Democratising India’s Public Healthcare Ecosystem

Solving access, availability and affordability challenges of primary healthcare for remote and unserved vulnerable populations

Even today, many of India’s remote locations and isolated tribal belts remain undiscovered, mainly due to geographical distance and tough weather conditions. Additionally, rising treatment costs and the shortage of skilled health professionals in public health centres, pose as a challenge in delivering basic healthcare to its people. As a result, native communities residing in these rural areas are most often marginalised and underserved.

Observing the need to democratise India’s public healthcare ecosystem by supplementing the Government’s efforts, Piramal Swasthya, the philanthropic arm of Piramal Foundation aims to transform India’s health ecosystem through high impact solutions, thought leadership and partnerships. Today, our 4000+ strong workforce comprising over 580 doctors and specialists, covering 16 different states of the country, makes Piramal Swasthya one of the largest public healthcare organisations in India. Our work in the primary healthcare space focuses on maternal, child and adolescent health, as well as non-communicable diseases (Diabetes Mellitus, Hypertension, Oral Cancers, Breast Cancers and Cervical Cancers).

We are a learning organisation with a strategy to drive sustainable impact at scale, with the help of knowledge, expertise and experience. This enables us to deliver evidence-based, beneficiary-focused solutions that help us to contribute towards changing health-seeking behaviour of communities. Our flexible partnership models and technology-enabled innovative solutions aim to improve health outcomes by serving one million beneficiaries every month, with services designed to reach the remote rural underserved communities. Our service delivery channels: Remote Health Advisory & Intervention Services (RHAI), and Community Outreach Program: Mobile Health Services are conceptualized around technology. To address current healthcare challenges, Piramal Swasthya has developed integrated community models comprising health advice, specialist consultation, patient education, awareness on healthy practices, nutrition hub etc., with the objective of reducing Mother and Infant Mortality rates in intervention areas. Project ASARA, our unique Tribal Healthcare Program, covering the tribal belt of Araku Valley in Andhra Pradesh is specifically designed to overcome the barriers of healthcare delivery in remote underserved areas.

 

Discovering on-ground realities

Our operations in Andhra Pradesh provided us in-depth insights and a complete understanding of the everyday realities of the nomadic tribals residing in the hard-to-reach locations of Araku Valley.

We discovered that the area’s pregnant tribal women do not have access to proper care, counselling and treatment, due to the tough terrains and difficult conditions. Secondly, a majority of the tribal children and adolescents in the Araku Valley suffer from anaemia and stunted growth because of poor awareness amongst the tribals on the importance of a nutritious diet. Although freshly grown millets, ragi, vegetables and fruits are readily available in the region, they are sold in the open markets and not consumed by them. In addition, decade old superstitious beliefs, which dictate that cow milk is meant for calves and not for humans, deprives the tribals of the much-needed nutrients and proteins.

These were a few factors that contributed to the high maternal and infant mortality rate in the region.

 

Ending preventable deaths

We realised that medical intervention alone will not have a sustainable impact and that our approach must include several factors to tackle the challenges faced by the communities in the area. Our strategy must incorporate community outreach, education, awareness, capacity building, access to specialists through telemedicine, identification of high-risk cases, referral and follow up. Taking all of this into account, Piramal Swasthya carefully designed Project ASARA to combat the region’s tribal health challenges and deliver overall primary healthcare to 1179 hard-to-reach habitations in Vishakhapatnam’s tribal belt area.

Our intervention included telemedicine services in Araku, Paderu, Chintapalle and Dombriguda mandals, as well as specialist care and quality healthcare service delivery to tackle the issue of inaccessibility. These centres are linked to our specialist obstetricians and gynaecologists in Hyderabad, and provide monthly antenatal and postnatal care for pregnant women and their infants, counselling and social interventions, training of traditional birth attendants, promotion of institutional deliveries and health and nutrition education to adolescents in these habitations.

Simultaneously, our trained Auxillary Nurse Midwives (ANMs) from these centres travel from habitation to habitation to register and create a database of pregnant women. This in turn, helps us keep a tab on the number of pregnant women in the area and provide them with necessary services. These ANMs also provide services at their doorstep and take them to the telemedicine centre and to the government hospital for their deliveries.

Additionally, to improve the nutrition level and awareness in the area, we set up a Nutrition Hub with the aim to increase local knowledge on diet during pregnancy and lactation; and ensure that children under five years receive proper nutrition through production, processing and preservation of locally available nutritious food.

Owing to the consistent and dedicated efforts by our staff and team over the past six years, we have served 49,000 pregnant women, reported zero maternal deaths in the last two years and improved the percentage of institutional deliveries from 18% to 68%. These achievements bolster our resolve and aim to complement and supplement the existing healthcare system. The Piramal Swasthya team is making great strides towards transforming the health ecosystem by moving towards a rights-based approach to achieve health promotion and behaviour change among the communities while providing quality services.

