A Mangalyaan model of healthcare

Cost-effective, timely and outcome-driven use of technology is the answer to India’s healthcare problems

Rajendra Pratap Gupta | April 16, 2016


#polio   #healthcare   #technology   #AIDS   #RMNCHA  
Mangalyaan model of healthcare
Photo: Arun Kumar

The world over, we are struggling to make healthcare cost-effective, accountable and outcome-driven. But so far, it has been far from success. The Commonwealth Fund Report 2014 (‘Mirror-Mirror on the Wall’) analysed the top 11 healthcare systems. According to the report, the US is number one in healthcare spending but 11th – right at the bottom – in overall rankings. The UK is number one in efficiency, quality of care and overall rankings but one notch above bottom, 10th, in healthy lives. France is number one in healthy lives but is 9th in overall rankings. Thus, none of the healthcare systems has a model that can be replicated and, for sure, more money does not mean better healthcare!

India has its own unique problems, and copying the West would be like importing failures from the West. But I am optimistic. In India, we are still building our healthcare system, and so we don’t have any baggage, and we don’t need to roll back things and undergo a painful reversal process. So, it is going to be a lot easier for us.

Also, we don’t have business lobbies. The US spends about 18% of GDP on healthcare, and the healthcare lobbies would not allow for any change that affects their balance sheets. 

The majority of our population is young and presumably healthy. Besides, we have at hand the findings from the failed models of the world and their success stories. But we must be mindful of our challenges. The major ones include:

Financial condition

Financial condition of our country is not good! I can say that with surety because of my work in public policy formulation. Our debt is over '46 lakh crore, that is, '38,000 on every Indian, and we have bonds maturing every year, which the government has to pay for till 2019, of about '2 lakh crore every year. Add to this the deficient rainfalls and the slowing global economy. Now we know why healthcare, or for that matter any other social sector, will never get the funds it needs, and the competing priorities will let us down.

Geographical condition

More than 80 crore people live in rural India, and they will remain out of the scope of modern medicine for years to come. Take my assurance: doctors are not going to rural India for another 20 years.
Also, we are transitioning from being the ‘disease capital’ of the world to the ‘death capital’. The chronic diseases are becoming our biggest killer, and they are occurring at a much younger age.

Systemic challenge


We are laggards in terms of technological adoption, and we are still living in the old school of thought that talks about the three-tier model of primary, secondary and tertiary care, and this is never going to work! We need a system of care, which is well-integrated.
The silver lining is that, despite these challenges, India shows the way to address the healthcare problems.

Let us look at our key success stories:

•    Polio eradication is a phenomenal success story for a vast and diverse country like India.

•    AIDS control is another success story. We have been able to halt the growth of AIDS in India.

•    Rashtriya Swasthya Bima Yojana (RSBY) is another success story despite its limitations. This scheme is now the template for universal healthcare
(UHC), and is a phenomenal success story of cashless healthcare for the bottom of pyramid through public-private partnership (PPP).

•    Tamil Nadu Medical Supplies Corporation (TMSC) is another success story. The issue of cost was addressed through centralised buying and solved the problem of leakage, corruption, spurious drugs and irrational use of drugs, through the adoption of treatment protocols and guidelines.

There are lessons to be learned from these success stories, and the learnings can be utilised for better management of chronic diseases, rural health, geriatric care, reproductive, maternal, newborn, child and adolescent health (RMNCHA), etc.

On one side, we have a challenge, and on the other side, we have an opportunity. Let us further see this:

On one side, we have the urban-rural divide and then on the other side, we have the best brains in technology and over one billion cellphone connections to bridge the divide using digital health. 

On one side, we have financial constraints, and on the other side, we have the capabilities in the private sector that we can leverage.

On one side, we have 110 million senior citizens, and on the other side, we have 65% of the population who are young and healthy.

What we could not achieve even with 3.9% of spending on healthcare, our neighbour, Sri Lanka, could with 3.3% of the spending. There is a lesson to be learnt from this.

But the most inspiring lesson for healthcare is from the Indian ‘MOM’ model, that is, the Mars Orbiter Mission or the Mangalyaan model. MOM is a disruptive innovation from India which the world is compelled to look at and learn from its success. Shouldn’t healthcare also learn from the ‘MOM’ model, as I call it?

Let’s see this interesting example of how India innovates and leads:

•    Cost effective: We spent $74 million on MOM, while the US spent $671 million on Maven

•    Fast and timely: India took 15 months for the MOM, while Maven took five years
 
•    Asset light: Our MOM weighed 1 tonne and Maven weighed 2.5 tonne

•    MOM carried 15 kg scientific instruments and Maven carried 65 kg load

•    Outcome driven: We landed in our very first attempt!

In fact, the Hollywood movie Gravity cost $100 million, and Indians were innovative enough to reach Mars in just $74 million!
Wow! Aren’t we the best in the world? It is India-class standards for the world we should talk of!

MOM was the most cost effective interspace mission ever taken anywhere. We need to replicate that success story in healthcare. Cost effective, asset light, fast and timely, and outcome driven and effective: these are the attributes we need to solve our healthcare problems. We need to learn from the mindset, value systems and thinking on how we succeeded at MOM, and apply them to healthcare, and we will find the solutions to the world’s biggest challenge – ‘unsustainable’ and ‘ineffective’ healthcare delivery. Moreover, a country where 1.31 billion people wish and work for its success, MOM … shows us the way!
 

Gupta, a public policy expert, is the author of ‘Healthcare Reforms in India – Making up for the Lost Decades’.

(This article appears in the April 15-30, 2016 issue)

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