The much-awaited low cost laptops are ready to be delivered to IIT-Rajasthan. The institute is the nodal institute for conceiving and monitoring the progress of manufacturing of these gadgets in various states. The first lot of 10,000 laptops – the HRD ministry calls it low-cost access-cum-computing device — came after six years of its conception.
IIT-Rajasthan will receive the laptops in late June, and over the next four months 90,000 more would be made available at Rs 2,200 a piece.
The announcement was made at the recent state education ministers' conference. After the supply of 1 lakh laptops, every state will get 3,000 pieces. The Centre would subsidize 50% of the cost. Effectively, a student would have to pay Rs 1,100 for the gadget. Officials said manufacturing of one lakh laptops has been done in India.
As for the cost escalation from the earlier promised price of Rs 1,500, officials said it is due to increase in input cost. "But once more orders are placed, the price would be renegotiated and brought down to Rs 1, 500," an official said.
The delay in manufacturing this device was caused because the company which was given the contract to manufacture one lakh pieces, was bought over. "Now, we've built enough safeguards in the contract with new manufacturer," the official said.
The low-cost device has a seven-inch touch screen, two USB ports, battery that runs for three hours, external hard drive or solid state memory support up to 32 GB.
The device would have Word, Excel, power point, PDF, Open office, web browser with javascript support, zip/unzip facility, video streaming, flash video and many other software applications. It can operate in extreme conditions, officials said, adding that IIT-Rajasthan is putting the samples through further tests.
[Source: Times of India]
Thursday, June 9, 2011
Saturday, May 28, 2011
The Best Way To Innovation? – An Important Lesson from India
Indian Jugaad works not only at the BOP but also at the TOP(top of the pyramid)
Source:http://blogs.forbes.com/karlmoore/2011/05/24/the-best-way-to-innovation-an-important-lesson-from-india/
Innovation seems to be a prime directive at almost any firm I run into, regardless of industry. How do you get more of it? In these tough times the answer is no longer to throw money at it. What we increasingly need is frugal innovation, what the Indians call Jugaad. It is an idea, whose time has come.
Earlier this year I had the pleasure of traveling to India with 30 McGill MBA and B.Com. students to meet with executives of a number of large companies in New Delhi, Mumbai, and Bangalore as part of the ongoing Hot Cities of the World Tour. The word Jugaad turned out to be the word of the trip. A word that I believe should be adopted by many firms in the West.
We first ran into the word in London enroute to Delhi. What would have otherwise been an unfortunate 15 hour layover at Heathrow on the way to India, was made quite enjoyable thanks to a few activities in London, including a visit to the offices of The Economist. We sat down with Adrian Wooldridge, Management Editor and Schumpeter Columnist, who had just returned from India and was glad to share some of his thoughts with us.
One of the hot topics: frugal innovation, the essence of which is captured by the Jugaad mindset, a Hindi word that in a nutshell refers to making do with what one has to solve one’s problems (also implying a certain degree of improvisation). In a business context it means bringing innovative products to market despite limited resources – if not thanks to limited resources, since it is the financial constraints of producers or customers (or both) that drive the innovation in the first place. Frugal innovation results in great value: no-frills, good quality, functional products that are also affordable to the customer with modest means. If you want to hear more of what Adrian said about frugal innovation, listen to the youtube video below. It is only a recording, there is nothing to watch due to technical problems.
Throughout the trip’s many discussions three examples of frugal innovation stood out. One that everyone has heard of is the Nano, unveiled by Tata Motors in 2008, which now retails for just over US$ 3,000. Equipped with only the bare essentials, the car is mainly aimed at the domestic market where it is not uncommon to see a family of four crowd onto a motorcycle or scooter. Though it is still too early to say whether the Nano will truly become “The People’s Car”, we were told that it problems with working on really hot days, it nonetheless provides a good example of frugal engineering.
