Elsevier Commits To Revive Indian Healthcare System

Dr. John Danaher, Elsevier is a prominent healthcare expert with a comprehensive background as an educator, entrepreneur, and respected physician. At Elsevier, he heads the Clinical Solutions division and is former leader of Education where he led the transformation from a traditional publisher to an educational digital solutions provider, focused on improving student and program outcomes. His deep understanding of both patient needs and the shortage of qualified healthcare professionals drove him to find solutions for students through a quality education that puts them on a career path to long-term, prosperous employment.

In Conversation with BW Businessworld, he talks about Indian Healthcare system and need to upgrade the system to prevent health hazards and to increase workforce productivity.

What do you think of Indian healthcare system?

I think the Indian healthcare system is overloaded with vast demand – supply gap, but is at the cusp of some significant changes, with increasing focus and investments. I am very encouraged to see the focus that the Indian people have on healthcare and the priorities of the Indian Government, with the recently-announced National Health Policy (NHP) 2017 acknowledging the critical role that digital health tools are expected to play to improve efficiency and public health outcomes in India.

Have you heard of Gorakhpur tragedy where many children died in a hospital in Uttar Pradesh? What do you have to say about that?

Yes, I heard about the unfortunate incidence. There are couple of points I would like to make – One, obviously it is about Japanese encephalitis, a preventable disease endemic to that particular area. There is clearly an opportunity for promoting healthy lifestyle and preventing recurrence of the disease in that geography. .

I have a feeling that public health is clearly a focus area for the government and there is an intent to take some critical steps in this direction to promote quality healthcare to all Indians.

Secondly, with respect to the specific tragedy, it’s clearly a case of operational inefficiency that led to the unfortunate incidence. This points towards the need for better operational governance in the healthcare system. There are tools and techniques to help prevent such situations, and we need to look at all available options to prevent recurrence of such incidences.

So, do you think that the Indian government is working better in the healthcare?

I get this sense from my meetings in two areas – a number of ministers were saying at the conference and the various representatives from Niti Aayog. Clearly, there are two priorities of this government and they are healthcare and education. From my experiences in the healthcare sector in South East Asia, you know that those two priorities are the right focus and the right emphasis. I attended a session in which Alok Kumar from Niti Aayog was present, I was impressed by the flexibility that the Indian government is taking to address the healthcare needs of the Indian people. I am also very impressed by the electronic medical records initiative for data capture. The appreciation to improve the healthcare for 1.3 billion Indians clearly has got to fundamentally start in the communities, villages and in big cities, etc. From our perspective it is to think about Public – Private partnership (PPP). So that is the area that we are extremely interested in doing everything we can to support the government priorities, and to figure out how to work with various organizations such as Niti Aayog, etc.

What do you think are the areas we need to touch upon for a futuristic approach? Can you suggest something?

In my opinion, there are three issues that has to be addressed. First one is what I refer to as ‘Low-tech’ issues. In the low-tech issues there are some things that have to do with clean water, sanitation, nutrition, communicable diseases, and infrastructure. I also spent time looking at the Japanese healthcare system and it’s these determinants of health that are the greatest predictors of the health outcomes. Japan, for example, they have the lowest mortality rate and they have long longevity because the population is well educated. It has housing, good nutrition, etc. So clearly what I would describe as a part of the reform for India in my opinion, consists of addressing the low-tech issues.

Then, there are ‘high-tech’ issues brought about by the democratization that the internet provides. Which is where we can be of great help to India in achieving its objectives. Elsevier produces more than 17% of the world’s clinical content and we produce it in lots of different forms and people know us. What we are very interested in with the high-tech issues, is where our content can be delivered to the Indian population in ways such as symptoms checkers, various patient engagement tools and education. Those are the things at the grassroots level we are interested in exploring. How do you get the digital solutions into the hands of the people in the communities and to 1.3 billion Indian people? In rural areas you have to educate the Asha workers and the various community healthcare workers, who are the ones to operate that point of care devices and collect the standardized information. There is definitely a role to play for high-tech solutions.

