May 1, 2021
Day 4 into the lockdown in Bangalore, I was thinking of how we could transform healthcare in India. I thought of starting right at the bottom - the Primary Health Centers
This is an area ripe for social (for profit) entrepreneurship. And given that health care is a necessity and a core function of the Government. One could create a win-win for enterprises and consumers in partnership with the Government. I've just looked at the Primary health infrastructure as a strong system at the ground level can help increase overall health and wellness. Here are some stats and thoughts.
There are 30,045 primary health centers in India that are run by the government (Ref. 1 below). Each one typically caters to a population of 20,000 (rural/inaccessible areas) and 30,000 (Urban areas). These serve as a first level of healthcare. These typically have infrastructure to support an initial level of treatment before referring to the nearest larger hospital.
The National Health Policy 2017 proposed to create 150,000 wellness centres across India by 2022. This would typically cater to about 3,000 to 4,000 people per center. Very similar to programs in countries like the UK & Thailand. (Ref. 2). India would need to spend Rs. 30,000 Crores ($ 4 Billion) per year to run this. India's GDP in 2020 was $2.5 Trillion. In the 21-22 budget there was an allocation of Rs. 1.2L Crores for healthcare. While these would also go to other areas in healthcare - the Ayushman Bharat Health & Wellness Centers (ABHWC) program was allocated Rs. 6,400 Crores ($ 850M). That’s about 25% of what’s needed to run 150k centers. (Ref. 4)
The government could allow private enterprises to adopt/support/build and manage these. I am sure we can find enough businesses to operate these and business models that enable a win-win. The entire infra for say geo clusters of 250+ centers could be offered to a single player as it would help them leverage investments for higher operational efficiencies.
Here is a illustration of one such center, which is part of a cluster managed by Acme Corp, that was offered management contract for 1,000 centers.
Ayushman Bharat - Acme Center A-0001
A wellness center of about 4,000 sq feet. Housing 5 beds. 20 full time staff, pharmacy, store, lab, ambulance and infra as per guidelines (Ref. 6). All health records of individuals would be through the Ayushman Cards (Almost 18M of these have been issued) (Ref. 5). One could log in a case and get appointment fixed based on the severity of the case and doctor availability. In most cases the prescription can be done via app by the doctor. As the medical records of the patient is available - the doctor could make the appropriate diagnosis remotely - saving them time for cases that need physical presence. All basic services would be free of charge including medicines.
The wellness centre could sell ancillary products/ services to generate additional revenue. This would be limited to health/ wellness products. The coverage (captive market) for Acme would be about 3M people, about 3000 per center. Going by the data on the investment of 20L per year for each - it’s about Rs. 200 Crores/ year - about $26M. The Govt funding could be based on a funding model where it pays say Rs. 400,000 per center. (Based on the allocated budget for 21-22). This will generate Rs. 40 Crores (About $5.3M). And the rest could be through other offers and services. Doable? One would need to generate Rs. 533 ($7) per person per year. I think it leaves enough opportunities for "ethical monetization". Ethical monetization is something I coined where one does not take advantage and sell products or services that consumers don't need. So Acme could easily generate profits!
Acme Corp would generate employment for atleast 20,000 people (Approx 20 per center), of which 70% would be core healthcare professionals. I thought of also sharing some stats on healthcare workers in India. There are about 1.2M allopathic doctors in India, 2.3M nurses, 1.2M pharmacists, 0.2M dentists, 0.8M alternate med doctors (AYUSH) (Ref 3). One could leverage technology increase the number of patients each worker can serve. A simple example is the use of electronic BP machines that can be used with minimal training. Using automation to reduce time on tasks like manual report preparation, tele medicine and video consultations to address demand spikes. Acme would have centralised training infrastructure, cold chain for meds, ambulance, call centers & emergency management system etc. They would be managing 5,000 beds (5 per center). To put things in perspective - the Manipal group is the second largest hospital group in India with 7,000 beds (2021).
Healthcare is also getting Government interest. Few of these initiatives are managed under the Prime Minister Jan Aarogya Yojana (PM-JAY). The link below (Ref. 5) gives one a glimpse of all activities being done. It also has a startup challenge. But unfortunately most of the $ are chasing urban oriented businesses vs these.
Tks & hope this helps spark some ideas
Vinod
Data on Primary Health Centres in India. (https://pib.gov.in/PressReleasePage.aspx?PRID=1656190)
https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-021-00575-2
http://clinicalestablishments.gov.in/WriteReadData/360.pdf [Standards for PHCs by the Govt]
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