New low-cost technology in healthcare also has everyone talking. For instance, GE, which operates tech centers in Hyderabad and Bangalore, has introduced breakthrough items such as an electrocardiogram in a backpack and a computer-based portable ultrasound machine. They sell for only US$ 1,000 and $15,000 respectively (fractions of the usual prices for those devices) and are said to have the potential to revolutionize access to healthcare in developing countries. These products are now also being sold in the US. Interestingly enough, frugal innovation reverses the historical notion that multinationals innovate in rich countries in order to sell their products in poor countries. Hats off to the late C.K. Prahalad and his book, The Fortune At the Bottom of the Pyramid.
The concept of Jugaad, however, is not just about developing new technology. In fact, we witnessed firsthand the work of the Dabbawalas in Mumbai who demonstrated exactly that. The business model is simple: Dabbawalas collect freshly cooked meals in boxes from the homes of Mumbai residents and deliver them to the workplace for a (very) modest monthly fee (Dabbawala means “one who carries a box” in Marathi). What is not so simple is the delivery process. 5,000 Dabbawalas deliver 200,000 boxes per day using only bicycles and various modes of public transportation. Their supply chain is made up of a complex series of collection zones, sorting points, and delivery zones, supported only by an elaborate manual coding system. The codes are made up of only numbers and colors because 50% of the employees are illiterate. The only modern technology used in the process is are a website and a text message receiving system which allow customers to request deliveries in real time. Forbes Magazine awarded its Six Sigma certification in 2001 to the Dabbawalas based on a 99.999999 percent delivery accuracy rate (1 error for every 16 million transactions).
We spent over an hour at one of the sorting points observing the Dabbawalas, doing our best not to get in the way of the constant exchanges of packets between bicycles, a sort of controlled chaos (which we came to learn describes much of Indian city life). We recounted a few lessons that we took away from the experience. For one, frugal innovation goes beyond clever R&D. It has a lot to do with process – in this case, maximizing the efficiency of the supply chain. Second, sometimes less is indeed more. No fuel, no capital investment, almost no modern technology, and yet a high quality of service: that’s frugality at its best. And third, the circumstances of the operating environment matter a great deal when it comes to frugal innovation. One of the main reasons the Dabbawalas are so successful in Mumbai but haven’t yet expanded to other cities is that their system is built on a combination of characteristics that is unique to Mumbai.
A few days in Bangalore and Mysore allowed us to spend some time with two companies that are at the other end of the tech spectrum: Wipro and Infosys, two of India’s top IT companies. At Wipro, much of the discussion centered around cloud computing which, I must admit, was a indeed a little cloudy prior to this informative session. Cloud computing is frugal because it eliminates the need for expensive local storage on computers, and optimizes the use of remote data servers due to scale advantages.
But how is frugal innovation sustained? A tour of Infosys’s spectacular 335-acre campus in Mysore and a visit to its Leadership Institute made it clear to us that the company doesn’t leave that up to chance. Gone are the days when Indian IT companies could rely on their access to cheap labor to compete on price with foreign multinationals – the fact that IBM is now the second largest private sector employer in India is just one example of why. So the differentiating factor is quality of service, which must be upheld by constant innovation. Much of Infosys’ ability to continually innovate can be attributed to its emphasis on recruitment and training. The campus in Mysore alone produces 10,000 graduates every year while grooming another 500+ employees, chosen from offices around the world, to eventually hold senior leadership positions. Infosys has grown from 7 employees and US$ 250 in 1981 to a truly global company with over 130,000 employees and a market cap of over $US 35B today, so there must be something about its model that works.
How do we use frugal innovation back here in the West? Actually, I think we are doing a lot of it now but given where our economies are I believe we need to use it more. With one big airline that I am working with I am encouraging senior managers to adopt this approach.
The airline industry today simply does not have money to throw after their problems, if it ever did. There is still room for CEO led big hunkin’ transformational change. But I think the dominate route to corporate transformation is to allow a 1,000 flowers to bloom, fertilize the best and then when they have proven themselves in pilots, scale them up and spread the key few winning innovations across the organization. This connects middle managers that are close to the customers and the day-to-day work of the airline with the real business problems of today’s airline industry. As middle managers they have credibility and access to the senior executives who, correctly, control the purse strings. In my mind, Jugaad is a concept that appears to work in India and back here in the West.
