August 9, 2009

Swine Flu Update

I had an opportunity to meet with the local State Health Secretary while on a TV show.  I walked him through the issues I faced and some simple solutions they can use.  So here is what the government has done:

1. Patients can be tested in multiple location including private hospitals with better amineties

2. Local testing lab in Bangalore to be used for faster testing

3. Increasing equipment to Rajiv Gandhi hospital – including masks

4. They have talked to St. John’s hospital and other medical professional to kick off a training program for all health workers

In addition I was lucky to meet Dr. Sanjiv Lewin from St. John’s who

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July 22, 2009

Healthcare opportunities in India Part 1

There are a lot of reports about the healthcare industry in India, the growth potential and opportunities like here by PWC (circa 2007), the US Commercial Service, the India Brand Equity Foundation (IBEF).

All of them highlight:

  • India spend s~6% of it’s GDP on healthcare
  • On a per capita basis this is miniscule to meet the needs of the 1.1 billion people
  • Majority of spend is private $$ by middle class and rich citizens
  • Heath insurance penetration is very low
  • Huge gap in the number of trained staff and facilities required for the large population

Over the last decade or so, there have been some phenomenal improvements in the healthcare diagnostics and delivery with companies like Apollo, Fortis and Manipal opening up great centers across the major urban center.  The biggest catch is these companies are still targeting the less 10% of the population that can afford to spend on healthcare or have insurance coverage

With this situation, if we look at the opportunities in the sector is really in addressing the needs of the non urban and low income groups.  These groups currently rely only on the government for the healthcare services.  Unfortunately the government alone cannot address their needs.

For example in the state of Karnataka there is an acuate shortage of staff and facilities as seen in the table below.  The state needs 254 Radiographers and has only 30.

Particulars Required Actual Short Fall Short Fall %
Radiographers 254 30 224 88%
Paediatricians at CHCs 254 116 138 54%
Health Worker (Male) 8,143 3,762 4,381 54%
Health Assistant (Male) 1,679 837 842 50%
Laboratory Technicians 1,933 1,242 691 36%
Total specialists at CHCs 1,016 691 325 32%
Health Assistant (Female) 1,679 1,170 509 30%
Multipurpose worker (Female) 9,822 7,244 2,578 26%
Physicians at CHCs 254 192 62 24%
Pharmacist 1,933 1,472 461 24%
Community Health Centre 302 254 48 16%
OBGYN 254 215 39 15%
Nurse/Midwife 3,457 3,100 357 10%

Source: Ministry of Health, Government of India 2008-09 report

Looking at this one obvious opportunities is:

Micro health insurance:  Current government schemes which utilize a re-embursement mechanism have failed as affordability is still an issue for the group.  We need schemes that provide cash less insurance coverage.  One good case of this a company called ARC – Accident relief Care for short.  ARC provides cash group accident cover for the low income groups for as little Rs 2-3 / day.  Their target market is auto drivers, waiters who live from day to day cash collections and a single day’s lost due to any accident can lead to dire consequences for them and their families.  Extending the ARC concept to other markets and offering new products is a great opportunity.



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July 21, 2009

Brush with Swine Flu

Ok so I had  swine flu.  The funny thing is I did not get it from traveling but caught the virus right at home.   In India they say it is my karma.

The good parts first:

  • I stayed at the Rajiv Gandhi hospital which had a sanatorium like feel with lots of trees, low rise buildings and no traffic
  • The staff, nurses and doctors were just amazing.  Lots of great care and support
  • Gave me a couple of days to look and experience the real state of  healthcare in India rather than have an academic view of it

Now the real meat:

  • We have a limited supply of the drug and test kits.  When I got tested, the lab in Pune was only testing for swine flu
  • I got tested after repeated requested for 3 days and it toke another 2 days to get my results back. that is 5 days to get a result
  • I was not shown the results but the information was given to someone at the hospital by phone. No verification, no paper trail, nothing.  Human beings make mistakes and not having proper communication mechanisms in this day and age (an email, a fax anything will do) is ridiculous
  • The government forces all people who undergo a test and are awaiting the results to stay at the Rajiv Gandhi institute so they can contain the spread.  Two issues here: one a person who has not tested positive has a high probability of getting infected by being in such close proximity to an infected patient; second: the facilities at the hospital are just disastrous (see pictures below).  Most people feld the hospital without getting tested when they just saw the place. Bangalore has some great medical facilities but we were forced to only stay at this government run hospital.  Here are some key features of the place:
    • 14 beds in a dorm style.  Bed were old, sheet did not look clean and blankets definitely had stains.
    • 2 toilets both Indian style (do a google to figure this out). One for the guys and another for the ladies
    • No soaps or toilet paper
    • There was active construction work going on, so patients were entertained by constant banging on the roofs, strong smell of paint and dust everywhere
  • The hospital did not have a simple thermometer to test patients. I bought them one
  • Finally I had a cheat x-ray taken and the lab was from another world.  It had one seemingly working machine and lots of old crap with tons of dust on them.  There was no changing rooms, no proper magnetic protective shields
  • Another big issue is the staff though competent have not been trained to handle swine flu.  I saw vague uninformative circulars being sent by bureaucrats.
  • Finally: there was no food and everything had to be got from restaurants near by.  I don’t think unhygienic restaurant food is ideal for flu

So here are some quick things that can be done to solve these issues:

  1. Allow other private hospital to test patients and have those suffering from the virus at least get comfortable accommodation, food and facilities
  2. Open up more testing labs- especially the great lab we have in Bangalore
  3. Charge patients for the health services – Most people infected with swine flu are more than willing to pay for the testing, stay and medication.  Please charge them and in return provide them with adequate facilities
  4. Spruce up the facilities at Rajiv Gandhi – Instead of building gazebos outside, please build a couple of additional toilets, get some basic supplies like sheets, thermometers, masks and soaps
  5. We have some very competent healthcare professionals.  Please get a group of them together and develop a well thought through strategy and action plan.  Please train medical staff on these and empower them with processes and techniques to address the key issues.

