Does India Need an EMR?

17. February 2013 · 2 comments · Categories: HealthCare, HealthCare in India, Strategy · Tags: ,

When we look at understanding how we can address the major gaps in providing Quality HealthCare, the one point which comes to mind is why we are not utilizing the power of Technology to bridge this gap.

Let me start with a story – Few years ago, I had to take my Dad to a Doctor for cough. We went to a Speciality Hospital near to a home (a Major Brand, do not want to use the name here though). This hospital had two facilities in the City. When we went there, the first thing which happened in the Registration. A Plastic Card (dimensions of a Credit Card) was printed with a picture and basic details – DOB, MRN and Place of Issue were printed.

After the initial check up, the Doctor wanted a test to be done which was not available in this facility and hence we were requested to go to the other one. After going there, I provided the card to bring out the details of the test ordered. The front office person informed me that they do not have connectivity with the other Branch and hence I had to pay the registration fees (Rs.100) and post that, looking at the Hard Copy of the Prescription, entered the details. Then I had to go to another Doctor (since the consolidated list of Doctors in the Hospital is not available and the prescription had to be cross checked) to re-confirm the test and then we proceeded for the test.

This hospital has made major investments in using Technology in their Hospitals. Staff are trained and the charges of this Hospital is also definitely not nominal.

What does this story illustrate? A simple aspect of integrating two facilities has not been taken seriously. Why? Is it because they lack the technological infrastructure? Or, is it because they can make more money (Double registration fees)? Or, is it unwillingness to invest further on the technology required to integrate? There are many questions which arise, however, for me, it is just the fact of lack of “Ownership” from the management side.

In a country like India where the demographics play an important role, there are many multi-national Hospital Chain’s and single facilities which have setup shop across the country over the last decade and continue to do so with huge investments coming up in the next decade.

The Government, with due respects has its own, things to do and hence am not even considering the fact that they should take ownership to force Hospitals to implement any automation to their care facilities.

With the vastness of the Country dynamics and considering the fact that the system works in a silo, is it easy to consider implementing basic EMR across all Hospitals and Clinics across the country? I do not think so.

Even though technology has become affordable, the socio-economic factors like affordability of Care facilities with-in a 10 KM radius across the country makes it difficult to even imagine implementing EMR across the country.

Continued – Part 2

Indian HealthCare Education – How is it distributed?

07. October 2012 · 2 comments · Categories: HealthCare, HealthCare in India · Tags: , , ,

India ranks 112 in the World Health Organisation (WHO) Ranking of The World’s Health Systems. When it comes to per-capita spending on Health Care, India spends a little over 6% of GDP on HealthCare.

These are the common statistics which we see every day. What I wish to share are the other aspects of Indian HealthCare system which provide a strong support.

Imagine this, India is the World’s Second Largest Populated country and it is projected that we will overtake China by 2050 and the reality of data according to WHO is that India has about 0.49 Doctors and 0.80 Beds for every 1,000 Population in the country. When you hear/see these numbers, it does sound alarming! How are we going to put up with the Population Growth, provide basic HealthCare and create an Ecosystem for building robust Health Services across the country?

If the situation is bad when compared to other developed economies, then how is our Average Life Expectancy has been steadily increasing over the years? In 1947, when India got Independent, Life Expectancy was 47 Years and today, after 65 Years of Independence, we are at 65 Years. By 2025, it is projected that Life Expectancy would be 72 Years.

All the Health data which we see is primarily considering the English Medicine System or Allopathy. India and also other countries offer alternatives to the English Medicine. What we will look into here is how the HealthCare is structured and Health Education along with fundamental understanding on how Government spends its 6% on HealthCare along with what reaches the population living Below the Poverty Line (BPL).

HealthCare Systems in India

India has the most number of HealthCare systems when compared to any country in the world. Below are the five most known systems.

  • Allopathy (English Medicine)
  • Homeopathy
  • Ayurveda (Traditional Indian)
  • Unani
  • Naturopathy & Herbal Medicine

Formal Education for Doctors

India offers education in Allopathy, Homeopathy, Ayurveda, Unani and Naturopathy & Herbal Medicine. All education is recognised and Doctors who pass out of colleges are given license to practice any where in the country.

The below graph shows the admission trend to Graduate Allopathic Medicine Course over the last 20 Years. If we carefully observe, there has been a decline in admissions in the last two years when compared to earlier. Interesting.

MBBS Admissions

 

The Dental Education has quite picked up in the mean time. However, it is a poor state where the enrolments to Post Graduate Programs has been less than 10% of the actual Graduates. There are certain strong reasons as to why this happens and we will look at it later.

BDS/MDS Admissions 1991 – 2011

 

Now, let us have a look at how the Medical Education System is structured in India.

Medical College Distributions

 

Allopathy accounts to only 39%, which is around 314 Medical Colleges. in the remaining 71%, Ayurveda has 31% (249 Colleges), Homeopathy has 23% (186 Colleges) and Unani has 39 Colleges, Siddha has 8 Colleges and Naturopathy has 10 Colleges.

 

 

List of Incubation Center’s in India 2012

16. September 2012 · Write a comment · Categories: Entrepreneurship, Incubation, Startup

In 2007, I posted a list of Incubation Center’s in India. However, in the last 5 Years, things have changed and there more and more center’s being added to the list. Below is an updated list and am sure am missing quite a few. If you know any center I am missing, please feel free to add as a comment and I will update the list.