This column was with written with a great deal of input from two McGill students who joined me on the trip to India this year, Veronica Dasovich from St. Paul, MN, one of our many wonderful U.S. students at McGill and Daniel Novak, a native Montrealer.
Source:http://blogs.forbes.com/karlmoore/2011/05/24/the-best-way-to-innovation-an-important-lesson-from-india/
Innovation seems to be a prime directive at almost any firm I run into, regardless of industry. How do you get more of it? In these tough times the answer is no longer to throw money at it. What we increasingly need is frugal innovation, what the Indians call Jugaad. It is an idea, whose time has come.
Earlier this year I had the pleasure of traveling to India with 30 McGill MBA and B.Com. students to meet with executives of a number of large companies in New Delhi, Mumbai, and Bangalore as part of the ongoing Hot Cities of the World Tour. The word Jugaad turned out to be the word of the trip. A word that I believe should be adopted by many firms in the West.
We first ran into the word in London enroute to Delhi. What would have otherwise been an unfortunate 15 hour layover at Heathrow on the way to India, was made quite enjoyable thanks to a few activities in London, including a visit to the offices of The Economist. We sat down with Adrian Wooldridge, Management Editor and Schumpeter Columnist, who had just returned from India and was glad to share some of his thoughts with us.
One of the hot topics: frugal innovation, the essence of which is captured by the Jugaad mindset, a Hindi word that in a nutshell refers to making do with what one has to solve one’s problems (also implying a certain degree of improvisation). In a business context it means bringing innovative products to market despite limited resources – if not thanks to limited resources, since it is the financial constraints of producers or customers (or both) that drive the innovation in the first place. Frugal innovation results in great value: no-frills, good quality, functional products that are also affordable to the customer with modest means. If you want to hear more of what Adrian said about frugal innovation, listen to the youtube video below. It is only a recording, there is nothing to watch due to technical problems.
Throughout the trip’s many discussions three examples of frugal innovation stood out. One that everyone has heard of is the Nano, unveiled by Tata Motors in 2008, which now retails for just over US$ 3,000. Equipped with only the bare essentials, the car is mainly aimed at the domestic market where it is not uncommon to see a family of four crowd onto a motorcycle or scooter. Though it is still too early to say whether the Nano will truly become “The People’s Car”, we were told that it problems with working on really hot days, it nonetheless provides a good example of frugal engineering.
New low-cost technology in healthcare also has everyone talking. For instance, GE, which operates tech centers in Hyderabad and Bangalore, has introduced breakthrough items such as an electrocardiogram in a backpack and a computer-based portable ultrasound machine. They sell for only US$ 1,000 and $15,000 respectively (fractions of the usual prices for those devices) and are said to have the potential to revolutionize access to healthcare in developing countries. These products are now also being sold in the US. Interestingly enough, frugal innovation reverses the historical notion that multinationals innovate in rich countries in order to sell their products in poor countries. Hats off to the late C.K. Prahalad and his book, The Fortune At the Bottom of the Pyramid.
The concept of Jugaad, however, is not just about developing new technology. In fact, we witnessed firsthand the work of the Dabbawalas in Mumbai who demonstrated exactly that. The business model is simple: Dabbawalas collect freshly cooked meals in boxes from the homes of Mumbai residents and deliver them to the workplace for a (very) modest monthly fee (Dabbawala means “one who carries a box” in Marathi). What is not so simple is the delivery process. 5,000 Dabbawalas deliver 200,000 boxes per day using only bicycles and various modes of public transportation. Their supply chain is made up of a complex series of collection zones, sorting points, and delivery zones, supported only by an elaborate manual coding system. The codes are made up of only numbers and colors because 50% of the employees are illiterate. The only modern technology used in the process is are a website and a text message receiving system which allow customers to request deliveries in real time. Forbes Magazine awarded its Six Sigma certification in 2001 to the Dabbawalas based on a 99.999999 percent delivery accuracy rate (1 error for every 16 million transactions).
