Posts from the ‘ Health ’ Category

26 million babies will be born in India this year and an astonishing 57% will be delivered without the supervision of skilled health care professionals.  As a result, over 100,000 women will die due to the lack of adequate care.  As indicated by several other posts on this blog, India’s health care infrastructure ranks amongst the worst in the world.  Government hospitals are grossly under-resourced and often corrupt, while private hospitals are out of reach for the vast majority of the country’s poor and middle class.  At the lower end of the spectrum, a delivery in a private hospital costs about Rs 25,000 (about $550).  This is about two-thirds the average annual household income.

Through a unique combination of expertise, a passion for change, and a compelling business model, LifeSpring Hospitals aims to drive a wedge through those numbers. As a joint venture between public sector contraceptive maker Hindustan Latex and New York-based social investor Acumen Fund, LifeSpring was set up to be a chain of maternal care hospitals for low-income households.  Its first hospital was set up in Hyderabad in 2005 and it now has a total of 9.  It plans to have 18 hospitals by the end of this year and 150 hospitals by 2015.  Each hospital can serve about 10,000 women per year, so the impact LifeSpring will soon have is tremendous.

At LifeSpring, a regular delivery can cost as little as Rs 2000 (about $45).  A Caesarean section costs as little as Rs 7000, which is just one-fifth the cost of a private hospital.  All this and the hospital chain is profitable—simply by applying principles of business that would be intuitive in almost any other company.  LifeSpring sets up small hospitals, with typically 20 to 30 beds each, primarily near slum localities.  This way, real estate costs are low, the hospitals generate high footfalls and vacancy rates are kept low.  LifeSpring doctors, on an average, perform four times as many operations as their peers in other private hospitals.  By focusing on just maternal care, the hospital chain is able to standardize clinical procedures and kits, further bringing down costs.  Then, like other social ventures, LifeSpring utilizes a cross-subsidy model, where higher income women can choose a more expensive semi-private or private room, allowing procedures for lower income women to be cheaper.

Unlike most hospitals in India, private or public, LifeSpring is uniquely customer focused.  Its medical professionals are forthcoming in their communication and cheerful in their approach.  As CEO Anant Kumar says, “After all, pregnancy is no disease.  So, why should we call them patients?” With its aggressive growth plans, LifeSpring is constantly looking for obstetricians and gynecologists, radiologists, surgeons, pediatricians, anesthesiologists, nurses and other health care professionals.  With Indians accounting for 5% of America’s physicians and 10% of America’s medical students today, LifeSpring could be an excellent opportunity to gain experience and give back all at once.

With Rachel Ray lobbying on Capitol Hill, Michelle Obama gardening at the White House and Jamie Oliver camping out in West Virginia, the topic of school lunches is starting to get the attention it requires.  It is flabbergasting that it has taken so long. Children spend 180 days a year consuming 1 to 2 meals per day at school, and only 6 percent of US schools meet the USDA’s lax nutrition standards.  According to the Center for Disease Control, 1 in 3 children born after the year 2000 will get Type II Diabetes.  The situation is so grave that a group of retired military officers called Mission: Readiness has called school lunches a “national security threat.”  It turns out that 27% of all Americans aged 17 to 24 are too overweight to join the military and it is now the leading medical reason that recruits are rejected.  Adding insult to injury, a USA Today study found that the meat supplied by the USDA to schools does not meet the safety standards of most fast food restaurant chains.  Chains such as Jack in the Box have limits for certain bacteria which are 10 times more stringent than what the USDA sets for school beef.

From a preventative health care perspective, making school lunches healthy is obvious.  Obesity-related diseases account for 10% of America’s health care bill and that number is expected to double over the next 20 years.  In recognition of this, the 2010 Child Nutrition Act was recently approved by the Senate Agriculture Committee and is expected to be voted on this summer.  Currently, the reimbursement rate for free lunches served to low income children is $2.68 per lunch.  The bill will raise the rate by a measly $0.06 per lunch.  Experts believe the rate needs to be increased by $0.35 just to keep the quality of lunches the same, and by at least $1 to make lunches healthy.  One of the main reasons schools have vending machines is to generate revenue to make up for the shortfall from the government’s current reimbursement rate.  As most vending food is unquestionably unhealthy, this is only exacerbating the problem.  The bill will also give the USDA expanded authority for setting nutritional standards in both cafeterias and vending machines.  Assuming the department does not succumb to the lobbying interests of large food companies, there is much to choose from the fledgling natural and organic industry—low sodium chips from Cape Cod or Kettle, energy bars from Lara Bar or Clif Bar, or preservative-free ready meals from Amy’s Kitchen or Tasty Bite.

As upcoming legislation will not deliver the sweeping reform that is required, it is still up to local school systems to deliver examples of change.  One such example that the country should pay attention to involves the efforts of Tony Geraci in Baltimore. As Director of Food and Nutrition for the Baltimore City Public School system, Mr. Geraci is re-shaping how the city’s 83,000 students perceive food.  His approach involves students at every level.  As part of the curriculum, students design lunch menus that meet strict nutritional requirements for each day of the school year.  The design of these menus weaves in science and nutritional learning to further engage students.  He cancelled contracts for pre-made lunches and has prioritized the school district’s $35 million budget for fresh and local food.  Last year, Mr. Geraci convinced the city to donate a 33-acre piece of land to the school system, where he built the Great Kids Farm.  The farm, which is run by students, will serve as an incubator for organic school gardens around the city.  As an experiment in entrepreneurship, he is also launching 3 student-run restaurants that will serve the farm’s produce.  In grade schools, he has introduced a concept called “no-thank-you bites.”  At the end of each line in cafeterias are sample cups of a high nutrition food such as lentils or radishes.  If students try them and don’t like them, they simply say “no thank you.”  If they do like them, they would have broadened their palates.  For each bite students taste, they get a star next to their name, and at the end of each month, cafeterias hold “constellation parties” to honor the winners.  Now, in order to scale his approach, he is lobbying the state for a large centralized kitchen to serve flavorful, nutritionally designed meals across the system.  By thinking outside the box, challenging the bureaucracy and simply making food fun, Mr. Geraci aims to transform the health destinies of an entire population.  Legislators and local school systems need to take notice.  Independent filmmaker Richard Chisolm is currently directing and shooting A Recipe for Change, scheduled for release this fall, which documents the transformation of the Baltimore public school food system.