NS Raghavan Center for Entrepreneurship and Learning (NSRCEL), IIM Bangalore
Technology Business Incubator BITS Pilan
Center for Innovation, Incubation and Entrepreneurship IIM Ahmedabad
Entrepreneurship Cell IIT Kharagpur
Center for Entrepreneurship SP Jain, Mumbai
C-TIDES IIT Chennai
TeNeT IIT Chennai
Society for Innovation & Entrepreneurship IIT Mumbai
Nirma LabsSIDBI Innovation & Entrepreneurship Center IIT Kanpur
Entrepreneurship Development Center IIT Guwahati
Foundation for Technology and Innovation Transfer (FITT) IIT Delhi
Abhiyan IIM Lucknow
E-Cell IIM Kozikode
Center for Innovation & Entrepreneurship IIM Kolkata
Entrepreneurship Development Institute Ahmedabad
ICFAI Center for Entrepreneurship Development Hyderabad
MICA Entrepreneurship Development Center Ahmedabad
Wadhwani Center for Entrepreneurship Development ISB Hyderabad
TIME-IS DST, Government of India
JSS Academy Science & Technology Entrepreneur Park Noida
National Institute of Industrial Engineering Mumbai
Entrepreneurship Center IIT Rorkee
Ekta Incubation Center West Bengal University of Technology
E-Cell NIT Trichy
VIT Technology Incubator Vellore
Technopark Technology Business Incubator (T-TBI) Trivandrum
Center for Bio-Technology Anna University Chennai
National Design Business Incubator Ahmedabad
NIT Calicut
International Crops Research Institute for Semi-Arid Tropics Hyderabad
Kongu Engineering College NEN e-Cell Erode
Advanced Materials Technology Incubator Hyderabad
Center for Entrepreneurship SPJMIR Mumbai
North Eastern Development Finance Corporation Guwahati
NSIC Technical Services CenterBirla Institute of Technology Mesra
NIT Suratkal
STEP, BEC Bagalkot
Maulana Azad NIT Bhopal
Science and Technology Park, University of Pune
Science and Technology Entrepreneurs Park Ludhiana
STEP – Thapar Institute of Engineering & Technology Patiala
STEP – PSG College of Engineering
IncuCapital TechnoPark Trivandrum
ICICI Knowledge Park Incubation Center Hyderabad
Gujarat GrassRoots Innocations Augmentation Network Ahmedabad
CIE IIIT Hyderabad
L-Pad

 

Issues with HealthCare IT in India

07. May 2012 · 1 comment · Categories: HealthCare, HealthCare in India · Tags: , ,

Over the last few years, have been fortunate enough to be working with the HealthCare sector in India.

In the due course of time, I have been interacting with IT Departments of various Hospitals (Very Large and Large and to some extent at the Primary Health level too). What I have been trying to understand is the key reasons as to why the IT penetration has been at a distant in the Indian Hospitals. There are quite a few valid reasons and I also encountered one other not-too valid reason, but will have to give it a benefit of doubt.

Time factor – One of the key factor why Hospitals see resistance from Doctors to use IT systems is because of the number of clients (patients) they need to see. On an average, a Doctor in any Hospital in India see’s an average of one client every two minutes (the raw data might be even more). In these two minutes, the Doctor has to understand his client problem, establish a connection (Important in the Indian Context), provide guidelines for the analysis and prescribe. The complete process takes definitely more than two minutes, and if the Doctor tries to spend time on the computer taking notes, his/her client might not appreciate it and not return back to them. People in Cities understand the importance of technology, however, in India, as 80% of the population still lives outside Cities, it might not be practical for the Doctor/Hospital to make them understand the same.

Cost – The second most important reason which needs serious consideration. 70% of HealthCare costs are “out of pocket”. Hence, when Hospitals/Doctor’s Clinic implement the use of technology, client tends to understand that cost of treatment is “higher” and hence avoid’s those kind of Hospitals/Doctors.

There is no support for Hospitals/Doctor’s to use Technology from the Government. Hence, the cost has to be shared by the client, which directly impacts their revenue.

Technology Education – There are no initiatives by the Government to spread awareness of the benefits of using Technology to end users. Even though there might not be immediate acceptance for this, on the long run, people would definitely see the benefit.

As an illustration, Government of India spend considerable time and money on the “Eradicate Polio” initiative and this has been a success. Even though initially the message was not taken seriously, now when a child is born even in the remotest place of the Country, parents immediately inquire of the Polio Drops schedule and ensure that their child gets them. The results speak for themselves – Today, India is “Polio Free”.

Variety of HealthCare Practices – India is a very large country and has variety of HealthCare Practices – Homeopathy, Allopathy, Unani etc. People change their practice depending on the kind of ailment. I have also seen and known people who follow a certain practice sticking to the treatment in serious conditions too, but very rare.

This does not have a direct impact on the HealthCare System/Process, however, this plays a vital role when people shift their accustomed practice.

More detailed information on various practices and Infrastructure in my earlier post.

Acceptance by all Stakeholders – Even though every Individual accepts that IT is an integral part of delivering Quality HealthCare, acceptance by all stakeholders also plays a very vital role in rolling out technology solutions.

As an Illustration, Government employees need to submit manual receipts and documentation for their medical reimbursement. Also, many Insurance providers do not completely follow the approval and reimbursement process online.

In summary, a Hospital/Doctor’s office is not encouraged in all aspects to implement Technology. There are many a times when they need manual documentation. To avoid multiple process flows, Hospitals keep their Technology inquisitiveness away.

However, things are changing. With a recent success story of how the Andhra Pradesh Government implemented Aarogyasri, many states have been trying to follow the same.

There are quite a few other concerns and problems for Hospitals to implement IT, however, if we have a humble beginning, success will definitely follow.

Startup Weekend

18. August 2011 · 1 comment · Categories: Startup · Tags: ,

I got associated with Startup Weekend recently and have been thoroughly enjoying my association with them. Am working with the team who is bringing the Hyderabad edition and wanted to share all the information regarding the event here.