We spent over an hour at one of the sorting points observing the Dabbawalas, doing our best not to get in the way of the constant exchanges of packets between bicycles, a sort of controlled chaos (which we came to learn describes much of Indian city life). We recounted a few lessons that we took away from the experience. For one, frugal innovation goes beyond clever R&D. It has a lot to do with process – in this case, maximizing the efficiency of the supply chain. Second, sometimes less is indeed more. No fuel, no capital investment, almost no modern technology, and yet a high quality of service: that’s frugality at its best. And third, the circumstances of the operating environment matter a great deal when it comes to frugal innovation. One of the main reasons the Dabbawalas are so successful in Mumbai but haven’t yet expanded to other cities is that their system is built on a combination of characteristics that is unique to Mumbai.
A few days in Bangalore and Mysore allowed us to spend some time with two companies that are at the other end of the tech spectrum: Wipro and Infosys, two of India’s top IT companies. At Wipro, much of the discussion centered around cloud computing which, I must admit, was a indeed a little cloudy prior to this informative session. Cloud computing is frugal because it eliminates the need for expensive local storage on computers, and optimizes the use of remote data servers due to scale advantages.
But how is frugal innovation sustained? A tour of Infosys’s spectacular 335-acre campus in Mysore and a visit to its Leadership Institute made it clear to us that the company doesn’t leave that up to chance. Gone are the days when Indian IT companies could rely on their access to cheap labor to compete on price with foreign multinationals – the fact that IBM is now the second largest private sector employer in India is just one example of why. So the differentiating factor is quality of service, which must be upheld by constant innovation. Much of Infosys’ ability to continually innovate can be attributed to its emphasis on recruitment and training. The campus in Mysore alone produces 10,000 graduates every year while grooming another 500+ employees, chosen from offices around the world, to eventually hold senior leadership positions. Infosys has grown from 7 employees and US$ 250 in 1981 to a truly global company with over 130,000 employees and a market cap of over $US 35B today, so there must be something about its model that works.
How do we use frugal innovation back here in the West? Actually, I think we are doing a lot of it now but given where our economies are I believe we need to use it more. With one big airline that I am working with I am encouraging senior managers to adopt this approach.
The airline industry today simply does not have money to throw after their problems, if it ever did. There is still room for CEO led big hunkin’ transformational change. But I think the dominate route to corporate transformation is to allow a 1,000 flowers to bloom, fertilize the best and then when they have proven themselves in pilots, scale them up and spread the key few winning innovations across the organization. This connects middle managers that are close to the customers and the day-to-day work of the airline with the real business problems of today’s airline industry. As middle managers they have credibility and access to the senior executives who, correctly, control the purse strings. In my mind, Jugaad is a concept that appears to work in India and back here in the West.
This column was with written with a great deal of input from two McGill students who joined me on the trip to India this year, Veronica Dasovich from St. Paul, MN, one of our many wonderful U.S. students at McGill and Daniel Novak, a native Montrealer.
Thursday, March 17, 2011
SughaVazhvu: Replacing Doctors in Primary Healthcare Centres with Use of ICT
Inside Nachiket Mor’s Healthcare Laboratory
Nurses instead of doctors, software solutions instead of human judgement. This is the ex-banker’s radical premise to reconfigure primary healthcare in rural areas. M Rajshekhar checks out a pilot in a Tamil Nadu village.
Source: Economic Times, Kolkata Edition, March 18, 2011.
Nachiket Mor has been a banker half his life. He’s crafted new models to deliver financial services to villages. Yet, he is as comfortable talking about lipid-profile tests as liquid funds. Lately, though, he’s been listening a lot, to doctor-patient conversations at Karambayam, a village of about 3,000 people in Tamil Nadu’s Thanjavur district.
Karambayam is the site for one of the two healthcare clinics set up by Mor and his 30-member team to reconfigure primary-healthcare delivery in rural areas. It’s far removed from his life four years ago, when he was tipped to succeed KV Kamath at ICICI Bank. On leaving the bank in 2007, he moved to the ICICI Foundation to work on rural development. Last September, he left the foundation to take charge of ‘SughaVazhvu’ (happy life in Tamil).
