Author: gopaldevanahalli

Interested in Healthcare, Education, Digital, Public Policy

Categories
Healthcare

Covid Vaccine Distribution in India

India recently announced the approval of two vaccines – a) Oxford – Astra Zeneca & b) Bharat Biotech  – https://www.bbc.com/news/world-asia-india-55520658 . The big challenge now facing India is, how to vaccinate 1.3 billion people in the shortest time possible.

The numbers are staggering – both these vaccines are double doses and hence 2.6 billion doses need to be administered. Even if 3 million doses are administered a day, it will take over 2 years for the entire population to get vaccinated. The US, one of the first countries to start the vaccine rollout, is administering around 250,000 doses per day and the plan is to get to 1 million per day – https://www.businessinsider.com/fauci-us-vaccine-rollout-timeline-million-people-per-day-2021-1

While India has a good track record on vaccination, the infrastructure is primarily to vaccinate children (for example – no adult flu shots like in the US). Over 27 million new-borns are targeted annually for immunization under Mission Indradhanush, though the coverage is around 80% and varies across states – https://www.unicef.org/india/what-we-do/immunization. For Covid-19 vaccination, at 3 million per day, we are talking over 90 million per month!

In Aug, 2020, Nandan Nilekani, the Chairman of Infosys, had written an article on how to go about this mammoth task – https://www.hindustantimes.com/analysis/how-to-secure-india-against-covid-19/story-0HGNCAvDfFHtG9O8CBmDqL.html. He talked about building a vaccination infrastructure at scale(over 100,000 points), use Aaadhar to authenticate; issue digital vaccination certificates and have a workforce of over 200,000 people for this job.

The Indian government(GOI) hasn’t yet published a detailed plan on the vaccine rollout – there is mention of 300 million people being vaccinated by July https://www.hindustantimes.com/india-news/centre-draws-plan-for-vaccine-roll-out/story-8etCcg99dqlqnX6ysTVjOJ.html. The GOI will be working closely with each state government in the roll-out. In my view, the following are needed to make the roll-out a success:

  • Leverage Aadhaar to reach out to citizens and ensure that everyone is getting the vaccine dose – issue digital vaccination certificates
  • Involve private enterprises in the roll-out – private hospitals, clinics & diagnostic centers
  • Set-up dedicated vaccination centers across the cities – this will also give employment to thousands of people who are currently affected by the pandemic
  • Leverage private groceries for strengthening the supply chain including storage
  • Have a clear and transparent plan on who gets vaccinated when – jumping the queue should be treated harshly. Also ensure that disenfranchised societies don’t lose out
  • Address vaccine misinformation by being very transparent – time to leverage social media especially Whatsapp positively?

This is a grand challenge that India faces, but by planning and executing well, India can pull this off.

Categories
Career

The importance of planning during a job search

A few weeks back, I got a message from an ex-colleague from Bengaluru, wanting to talk about his career. Usually this is code for wanting to switch jobs but in this case, it was worse – my ex-colleague had recently been laid off during the midst of the pandemic. He had been working in this company for close to 10 years after graduation and this had come across as a complete surprise to him. He told me that for the last few years, he was working in business analytics and had developed good skills in that area.

He asked me if I could connect him to people who were hiring. While I said I would do that, I asked him, how he was going about his job search. The answer didn’t surprise me – like many other people I had interacted with in a similar situation, he didn’t really have a plan.

I suggested that he do the the following to build his plan.

  • List the category of companies that he should he be applying to:
    • Companies is his current industry – they would value his industry knowledge – this was a limited set of companies
    • Indian consulting companies – which would value his industry knowledge and his business analytics skillsets
    • IT services companies – they may value his skillset but not necessarily his industry knowledge as their clients were mostly outside of India
    • Companies focused on business analytics – this was his most recent experience and there were specialized companies
    • Start-ups – He wasn’t sure about this category considering the pay & the risks involved
  • Customize his resume for each category – emphasizing the aspects in his career which were relevant to that category
    • For example, he had worked on an important IT project in a business role and that was relevant to highlight to the IT services companies.
    • He had worked on a customer experience initiative and that was good to highlight to the Indian consulting company
  • Identify the companies in each category in the locations he wanted to be in
    • He was based in Bengaluru but was open to a few other cities
    • As we discussed, he realized that there were 10-20 companies in each category – the job universe had suddenly become quite large
  • Identify contacts that could refer him to those companies
    • His networking was quite restricted considering that he had worked in only 1 company
    • We however discussed and identified individuals apart from ex-colleagues – people from product and IT companies; thought leaders in his industry
    • His other networks – alumni networks, social networks
  • Reach out to the contacts and ask them to introduce
    • This is usually hard for many people – especially if you haven’t cultivated the networks over the years
  • Let people know that he was available to work as a free-lance consultant. The job search could take time and in the meantime he could take on short-term projects