————

Entrepreneurship, technology and innovation have never been as important in our world as they are today. With that, entrepreneurs and innovators across India need all the help they can get through mentors and meeting the right investors.

At Startup Weekend (www.StartupWeekend.org) we bring together aspiring entrepreneurs and provide a platform to give shape to their ideas.

Startup Weekend (www.StartupWeekend.org) is founded by Andrew Hyde in 2007 and funded by Kauffman Foundation. You can read more about us at http://startupweekend.org/about/our-story/

What happens at SW?

More than 100 aspiring minds come together to identify ideas to give shape. All 100 can share their ideas or they can be part of another idea. Ideas are shortlisted, teams are formed and over the next 48 Hours, the idea takes shape. We have Investors, Idea Evaluators, and Mentors available to guide teams through the process. On the last day, ideas are presented and the shortlisted ideas take away cool prizes.

Startup Weekend in India

Startup Weekend came to India in 2011. The first two events were organized in Delhi (March 4-6, 2011, http://delhi.startupweekend.org) and Bangalore (March 11-13, 2011, http://bangalore.startupweekend.org).

During Delhi Startup Weekend, 34 Ideas were Pitched, 10 Teams formed; 8 Partners, 5 Mentors.
During Bangalore Startup Weekend, 67 Ideas were Pitched, 15 Teams formed; 7 Partners, 4 Mentors, 20% of teams won prizes.
Now, we are bringing Startup Weekend to Hyderabad from 2-4 September 2011.

To know more about the event, visit http://bangalore.startupweekend.org. You may also join our announcement only mailing list at https://groups.google.com/forum/?hl=en#!forum/startupweekendind, which will keep you posted on the event and other details.

Choosing to Cruze

01. July 2011 · 8 comments · Categories: Cruze · Tags:

Having read the title of this post, am sure you know by now what I am going to rave about. But, before that, wanted to dedicate a paragraph for my earlier beast and king of India Road, the Mahindra Scorpio.

What do I say? In one line, there is nothing to beat a Scorpio  for the price range and for the comfort even today and I am also sure that there will be no competition in the near future too. Mahindra struck the right chords when designing that car. When I was buying it, friends and family said that it is too big a car to drive in Bangalore, but I did not give in. Went ahead and today, I have no regrets of having bought it. I thoroughly enjoyed every moment of the last five years. As I was closing in to 80,000 KM, the only thing I was not enjoying is that the Clutch was getting heavy (or rather the traffic is increasing). Read all about my drives and maintenance schedule on my blog (Scorpio Maintenance,Scorpio Drives)

I wanted to move  to a car as there are no SUV’s in the price range I was looking :( Started my research in January 2011 and it took me five months to close in to Cruze.

Available Options
Not many, but just three – VW Jetta, Honda Civic, Skoda Laura and Chevrolet Cruze.

Check out the video comparison between the three cars from AutoCar.

VW Jetta – Apologies, but a straight NO. They do not have an automatic variant in Indian market and does not even come with 50% of the features what its competitors have to offer.

Skoda Laura was always out of my lists as I personally believe that it’s prized high above it’s true value. Also, the reviews I have been reading of the after sales service kept me away. Adding to these, the maintenance costs are High too. Also, Automatic transmission is close to 20 Lakhs, which is way above my budget. Also, the true comparison is with the L&K 2.0 TDI AT which is way beyond in the price for me.

Honda Civic was in my mind. Like many other reviewer’s, I was also skeptical about the ground clearance. Let me share my experience. One day, in December 2010, I went to Magnum Honda at Mekhri Circle and was speaking to their sales person, Mr. Santhosh, a wonderful sales person. When I talked to him about the ground clearance, he said only one thing, “I will give you the complete list of Civic owners in Bangalore and Bellary (a mining area in Karnataka where the roads are very bad and this I heard and I have never been there), you randomly pick any 10 numbers, call them and ask them if they have spent any money on the car maintenance because of the low ground clearance and even if two out of the ten you choose say yes, then I will get you the car at an unbelievable price for you” are the exact words he told me. I was really impressed with his challenge. Also, if there are people spending around 15-17 Lakhs on the car and if this was a real big problem, there would not have been any sales for the car was my thought. Also, he bough the car and took me for a long drive and made me drive in places where there is no road and also ensure that i went on all the speed breakers. I did hit the bottom of the car when was crossing few speed breakers, but it was only scratching my heart and not the car :) I was very impressed with the confidence of Mr. Santhosh. My parents liked the car and especially, my mom was very impressed because it had a very large rare door which was making it very convenient for her to get in and out. My mom loved the silver colour and her pick was the Civic with Silver colour.

Chevrolet Cruze – I test drove this car way back in November 2010 and was very impressed in the first ride. My heart went to it, but somehow could not relate an American Car with a Diesel engine; Didn’t know the history of Cruze by then and now, I know. So, accepted :)

Comparing the Overview, Specification, Features, Other Features of all the Four Cars.

What I was looking for?
In the order of priority:
1. Sturdiness
2. Power
3. Safety
4. Ability to do long drives without tiring me :)
5. Value for my sweat and blood

Before I go into details of each of my requirements, let me share my shortlists – Honda Civic and Chevrolet Cruze.

Sturdiness
What is Sturdiness and why have I rated this on the top?
sturdiness is the state of being vigorous and robust or the property of something that is strongly built or resoluteness evidence by strength of character.

  • Civic fails to impress me on this. It is delicate (looks delicate though).
  • Cruze looks like a leopard sitting on the ground with all four legs stretched (Not comparing to BMW et all)

Body Structure (Civic Vs Cruze)
  • Read the Civic Skeleton/Body structure details here. Honda introduces the Advance Compatibility Engineering (ACE) body structure with the Civic.
  • Read the Cruze Skeleton/Body Structure details here.