SughaVazhvu is testing a radical idea: can technology replace doctors with nurses, human judgement with software solutions? “It is difficult to expect doctors to stay in villages,” explains Mor. “So, we are asking if a combination of technology and a reasonable amount of training (to local nurses), under the supervision of a doctor, can deliver superior outcomes.”
SughaVazhvu bears the imprimatur of Mor in its conception and design. By the end of his ICICI Bank stint, says a former colleague, Mor was seen as an “idea factory” without the ability to execute. “He once wanted to open 15,000 vocational training centres. We opened none,” says the ex-colleague.
“He over-promises, maybe because he is in a hurry to do something great.” As such, studying SughaVazhvu — the ailments it has diagnosed in rural healthcare and the cures it has been testing since November 2009 — is also a good way to reappraise Mor.
The clinic in Karambayam is a two roomsand-a-porch affair. On the porch lie three benches and some potted plants. The first of the two cream-coloured rooms inside is rimmed with paraphernalia for diagnostic tests. The second room is where the nurse and doctor meet patients.
As primary health centres (PHCs) go, it’s well-stocked. Most government PHCs remain dysfunctional, crippled by an absence of doctors, medicines, equipment and medical records. “Doctors make their diagnosis more on the basis of judgement than data,” says Zeena Johar, president of ICICI Knowledge Park’s Centre for Technologies in Public Health (ICTPH).
Then, while chronic diseases like diabetes are widespread, the equipment for spotting and treating them is missing at the PHCs. As are essentials like eye-care and dental. Mor, who is a member on the Planning Commission’s National Commission for Universal Healthcare, says 95% of healthcare needs can be met at PHCs.
“The PHC should deliver ‘managed healthcare’ — tracking an individual’s health indicators over her life — and direct her to secondary, tertiary and home care as needed.” He thinks technology, arranged and harnessed intelligently, can be the answer.
So, SughaVazhvu monitors the health of the people of Karambayam and Alakkudi — the other village where it has a centre. At the outset, it asks villagers extensively about their medical history, through a standard questionnaire. The objective is two-fold: one, when a patient makes a repeat visit, their symptoms can be seen in conjunction with their medical history. Two, a person’s health can be tracked continuously.
SughaVazhvu is also testing if technology can help address the shortage of doctors. It is testing a nurse-managed, doctor-supervised model, pumped by technology and protocols. “Medicine is driven by rules,” says Johar, a PhD in molecular diagnostics and biochemistry. SughaVazhvu relies on three sets of protocols. The first captures a patient’s medical information. The second codifies how the tests are to be conducted. The third helps with diagnosis of 20 common ailments, including upper respiratory infections, gastro-intestinal problems, diabetes and hypertension.
When a patient comes to SughaVazhvu, the nurse feeds the person’s symptoms into the computer. The software views the symptoms in conjunction with the patient’s medical history, and recommends diagnostic tests. If the diagnosis is confirmed, the treatment recommended is validated by a doctor and administered. If not, the nurse refers the patient to a doctor. This model, claims Mor, reduces the need for a doctor. The Medical Council of India mandates one doctor for every PHC. SughaVazhvu has asked the council to allow one doctor to supervise 5-20 centres. “80% of diseases can be dealt through protocols,” says Johar. Dr T Sundararaman, who runs the National State Health Resource Centre, which advises the Central and state governments on the National Rural Health Mission, is unsure. “At a couple of levels, this (SughaVazhvu) is very simplistic,” he says. “Diagnosis involves pattern recognition. I’m not sure you can replace judgement with a database.” He doesn’t think technology will make the difference. “Trained nurses will.”
Sundararaman also warns about the power and politics in healthcare. “When you are doing pilots, everything is fine. The opposition starts when you try to scale up,” he says. “Political boundaries have to be scaled.”
These are still early days for SughaVazhvu. It doesn’t have concrete answers on the model or its funding. Each centre entails a capital cost of 5.5 lakh and a running cost of 70,000 per month. ICTPH is funding the entire amount. When it was free, the Alakkudi centre was seeing 120 patients a day. When it started charging 50 per visit, hardly anyone came. It has since reduced the fee to 15, and now sees about 10 patients a day. What makes finding answers tougher is the state chosen for the pilots — Tamil Nadu.