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January 25, 2009

Bharathpur Bird Santuary

We were on a business trip driving through a town called Bharthpur in Rajasthan. Bharthpur has an amazing national park which is also a bird sanctuary called the Keoladeo National Park.

So I got a few of my collegues out of bed before dawn and we had this amazing walk through the national park. Pictures are from our walk there and some birds we caught on camera.

About Bharthpur:

Bharthpur is still a sleepy small town. The town has enormous tourist potential and does attract up to visitors a year.

Interesting Bharathpur Park is over 250 years old and has between 250-350 species of birds.  This is the ONLY World Heritage site in Rajasthan.

Issues:

According to a UNESCO investigation, the park is under serious threat due to lack of water supply and environmental changes.  Since most of the birds at Bharthpur are water birds, they depend on the monsoons and open landscape for their existance.  Over the last 10-15 years, the drop in monsoons, the reduce water supply from natural water sources (from construction of dams) and the growth of new vegetation is seriously affecting the bird population.  A 2008 UNSECO study points out some of these issues.  One serious issue pointed out is of the endangered Siberian Crane species which has always migrated and spotted at the park, is not seen since 2002.

Travel etc:

There are lots of resources online on how to get there.  Our itinerary was quite convoluted and not aimed at traveling to Bharthpur in particular so I cannot add much value here.  One thing I can talk about is the lack of hotel accommodation.  We had a tough time making a booking over the phone and ended up in a guest house / rest house run by an ex-army gentleman.  He was a great host and very accommodating but the facilities were terrible.  The key issues for a place this beautiful is that there are few clean hotels and even fewer clean places to eat.

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January 25, 2009

Micro-business Kullad chai

Here is another very typical Indian micr- enterprise.  This is a highway tea stall some where in Rajasthan.    He is boiling milk in the big vessel on the left.  The red round device is to pump air into the coal stove.  It has a hand crank that he turns and air is supplied through a pipe.

Now on the right is a big stack of clay cups (Kulhad).  These are locally made single use cups that add to the flavor and experience of the tea.   The cups are made all around in villages by local units typically run from in a person’s home or farm.  The cups provide an additional revenue stream to the households.

The cups are fired in small home made ovens.  Apart from the carbon produced in the firing, this is a very eco-friendly product.  The production uses all-natural, local resources and are hand made.  The used cups are crushed and blended into the surrounding soil in the local farms.  This is definitely refreshing compared to the increase use of plastic cups all over India.  The biggest issue I have noticed with the plastic cups are that they tend to litter the entire area and will eventually go into a landfill, be burnt or disposed of in other noxious ways.

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October 28, 2008

Halloween Creations

This is the product of the Halloween party for a bunch of 4 year olds. Couple of interesting items:
  • This is in Bangalore India and all 4 year old kids were completely into Halloween – costumes, tick or treating, etc etc . My first exposure to Halloween was in the US, so I am surprised at the exposure 5 year old have to US culture
  • Second not sure whose artistic creation this cupcake is, but I know it has a 4 year old behind it. I thought I’d give the kid a shout out.

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August 18, 2008

Micro Business – Corn Entrepreneur

This is a typical Indian entrepreneur, Malamma, with her school going daughter next to her.  I met this lady in Lal Bagh at the flower show.  Curious, I had a quick chat about her business and life.  First off, here are the economics:

Fixed Costs:
Coal = Rs. 150 ( 5 Kgs per a day)

Variable Costs:
Corn = Rs. 300 (A bag of 100 kernels)

Revenues:
1 Kernel = Rs. 10 (on a good day)

Gross Profit = Rs. 7

So this lady has to sell about 22 kernels to break even.
On a good day like this she sells 50 odd kernels.  That gives her:

Gross Profit = Rs. 350
Fixed Costs = Rs. 150
Net Profit = Rs. 200 (US$ 4)

(For simplicity, we ignored travel costs, garnish costs – lemon, salt and her opportunity costs)

So she usually sets up shop only on special occasions like these, at fairs and large public gathering.   She picks up a bag of corn from the central market early in the morning (6-7AM) takes it to the location, finds a good location and starts up the coal flames in time for customers. Malamma is great business person, she understands her customers (rainy days are better, men with their girlfriends / wives / kids buy easily) and is extremely positive and motivated. She knows that she has to be smiling and positive.  To stay competitive, she understands, location is key and has a strong voice to shout out and attract customers away from other vendors.

She works 12-14 hours a day.   She wants to build assets for her kids and educate them. Given her hard life, one might expect her to feel sorry for herself.  In fact she is happy and content, despite having  to work hard, travel long distances and bear the heat from the naked coal flame.

Talking to her is energizing, this lady who is so full of life and optimism.  She is not looking for pity or hand-outs but is working really hard to build a future for her kids, give them education and participate in the great Indian growth story.  She did not talk about what her problems were or what she does not have but focussed on what she wants to achieve.

One note: I did not notice a mobile phone with her, so there is still some market left for the operators :)

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