I am sure you got the synopses of both the structures, both are well engineered and crafted to be sturdy. With my limited knowledge of detailed design of the structure, I rate Cruze 1 point more than the Civic in this category.
Power

One of the most important factors for me. I got used to a bit powerful car and wanted my next one to be a bit more powerful, not just in the books, but in actual performance too. (Scorpio comes with a 122 PS @4000 RPM Power, but the wheel base and Torque of 290Nm @1800 RPM gives you the feeling of power).

Civic promises a 132 BHP powered petrol engine but losses it’s edge in the torque with 172Nm@4300 rpm.
Cruze comes with a 150 BHP 2.0 Ltr VCDi engine with a displacement of 1999 CC and 327Nm@2600 rpm. However if you test drive both, you will clearly see the difference in the initial pick up itself.
This was the killer. By now, I have almost decided on Cruze :)

Safety
Two categories to note – Passenger Safety and Pedestrian Safety (Because, it is common in India for people to cross the street suddenly, not because they want to, but because there is no other option).
Passenger Safety

  • Both Cars come with Driver and Passenger Air Bags. Outside India, Cruze also comes with Air Bags for the rare passengers and also the top. Unfortunately, they do not have this in India :(
Pedestrian Safety
  • In Civic, to help reduce pedestrian injuries in the event of a collision, the hood and fender areas are designed to deform if contacted by an adult or child pedestrian. Energy-absorbing collapsible hood supports, wiper arm pivots and fender mounts are designed to allow substantial deformation in an impact.
  • In Cruze, the protection design to the hood and relating hinge structure reduces the chance of pedestrians striking the engine block.

I am not going into the finer details, both cars come with ABS. However, Cruze comes only with ABS and Frond and Rare Disk Breaks, where as the Civic comes with ABS, EBD and BA along with Front Ventilated Disc Breaks and Disc Breaks for the Rare.

What is ABS and EBD? Read the definition here
.

Ability to do long drives, without tiring me :)
I love driving and my drives relax me. With the Santro (2003 May – 2006 May) and Scorpio (June 2006 – May 2011), I totally clogged 1,32,000 KM (55,000 KM in Santro and 77,000 KM in Scorpio), averaging about 1,375 KM per month.

Naturally, my next car should be something with should take me further and relax and provide more pleasure. Considering the Psychological aspects of the low ground clearance and not providing enough power to substitute, Cruze won more points.

Value for my sweat and blood…
This is quite natural for everyone :) and I am no exception. I earn my money and naturally, it should not go waste. For me, Car is an Investment (I am sure for any Man, it is), but a little more for me.
Somehow, my heart was not 100% ready with the investment on Civic, but definitely 101% for the Cruze.

Identifying the Dealer
I initially went to Sundaram Motors on Kasturba Road, Bangalore. The sales person was decent. He asked me when I was planning for the car and I said immediate. I told him that I would come back in 2-3 days with the documents required. I was back to research on the dealership and did find few issues with the dealership, sales and service. I live in North Bangalore and was seeing if there was any dealership in this part of the town so that the service center is nearby. I figured out that there was Trident Chevrolet dealership in Kalyan Nagar and called them. Went there on a Sunday morning and Mr. Arun greeted me. I was comfortable with Trident because I bought Santro also with Trident.

Experience with Dealership and the Sales Person
Mr. Arun is a very calm and sober Sales person. He has been with Trident for over 8 Years and ensures that the customer is happy with their selection :) I bugged him to the core with my questions. I used to call him once in a week (I waited for 4 weeks for the Cruze) for a test drive and he patiently used to come and give me a ride…

Call Arun on 97437 86901 if you are looking for a Cruze and you will not regret it. I am in no way marketing for them, but just sharing my experience with Trident and Arun.
Customization

If you ask me, no customization required.

Music System – The music system in Cruze is not a very good one. It is decent one. I am still researching on the Stereo, will post after I find out a good fit.

Types – Cruze comes with JK Tyre, not the best. They should have given Bridgestone or Michelin. I am not changing them now, but if you are looking to customize, do read Choosing the right Tyre for your car.

In Dash Multi-Purpose System – Caska is the one of the best which is custom made for Cruze. It includes DVD Player, Bluetooth Phone integration, GPS Navigation and iPod Integration. One Team BHPian has got it, check out pictures and his review here.

Choosing to Cruze
I booked the Car 6 June 2011 and got the delivery on the 30 June. Click here to check out the pictures.



What Book has changed your Life?

07. June 2011 · Write a comment · Categories: BookReviews, BoP · Tags: ,

Fortune at the Bottom of the Pyramid

I read this book way back in early 2005 and it did quite change my thought process. Even though this book focus’s on helping Organizations understand how Innovative Products work in the Emerging markets, there is a key take away for Social conscious people like me.

The book embarks on a journey, in which Late Dr. Prahlad argues that organizations always work with the top and middle of the pyramid, but forget the largest part of the pyramid. Any products and service can be produced at better quality for a lower price when it reaches many more than what is anticipated. The discussion/argument is not about the exclusive products like cars or luxury items, but others which are quite necessary. The book takes you thorough case studies of organization who have innovated to help people who absolutely need few things, ranging from Home to HealthCare to daily consumables.

I am not going to go deep into any of the case studies, but would like to share how it motivated me to think differently. Before I read this book, my understanding of the world and organizations was very limited, but this book opened my eyes to a whole new world of understanding what consumer needs and how this has changed they organizations did business.

