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Abstract of aper
1he Great Ind|an 8a|anc|ng 1r|ck nea|thcare for A|| by 2020
1o be presented at eWor|d Iorum 2011
8y

Sat|sh k|n|
Ch|ef Mentor Nat|on 8u||d|ng ro[ects of ANII1 A|umn|
Iounder Iormer Ch|ef Mentor 21
st
Century nea|th Management So|ut|ons vt Ltd
Iounder r|nc|pa| Coach 1rust nouse Managament Consu|tant vt Ltd
Iounder Member 8us|ness rocess Counc|| of Ind|a
Lxpert Member nea|th M|ss|on 8ombay I|rst
Contact
k|n|sat|shQgma||com
Mob||e +919820138S74
Leve| 8 V|bgyor 1owers 8andra kura| Comp|ex Mumba| 4000S1 INDIA


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l am ofLen asked how l can be so crlLlcal abouL currenL sLaLe of PealLhcare ln lndla and yeL be so upbeaL
and commlLLed Lo achlevlng Pon ur A! Abdul kalam's vlslon of PealLhcare for All by 2020"
l would llke Lo LransporL you back ln Llme Lo Lhe summer of 1990 1he lndlan economy whlch Loday
boasLs of lorelgn Lxchange (lL) reserves of over uSu 273b was on Lhe brlnk of bankrupLcy Cur lL
reserves was scraplng Lhe boLLom aL uSu 06 bllllon whlch was enough Lo cover [usL 3 weeks of essenLlal
lmporLs 1he govL of Lhe day was forced Lo alrllfL 67 Lons of lndlan gold reserves Lo lMl Lo ralse an
emergency loan of uSu 22 8llllon lndla had losL all credlblllLy ln Lhe lnLernaLlonal markeL
AL Lhe peak of Lhls naLlonal mood of shame ln an arLlcle ln a buslness dally l had severely crlLlclzed Lhe
counLry's sllly pursulL of lmporL subsLlLuLlon for conservlng lL and also our lnablllLy Lo look beyond
LradlLlonal exporLs Lo generaLe lL revenues lnsLead l had suggesLed LhaL lndla has a glorlous fuLure ln
sunrlse lndusLrles such sofLware exporLs Lourlsm 1hey had poLenLlal Lo generaLe noL only lL buL
also [obs for our educaLed 8uL only lf we dare Lo break away from old mlndseLs and lnnovaLe ?ou musL
remember LhaL ln 1990 Lhe sofLware exporLs buslness was ln lLs lnfancy wlLh less Lhan 8s 2330 crores
revenues nobody had even heard of lnfosys excepL a few cusLomers and frlends famllles of Lhe
promoLers My predlcLlon of a flourlshlng sofLware exporLs crosslng 10000 crs by year 2000 employlng
over 200000 englneers dld noL go down well wlLh Lhe cynlcs 1he leLLers Lo Lhe dally's edlLor accused
me of fanLaslzlng and lndulglng ln grandlose vlslons
8uL my falLh ln lndla and lndlans was more Lhan [usLlfled by Lhe l1 secLor n 8 narayanamurLhy
nandan nllekanl ( lnfosys) Azlm rem[l ( Wlpro) l C kohll 8amadoral ( 1CS ) and oLhers lead from
Lhe fronL WlLh clean eLhlcal cusLomer cenLrlc buslness sLraLegles and pracLlces And a focus on
lnnovaLlons ln buslness dellvery models lnvolvlng people empowermenL quallLy processes and use
of Lechnology 1he slngle blggesL lnnovaLlon of l1 lndusLry was use of lnformaLlon CommunlcaLlon
1echnologles and dramaLlcally reenglneered processes Lo enable remoLe ouLsourclng 1hus maklng lL
posslble for mllllons of skllled lndlans Lo work on overseas pro[ecLs wlLhouL havlng Lo physlcally Lravel
March 2000 saw lndlan sofLware exporLs crosslng 12000 crores ( uS$ 3bllllon ) wlLh uS Luropean
cusLomers asklng for more !usL 10 years laLer by March 2010 Lhe l1/8C revenues crossed a
sLaggerlng 8s 300000 crores (uS$ 70bllllon ) employlng 22 mllllon skllled manpower 8y 2020 lL ls
esLlmaLed Lo cross uS$ 230bllllon employlng 73mllllon people accounLlng for 23 of Lhe counLry's
exporLs and conLrlbuLlng Lo 63 of Cu of a resurgenL lndla
1o zoom from 0 Lo uSu 230 bllllon ln [usL 30 years ls Lhe sLuff economlsLs and planners can only dream
off ?ou may ask whaL has Lhe success of l1 /8C secLor goL Lo do wlLh PealLhcare? 1here ls noLhlng
common beLween Lhe Lwo Whlch ls absoluLely Lrue
8uL l have dellberaLely Laken Lhls analogy as lL has many lessons for people llke me ln PealLhcare who
are concerned abouL Lhe abysmal sLaLe of healLhcare ln lndla and are commlLLed Lo do someLhlng abouL
lL raLher Lhan [usL moan abouL Lhe sysLem and vesLed lnLeresLs and go back Lo buslness as usual