I told him to create the plan and treat the job search like any other project. When faced with a major situation like a job loss, it is a natural tendency to lose control and get into a state of helplessness. I believe, that by developing a plan and executing on it every day, one could avoid that and can get positively energized – this would help in being more successful in the job search.

Categories
General

Reflections on 2020

For most of humanity, 2020 would rank as the worst year in the last couple of generations. The Covid pandemic has caused misery to millions of people across the world. Many people have lost lives, and many more have lost livelihoods due to the harsh measures taken to fight the pandemic. Life has also been very different for office goers, college students and school kids. With the approval of the 3 vaccines, it is expected that the world would finally be able to see the back of the pandemic by June 2021.

As I look back on 2020, the first thing that comes to my mind is gratitude – to the front-line health workers who fought bravely against the pandemic; the people who worked on delivering groceries and food to our doorsteps when we couldn’t step out & the public/government officials who responded to the pandemic.

I am also deeply grateful to various scientists, public health officials, pharma companies & philanthropists like Bill Gates who ensured we got vaccines in record time – this clearly shows that when the world gets together, seemingly impossible things can get done.

Many of us were lucky & privileged to work in jobs which could get done from home and work in industries where were less impacted by the pandemic – some businesses like the tech sector actually boomed during this time period. But so many others have been deeply impacted – their jobs were lost & companies were shut down. It will be a few more months of deep economic pain, before we see the turnaround, which I am pretty confident will happen once the vaccines are rolled out.

I was forced like many others to live a very different lifestyle – but some good things have emerged – spending more time with immediate family; connecting with more friends on Zoom, more reading & meditation(the not so good was the amount of time on TV).

The last 9 months have shown me that life is precious & momentary & it is important to appreciate every moment in ones life. As we step into a more hopeful 2021, here’s wishing everyone a happy new year.

Categories
Healthcare

Doctor Protests!!

There have been protests across the country by the doctors over the last few days, triggered by the disgraceful beating up of a junior doctor in a government hospital in Kolkatta. This crime against a doctor, unfortunately, is not an isolated incident. Many such incidents have been reported across the country in government as well as private hospitals.

Doctors have expressed the feeling of being let down by society – while they have been trained to handle anxious patients & family members, how can they deal with violence? Just imagine the mental state of a doctor if he or she doesn’t feel secure in their workplace. What if the same happens to any of us – say a banker or a hotel manager or an IT professional?? At this rate, apart from learning very difficult subjects in medical college, they have to be trained in self-defence!!

As citizens, we may feel frustrated with our Indian healthcare system – but doctors are not the reason for the many issues which affect our healthcare system:

  • Acute shortage of Doctors esp. in Government Hospitals – As of 2017,  India had around 10 lakh registered allopathic doctors and with an assumed availability of 80%, the Government of India, has said that we have 0.62 doctors for every 1000 persons. This is lower than the WHO norm of 1 doctor for every 1000 persons. The average population served per government allopathic doctor is 11,039.
  • Shortage of hospital beds – There are around 7.1 lakh hospital beds out of which 2.8 lakh are in the rural areas(which has 60% of India’s population). For rural, this translates to around 0.37 beds per 1000 people as against WHO norms of 3.5 beds per 1000 people!!
  • Poor insurance coverage making healthcare expensive. The government has launched Ayushman Bharath recently which is a great move towards insurance coverage for the poor. Many states also have various programs to cater to this aspect of healthcare. However cost of treatment is still a big issue for many patients and they are forced to opt for non-optimal health treatments.