Today, we have organizations building even cars exclusively for the price sensitive population (Tata Nano car which costs only $2,500). The products and services which have been innovated for the bottom of the pyramid (price sensitive population) also has impacted the middle and top of the pyramid. Organizations realized this a bit late. The prime understanding of any good producer is that any product/service accepted by consumers will always be accepted. However, one aspect which organizations miss is that even in non-price sensitive markets, people consume only limited quantities. However, when you produce goods and services in smaller quantities, acceptance might also go up!

Look at the classic example of Aravind Eye Clinic in Madurai, Tamil Nadu, India. This organization has constantly innovated from the beginning to provide cost effective eye care. If you speak to the founder, his inspiration is McDonald’s. He was amazed the Quality of food available at any of the McDonald’s outlets across the world, which is precisely the same anywhere and everywhere. Being an ophthalmologist, he wanted to create something which has the same quality anywhere and everywhere. Today, Aravind Eye Clinic performs more than 600 eye surgeries each day and these surgeries cost as low as $50. What is the outcome? Acceptance in the 80% of Rural India that they too can better their lives.

If I keep quoting case studies, the list goes on. However, the key take away for me is to produce something/anything which can be accepted at the bottom of the pyramid and impacts their lives. This will translate to acceptance at the middle and top of the pyramid too.

HealthCare Infrastructure in India

18. May 2011 · 9 comments · Categories: HealthCare, HealthCare in India · Tags: ,
There have been many articles, research papers and writeup on this topic available on the web. As part of a research project, I managed to gather some data points for understanding the State of HealthCare in India. Thorough this post, would like to share my findings and provide some references for a better understanding on this subject.Economically, India has been consistently growing at over 8% GDP every year for the last 3 years and if the Economists prediction goes right, we will continue to grow the same way for the next few years.

HealthCare is one of the key parameters in which a country’s Development and stature are measured. To begin this discussion, let us first understand the structure of HealthCare in the Indian Context.

Primary Health Care is essential health care; based on practical, scientifically sound, and socially acceptable method and technology; universally accessible to all in the community through their full participation; at an affordable cost; and geared toward self-reliance and self-determination (WHO & UNICEF, 1978).
The World Health Organization (WHO) has identified five key elements to achieving this objective:
  • Reducing exclusion and social disparities in health (universal coverage reforms)
  • Organizing health services around people’s needs and expectations (service delivery reforms)
  • Integrating health into all sectors (public policy reforms)
  • Pursuing collaborative models of policy dialogue (leadership reforms); and
  • Increasing stakeholder participation.

Primary HealthCare in India

In 1947, the year of India’s independence, average life expectancy was 29 years and today, in just 63 years, it has reached 65 years. According to estimates, it will reach 74 Years by 2025. There are many reasons for this impressive progress in life expectancy in India and one of the key reasons is the maturity of the Primary Health Care facilities and services in India.

PHC was conceptualized in 1946, three decades before the Alma Ata declaration, with the recommendations of the Bhore committee, that laid emphasis on social orientation of medical practice and high level of public participation. The government followed it up with setting the Community Development Plan in the 1st 5 year plan (1951-55) and Health Survey and Planning Committee in the 2nd 5 year plan.

Primary HealthCare as a key initiative has been an Objective only in the 9th 5 Year Plan (1997-2002).

  • Department of Women and Child Welfare (DoWCW) is responsible for the overall implementation of HealthCare schemes in India.
  • The Central Government is responsible for providing funds for HealthCare infrastructure across the country.
  • The State Government is responsible for allocation of funds to respective regions and building up the personnel and HealthCare facilities across the state.
  • At times of emergency, the Central Government is responsible for collecting and distributing Medicine’s and required support to the state/region.
  • The Government provides a three-tier (Primary, Tertiary and Secondary) support structure for addressing the HealthCare needs across the country.
Structure of Indian Public HealthCare System
The Indian HealthCare system is a three-tire structure which focus’s on delivering care at the individual level. This structure is designed according to the population norms.

Population

Urban

Hilly/Tribal/Rural
Sub Center

5000

3000
Primary Health Center

30,000

20,000
Community Health Center

1,20,000

80,000
Sub Center
The Sub Center is the closest to the common man and becomes the first point of contact in the three tire system.
  • Each Sub Center is managed by an Auxiliary Nurse Midwife (ANM) and one Male Health Worker.
  • One Female Health Assistant and One Male Health Assistant manage 6 Sub Centers.
As of 2008,
  • There are 1,58,792 Sub Centers.
  • 53,390 ANM’s
  • 1,46,036 Male Health Workers
  • 23,458 Female Health Workers
  • 23,458 Male Health Workers.
Primary HealthCare Center (PHC)

Primary HealthCare Center’s form the second tire in the system (Secondary Care) and each PHC is a hub for 6 Sub-Center’s. A PHC typically has a 4-6 beds for addressing immediate and basic Health Care necessities.

Community Health Center (CHC)

CHC forms the third tier in the system.

  • A CHC has 1 Surgeon, 1 Physician, 1 Gynecologist and 1 Pediatrician along with 21 Paramedical Staff.
  • CHC is a 30 bed facility.
  • 1 CHC for 4 PHC’s.

Now, let us look at the core data of HealthCare Infrastructure in India.

