Reforming rural healthcare

Talking of rural healthcare solutions, there lies a fundamental ideology. The ideology of inclusiveness. This statement might sound absurd to some private company affiliates, as business and inclusiveness appear so disjointed from each other. So, before I share my thoughts on rural healthcare, let me give you a rationale for ‘inclusion’ as the basic ideology for rural healthcare. More inclusion… more customers….. greater sustainability! Although ‘inclusion’ might appear as an ideological argument from scholars like Amartya Sen; it indeed has a bearing on business ideology as well.

However, going rural is not an apple-to-apple affair, but a conscious effort to understand the rural customer, and not trying to sell them urban-product-copies. Rural customers’ paying capacity, ethos, needs and demands are drastically different from their urban counterparts. Probably from these differences emanates the idea of National Urban Health Mission being a distinct entity and not merely an extension of the National Rural Health Mission.

Same size doesn’t fit all!

I don’t intend to reemphasise on the topic, but to explore the magnanimity and dynamicity of our rural population which covers 70 per cent of our population, 833 million individuals, contributing 33 per cent to national savings, 45 per cent to the total GDP and 57 per cent to the total contribution. Such are the encouraging figures of rural India. Yet, despite all the encouragement, our efforts to go rural fall short. The reason is a lack of understanding that ‘same size doesn’t fit all’ and the necessary effort to understand ‘what exactly fits’. Another important factor is a complete or partial disregard to the paying preferences and capacity of the rural consumer. We rule out a rural business possibility by focusing too much on their paying capacity with a limited understanding of their paying preferences. How many of us have conducted studies on rural customer understanding and stratification? The dogmatic understanding of the rural economy is our prime mental barrier.

So what will?

So if same size doesn’t fit all, then what will fit our rural fellows? I am going to plunge into my business to address this question.

At Metropolis, by and large we undertake four categories of tests: routine, semi-specialised, specialised and super-specialised tests. However, in the case of a rural customer, often this categorisation gets altered and some of our general tests also tend to fall under the semi-specialised category. This flux is due to the doctor-prescription driven demand for the tests. In an urban health centre, a thyroid test would be a routine test, but for the rural masses this test would actually shift to semi-specialised. Why? Primarily because of the disease pattern, secondly due to the lack of trained medical personnel. The demand dynamicity changes. Given the case, there are two major growth drivers here. One is increasing the levels of awareness and the other is training of rural healthcare staff. Providing cost-effective solutions which a rural patient can afford to respond favourably to the generated demand.

Cost efficiency and innovations registry

When I think of diagnostics, point of care (POC) devices come first to my mind for their cost-efficiency. While an urban family’s point of care might begin at home (take the Glucometer example); in a rural setting these POC devices could be provided as an institutional service. However, we are so focused on tertiary care that we fail to see simpler solutions. Since we lack a centralised database of technological innovations where business potential could be sought, I am sure many such innovations get shelved. These shelved innovations from an intelligent country like India have enormous potential. We don’t even know the depth and the extent of such innovations. Hence, if we are to pick and choose game-changing technological innovations, a centralised healthcare innovations registry with a special focus on rural innovations is indispensable. This digital era is most favourable to make an innovation registry available and accessible. Unfortunately, such rural healthcare innovations registry is nowhere in the picture. As a business leader, I would be more than compelled to visit these innovations and explore ideas that could help make diagnostics cheaper.

Furthermore, it is important to cut off the frills on healthcare innovations and reduce the excess cost of getting them transferred to the consumers. Rural customer marketing is no-nonsense marketing, if your service is good; the cultural setting allows free word-of-mouth marketing. The service acceptance hinges on doctors, fellow folks and opinion leaders.

Financial access to health

All demands cannot be addressed by POC devices; neither can reducing prices alone ensure improved accessibility. The financial means to access healthcare services is an equally important demand determinant. Although there have been some efforts towards national health insurance, many more financial innovations are needed. The micro-insurance projects should be further studied and explored, and innovations in financial packages should be tried by both Government and private players. A laudable innovation in the national insurance programme is that of engaging private service providers in direct healthcare delivery as well as in third party administration. This is an innovation in its own way, and has a huge potential to reduce cost of health insurance.

Government support – if not complete intervention

I will echo my budget comments, which remain unheeded. Government cannot provide all services and it needs private sector reinforcement to reach the rural population. The most practical example from the diagnostic industry is the taxes on reagent costs and unexplored indigenous reagent market. With these baseline challenges any peripheral innovation to reduce the diagnostic cost wouldn’t lead to the desired level of price control. Such baseline challenges have kept the rural markets inaccessible for private players, while the government infrastructure continues to remain inadequate. Measures like tax exemptions on reagents and financial incentives could propel the private players towards the rural landscape.

Rural India is an unexplored treasure island of opportunities and success. We need to map out the means to reach it.