As you can see above, these issues are not because of our doctors!! They are doing their best with the hand they are dealt with. Healthcare outcomes in such a situation are not going to be ideal. In addition to that, medicine by its very nature cannot give a 100% probability of success – some diseases can be complex and outcomes depend on patient attributes. That doesn’t mean, that there is no medical negligence – but to blame everything that goes bad, on the doctor is very unfair and to resort to violence against the doctor is criminal!!

What the doctors need are as follows : a) Security in the hospitals b) Law to be strictly enforced for violence against doctors c) Awareness campaign to sensitize the citizens that Doctors need to be treated with a lot of respect. In my view the awareness campaign is critical because ultimately the community has to rise against any person who wants to harm the doctor. It is imperative that West Bengal and other state governments as well as the central government take up the issue of doctor safety on priority – otherwise, our healthcare system will regress instead of progressing!!

References:

https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/less-than-one-doctor-for-1000-population-in-india-government-to-lok-sabha/articleshow/59697608.cms

https://www.cbhidghs.nic.in/WriteReadData/l892s/Chapter%205.pdf

Categories
Healthcare

Deaths of children in Bihar because of Encephalitis

It has been shocking to read that over 100 children have died in Muzaffurpur and nearby districts in Bihar.( https://www.indiatoday.in/india/story/encephalitis-fever-bihar-1550297-2019-06-17). They were affected by Acute Encephalitis Syndrome (AES).

On checking the central government data on this disease( https://www.cbhidghs.nic.in/WriteReadData/l892s/Chapter%203.pdf) , the deaths over the last few years have been primarily in the Assam, Bihar, UP & West Bengal as per table below:

State Year-2013 Year-2014 Year -2015 Year-2016 Year-2017
Assam 272 360 260 187 178
Bihar 143 355 90 102 51
UP 609 627 479 621 593
West Bengal 226 348 351 256 153
Other States 23 29 30 135 35
India Total 1273 1719 1210 1301 1010

 

In 2016, the Other States is high, because there were 115 deaths in Orissa. This was also the year where 125 children died in one hospital in Gorakhpur, UP which happened to be the constituency of the Chief Minister, Yogi Adityanath.

Even in the previous years, according to a research report “https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644291/” between 2008 and 2014, there were 44,000 cases reported over 6000 deaths from encephalitis, mainly in UP and Bihar.

While Japanese encephalitis virus (JEV) is the leading cause of acute encephalitis, there could be other causes including other viruses. While there is a vaccine for JEV which is being administered to children, clearly the outbreaks indicate that there are other unidentified causes. In fact, one of the theories is that a toxin in litchi fruit can cause this – as Muzaffarpur is a litchi fruit growing region, and cases tend to peak during the harvesting season.

The central government has apparently allocated over 4000 crores over the last few years specifically to address Acute Encephalitis Syndrome. The number of deaths across these years and the current epidemic in Bihar, clearly demonstrates that more needs to be done on an urgently basis to prevent this!

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Uncategorized

Will Suresh Prabhu get the Train back on the Rails??

It is quite apparent that Indian Railways(IR) is in bad straits – with Operating Ratio(Revenues Less Costs) at over 90% in the last several years. This has led to inadequate investments in capacity building. This combined with delayed projects has resulted in IR’s share of freight in the economy dropping from over 60% to 33% since 1980. Also IR’s proportion of passenger traffic is also hovering at around 14%. This is quite shocking considering the Indian Economy’s growth since the 1991 reforms.

Well, there is no need to look deep into the reasons for the state of IR. The singular reason in my opinion is the structure of IR which is antiquated dating back to 1905 when the Indian Railway Board Act was passed. It has clearly outlived its usefulness decades back. Whilst several countries in the last few decades have reformed the way Railways is organized, India has continued with the same industry structure.

The main problem is that IR has a structure wherein the policy, regulation and operations are all mixed up under the aegis of the Railway Board.  Because of the inherent conflict in this industry structure, economic reasoning has not been used to set tariffs – passenger fares are heavily cross-subsidized by freight charges. New projects are taken not based on necessity but based on pressures from politicians – most of them don’t even get completed. No wonder, in the last 30 years, as many as 676 projects were sanctioned worth 1,57,883 INR crores.  Of these, only 317 projects could be completed and 359 projects remain to be completed

The Modi government has announced 100% FDI in Railways. Also over the last 2 years, Public Private Partnerships have been embarked on – however unless the structure of IR changes, these measures will not succeed – no private player will want to get into a sector which is organized in such a fashion.