 

The way forward

India has made a commitment to achieve sustainable development goals (SDGs) by 2030. To usher in transformation in India by achieving the SDGs, we need quality implementation at scale, need-based innovative approaches and robust policies. Piramal Swasthya aims to bring in transformation through operational excellence, consistent research and innovation, focus on impact and advocacy.

With the success of our pilot in Araku Valley, our expansion plans aim to maximise reach in tribal areas and empower communities through community outreach, telemedicine services and nutrition hubs. We believe that the replication of this model across India’s tribal areas will have significant impact at scale on the country’s overall health indicators.

We, at Piramal Swasthya, strongly believe in collaborating closely with the government and plan to replicate the tribal health program across the country’s tribal areas, in turn, contributing towards achieving India’s Sustainable Development Goals (SDGs), ahead of time.

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American and Chinese tech titans battling in South East Asia

There is a major contest playing out on the smartphone screens of consumers in India, Indonesia and other emerging economies of South East Asia. American tech titans, holding billions in their thrall, are pitted against a Chinese dream team, as they vie for global domination.

Time and capabilities have changed as Chinese tech firms that once mimicked Silicon Valley products have now become pioneers. Mainland firms are now ready to make a strong play for markets which neither they nor American firms can call home. As they vie for the next billion consumers to come online, Alibaba is taking on Amazon, Baidu is matching against Google and Tencent is proving its mettle against Facebook. WeChat, a messaging app run by Tencent with endless bells and whistles, for example, rivals anything from California.

The American and Chinese tech giants have very different strategies. American firms typically set up outposts from scratch. They fund subsidiaries that offer to Indians or Mexicans the same services that their domestic users might expect. For example, Amazon in India has built a network of warehouses to fulfil e-commerce orders, rolled out its Prime video service (with added Bollywood content), website-hosting services and so on. Google and Facebook also provide offerings similar to those that consumers get in America. Google customers worldwide use the same Chrome browser, YouTube website or Android phone-operating system—and are served advertisements in much the same way. Also, it is easier for English-language firms than for Chinese ones to hire staff or to attract users.

On the other hand, the Chinese strategy in emerging markets has been not to set up shop itself but instead, to invest in local players, whether by buying them outright or acquiring a minority stake. The Chinese have built a constellation of firms focused on shopping, payments and delivery. These include Paytm and BigBasket in India, Tokopedia in Indonesia, Lazada in Singapore, Daraz in Pakistan and Trendyol in Turkey. Interestingly, most of their customers probably have no idea that these apps are backed by a Chinese tech titan.

The different approaches reflect the way the Western and Chinese firms make money. Google and Facebook earn the bulk of their revenue from advertising against services their users flock to. The downside of the American approach is that subsidiaries are wedded to a business model that proved itself in completely different circumstances. In contrast, the competitive advantage of Chinese firms has historically come from processing payments and organising distribution of goods in countries where these were previously tricky. The Chinese firms have a proven record of chaperoning hundreds of millions of emerging-market consumers onto the internet. They also enjoy the tacit support of their country’s government, keen on pushing them to expand in the countries near China. Yet, the Chinese firms sometimes end up competing against themselves.

The dynamic Southeast Asian market has emerged as the battle field for the burgeoning penetration of e-commerce, smartphones and digital economies. Whether the Chinese tech companies continue to globalise while challenging its Western counterparts or the latter successfully win the next billion internet users, this battle will define who primarily generates technological growth over the next two decades.

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Where does India-UK trade go post-Brexit?

It wasn’t supposed to be like this. As Brexiteers celebrated a wholly unexpected result the morning after the Brexit vote, the country was supposed to free itself the shackles of the European Union and go forth and trade with the rest of the world like never before.

A paper released by the Commonwealth just a few months after the Brexit vote said that trade “would increase trade between the countries by 25 per cent”. A recent India-UK Week of activities was euphoric in its ambition for increased bilateral trade.

But a few weeks ago, Unearthed released a copy of the official bilateral UK-India Trade Review, prepared for Joint Economic and Trade Committee (JETCO) on 11 January 2018. The document has been described as a key text for the new UK-India trade partnership announced in April at the Commonwealth Heads of Government Summit in London in April.

In short, it said that India will not benefit much from relaxation in non-tariff barriers such as inspection regimes and food standards post-Brexit, under the British government’s current proposed version of Brexit, because many decisions will “remain within EU competence”.

Based on current and potential future importance, the five goods sectors identified as “sectors of interest” for the UK are aerospace, chemicals, automotive, food and drink and life sciences.

In the services industries, UK education is likely the most important sector, followed by travel and tourism, and ICT. The big areas of potential identified here are in financial services, business and professional services exports from the UK to India.