Mor says Tamil Nadu was chosen because its healthcare set-up is good enough to experiment with next-generation questions. But it also means SughaVazhvu is competing with a good, and free public health system. Further, villagers have not grasped SughaVazhvu’s USP: healthcare management.
At the Alakkudi centre, Dr Chitra Ramaswamy says the below-poverty-line (BPL) households first go to the government PHC, but come to SughaVazhvu if they are not cured. The rich come to SughaVazhvu first, but go to Thanjavur if dissatisfied.
SughaVazhvu resembles the rural banking pilots of Kshetriya Gramin Financial Services (KGFS), another pilot mentored by Mor. Both seek to replace, to some extent, tacit knowledge with protocols.
Says an industry peer who has seen Mor from close: “Nachiket has managed to create a team that complements him better. That was not the case in ICICI.” Also, he says, Mor is spending more time in the field — that too in a limited geography thinking about a limited set of issues. “I see a lot more grounded ideas.”
Unlike KGFS, Mor doesn’t see SughaVazhvu being scaled up. “We just want to try different permutations and combinations,” he says. The plan is to set up five clinics, all funded by ICTPH, and leave it at that, but discover, perhaps, answers that help reconfigure how primary healthcare is delivered to rural India.
It is difficult to expect doctors to stay in villages. So, we are asking if a combination of technology and a reasonable amount of training (to local nurses), under the supervision of a doctor, can deliver superior outcomes
Nurses instead of doctors, software solutions instead of human judgement. This is the ex-banker’s radical premise to reconfigure primary healthcare in rural areas. M Rajshekhar checks out a pilot in a Tamil Nadu village.
Source: Economic Times, Kolkata Edition, March 18, 2011.
Nachiket Mor has been a banker half his life. He’s crafted new models to deliver financial services to villages. Yet, he is as comfortable talking about lipid-profile tests as liquid funds. Lately, though, he’s been listening a lot, to doctor-patient conversations at Karambayam, a village of about 3,000 people in Tamil Nadu’s Thanjavur district.
Karambayam is the site for one of the two healthcare clinics set up by Mor and his 30-member team to reconfigure primary-healthcare delivery in rural areas. It’s far removed from his life four years ago, when he was tipped to succeed KV Kamath at ICICI Bank. On leaving the bank in 2007, he moved to the ICICI Foundation to work on rural development. Last September, he left the foundation to take charge of ‘SughaVazhvu’ (happy life in Tamil).
SughaVazhvu is testing a radical idea: can technology replace doctors with nurses, human judgement with software solutions? “It is difficult to expect doctors to stay in villages,” explains Mor. “So, we are asking if a combination of technology and a reasonable amount of training (to local nurses), under the supervision of a doctor, can deliver superior outcomes.”
SughaVazhvu bears the imprimatur of Mor in its conception and design. By the end of his ICICI Bank stint, says a former colleague, Mor was seen as an “idea factory” without the ability to execute. “He once wanted to open 15,000 vocational training centres. We opened none,” says the ex-colleague.
“He over-promises, maybe because he is in a hurry to do something great.” As such, studying SughaVazhvu — the ailments it has diagnosed in rural healthcare and the cures it has been testing since November 2009 — is also a good way to reappraise Mor.
The clinic in Karambayam is a two roomsand-a-porch affair. On the porch lie three benches and some potted plants. The first of the two cream-coloured rooms inside is rimmed with paraphernalia for diagnostic tests. The second room is where the nurse and doctor meet patients.
As primary health centres (PHCs) go, it’s well-stocked. Most government PHCs remain dysfunctional, crippled by an absence of doctors, medicines, equipment and medical records. “Doctors make their diagnosis more on the basis of judgement than data,” says Zeena Johar, president of ICICI Knowledge Park’s Centre for Technologies in Public Health (ICTPH).
Then, while chronic diseases like diabetes are widespread, the equipment for spotting and treating them is missing at the PHCs. As are essentials like eye-care and dental. Mor, who is a member on the Planning Commission’s National Commission for Universal Healthcare, says 95% of healthcare needs can be met at PHCs.
