Insights (Essays)

Insights (Essays) May 2009

India on My Mind

Neil Seeman

I have never visited India. I know little of its culture, geography, history, or politics.

One thing I know is that lots of smart people are writing about healthcare innovation in India. In Canada, more smart people have been thinking about how best to measure innovation. To be sure, measuring innovation is slippery: it's hard to quantify "accidental triumphs" or "successful failures" in healthcare. We often revert to measuring interesting, but limited, output indicators: patents, publications, citations.

What if we could measure a country's agility to innovate? This leads me to India.

India's Healthcare Innovation Pivot

A pivot is the central point, or pin, on which a mechanism turns or oscillates in a new direction. Can we measure a region's ability to "pivot" - to bridle the horse and gallop off in a new direction? The Indian healthcare economy is pivoting.

As the Wall Street Journal's Peter Wonacott reported last month, rural India is defying the global economic slump. He wrote: "In poor and largely rural states from Orissa in the east to Rajasthan in the west, many new leaders have invested in health, education and infrastructure. That has set the stage for the creation of industry and consumer markets and enabled upward mobility."

Nitish Kumar, chief minister of Bihar, India - where only one in ten people can read - has recruited private-clinic doctors from rich regions to public hospitals in the country's poorest state. In an alliance led by his Janata Dal party, Mr. Kumar champions "Government 2.0" - the low-tech variety. He hosts Monday open houses at his home, where ministers must respond to public complaints. Bureaucrats travel with him to town-hall meetings across the most impoverished areas of the state, where they pitch tents in mud fields.

India's economy is standing up boldly athwart the global downturn, and pockets of innovation in rural India are leading the country forward. Speaking at a recent meeting on "India's Future" organized by the Confederation of Indian Industry in Coimbatore, Gurcharan Das, author of India Unbound and former CEO of Procter and Gamble (India), said India's economy will recover faster than others'. The International Monetary Fund projects India's economy will grow 5.1% in 2009 (versus 0.5% for the rest of the world).

In Bihar, there are auspicious signs: The number of people migrating out of the state dropped 27% in the 2006-08 period compared with 2001-03, according to the Bihar Institute of Economic Studies. This, despite the fact that more than half of Bihar's 83 million residents live below the international poverty line of about $1 dollar (US) a day.

Writer Vijay Vaitheeswaran has noted how India is better-equipped than many richer nations to embrace healthcare innovations. Fewer than 20% of US surgeons in America use health information technology (HIT). In contrast, according to Technopak Healthcare, a consulting firm, nearly 60% of Indian hospitals take advantage of HIT. India is fast becoming a hub for clinical research. Admittedly, India has a long, long, long way to go: tens of millions of Indians go without healthcare despite the country being a global hotspot for "medical tourism." India owes much to its destitute: the level of malnourished children is higher than that of sub-Saharan Africa.

Yet, over the last decade, India has also emerged as the destination of choice for US healthcare organizations that take HIT seriously, in part because of India's low-cost labour force - but also because of the ingenuity the country has shown in its embrace of new business processes. Recognizing the scarcity of trained e-health professionals in America, India has jumped in. The Nittany Institute in Chennai is suddenly overflowing with Indians taking courses in medical coding, IT Infrastructure management, even "e-talk" - the jargon of e-health.

The Diaspora Returns to Lead the Pivot

"India has always had access to intellectual capital," says my colleague Amol Deshpande, "but it has lacked good infrastructure and abundant early capital funding." Amol recently returned from Mumbai where he met Indian-born entrepreneurs at healthcare expos. He recalls some revealing conversations. "I was born in India," conference attendees would tell him, "but I just came back after 12 years in Silicon Valley." "The return of non-resident Indians with entrepreneurial minds, their own capital (from the US) and relatively cheap access to good technological infrastructure has begun to change the innovation landscape," Amol tells me. "Combined with increased demand from a growing middle class and rising rural economy, innovation will begin to flourish."

The Indian healthcare economy is pivoting thanks to money, brainpower and raw ingenuity. The poorest regions of India are leading this bottom-up revolution; they have the most to gain.

Can Canadian Healthcare Pivot?

It is the "bob and weave" of the Indian economy that impresses me. As the global economic punch arrives, India bends its legs quickly and simultaneously shifts its body. Will Canada pivot or buckle? I don't know. Manny "Pac-Man" Pacquiao, the Filipino boxer who is emerging as the next all-time great, "slips" from opponents with beauty; hand-speed is what makes him special. Ali's magic was in footwork, not his punch. My own boxing trainer, Theo Asante, always tells me "anyone can throw a punch"; it's avoiding the punch that matters. People who measure innovation should consider how to measure agility. Look to India.

Some additional links of interest:

P.S. More on "I don't Know"

Last week's essay on "I don't know" was "tweeted" on Twitter. Trisha Torrey, a globally renowned patient advocate and writer for, picked up the discussion and asked her readers if their doctor had ever told them, "I don't know". See the results of the poll here.

About the Author(s)

Neil Seeman is Director and Primary Investigator of the Health Strategy Innovation Cell at Massey College, University of Toronto.


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