IT and related professional services are by far the largest export from India to the UK. India therefore has a significant interest in concluding a bilateral social security agreement to ensure social security (National Insurance contributions) are not subject to double payment.

The Review highlights financial services as an area of increasing prominence for India globally, but that currently “links between the two countries are not yet deep enough to untap the full commercial potential for either side,” despite multiple bond listings on the LSE in the last three years, and a boom in AIM listings a few years earlier.

Issues faced by UK and Indian businesses in sectors of interest

While Indian IP law was seen as thorough, IP enforcement in the automotive sector was highlighted as a major challenge impacting the flow of advanced concepts and technologies from the UK.

The UK’s comments echoed similar frustrations other governments have too, largely around the complexity that comes from the lack of a common regulatory approach across states in India.

For example, in aerospace, while the scale of opportunity in India is massive, on-the-ground realities of the ease of doing business are different. Lengthy customs delays, lack of transparency and unrealistic local content requirements make it different to bring world-class technology to India.

In chemicals and the food and drinks sectors too, India has complex regulatory requirements that require harmonisation with global norms. For the latter, federal, state and intra-state regulation can be very confusing for foreign SMEs, product registration is difficult, as are many inconsistent labelling and licensing rules. That said, Indian exporters to the UK have broadly similar, specific complaints, which are highly likely to remain post-Brexit.

But the one big difference between the two is that the EU’s regulatory requirements are consistent across all EU markets, whereas India’s market is internally fragmented.

Repatriation of funds is unnecessarily complicated, due to regulatory complexity. While the Review didn’t specifically highlight the use of hawala transfers, progress in this area would be welcome all around.

Avoiding double-payment of social security contributions is an issue disproportionately impacting Indian IT workers in the UK. Pension rules introduced by the Conservative government outline that an employee is eligible for pensions benefits only after ten years of NI contributions. But Indian professionals often stay for less than ten years, still pay NI, and also pay social security back in India.

The big elephant in the room in the report was immigration. Just a page was devoted to this out of a 52-page report. This remains, by far, the big issue as far as Indian exports of services to the UK goes. At the same time, if it was easier for Britons to work in India at least by providing clearer FRRO, both countries would greatly benefit.

When we run monthly Doing Business in India seminars with chambers of commerce around the UK, including the Doncaster Chamber and East Midlands Chamber of Commerce, India is still perceived as a land of opportunity, but great complexity for UK SMEs. Not once has an SME said in these seminars that Brexit is a predominant reason for them wanting to trade more with India, as many in Westminster would boldly suggest.

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Balancing the issue of legal liability in the Age of Autonomous Vehicles

The constant development of technology has effectively changed the world we live in. It is safe to say that in 2018, most of the world and its inhabitants explicitly depend on technology in some shape or form.  However, as I navigate the waters of the legal sphere as a law student, I have come to appreciate the effects that new technologies have in shaping areas of the law.

No, we’re not talking about RoboCop or Isaac Asimov’s three laws of robotics, but something far simpler. Specifically, it is the focus on the age of autonomous vehicles that could challenge the laws that are currently in place. Would these introductions require new laws to regulate legal issues that may arise? Or would it rest on an alternate interpretation of the existing laws?

Though it might seem pedestrian compared to the futuristic realties often portrayed on the silver screen, this advancement poses several complex legal issues that are yet to be resolved. The novelty of this technology also means that there is no direct legal precedent for courts to rely on, making it all the more crucial to deal with questions of liability cautiously.

The majority of traffic accidents are caused because of human error and rashness be it by a pedestrian or an individual operating a vehicle. Driverless vehicles aim to eliminate human error and put in its place a software which displays road awareness and reaction speeds superior to any human driver. As a result, the driverless vehicle is hypothesised to be the safest vehicle on the road.

However, this does not guarantee a zero-accident rate as there will always be uncontrollable variables. And this raises the question as to who is liable when a driverless vehicle is involved in a traffic accident? The general direction points to product liability or liability of the manufacturer.

According to a paper written by Mark A. Geistfeld for the California Law Review, a manufacturer would fullfil its tort obligation by designing a “fleet of fully functioning autonomous vehicles [that] performs at least twice as safely as conventional vehicles.” Though this might appear to be a rather onerous burden on the manufacturer, it coincides with the very purpose of autonomous vehicles i.e. maximizing safety. Therefore, it should be expected that these vehicles are held to a higher standard compared to that of an ordinary, reasonable driver. Another responsibility of the manufacturer, pointed out by Geistfeld, is the disclosure of inherent risks of the vehicle’s operating system. By sufficiently disclosing these risks, manufacturers would allow auto insurers to calculate the premium rates to be offered, thereby providing a clear and quantitative indicator of risk to potential consumers. More importantly, countries need to put into place a regulatory framework for autonomous vehicles which clearly outline the duty of the manufacturer, the standard of care that they should be held to, and the ensuing liability should a fully functional driverless vehicle be involved in a traffic incident.