The government needs to change the way IR is organized. There has to be an institutional separation of roles into policy, regulatory and management functions. Policy making should be the function of the Ministry of Railways. In fact over a period of time, this ministry should become a part of the Ministry of Transport. A Railway Regulator has to be set-up on the similar lines the Telecom Regulator(TRAI) or Stock Markets Regulator(SEBI) whose role would be to help set tariffs and regulate the market forces to prevent any market failures. The third piece of the Industry – Management of Railways has to be corporatized. Also, there has to be a separation of the entities managing infrastructure and operations. Bharat Railway Network(BRN) should be set-up to own, manage and expand the Railway Network. New corporate entities need to be created to manage the current passenger services and freight services(separate companies). These companies will use the Network by paying access fee to BRN. By introducing this structure, it will become a level playing field for other private players and this will attract a lot of investment.  This will also ensure that any subsidies that may be given for passenger fares will be funded by the Government. Also, investments in capacity building will be prioritized based on sound economic reasoning. Any investments because of “social” pressures will be funded by the Government.

BRN can also invite private players to operate several railway stations on a PPP model – the land and air space in the railway stations can be monetized through setting up of shopping malls. Also existing Railway Production Units have to be corporatized and over a period of time privatized.  These companies will need to compete with other private rolling stock companies

With this kind of approach, there will be prioritized investments in improving freight network – acceleration of the setting up of Dedicated Freight Corridors, Logistics parks etc. Because of market forces, the Freight operator will re-invent themselves as logistics companies rather than remain as a rail freight company.

Similarly passenger services entities will focus on improving customer satisfaction and ensure on time arrival of trains, good passenger amenities and invest in lines which make economic sense.

What is being recommended here is not rocket science – several countries like Japan, UK, Germany & China have reformed their Railways Sector. Of course there would be resistance from employee unions and vested interests like the politicians and railway contractors. The government will need to convince the employees that this reform will actually result in more jobs as the sector will grow with the reform in the structure. Resistance from politicians can hopefully be managed by the Modi Government which has a majority and is not dependent on coalition partners.

Lets hope that Suresh Prabhu in the Railway Budget embarks on reforming the Railways along these lines. Else instead of helping the Indian Economy Indian Railways can become an albatross and pull the economy down.

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Uncategorized

Can an Indian MP have an ongoing two-way conversation with Citizens?

One of the biggest criticisms of Indian Democracy is that once the elections are over, the citizens see very little of their representatives!! When I was living in the US, I used to read with surprise & envy about how easy it was to get in touch with your Senator & Congressman.   Also, I used to read there about how Presidents would urge citizens to flood their representatives with calls and letters on their opinions about laws – in an attempt to get the representatives to vote in a particular way. It appeared that the representatives & citizens kept in touch even after the elections – it was a 2 way conversation.  Also in the US, referendums are used frequently to get citizen inputs on key issues – whereas in India once the elections are over, citizen involvement in the governance is a big zero!! The other issue is that the citizens get to evaluate the candidates during elections only for a maximum of 2 months, whereas in the US it is over several months(that itself will be a subject of a future blog!!).  So citizens get to truly interact with their representatives only for 2 months in 5 years!! And we call this democracy!!

In India, the arguments for not keeping citizens engaged  post elections are as follows:

1) The sheer number of people – The average number of constituents a Congressman represents in the US is around 7,00,000. The Average number of people an MP represents in India is 22,00,000. In Bangalore 3 MPs cover over 80,00,000 people.  The MPs & MLAs say that it is not really possible to engage!! Of course our Indian representatives argue that atleast some of them hold Junta Durbars periodically – but that is only a minuscule of people – the AAP Junta Durbar fiasco in Delhi where lot more people turned up then expected atleast clearly shows that Citizens are keen to meet their representatives.

2) Communication channels – till very recently most Indians didn’t have access to phones. Also the database of addresses weren’t really there for an MP or MLA to tap into. The addresses in different databases including voter rolls had lots of errors.  For citizens to get in touch with their representative – there was no concept of toll free numbers to call into till recently. This scenario has changed dramatically in the last few years with mobile phones & missed calls; internet access and call centers(ironically India is the leader in call center outsourcing)!!

