[Article Source : Business Standard]

Of the 5 billion medical injections administered in India every year, 62 percent are unsafe – startling figure that brought Marc Koska, inventor of non reusable K1 syringes, to India

This is how the article starts – one of the innumerable “startling” facts waiting to jolt the social entrepreneur inside us into action. With the population at large struggling for basic necessities, medical care and medical safety get relegated to the background and even numbers like 300,000 – the number of people killed as a consequence of usage of unclean syringes – seems adjustable.

However, this particular fact jolted Marc Koska into action. Marc heads the company, Star Syringe – which pioneered the non reusable K1 auto-disable syringe and also spearheads the UK-based charity SafePoint.

SafePoint spearheaded a campaign across the country in November last year, which propelled the government to make the use of Auto Disable (AD) syringes mandatory in all public health centres from April 30

While reading the article I was inclined to think of the ban on smoking in public places and wanted to know what if this directive too went the same way. The last paragraph provides an answer – “At the moment, not using AD syringes is not a punishable offence”

Social entrepreneurs play a vital role in goading the government to take cognizance of issues of the land and pass legislation to tackle them. However, in a country like India, passing the legislation is, but, just a start. We also need to ensure that laws are implemented in the spirit.

On the sidelines – Read this article while reading up on Marc Koska. Incidentally, I also read an article on Social Edge a couple of days back “Are the Only Innovations in Social Entrepreneurship Anglo-Saxon?“. I have not yet taken a side in this interesting debate. At the same time I want to mention it at this point because sometimes there are underlying reasons why the very same facts have varying affects on various people. The same incident can be life-changing for one and life-as-usual for another. Something for us to chew on!

Update from the Editors: This project has actually be reported on before by Prerna. You can read it here. What is new is the inclusion of an education component.

In an interesting role reversal, The Government of India along with its technical partner for the project HCL Infosystems, will be “setting up an e-networking infrastructure in 53 African nations to share its expertise in the field of medicine and education.” [iGovernment]. The initiative will remotely connect twelve hospitals within India to five of their African counterparts in order to disseminate best practices for medical care. Additionally, seven Indian universities will establish linkages with five African universities for tele-education services.

According to HCL’ CEO Ajai Chowdhry,

“We have to understand the challenges complex markets like India and Africa face and work towards enabling IT as a means for development. This pan-Africa e-network project is a significant step towards allowing this expertise to benefit African countries in their developmental efforts.”

The efforts do not end there, however, as these seventeen hospitals (12 India, 5 African) will then connect to 53 remote facilities across Africa. “The tele-medicine and video conferencing capabilities will enable e-diagnosis and advice for patients at these facilities.” A similar scope will be implemented for the universities as well.

My reaction is after the jump.

In my opinion, this venture is great for three major reasons. First, it is a rare example that I have come across where the Indian government appears to be effectively using the PPP (public-private partnership) model on an international scale. Doing so provides for a mutually beneficial means for improving international relations between India and its allies.

Second, the effort recognizes that development cannot occur in a strict linear or chronological path. India has many problems with its own medical and education sectors, and could easily have decided to wait until they have ’solved’ their own problems before reaching out and helping others. But that short-sighted thinking fails to recognize that such problems are persistent, pervasive, and in some respects permanent, and the failure to at least disseminate whatever lessons learned so far would have serious consequences for other nations. The fact that India looks to help others does not preclude that the country is still searching for ways to help itself.

Third, and this one is linked to the two reasons above, this initiative provides an opportunity for India to test new ideas both at home and abroad — leveraging a greater network of beta users that will hopefully help them improve the services more quickly. Doing so should help not only the people of Africa, but Indian citizens as well who will likely benefit from the same technologies that are being implemented in the African continent.

Plastic is a daily companion, even in the remotest of villages. The roads may be not be paved, means of transport may be scarce, but there is bound to be a cluster of small stores that inevitably sell the same products – tobacco, fried snacks, water pouches, Balaji potato chips – all wrapped up in plastic. Whether it’s North India or South India, the story seems to be the same.

The sheer affordability of plastic is what has made these types of amenities commonplace. But it is also the this very characteristic that has led to the accumulation of megatons of plastic in landfills and garbage dumps – plastic that will outlive us and possibly our offspring, and contribute to environmental degradation in the process.

So what’s the alternative? Ireland has started taxing the usage of plastic shopping bags, cutting consumption by 90%, and raising millions of euros in revenue in the process. In a few states in India (Himachal Pradesh, for example), the usage of polyethylene bags is completely banned. These types of methods seem to suggest that what is required is behavioral change – if plastic is here to stay, then we must find ways to minimize its usage, maybe by abstaining from buying products wrapped in obscene amounts of utterly pointless plastic packaging, or using cloth instead of plastic. That’s one option.

