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Learning from India’s Healthcare System

  Jun 14, 2018

By: Dr. Mercy Wanjala,
MBA, Healthcare Management – Student.

What is the first thing that comes to mind when you catch wind of the words “Indian healthcare system?” Do visions of horrendously crowded and dilapidated hospitals, with patients carpeting the corridor floors flash through your mind? Well, I am sorry to disappoint, that is not the whole story. Before we embarked on the study tour, we all wondered, why India? Now we know. I would need pages on end to write about this, so here is a snippet.

First impressions are lasting impressions

Well, this is true of our host Chitkara University Business School in Punjab State. They gave us a near presidential welcome (everyone who is someone literally rolled out the red carpet, including the vice chancellor and co-founder Dr. Madhu Chitkara) followed by overwhelming presentations and discussions around the Indian Healthcare system. The students, to give us a taste of the Indian culture, treated us to sumptuous Indian cuisine, Indian dance and an Indian fashion show. To crown it all we got a front row seat on the amazing innovative health solutions. Just but to mention a few;

  • The PICU; portable ICU cable of patient monitoring and can be remotely controlled by a doctor to deliver emergency drugs, although this is work in progress.
  • EPancrease – a device invented to reduce the trauma that comes from daily insulin injections. It uses radiofrequency to measure insulin levels subcutaneously discharge the required insulin dose.
  • Health cube system- a portable device that can perform up to 24 diagnostic laboratory tests.

Saving the best for last, the university has a place they call “the incubator” a building where great ideas are transformed into life-changing innovations and businesses. When we walked in, we felt like we had walked into a Google office space! Every year, a consortium of business leaders and university management have a sit down to pick the most viable ideas presented by the students. The ideas picked receive funding and get a workspace at the incubator. The student then works on the idea and develop it into a business.

Why is health care cost in India so low?

Many theories have been postulated as to why healthcare in India is so affordable including questionable quality. However, the answer is simpler than you might think, three words actually; economies of scale. India has a population of approximately 1.47 billion set to grow to 1.6 billion in the next few years. This translates to an enormous healthcare market. There are large super specialty hospitals providing care to millions of patients meaning a small fee charged to each of them translates to huge revenues.
Secondly, India has a robust pharmaceutical sector with dozens of manufacturing plants producing generic drugs for local use and for export.

Lastly, the cost of setting up a health facility is high, particularly the cost of land. This is where the state comes in by offering hospitals like Fortis free land in return for services offered to the below poverty line (BPL) citizens. This way, private entities do not have to set the cost of service high to enable them to break even, contributing to affordable health care services.

Who pays for the poor?

With an insurance penetration of only 30% and high out of pocket expenditure, how do the poor afford health care? The Indian government has developed a way of ensuring everyone, especially the poor have access to quality healthcare. Village Development Officers (VDO) identify the poor based on certain set indicators. Those categorized as BPL- have unique identity cards that they present to healthcare facilities to gain access to free services.

Partnerships that work

Chitkara University Nursing School has a partnership with Fortis hospital to provide them with skilled workforce while Fortis provides a venue for clinical training and experience. The nursing students are hired by Fortis after completion of their training. The Indian government offered free land for the development of Fortis Hospital in return for free medical care for citizens in the BPL category.

Quality is everybody’s business

Dr. Reddy’s lab is a pharmaceutical manufacturing plant in a third world country but offers first world healthcare quality. We visited their Formulations and technical operations (FTO) manufacturing plant in Baddi. The $70 million investment sits on carefully manicured lawns and pathways designed to enhance safety and movement around the plant. If there was ever a place to witness lean operations in action, this was it. The management has employed Kaizen and Lean six sigma operations to ensure efficiency and produce high-quality products. Most processes have been automated including the use of robots where human input is not required.

Even more impressive is the board at the entrance with an employee contract, signed by all employees that reads, “I pledge to give my time, talent and energy to create enduring positive change in the community that I live and work in.” Talk of inspiring, loyalty and commitment. At that moment, when I saw this on my way out, I realized that it is not the employment of all these practices that maintained high standards of safety and quality but the underlying mindset. It is a culture that supports enduring practices and a mindset that enables them.

Innovation distinguishes between leaders and followers

Post Graduate Institute of Medical Education and Research (PGIMER) hospital Chandigarh is the second largest tertiary care institute in North India. The medical superintendent, Dr. Gupta has been managing the hospital for 23 years. If you thought our outpatient departments in government-owned hospitals are crowded, think again. Imagine an outpatient department with almost 300 patients waiting to be seen. What was most impressive was the fact that all of them had been categorized according to set international emergency code standards.

To Dr. Gupta and his team, every challenge is a chance to innovate and I believe this attitude is what has set this government-owned health facility apart. What caught my attention was the use of tele-evidence. Realizing the number of a person to hours and resources lost in doctors having to appear physically for court summons only to give evidence, the hospital decided to come up with this innovative solution. Doctors would give evidence to the court via live video conferencing. This move necessitated an amendment of the national evidence act after the state was convinced it would save INR 38,708 and 3722 persons per year.

Beauty from ashes

Chandigarh means the beautiful city. Therefore, I cannot sign off without mentioning the Rock Garden Chandigarh. This beautiful piece of art is made of pure waste! The magnificent maze filled with sculptures, waterfalls and wall paintings, is also known as Nek Chand’s Rock Garden after its founder Nek Chand a government official who started collecting waste materials from demolition sites; recycling them and using them to build a maze. Wondering what to do with the waste menace in Nairobi? Here is a solution!

About the MBA – Healthcare Management Programme International Module

The Master in Business Administration-Healthcare Management Programme offers an intensive one-week international module. This year, the students were hosted at Chitkara University, with visits to Fortis Hospital, Punjab Government Health Department, Dr. Reddys Lab, ALKEM Lab and Equipment Manufacturing Company. The module delivered by renowned Health care experts and Business Leaders in the healthcare sector gives a rich blend between the involvement of academia and industry players. Through the learnings from top healthcare facilities in India from both Privately and Government owned Health facilities, participants can effectively put the knowledge gained into practice.

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