It is very common from anyone who
has worked in the IT sector to come across the term ‘scalable’. Basically it
points to the capability of the technology components – hardware and software –
to ramp up as the business demand goes up. The implicit requirement is that
this ramp up is achieved in a relatively short period of time (compared to how
things used to ‘scale up’ in the past) and without compromising the performance
of the system.
In business also most start-ups
are faced with this question by prospective investors and clients. Their ideas
are great and workable and some are even profitable very quickly. But then
comes the question of scalability and replicability. Here the expectation of
the potential investors and clients is that the design of the business model
should allow it to grow quickly. But the thing I’m pondering over is that are
all business models scalable? Is it right to expect every business to be
scalable? What if a particular industry dynamics do not allow scalability?
Should I be bothered if it seems that my business model is not as scalable as
other business models in other industries?
In the previous post, there was a
discussion on various factors that contribute towards creation of an urban
healthcare delivery system and on efforts of iKURE towards creation of an
ecosystem of partner organizations and experts to finally create a rural
healthcare delivery system. You can refer to the post here.
Now the question arises – Is our
delivery model scalable? Or for that matter, is even the urban healthcare
delivery system scalable?
The basic elements of a care
delivery system are healthcare providers,
namely doctors and nurses, supportive
services like diagnostics, pharmacy and blood bank, care setting which comprises of the physical infrastructure of the
clinic/hospital, bed capacity & types and the medical equipments installed
in the setup and other ancillary functions like purchase & stores,
housekeeping, engineering, med gas etc. Let me also add IT to this list of
elements of a care delivery system. So as I discussed in the beginning of this
article, scalability is not new to IT and this is a tried and tested model in
the sector. But can we stretch or scale up other elements of the care delivery
system? How reasonable is it to assume that we can create more health
professionals like doctors and nurses in a short time without compromising
quality? How economically feasible is it to add more beds and clinics and hospitals
infrastructure? How easy is it for anyone to ramp up ancillary functions of a
hospital, like stores, housekeeping and engineering?
By very nature, healthcare industry
is infrastructure-dependent. Apart from that, there’s this issue of lack of
qualified medical professionals. So one would wonder that if one doesn’t have
enough staff and support services, what is the point in creating more
infrastructure. There’s similar challenge in rural healthcare delivery as well.
There are statistics that say there are very few doctors serving India’s
massive rural population, compared to relatively better availability of doctors
in urban areas. Similarly, there are statistics on paucity of health
infrastructure in rural areas and most new infra being developed in cities
only. The ROI-driven growth definitely will happen in cities and there are
customers who can afford and pay for the healthcare infra built in the cities. In
this context, the infrastructure and availability of healthcare professionals
in rural areas become bottlenecks in scalability of rural healthcare delivery
models.
iKURE’s model is trying to
address a different kind of challenge. Whatever healthcare facilities are
available in the villages are also not upto the quality standards. So on one
hard the villager doesn’t have many options and on the other hand, the only
option available to him also is not upto the mark. It’s our endeavour to give a
better deal to healthcare seekers in rural areas by creating a collaborative
platform where a rural doctor can coordinate care delivery with the assistance
of a city-based specialist consultant. With the use of low-cost diagnostics and
timely advice from the doctors, we can prevent the health of the patient from
deteriorating further and escalate the case to a higher centre of care at the
right time. All it takes is a basic infrastructure to be put into place. A small
patient-examination room with a computer kept close by can become an iKURE
kiosk. The health-worker or the doctor needs to be trained in using iKURE’s
software. Communication can happen in English or in regional language.
From a scalability point-of-view,
we have a key challenge in terms of taking technology to the rural clinics. As
a software company, we specialize in the application which meets the
requirement. But investments are also required in the digital infrastructure to
be put at the kiosk. All this has to be done without increasing the cost of the
treatment to the patient otherwise the whole exercise will lose its purpose. In
the Salboni project of iKURE, the CSR partner JSW Steel takes care of these
costs and even provides branded medicines at no cost. This model is easily
replicable if there are corporates whose vision is to see a healthier community
in the areas in which they operate. State governments can also leverage this
low-cost technology by bringing its health centres under the ambit of such a
project.
As a company iKURE has been able
to generate sufficient interest and it’s a matter of time when we fulfill our
vision. The need really is to associate with partners who are committed to the
cause and who understand that scalability in a healthcare delivery system
cannot be achieved overnight. The community has to be taken into confidence and
their involvement is essential. Investments in infrastructure have to be made
with a greater focus on SROI (Social Return on Investment) and monetizing the
investments through alternative activities which can be aligned to education,
livelihood, financial support, women empowerment, e-governance and many more.
Innovation is the key.