Personnel Availability

Required In Position Shortfall
CHC 6491 4276 2337
PHC 26022 23458 4477
Sub-Center 158792 146036 20486
Doctors at PHC 23458 24380 3537
Multipurpose Worker (Female) at PHC & SC 169494 153537 21066
Nurse MidWife 53390 44940 18017
Only ANM 19385 21313 1841
Health Assistant (Female) 23458 17599 6481
Health Assistant (Male) 23458 17972 8827
Health Worker (Male) 146036 60247 79322
Laboratory Technician 27734 12885 14135
Obstetricians and Gynecologists (PHC) 4042 1029 2576
Obstetricians and Gynecologists (Other Location) 219 143 115
Peadiatrician (PHC) 4042 791 2814
Peadiatrician (Other Location) 219 73 146
Pharmacists 27734 20964 7017
Physicians (PHC) 4042 1043 2562
Physicians (Other Location) 219 81 138
Radiographers 4276 1695 2280
Surgeons 234 81 142
All Specialists at PHCs 17104 4279 11033
Total 739849 556822 209349

Infrastructure – (District Hospitals, Ayurvedic Dispensaries & Hospitals, Family Welfare Center and Referral Hospitals)

State District Hospitals Ayurvedic Dispensaries Ayuevedic Hospitals City Family Welface Center Referral Hospitals
Andhra Pradesh 16 557 9 0
Assam 22 380 1 0
Arunachal Pradesh 14 2 1 0
Bihar 25 311 11 12 70
Chhattisgarh 16 634 8 0
Goa 2 77 1 0
Gujarat 23 493 48 106 409
Haryana 21 472 8 0
Himachal Pradesh 12 1109 25 0
Jammu & Kashmir 14 273 2 0
Jharkhand 24 122 1 0
Karnataka 27 589 122 2 57
Kerala 14 740 124 0
Madhya Pradesh 50 1427 34 0
Maharastra 23 469 55 0
Manipur 7 0 0 4 8
Meghalaya 5 12 1 0
Mizoram 8 0 0 0
Nagaland 11 85 0 0
Orissa 32 624 8 0
Punjab 20 507 15 0
Rajasthan 33 3539 100 0
Sikkim 4 1 1 0
Tamil Nadu 27 35 7 104 100
Tripura 2 55 1 0
Uttar Pradesh 71 340 1771 0
Uttaranchal 18 467 7 0
West Bengal 16 295 4 0
Andaman & Nicobar 3 5 1 0
Chandigarh 1 6 1 0
Dadra and Nagar Haveli 1 3 0 0 1
Daman and Diu 2 1 0 0
Lakshadweep 1 2 0 0
New Delhi 9 148 10 0
Pondicherry 4 16 1 0
Total 578 13796 2378 228 645

Infrastructure – Homeopathic Dispensary & Hospitals, Medical Colleges, Unani Dispensaries/Hospitals

State Homeopathic Dispensary Homeopathic Hospitals Medical Colleage Rural Dispensaries Unani Dispensaries Unani Hospitals
Andhra Pradesh 286 6 32 196 6
Assam 75 3 3 1 -
Arunachal Pradesh 44 2 - -
Bihar 179 11 8 366 144 4
Chhattisgarh 52 3 3 6 1
Goa 59 1 1 - -
Gujarat 216 14 13 8347 - -
Haryana 20 1 3 19 1
Himachal Pradesh 14 1 2 3 -
Jammu & Kashmir 0 0 4 235 2
Jharkhand 54 2 3 30 -
Karnataka 42 20 36 176 51 13
Kerala 580 33 18 1 -
Madhya Pradesh 146 22 8 50 2
Maharastra 0 45 39 25 5
Manipur 9 1 1 42 - -
Meghalaya 10 7 - -
Mizoram 1 0 - -
Nagaland 115 1 - -
Orissa 603 6 4 9 -
Punjab 107 5 7 35 -
Rajasthan 178 9 8 102 3
Sikkim 1 0 1 - -
Tamil Nadu 46 9 25 1421 21 1
Tripura 93 1 2 - -
Uttar Pradesh 1482 8 16 49 210
Uttaranchal 60 1 3 3 2
West Bengal 1220 12 9 3 1
Andaman & Nicobar 15 1 - 1
Chandigarh 5 1 1 - -
Dadra and Nagar Haveli 1 0 3 - -
Daman and Diu 0 0 - -
Lakshadweep 1 0 - -
New Delhi 98 2 5 25 2
Pondicherry 7 0 8 - -
Total 5819 228 263 10355 1008 254

State wise Population to Infrastructure availability

State Population Sub Center PHC CHC Doctor
Andaman & Nicobar Islands* 356,265 3,125 18,751 89,066 4,880
Andhra Pradesh 75,727,541 6,048 48,234 453,458 34,204
Arunachal Pradesh 1,091,117 1,843 9,406 24,798 12,542
Assam 26,638,407 5,801 31,562 258,625 65,290
Bihar 82,878,796 9,356 50,505 1,183,983 52,958
Chandigarh* 900,914 64,351 450,457
Chhatisgarh 20,795,956 4,386 28,843 152,911 24,125
Dadra & Nagar Haveli* 220,451 5,801 36,742 220,451 36,742
Daman & Diu* 158,059 7,185 52,686 158,059 26,343
Delhi* 13,782,976 336,170 1,722,872 599,260
Goa 1,343,998 7,814 70,737 268,800 30,545
Gujarat 50,596,992 6,956 47,155 185,337 49,654
Haryana 21,082,989 8,665 50,198 245,151 60,237
Himachal Pradesh 6,077,248 2,934 13,535 83,250 14,932
Jammu & Kashmir 10,069,917 5,281 26,853 118,470 22,328
Jharkhand 26,909,428 6,799 81,544 138,708 81,544
Karnataka 52,733,958 6,476 24,025 163,263 18,562
Kerala 31,838,619 6,250 35,026 297,557 18,383
Lakshadweep* 60,595 4,328 15,149 20,198 10,099
Madhya Pradesh 60,385,118 6,836 52,554 223,649 57,951
Maharashtra 96,752,247 9,146 53,278 237,721 81,236
Manipur 2,388,634 5,687 33,175 149,290 20,771
Meghalaya 2,306,069 5,751 22,389 88,695 21,755
Mizoram 891,058 2,435 15,633 99,006 17,136
Nagaland 1,988,636 5,009 23,124 94,697 25,173
Orissa 36,706,920 5,488 28,700 158,904 27,130
Pondicherry* 973,829 12,647 24,970 243,457 14,321
Punjab 24,289,296 8,499 50,184 192,772 120,842
Rajasthan 56,473,122 5,257 37,574 161,814 36,623
Sikkim 540,493 3,677 22,521 135,123 12,869
Tamil Nadu 62,110,839 7,134 51,120 301,509 27,483
Tripura 3,191,168 5,512 41,989 290,106 12,514
Uttar Pradesh 166,052,859 8,092 45,001 322,433 82,985
Uttaranchal 8,479,562 4,804 35,479 154,174 9,792
West Bengal 80,221,171 7,746 86,819 229,860 99,038
Total 1,027,015,247 7,033 2,988,332 7,595,753 1,830,246