Another option is to revolutionize the manufacture of plastic completely, or, alternatively (especially in the face of an oil deficit), transition to an equally viable substitute. Long-term thinking, I know, especially since practically everything we consume uses plastic in some form, and leads to affordability in areas as seemingly disparate as medical care and transportation. But then, it’s the same argument we face with regard to the usage of oil – the question is no longer, “how do we transition to an economy that is less oil-dependent?”, but rather, “we must do so in order to sustain existence as we understand it.”

Fortunately, there are glimmers on the horizon that could potentially revolutionize the way we view plastic. One of them is an experiment being conducted by the Defense Food Research Laboratory (DFRL), Mysore, which has led to the development of a “packaging film” that degrades within 100 days. According to A.S. Bawa, DFRL Director, “various biodegradable films, based on granular starches like potato, tapioca, rice, corn, and others incorporated in Low Density Polyethylene (LDPE), are under development.” Currently, the plan is to experiment with the plastic in the military sector, and then potentially transfer knowledge and technology to the civil sector.

Source: Hindustan Times, May 30, 2008 (from “News You Can Use,” a print publication by Communication for Development and Learning)

The following is a guest post by Jason Ye, a MD/MBA student at Columbia University and an InSITE fellow alongside yours truly. Jason visited India during his spring break on a project organized by Columbia’s International Development Club and worked on pro bono consulting project with LifeSpring Hospitals. Go here for a post on this venture to provide affordable medical care to women and children. While Jason’s work must remain confidential, he was able to reflect on his experience during his work with this great organization.

I had always wanted to visit India, but never thought that I would go for at least another 15 years. When I fortuitously stumbled upon the opportunity to work with LifeSpring, a maternity hospital in Hyderabad, I jumped on the opportunity. It would seem that the entire trip accidentally fell into place. I was able to speak to the client for the first time only a week before I left, just barely got an appointment to get travel vaccinations, got my tourist visa the day before I traveled and bought my plane ticket on the morning my plane left. When I finally arrived in Hyderabad, I still had no idea what to expect. But my experience in India far exceeded any expectation that I could have had.

The first thing that I noticed was the famous Indian hospitality, which was so sincere and gracious that it sometimes made you feel uncomfortable. But besides kind, my hosts at LifeSpring Hospital, a niche provider of low cost, high quality obstetric care, were some of the most passionate and resourceful individuals I have met. Driven by their mission to bring quality health care to patients regardless of their income levels, they are testing the lower limits of low cost health care. A normal delivery costs only $38 USD and a caesarian section costs only $150 USD, a stark contrast to about $6,000 USD and $13,000 USD respectively at a US hospital. Despite the discrepancy in prices, the Indian doctors were as good as any American one; I verified this personally after scrubbing into a caesarian section. Although the facilities cannot compare to a US hospital or the elite private Indian hospitals, it was still much better and safer than the government hospitals.

After days of observations, research and interviews, I arrived at a set of recommendations which I hope will help LifeSpring continue its noble mission. But to some extent, I was the one who benefited most from this pro bono consulting project. LifeSpring’s vision of helping those who are most in need has reaffirmed the reason why I wanted to be a doctor. Its clever business model has taught me that success in entrepreneurship is not determined by capital, but by passion.

Of this I am certain: I will return to India and I will return to LifeSpring.

Why is the quality of medical care substandard in India? Is it because of a lack of medical professionals, or the fact that the public sector improperly trains many of them? One paper that has recently been published tries to test out the assumption that the major reason why the quality is generally low is because of a lack of knowledge on the parts of the doctors. The paper, which is explained on Ending Poverty in South Asia, separates along two criteria — that which doctors know and that which doctors do.

What doctors know—measured by testing doctors—represents the maximum care that a doctor could provide. What doctors do—measured by watching doctors—represents the care they actually provide to real patients. We call the first “competence” and the second “practice quality”.

The paper’s findings are after the jump.

First, public sector doctors always do a lot less than their private sector counterparts—between 66 and 50 percent less depending on how competent they were to begin with. Second, even in the private sector, there is a large gap between knowledge and practice. Doctors who correctly covered 60 percent of essential tasks when tested ended up covering just over 30 percent when dealing with actual patients. Third, about the only “doctors” who are practicing at the frontier of their knowledge are those with very low competence—those who covered 20 percent or less of essential tasks when tested.

These conclusions raise some troubling issues. First, the utility of additional training for doctors seems limited beyond the most basic levels, since they are unlikely to use this additional knowledge in practice. Second, this suggests that doctors need exogenous pressures to improve quality of care as their own desire to provide the highest level of affordable care is insufficient to ensure quality control.

The paper suggested other factors that may contribute to this such as a lack of well-defined malpractice laws and legal liabilities. However, the paper does recognize that before such hypotheses can be confirmed, a similar study on rich countries must also be conducted.