Cow Patties & Big Pharma

We’ve been reminded frequently during this seminar that the vast majority of India’s 1.2 billion people live in rural areas where access to healthcare is spotty at best. The reasons for the lack of quality healthcare outside urban areas are many, including lack of infrastructure, a largely impoverished population without means to pay for care; the very low level of public health care spending in India; and the lack of qualified healthcare providers particularly outside of the larger cities. Each of these factors influences the other; for example, we learned at the Public Health Foundation of India that there is a 70% absentee rate of doctors in public rural health facilities. A physician is hired for a job, but he fails to show up at the public facility 70% of the time because he can make more money seeing patients privately than the public system pays him. These factors create something like a perfect storm of inadequate healthcare, and what’s left behind is a country with one of the world’s 10 largest economies, producing health outcomes in its poorest states that are on par with Sub-Saharan Africa and struggling nations like Bangladesh.

As an MBA student, what I’m about to write may be considered sacrilege, but I work for a charitable, nonprofit healthcare organization, and I cannot help that I am fully indoctrinated in that model! I am fascinated that organizations like Novartis and Sanofi Aventis look at India’s public health failure in the rural areas and see a business opportunity. It brings to mind the artfully-stacked piles of cow dung patties we saw in the semi-urban villages outside of Delhi. These pharma companies are following the steps of that first guy who so long ago must have picked up a pile of poop, and said to himself, “this smells awful, but I bet we can use it for fuel.”

While personally my left-leaning perspective leads me to doubt that private enterprise can ever be trusted on its own to do right by individuals and communities as a whole, I have to acknowledge that business moves fast while government… well, lately it seems like the world-over, government just doesn’t move. Novartis in particular is working in rural communities towards improving health through its Arogya Parivar Rural Program. Of course their true intent is to sell these people drugs, and our guest speaker Anirban Roy who heads the program was forthcoming about that, but if Novartis sells medication that the community needs, at prices they can afford, while also improving the public’s awareness of other important health concerns, is there a problem? Well, at least for now, Big Pharma’s activities may be one of the most effective, if not the only, public health projects that the rural communities have going. I just hope someone is keeping an eye on them!

Public – Private partnership is a catch phrase we’ve been hearing a lot over the last week and a half, largely in relation to how private hospitals will provide care to those who cannot afford to pay. If we can compare health care in India to crossing the street in India, I feel like what we are seeing is the Private sector taking the Public sector by the hand and leading them into traffic. The only way to get anywhere here is to step in front of on-coming vehicles, and it seems like the Public sector isn’t ready to lead the way across the street quite yet.