centered around mHealth commending India for being the best adopter as per a PriceWaterhouseCoopers (PwC) report. Asif Saleh, Director-Strategy, Communications & Capacity Division, BRAC, an organisation in Bangladesh that started 50 years ago with a vision of providing ‘low tech, high touch’ care talked about using information, communication and technology to change people’s behaviour so that they are aware enough to protect themselves. Citing the fact that the country was able to increase its immunisation rate from two per cent to a current high of 85 per cent. He said that the process innovation is then the key. Talking about the challenge of relocating doctors to rural areas, Goyal from his experience suggested that providing amenities such as schools, residential facilities etc helps physicians to consider working in such areas.
Debunking a few myths on innovation Pitre of Sushrut Surgicals of set the tone by suggesting that the methodology for innovation needs to be repetitive and it needs to move from an art to a science. “We need to ask if a cost-effect relationship can be established. When this inadequacy is treated as a learning, only then can innovation be unearthed,” he added.
A patient-centric approach when designing a product was of consensus across the panel. Bhaskar Bhatt, Coordinator (Product Design), National Institute of Design, (NID) Ahmedabad put it in words when he said, “Design is about humanising technology.”
Nish Chashmawala, Co-Founder, MD and CEO, Consure Medical, a start up that focuses on fecal incontinence stressed how difficult it is to commercialise a simple product. Sudhakar Mairpadi, Director, Quality & Regulatory (Health Care Sector), Philips Electronics India noted that although the patent act does not support incremental innovation, Ministry of Health and the Department of Science and Technology are now realising the capability of the medical electronics industry through the new manufacturing policy. The lack of mentorship in the industry as a gap that needs to be addressed was also mulled upon.
Closing session
The concluding session saw Dr AK Shiva Kumar, Member, National Advisory Council, concerned with growing scepticism in the Government about the private sector, urging it to get its act right and become more transparent and accountable since it needs to join hands with the Government as per the Universal Health Care (UHC) plan. He emphasised the need for affordable care at primary, secondary and tertiary level that reaches the interiors of the country while also pointing out the demand for 5 million to 10 million health workers who need to be trained as paramedics and technicians to make this a reality.
“Lack of capacity in the Government to deal with training and certification requires healthcare professionals to take up the mantle,” he said. Payment through insurance and pre-payment thus reducing out of pocket expenditure at the point of service and integrating primary and secondary healthcare, were pointed out as the two pivotal points of a well performing healthsystem, by Mor. Stating that we can have affordable healthcare at $30 per capita, he stressed the need for greater Government funding and initiatives by the public sector in this regard.
Sinha of Omidyar added to the above saying that the market and the state need to work in harmony to ensure equitable distribution. Dr Kumar further elaborated that the emphasis is to provide universal primary care, and most of secondary care in order to reduce the expenditure of those who cannot afford it, so that tertiary care is only needed when required.” The Government is open to experimentation, innovation and piloting. The scope for public private partnerships is huge,” he enthused. The caveat is that there has to be genuine interest from the private sector, only then can they be given the task of contracting the services. The discussion then veered to the role of state vs the centre with health not being a priority subject in political circles and a tussle of funds between the state and the centre. While the centre lacks the political will and has the funds, the constitution mandates that health is a state subject. This coupled with state governments having a better understanding of their respective situations, the future would see more autonomy to the states. And hence what we need is more than just high end insurance schemes, we need a people’s movement that pushes for primary care, universal immunisation, lowering maternal births, thus demanding greater accountability from the healthcare system, concluded Dr Kumar.
The day-long event saw huge participation from close to 190 participants from the healthcare domain, including eminent panelists who helped delve into pressing issues that need to be addressed at the earliest to ensure that the millions of people at the base of the pyramid get the benefits that are overdue. While answers to all questions cannot be readily found, the day saw some tough questions being asked and equally tough answers given. Although we are still far away from the reality of affordable healthcare, such dialogue is a beginning in the right direction.