I will append more information as I get to learn more.

Most of the data was taken from Ministry of Family and Child Welfare (http://www.mohfw.nic.in) and also from search, papers and other websites. I ensured that I do not violate any copyright information.

Innovation Perspectives

21. September 2010 · 3 comments · Categories: Innovation, Project Management · Tags: , , , ,

On the 9th and 10th September, PMI Bangalore Chapter organized their Annual PMPC (Project Management Professionals Conference) at NIMHANS Convention Center, Bangalore. I got an opportunity to be invited to the conference at the last minute. Could not attend on both days but squeezed in as much as possible to be there on Day 1.

The key theme around the conference and its speakers has been “Innovation”.

Conference was well organized and there were eminent people who came to share their experiences including Mr. T N Seshan, former CEC of India. I could capture few interesting points during the conference and here, I am sharing them in Q&A format which could probably provoke your thought process.

How do we help “team” think Innovatively?

Many managers struggle with this. Innovation is not a skill, but attitude and the thought process. How can we change someone’s thought process when they are tuned to a particular style? Especially the learning style which we grew up with? One noble Professor who was part of the Panel  provided an interesting thought. Managers should keep pushing what he calls Stress Relievers. What he recommended is that we should push team members to inculcate the habit of reading. Along with this, Management should periodically give Puzzles to its team (group and Individual) and encourage them to solve. This will help them sharpen their thought process and start thinking of new ways of solving real live problems.

Helping team to de-stress regularly by encouraging them in Sports and Dancing is another way of motivating team to think different.

We are so used to follow instructions and solving problems in School and at College. What we need is a different way of solving problems. This comes only when Management/Managers give the opportunity to its team members to think different. Manager’s should definitely understand how to balance the pressure of the demanding milestones and also give the liberty to team members to think and solve a problem. Also, the success for the organization comes when Managers give the same freedom to their Managers.

Why is India far from Innovation?

Panelists had various thoughts on this. One perspective which struck chord with the audience is that we are more Service Driven. Others agreed, however also highlighted that there are various organizations which have started thinking in these lines. Intel’s Celeron processor was completely born out of India. There are many other innovations which are coming out from India. However, the cycle is taking longer due to the infrastructure. What I mean by Infrastructure is the system we have – Our Education System, Incubation Cells, Government Support, Investments and mentorship. These are working today, however, there is loads of differences when it comes to execution. We are definitely in-line, however it is taking longer than the usual cycle.

What are organizations NOT providing to foster Innovation?

One aspect which many have agreed is the timeframe and the service mindset. We need to Quantify results quickly than the anticipated time. This happens everywhere and most of the times. This becomes a burden for Innovation. Organizations need to develop their Delivery Models based on this. Time required for Innovation in solving the problem should be considered while estimating their timelines for Delivery. This builds the culture of Innovation in the organization and also teams are motivated to think in this direction. Organizations which have incorporated this have definitely been successful – Google (20% of time goes towards working on an individual’s passion), ThoughtWorks (Services organization) have been the true differentiators. There are many organizations across the globe, but mentioned the above examples so that they can easily be referenced.

How do you measure Innovation?

Many participants agreed that they use Innovation Index. Others who shared their experiences mentioned that they measure what needs to be delivered to how it is being delivered, essentially metrics.

For each of their goals, organizations should have a quantifiable measurement criteria and this helps measure their Innovation. How many different and effective ways have been proposed to solve a problem is what needs to be measured. This becomes a benchmark in the Organizations measurement.

Does aggressive growth need rapid Innovation?

It depends. There are various parameters in understanding what the end goal is. Organization Goals  take the center stage. What is the Priority of the organization – Growth or Innovative Solutions? Until this is answered, one cannot determine if each of them are inter-connected or inter-dependent.

Is Competition killing Innovation?

One Professor who was part of the Panel started with an interesting perspective on various Era’s:

Socialist – The Nehru age. We need to become an industrial economy to build the country.
LPG (Liberalization, Privatization and Globalization) – This happened across the globe. Each country wanted to build their economy to establish themselves.
WTO (World of Threats and Opportunities) – This is today. We have an Opportunity and Threat sitting beside each other all the time.
Did this kill Innovation? NO. What ever the perspective is, Innovation happens all the time and organizations ensure they stick to what they are doing. Going forward also, these aspects are always existing and how we handle them and build ourselves is what counts.

“Innovation is Attitude” – How can we develop this attitude?

No rocket science. Build the attitude from day one. Give the liberty to your teams to think on their own. Do not provide them with solutions to solve problems (like in a typical System Development Lifecycle). Let teams think for themselves and propose solutions. Match with what your experts have in mind and arrive at a cumulative solutions. This will provide confidence to your teams to think independently.