While several countries and innovators have advocated driverless technologies and its benefits, there are still those who are sceptical about the effect it may have on society. The chief concern is the potential security threat of the driverless vehicle’s system being hacked into or becoming infected by malware. It could also be a potential instrument for terrorist operations. Manufacturers have yet to specify the precautions that they will take to account for this threat. However, if a sufficient firewall is put into place and the programme is designed to have fail safes should it detect any third-party tampering, perhaps this will not be a plausible concern. Personal data protection and privacy laws that are currently in place should be able to account for such threats in the same vein as other software devices such as computers and smartphones. Once again, these statutes should be revised to ease the process of interpretation by the courts when handling this novel issue.

However, another issue of liability pertains to the role of the driver/passenger. What is to be expected of a person in a fully autonomous vehicle? The general trend seems to be that a driver, while alleviated of the physical act of driving, is still under a duty to keep a proper lookout and remain vigilant. It should be noted that there is a spectrum of automation with each level requiring the driver/passenger to have differing responsibilities.

Geistfeld’s paper further highlights that the National Highway Traffic Security Administration (NHTSA) in the United States of America for example, has provided a classification scheme which focuses on the level of human control from “no vehicle autonomy (level 0) to full vehicle autonomy under all conditions in which a human could otherwise perform the driving task (level 5).” This could be a template that other countries, regardless of their legal system, could look to, should they wish to explore the avenue of commercial distribution of autonomous vehicles.

Whether people remain sceptical or jump on the bandwagon of the fully autonomous vehicle, it appears as if the adoption of this technology is inevitable. Therefore, it is imperative that a country establishes a legal system that will be able to incorporate this advancement and account for the possible issues that are likely to arise. The world around us is constantly changing and the law should adapt to ensure proper regulation and accountability.

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Foreign Investors back India’s Electric vehicle push https://t.co/HCVK3TDt9N https://t.co/eWUP1mwNGl

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Foreign Investors back India’s Electric vehicle push

The Swiss engineering company ABB is poised to expand into India’s electric vehicle charging market by harnessing its strong foothold in the solar energy market to create a clean charging ecosystem for the country. According to the company, 50% of the solar energy passes through ABB inverters. The company has already installed a charging station at the NITI Aayog office, which is capable of charging an electric vehicle (EV) in 30 mins. The company locally manufactures

Bengaluru manufacturing unit has the capability of producing the necessary charging equipment and fast charging solutions are provided by the company in other countries. The company awaits government directives on various aspects of e-mobility like charging standards.

The Government of India does plan to electrify 30% of all vehicles by 2030. Although a formal EV policy has not been formulated at the national level, individual states are gradually adopting these in order to become electric vehicle friendly by reducing registration charges and creating supporting infrastructure vis-à-vis charging areas etc. Telangana has now become the fourth state after Karnataka, Maharashtra and Andhra Pradesh to have its own EV policy. The policy is mainly aimed at making the state EV vehicle friendly by measures such as reducing registration charges. It also aims at creating charging areas and basic infrastructure.

Even the private sector has shown interest in EVs with the motivation to create a clean ecosystem. Ola, with its Mission Electric programme, plans to have one million electric vehicles on its platform by 2021. It plans to introduce 10,000 EVs, mainly e-rickshaws, over the next 12 months. The company is working with state governments and hopes to have a robust business model ready, after an extensive period of testing.

Other companies like Suzuki, Toshiba and Denzo plan to produce lithium ion batteries for EVs in India. Currently, they are mostly imported from China. Lithium-ion batteries account for 50% of the cost of an electric vehicle and making them is relatively more expensive than the batteries for traditional cars. Thus, local production of lithium ion batteries will be a welcome move for a clean energy ecosystem in India.

As a way forward, India must make the switch to EVs and creating a clean energy ecosystem. According to a NITI Aayog and Rocky Mountain Institute report, India can save 64% of anticipated passenger road-based mobility-related energy demand and 37% of carbon emissions in 2030 by pursuing a shared, electric, and connected mobility future. This will also mean saving around INR 3.9 lakh crores in 2030, if the price of crude oil is taken as US$52 per barrel. The report further states that India’s massive IT industry can be mobilised to serve the needs of the new ecosystem by creating new employment opportunities and boosting foreign investments and the larger economy. Flagship schemes of the Government of India like Digital India and Make in India have already boosted entrepreneurship and will be beneficial for the economy.

Thus, India has the all the makings to successfully switch to EVs and create a cleaner and greener energy ecosystem in the near future.

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