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uesplLe all Lhe currenL hype abouL PealLhcare secLor ln lndla l personally belleve LhaL as an lndusLry lL
ls ln no beLLer sLaLe Lhan Lhe lndlan economy was way back ln 1990 l also belleve LhaL Lhe medlcal
fraLernlLy pollcy makers ln lndla are ln a Llme warp and need Lo urgenLly shake ouL of Lhelr apaLhy As
we had Lo ln 1990 Lhe healLhcare lndusLry needs Lo make a clean break from Lhe pasL and embark on a
paLh of lnnovaLlon lf lL has Lo meeL even Lhe baslc goals of unlversal healLhcare by 2020
LeL us flrsL examlne PealLh lndlcaLors as Lhey exlsLs Loday
Whlle sLaLlsLlcally lndla has progressed well on some baslc healLh lndlcaLors durlng Lhe lasL 60 years
slnce lndependence ( see llg 1) lL lags very much behlnd oLher developed and emerglng economles llke
Lhe 88lC counLrles
ln Lhe World PealLh CrganlzaLlon's ranklngs of naLlonal PealLhcare uellvery SysLems lndla flnds lLself a
very lowly 112 along wlLh SubSaharan counLrles and even behlnd 8angladesh whlch ls aL poslLlon 88!
33 of our populaLlon has no access Lo essenLlal drugs whlle 43 of our chlldren under 3 years of age
are malnourlshed 3 of Lhe populaLlon sllde under Lhe below poverLy llne every year due Lo Lhe
crushlng burden of healLhcare cosLs 1here are many more lndlcLors whlch palnL a very grlm plcLure of
Lhe healLhcare ln lndla
now leL us look aL Lhe how we are farlng on Lhe resources fronL 1he Lables below provldes a snapshoL
of healLhcare resources ln lndla and how lL compares wlLh oLhers





As
per currenL norms Lhe crlLlcal healLhcare resources whlch
deLermlne adequacy of servlces are medlcal faclllLles represenLed by number of hosplLals beds and
skllled manpower represenLed by docLors and nurses
Health !ndicator !ndia 13S0 !ndia 2006 USA2006 China2006
Life Expectancy at birth 37yrs 63yrs 7Syrs 71yrs
!nfant mortality per 1000 live births 146 S6 7 20
Nortality rate per 1 lac live births 7S0 S40 14 S6
Parameter Qty
No of Hospitals 16,000
No of beds 3,20,000
No of physicians S.7S, 000
No of pharmacists 3,S0,000
No of medical colleges 162
Parameters
per 1000
population
USA Europe Clobal !ndia
Physicians 1.34 3.2 1.23 0.S
Nurses 4.88 7.43 2.S6 0.7
Hospital beds 2.S 6.4 4.0 0.8


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Whlle Lhe resources ln Lable 3 seem Lo be qulLe large ln absoluLe Lerms when seen ln Lhe llghL of
lnLernaLlonal norms (see 1able 4) for accepLable level of healLhcare servlces lL Lhrows up huge demand
supply gaps lL ls furLher skewed by Lhe lndla 8haraL lmbalance
WhaL ls more shocklng Lo learn ls LhaL almosL 7073 of Lhe above resources are concenLraLed ln urban
lndla where 330mllllon (30) of Lhe 113 bllllon populaLlon reslde Leavlng only 2330 of Lhese
lnadequaLe resources for 800 mllllon populaLlon resldlng ln rural and remoLe lndla ( also known as
8haraL) 98 of all medlcal speclallsLs ln lndla are avallable
only ln meLros and sLaLe caplLals
1o meeL Lhese gaps we are Lold by healLhcare pundlLs LhaL
we wlll requlre an addlLlonal 13 mllllon docLors 23 mllllon
nurses and 12 mllllon hosplLal beds Lo meeL demands All Lhls
LranslaLes Lo lnvesLmenL of uSu 80bllllon!!
1hls flgure of uSu 80bllllon explalns why PealLhcare lunds
are golng balllsLlc abouL lndlan prospecLs
1he per caplLa healLhcare spend ln lndla [ uSu 33 ls
probably Lhe lowesL ln Lhe world ln 2010 Lhe LoLal
healLhcare spend was reporLed Lo be uSu 42 bllllon whlch ls a shade over 4 of Lhe Cu Cf Lhls only
20 ls spenL by govL / publlc secLor whlle 80 ls spenL ln Lhe unregulaLed prlvaLe secLor 8y 2020 lL ls
esLlmaLed LhaL Lhe healLhcare spend wlll zoom Lo uSu 280bllllon represenLlng 73 of Cu even as Lhe
populaLlon swells Lo 130 bllllon And CovL expecLs Lo Lrlple lLs ouLlay for healLhcare from 08 of Cu Lo
approx 23
1hls exponenLlal growLh ln [usL 10 years and Lhe bellef LhaL healLhcare ls a recesslonproof secLor does
presenL very exclLlng opporLunlLles for lnvesLors WhaL l am nC1 quesLlonlng ls Lhe 8eLurn on
lnvesLmenL ( 8Cl) poLenLlal of lnvesLmenL ln healLhcare 8uL whaL l am serlously quesLlonlng ls Lhe
vlablllLy of convenLlonal approach and perslsLlng wlLh LradlLlonal dellvery and buslness models Lo meeL
Lhe ob[ecLlves of provldlng healLhcare Lo all by 2020
1he urban populaLlon of lndla ls esLlmaLed Lo grow from Lhe currenL 330 mllllon (30 of 113 bllllon) Lo
320 mllllon ( 40 of 130 bllllon ) by 2020 1he purchaslng power of an urban lndlan ls 810 Llmes of LhaL
of a rural lndlan So lL ls a no bralner LhaL urban lndla wlll aLLracL mosL of Lhls 80bllllon lnvesLmenL and
hog Lhe avallable healLhcare resources of Lhe counLry Lo converL Lhls poLenLlal buslness lnLo proflLs 8uL
LhaL wlll sLlll leave 730800 mllllons ln rural lndla ( le 8haraL ) ouL ln Lhe cold LoLally dependenL on
PealLhcare servlces from govL secLor and nCCs and aL Lhe mercy of unregulaLed prlvaLe secLor and
unscrupulous quacks
lronlcally we also have Lhe exLreme example of uS whlch spends uSu 23 Lrllllon for [usL 310 mllllon
Amerlcans AccounLlng for 17 of Lhe uS Cu 1hls works ouL Lo a sLaggerlng uSu 8047 per person