I was present for a session by Sudhir of Lumium Innovations, Ahmedabad and that was very different.  Lumium is working towards becoming the Indian IDEO. He had a different perspective on thinking out of the box. He says that there is Nothing outside the box, but it is just a bigger box.

The session name on the agenda attracted double the capacity of the auditorium. The initial case-studies he presented which they were working on, gave a different light to many in the auditorium, but what attracted me is one slide he shared toward the end on the three tangents of the Box.

There are three tangents to the graph – Past, Present & Future

Past

  • Cumulative Learning
  • Discrete Experiences

Present

  • Systems
  • Consumers

Future

What happened in the Past is that we banked on our cumulative learning. Imagine the last project you worked on?  The project schedule was prepared based on a similar project done earlier. The design and architecture is based on past experiences of the Architects (This is what they are paid for, right?). The pricing has been based on the projected number of hours taken to complete the project (again, this goes back to referencing earlier projects). There is nothing wrong in this. It is a very well accepted perspective.

In the book Super Crunchers, Ian Ayres begins the book with a reference to column  in a famous wine magazine which mentions that a particular place in France, at a particular latitude and longitude and at a particular time frame produced the best wine in the world till date. How did this come about? This is based on various calculation of the location of the vineyard, climatic conditions and the quality of grapes grown. This came into writing when the columnist referred to various statistics of wine produced around the world. The prediction (even though its in the future) was based on historical data. He did not predict that we will have the best wine prepared in the future, but it is based on the past data.

What is happening at Present is that we are building systems based on the consumers requirement. There is no referential data available. Look at all the applications which are being developed for the Mobile space as an illustration. There is no reference because the mobile space is re-inventing itself everyday. A new kind of platform is being conceptualized and brought to the real world almost every day.

What will happen in the Future is that our reference point is going to be Technology and inclusion of Bio mimicry. How technology takes shape and how consumers want o see what the want and demand what they see.

Most of the notes above are my interpretations and my examples. Feel free to shoot your thoughts.

7 Leadership Lessons from World Cup

13. July 2010 · 1 comment · Categories: Entrepreneurship, Leadership · Tags: , ,

FIFA World Cup 2010 has just concluded and if you have been following the games, I am sure you have learned a lesson or two. My favorite team has been Spain since the beginning seeing their performance in the last 2-3 years. Most of my friends laughed at me and just wrote me down. Spain lost their first match and opinions became stronger. Well, I was confident of Spain since the day one and it actually became stronger after they lost their first game.

As I followed the games, I understood that this time it is going to be a different one. As expected, all “favorites” were out in either the league or Super 16′s. One team which has stood out was the Spain and there are definitely lessons to be learned from them. Here are the top 6 Leadership Lessons I learned:

Persistent – Even though they lost their first match, it is their Determination to win what mattered. The only thing which they concentrated was the game. Who ever the opponent is, the game came from the heart.

This is exactly what is needed from a Leader. No matter what the situation is, who the opponent is and what the game is, you need to have the determination to handle the game. Winning and Loosing are two sides of the game and there is nothing like he/she is stronger than me, more educated than me, have more experience than me.. These are all reasons we give ourselves. The fear of loss in us becomes the strength to the opponent and this is what takes the game away. You need to be confident of yourself and play it with your heart and no matter what, success is yours.

Consistent – Consistency comes from the mind. The Determination to always excel is what makes you a winner. Failure is the stepping stone to success, and if you close your mind thinking that the game is over, it is long over. Consistency is a must quality in each of us to make the difference and this does not come in a day, it is a constant practice. Also, when you are being consistent, you do not change the rules of the game, but you change the way you play. Just imagine if Gandhiji stopped his ‘Non-Violence’ strategy because he is not able to move forward? Would we have got Independence? He kept to the rules of the game, but kept on sharpening his playing skills which ultimately achieved what has to be achieved. From the beginning the Spanish kept to their cool side and only concentrated on being the wall to the opponent. They used every opportunity to hit a goal.

n FAILURE = 1 SUCCESS – It does not matter how many times you loose, but it matters if you have won the crucial game or not. In real life, no one wins everyday, but just because of that, if you stop practicing being consistent and determined and kept on changing your strategy, you will NEVER win. Only when you fail many times will you know how to be successful. Do you think it was any different with the Spain matches?

Goal! – You should DEFINE and quantify what you want to achieve and this is the key to success. But, this does not mean you bend the rules to reach your goal. In movies, we see always the Villan bends rules to become the winner, but the Hero always plays the game following the rules, and who wins? Even though movies are fictitious, the fiction comes from real life. The Spanish always got their goals (remember, they hold a record this year for scoring the least number of goals and still winning what matters) when they wanted to. They has to work hard for it, but when you are just determined to get it, you know you would get it.

TEAM WORK – Last but not the least, its all in the Team. Team should stick to their roles and live up to play the best of their capacity all the time. If one starts thinking that I am superior than the other, that’s it, the game is all over. Each one in the Spanish team came from different parts of the country but played together for one club until they achieved what they want. It’s all in the TEAM and there is never an Individual Winner, also will never be.

Play the way, the Game needs to be Played – You are playing a very truthful and committed game, but opponents are not always the same. You do not run away from a mosquito, but you do run when you see a Tiger. Why? In the last two games which mattered, the Spanish played the way the opponent was playing. With Germany, there were no fouls at all, but with the Dutch, the match holds a record for the maximum number of cards. However, one key aspect here one needs to remember, this should not deviate from the way the game needs to be played. You mend your game and not the rules!

Stay Cool – ALWAYS: If you noticed the games played, Coach played an important role and the one thing you notice is that he has always been cool.  No game can be played in tension and no game can be won with a disturbed mind.

The most important aspect of Leadership is keeping yourself Cool and Lite, else every decision you take turns out to be a disaster.

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