“The PHC should deliver ‘managed healthcare’ — tracking an individual’s health indicators over her life — and direct her to secondary, tertiary and home care as needed.” He thinks technology, arranged and harnessed intelligently, can be the answer.
So, SughaVazhvu monitors the health of the people of Karambayam and Alakkudi — the other village where it has a centre. At the outset, it asks villagers extensively about their medical history, through a standard questionnaire. The objective is two-fold: one, when a patient makes a repeat visit, their symptoms can be seen in conjunction with their medical history. Two, a person’s health can be tracked continuously.
SughaVazhvu is also testing if technology can help address the shortage of doctors. It is testing a nurse-managed, doctor-supervised model, pumped by technology and protocols. “Medicine is driven by rules,” says Johar, a PhD in molecular diagnostics and biochemistry. SughaVazhvu relies on three sets of protocols. The first captures a patient’s medical information. The second codifies how the tests are to be conducted. The third helps with diagnosis of 20 common ailments, including upper respiratory infections, gastro-intestinal problems, diabetes and hypertension.
When a patient comes to SughaVazhvu, the nurse feeds the person’s symptoms into the computer. The software views the symptoms in conjunction with the patient’s medical history, and recommends diagnostic tests. If the diagnosis is confirmed, the treatment recommended is validated by a doctor and administered. If not, the nurse refers the patient to a doctor. This model, claims Mor, reduces the need for a doctor. The Medical Council of India mandates one doctor for every PHC. SughaVazhvu has asked the council to allow one doctor to supervise 5-20 centres. “80% of diseases can be dealt through protocols,” says Johar. Dr T Sundararaman, who runs the National State Health Resource Centre, which advises the Central and state governments on the National Rural Health Mission, is unsure. “At a couple of levels, this (SughaVazhvu) is very simplistic,” he says. “Diagnosis involves pattern recognition. I’m not sure you can replace judgement with a database.” He doesn’t think technology will make the difference. “Trained nurses will.”
Sundararaman also warns about the power and politics in healthcare. “When you are doing pilots, everything is fine. The opposition starts when you try to scale up,” he says. “Political boundaries have to be scaled.”
These are still early days for SughaVazhvu. It doesn’t have concrete answers on the model or its funding. Each centre entails a capital cost of 5.5 lakh and a running cost of 70,000 per month. ICTPH is funding the entire amount. When it was free, the Alakkudi centre was seeing 120 patients a day. When it started charging 50 per visit, hardly anyone came. It has since reduced the fee to 15, and now sees about 10 patients a day. What makes finding answers tougher is the state chosen for the pilots — Tamil Nadu.
Mor says Tamil Nadu was chosen because its healthcare set-up is good enough to experiment with next-generation questions. But it also means SughaVazhvu is competing with a good, and free public health system. Further, villagers have not grasped SughaVazhvu’s USP: healthcare management.
At the Alakkudi centre, Dr Chitra Ramaswamy says the below-poverty-line (BPL) households first go to the government PHC, but come to SughaVazhvu if they are not cured. The rich come to SughaVazhvu first, but go to Thanjavur if dissatisfied.
SughaVazhvu resembles the rural banking pilots of Kshetriya Gramin Financial Services (KGFS), another pilot mentored by Mor. Both seek to replace, to some extent, tacit knowledge with protocols.
Says an industry peer who has seen Mor from close: “Nachiket has managed to create a team that complements him better. That was not the case in ICICI.” Also, he says, Mor is spending more time in the field — that too in a limited geography thinking about a limited set of issues. “I see a lot more grounded ideas.”
Unlike KGFS, Mor doesn’t see SughaVazhvu being scaled up. “We just want to try different permutations and combinations,” he says. The plan is to set up five clinics, all funded by ICTPH, and leave it at that, but discover, perhaps, answers that help reconfigure how primary healthcare is delivered to rural India.
It is difficult to expect doctors to stay in villages. So, we are asking if a combination of technology and a reasonable amount of training (to local nurses), under the supervision of a doctor, can deliver superior outcomes
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