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uesplLe huge healLhcare spends a ma[orlLy of Amerlcans belleve LhaL Lhelr healLhcare sucks 1hls
proves LhaL [usL spendlng huge amounLs of money on healLhcare wlLhouL changlng old ouLdaLed
lnefflclenL and wasLeful meLhods cannoL solve Lhe problem
1he healLhcare secLor ln 2010 ls faced wlLh a very slmllar slLuaLlon as our counLry's lL poslLlon was ln
1990 Lven lf we assume LhaL we can aLLracL lnvesLmenL of uSu 80 bllllon Lo bulld capaclLy of addlLlonal
12 mllllon hosplLal beds as pro[ecLed Can we produce 13 mllllon docLors and Lhe 23 mllllon nurses as
pro[ecLed ? As Lhls would requlre an addlLlonal 600 addlLlonal medlcal colleges and 1300 nurslng
schools an lmposslble Lask
lf we conLlnue Lo accepL Lhe wesLern norms of
producLlvlLy and exlsLlng processes for dellverlng
healLhcare we wlll end up ln a vlclous cosL splral llke Lhe
uS and/or conLlnue Lo [usLlfy our crlmlnal neglecL of Lhe
mllllons ln poor 8haraL ln every symposlum on healLhcare
we hear aL leasL one speaker who Lalks of a loomlng crlsls
and LoLal breakdown ln my oplnlon 8haraL has been ln a
sLaLe of crlsls for so long we wlll have Lo redeflne crlsls
When lndla speaks of loomlng crlsls we are really worrled
abouL Lhe crlsls spllllng over lnLo our own back yard
lL ls Lherefore hlgh Llme for naLlonal sLaLe level pollcy
makers medlcal fraLernlLy and educaLlonlsLs and LechnologlsLs Lo come LogeLher and charL a
dramaLlcally dlfferenL paLh for lndlan healLhcare sysLem on a war fooLlng A paLh whlch lncorporaLes
cross funcLlonal collaboraLlon and lnnovaLlon A paLh whlch embraces laLesL advances ln medlcal
sclences and aL Lhe same Llme reLalns all LhaL ls valuable ln LradlLlonal lndlan healLhcare sysLems A
paLh whlch envlsages lnnovaLlve processes medlcal devlces lC1 Lechnologles whlch Lake healLhcare
Lo Lhe people raLher Lhan people sLruggllng Lo flnd healLhcare when needed And flnally a paLh where
healLhcare goes beyond docLors and nurses and hosplLal beds as key resources and concelves and
creaLes a new breed of moblle paramedlcs who can lnLerface wlLh medlcal fraLernlLy Lelemedlclne
processes on one hand and healLhcare consumers on Lhe oLher
1he plcLure alongslde glves a slmpllsLlc deplcLlon of how Lhls CreaL lndlan 8alanclng 1rlck of PealLhcare
for All by 2020 can be achleved le by leveraglng eople rocesses s 1echnologles Lo achleve our
ob[ecLlves 1he deLalls of Lhls lnnovaLlve approach ls Lhe sub[ecL of my paper aL Lhe eWorld lorum 2011