The other part is addressing the digital divide, where some have access to the internet and others who don’t. Some of the things that I am hearing about is PPP with Microsoft and Google that are working with the government to offer last mile internet connectivity. Google I think has a program for railways stations. Enabling them with internet access. So, that is the kind of innovation which I think is terrific.

What are your plans in India? Do you think that business sentiment are favorable for healthcare ventures?

Unquestionably. Elsevier has been in India for 20 years, working in partnership with medical institutions, government agencies and NGOs. During this time we have developed a good perspective on the market and its unique characteristics. I have said this in my address at CII conference that there is not a doctor or nurse in India or around the world that hasn’t been trained using our content.

From business perspective, we are extraordinarily committed to this country. All our senior executives have spent time this year in India. India is a key strategic market in which we believe that innovative technologies paired with knowledge-based solutions can have transformative impact on healthcare; standardizing it to meet the needs of its vast populace.

Are you planning to launch any vertical in India?

Yes, there are some things we would be interested in offering. If you look at some of the work that we have done internationally, for five years we ran an online health symptom checker for the National Health System (NHS) in the UK. In the first year alone, we had prevented 1.3 million unnecessary visits through our online symptoms checker.

There were 10 million people in the NHS that received our services in one year. So, again we were able to avoid 1.3 million unnecessary hospital visits that resulted in 57 million pounds worth of cost savings to the government. We also have protocols for 90% of primary care doctors in New Zealand. We have seen hospital admissions reduced by half. These are online protocols that we do to ensure that we are delivering care in the right direction. We have both primary care, patient engagement tools and then we have lots of patient education tools that we are interested in introducing. So we would love to engage in rolling out some of these solutions in India.

Are you planning to partner with any of the Indian institutes?

Yes, we are working with all the leading hospital groups and also with academic centers to understand the partnership models that we will work in. We are also in discussion with the Indian Nursing Council to understand how they wish to roll out these competency frameworks for training nurses across the country.

We should not see it from a commercial lens, we are looking it from a business vertical lens, which will eventually help us to fast track the learning abilities of these nurses and ensure that the minimum standards of the training are met.

What are your plans for rural India?

Two things are very critical for India’s healthcare program. One, people need to be made self-reliant in assessing themselves; this can be done through tools such as symptom checker. The second most important thing is delivering or access.

Secondly, they need to find the right solutions that can empower the Anganwadi workers. These solutions should include not only knowledge but also the tools to do their job better. The first step is in recognizing the issue, and the second is to identify which priority problem areas need fixing, and lastly is having a right solution to solve the issues. Several players in the healthcare ecosystem are required to come together to make an impact.

According to your observation, which country is doing well in the healthcare sector?

One thing I do think that has been a relatively good example is the ‘Affordable Care Act’ in the U.S., which provided financial incentives for hospitals to adopt electronic medical records. Every single hospital in the U.S. has some form of electronic medical record. So, what came together in the U.S. is due a lot to government leadership and intervention, as well as the financial incentives given to help hospitals to adopt electronic medical records. Also, Japan has traditionally been the best role model in encouraging the adoption of healthy lifestyle factors such as exercise and good nutrition that lead to good health status.

Lots of people in India are moving towards yoga, are you catering to the needs of those people as well?

Ans: In my opinion, anything that leads to wellness, such as Ayurvedic medicine and yoga, and anything else that plays a role in prevention, and that helps people feel physically and spiritually fulfilled, is a terrific idea.

Would you want to talk about your company investments in India?

I think global companies seeking to operate in India and Indian companies in some ways are following a different business model. It has a different business model than what you may find in the U.S. and other western European countries. The price point tends to be lower but the volumes more than make up for it. The issue is that building volume or acquiring scale takes time. One of the realization I have about making investments in India is that if we judge the currency value against the U.S. dollar, it is going to have different return horizons. In China also, there is a realization that the business opportunities are definitely there, and it is just about finding and managing expectations that one of those returns will be realized.