3) MPs & MLAs can possibly do very little with the inputs – this of course is a cynical reason. But there is some truth in it – most MPs & MLAs have little influence on policies & law making –  because most of the work is done by the high command of the political parties. They also claim to have little influence in governance – the governing bodies at the state, center and corporation do the work. This argument in my view is wrong – Competent MPs & MLAs can make a difference and get themselves heard(read my other blog post – Who should I vote for – party or candidate : https://gopaldevanahalli.com/2014/03/21/who-should-i-vote-for-party-or-candidate/ ).

India being a leader in customer service outsourcing & mobile phone penetration, it is possible for an MP & MLA to come up with a scalable solution to truly engage with citizens post elections. They can do the following simple things:

1) Have a grievance tracking system in place. Any issue can be reported by a citizen who is immediately given a tracking number. The issue can be reported thru a phone call into a toll free number; thru a text message; on the web or by walking into an office. The MP or MLA would act on that issue – it could mean forward the issue to a government agency and demand resolution; or directly act on it if they have influence on it. The citizens are kept informed on the status of the ticket till closure. The MPs/MLAs can then publish the statistics on the grievances – how many received, resolution statistics, performance of different government departments etc.

2)Use technology to seek opinion on major legislation and issues of the day – referendums can be conducted thru electronic polls using mobile phones and internet. If the reality shows on Indian TV can do this, there is no reason why this cannot be done by our representatives. Once the MP/MLA gets a feel for what their constituents think, they can start having a larger influence on their party’s stance on these issues.

3)Identify the right MPLAD programs (where MPs get Rs.5 Crores per annum for development) and also track progress of the project. Citizens can tell them first hand – what is the progress of a MPLAD funded project. They can also get feedback on government schemes – for example, Right to Education in their constituency – they can get inputs from citizens on its implementation – what challenges were faced. These inputs can be given to the nodal agencies so that the implementation can be bettered.

How can they fund all this? For MPs, part of the MPLAD money can be used to fund this. I haven’t calculated the costs, but I do think a low cost solution is possible. What is required more than the money is the willingness to do this. I feel that one of the compelling reasons for a representative to do this would be a selfish reason – by engaging with their constituents, their chances of winning the next election will significantly improve.

Bangalore, being the technology and innovation capital of India, can become an exemplar for citizen engagement. Let us ask the candidates before the April 17th election in Bangalore – what are their plans for Citizen Engagement? Let this be one of the criteria for choosing the candidate.

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Uncategorized

Who should I Vote for – Party or Candidate ?

Bangalore will go to polls on April 17th –  an important question to answer – should I vote for the best candidate as the MP or should I vote for the Party irrespective of the Candidate’s competency & integrity.  Well I believe that we should vote for the  candidate and not the party. My reasoning is as follows:

  •  Bangalore has big problems facing it – water resources will get exhausted in the next few years; transport woes will only increase; Bangalore brand is losing its luster –thereby under-leveraging the promise of becoming another Silicon Valley.
  • To solve these problems – you need MPs who will bat for Bangalore – come up with solutions to these problems and then more importantly implement those solutions by working with different stakeholders – the Central Government, the State Government, BBMP, Corporates, International Agencies and the citizens of Bangalore.
  • We are a resource constrained nation and state – resources will flow only to those solutions which are well articulated & argued; seem to have a good chance of success and is being put forth by an MP who is well respected.
  • So the attributes required in an MP for a Bangalore Constituency – a) Is well respected b) Has a track record of coming up with solutions/ideas c) Is known for execution d) Has the ability to work across political divisions e) Understands the local issues well f) Is honest to a fault!!
  • I feel that such candidates are found in different parties.. there are honest, capable candidates in both BJP and Congress. Unfortunately, there are dishonest, capable candidates in both parties and more likely dishonest & incapable candidates in both parties. There are also honest & capable candidates in AAP, JD(S) and Nav Bharath.
  • It is important for us to evaluate the candidates across party lines and choose an honest and capable candidate in that constituency irrespective of the party – because the candidate will make Bangalore better and not the party.
  • And if you are wondering that the MP is also responsible for making laws which affect the whole country – my submission is that if you choose a capable & honest candidate who can fix Bangalore – he or she will also ensure that good laws are made in parliament!!

So join me in this election to vote for the best candidate and not the party!!