Social ventures are set up by entrepreneurs looking to fill a need for social services that would normally be provided for by the government—but that government might be negligent, despotic or simply asleep at the wheel.  They also tend to develop innovative products or business models, which allows them to sustain themselves differently than traditional charities.  Where they tend to struggle is in reaching the millions, usually hundreds of millions of people that require that service.  How does an organization quickly and effectively educate the 100 million illiterate children in India or provide safe drinking water to the 1 billion people on the planet that lack access to it?  Attempting to recreate the services of a government, and that too in a self-sustaining capacity is daunting to say the least.

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One of the less talked about, yet far-reaching aspects of the recently passed health care bill involves mandatory calorie declaration on restaurant menus.  Starting in 2011, the new law, which applies to any restaurant chain with 20 or more locations, directs the Food and Drug Administration to create a new national standard for menu labeling.  This will apply to menus, menu boards and even drive-throughs, and will affect over 200,000 restaurants across the country.

In the US today, the biggest contributor to health problems and the rising cost of health care is overeating.   read more…

As US lawmakers struggle to compromise on what is likely to be a highly compromised health care bill, it would behoove them to visit Narayana Hrudayalaya in Bangalore.  Narayana Hrudayalaya, which means “God’s compassionate hospital” in Sanskrit is today the world’s largest heart hospital, performing up to 50 major cardiac surgeries per day—more than the Cleveland Clinic and Mayo Clinic combined.  Set up in 2001, its founder Dr. Devi Shetty believed that through scale, he could offer world class health care and drive costs down, much the way it would work in any other business.  Today, with over 1000 beds, 24 operating rooms, state-of-the-art equipment and doctors from all parts of the world, a heart surgery can cost as little as Rs 65,000 (about $1500).  Moreover, no one is turned away from the hospital.  Those who cannot afford treatment are provided care at no cost.  While every patient receives the same quality of care, wealthier patients have the option of higher priced private rooms.  These higher prices subsidize those who cannot afford treatment. read more…

There are over 1.5 million people in India with End Stage Renal Disease (ESRD).  This means they have final stage kidney failure and need to be on dialysis or have a kidney transplant to stay alive.  Another 8.6 million people have Chronic Renal Failure (CRF), with some amount of kidney function permanently lost.  In order to serve all ESRD patients alone, India would need 250,000 beds or dialysis stations.  The country has less than 3000 and fewer than 700 nephrologists.  There are entire states with no beds or doctors at all.  With burgeoning demand, big city hospitals are moving patients from 3 treatments per week to 2.  This is not to mention the huge gap in quality and hygiene at most existing hospitals and dialysis centers. read more…

If there is an example of a new generation of young people who have decided to forgo high paying jobs in order to change the world, it is the team at Embrace Global.  Embrace was set up in 2008 by a group of Stanford graduate students, who came together in a class at the Stanford Institute of Design called “Entrepreneurial Design for Extreme Affordability.” read more…

On the tragic evening of November 26, 2008, during the Mumbai terrorist attacks, ambulances from 1298, a private ambulance service, were the first to arrive at the scene.  Mumbai only has about 100 ambulances with full life support systems, of which over 50 are run by 1298.  It is hard to say how much worse the disaster would have been if the city had to rely on public services alone. read more…

In 2001, the Indian Supreme Court mandated that all government schools in the country provide lunch to its students free of charge, known as a mid-day meals program.  Over the past 30 years, mid-day meals programs, led by the state of Tamil Nadu, have proven tremendous not only enhancing nutrition amongst children, but also as a mechanism to promote school attendance by parents.

One of the most successful organizations in providing mid-day meals is known as Akshaya Patra.  It was set up in 2000 by the ISKCON Temple along with several individuals in Bangalore, and funded by the central government along with private foundations.  Akshaya Patra today provides fresh, mid-day meals to over one million students across the country.  Their largest factory is in Hubli in Karnataka, which makes over 185,000 meals per day and delivers them to approximately 80% of the government schools in the district.  As one enters the facility, there’s a sign that says “welcome to the world’s largest kitchen.”  The factory, while being state-of-the art, is simple and intuitive in its layout.  It has equipment which sorts and cleans its own rice, cuts vegetables and cooks and fills food into transportable cans.  The cans are carried with fresh, warm food by over 40 trucks to schools across the district every morning.  The meal composition consists of a nutritionally designed sambar, rice and yoghurt.  A lot of thought has been given to the way the meal is prepared.  For example, 4-5 nutrition-rich vegetables ranging from beet roots to moong sprouts are mixed into the sambar. Vegetables are rotated through the week to provide variety.  Also, the vegetables are cleverly cut to be small, as children have a tendency to otherwise remove them!  These days, it is hard to find a corporate canteen in India where the dal or sambar doesn’t have the consistency of water.  At Akshaya Patra, the dish is hearty.

A.C. Nielsen estimates that since the Hubli facility was set up in 2006, enrollment in schools in the Hubli-Dharward district, which has a population of about 1.2 million, has gone up by 15%.  The impact on learning, retention, life span, future productivity and quality of life of these children is also likely to be statistics altering.