Limitations in scalability of healthcare delivery model and possible solution

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.