I grew up in a city that for most part of it was privately managed, i.e., a private organisation was managing most of the day to day running of the city. In the neighbourhood we had a 'Dispensary', a Community Clinic which is somewhat modelled in 'Mohalla Clinics' of Delhi.
For most of the daily ailments, pretty much 100% of the locality just walked upto the dispensary to get first level medical care.
As kids, if we bruised our knees when we played we went to the Dispensary for primary dressing and care. If someone in the family got fever, cough, cold or anything else - the first stop was to be this clinic. If the nurses or registered medical practitioners (RMP) in those clinics felt that we needed specialised care, they would either refer us to the hospital in case of emergency, or they will ask us to come by Doctor's schedule.
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| A Delhi Community Clinic - idinsight.org |
What this solved was two of India's core problems:
1) Accessibility - It made primary care easily accessible for most of the people at a stone's throw away.
2) Capacity - It also ensured that the specialised doctors and hospitals were not overly stretched by capacity.
The key tenet here? By way of right trainings and enablements, nurses/RMPs were able to do a little more than what otherwise their inherent skills would have allowed - looking at the symptoms, and doing the primary diagnosis to identify whether you needed specialised care or not. And then decentralised the model by bringing it at the community door steps.
Over the time the model went Kaput (was planned for revamp in 2017). Well trained Nurses and RMPs are a specialised skill now-a-days, and they could only do so much along with piles of administrative work that comes along.
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If we had to scale the model today and make it work - what do we do? How can technology and product play a role here? If you answered - "we can take the rudimentary stuff out of the R&R of medical care workers and automate those", then you couldn't be more wrong.
We don't need technology to make the nurse more productivity and clear more files. If we had to scale the model today - we would need to augment the skills of otherwise untrained staff to take over the day-to-day administrative work, that can free up the capacity of nurses/RMPs trained to deliver medical care and enable them to do more of it.
Building for Bharat requires a different perspective. India has a unique problem of over-capacity as well as under-capacity. While we have a large number of employable young who may be unemployed or looking for job, on the other hand we have our skilled group which is significantly stretched - engineers, doctors, nurses, judges etc.
One of the major reason for such a divide to exist is that a large majority of our working population are literate only upto primary level (~57.8%, incl. 32% non-literate) and merely 5% have gone up to receive professional qualification. Everything else - middle, secondary, matriculation, diploma etc. are spread in the middle at abysmally low numbers independently.
Where this impact is also easily reflected is in the employment - 99.4% of India's MSME are micro enterprises and more than three-fourth of those are run by <2 people. These are self employed people - who run Kiranas, Auto Repair, Salons etc. largely because of two reasons - (1) there are not enough jobs for the under-skilled, (2) it's not easy to get access to the jobs and resources out there to grow.
Thus the problem for India is whole lot different.
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The problem for India is not the after-effect of technology adoption and digitisation, where the need is for next level optimisation - take the productivity from X to nX (the 80-100 optimisation problem).
The problem for India is that technology adoption is fairly nascent, or may not even have been built in many cases, to make the population do what they couldn't otherwise (0-80 enablement problem).
So, if we solve for the former 80-100 problem, i.e., optimise for productivity, then we may be solving the wrong problem. Because, the 0-80 journey, i.e., enablement, hasn't happened in many cases.
And, even for that we cannot take the model and path that high-income economies have taken decades ago and simply replicate it. Our problems need more creative solutions. Think traditional banking from the West which just couldn't viably work for Kenya and the creative innovation of M-Pesa just changed the way people banked and sent money home in Kenya.
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| Digitization & Automation - India's problem and opportunity space vs. high income economies |
So, the problem statement is pretty simple - can we build technology that can augment the capability of a large under-skilled population such that:
- It can open up or create a new market for better paying and more productive work
- It can destress the specialised population by enabling under-skilled workers through technology to take over some of the non-specialised and administrative work, making the system overall multifold effective than what it is today
- It can provide access to tools and resources that can enable Individuals and Micro Enterprises to productively scale-up to the next tier, and create a lot more jobs in the process
- It can bring societal development and upliftment equally across the rural and urban areas
A lot of them are doing that, but only transactionally.
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When your online order for Fashion or Grocery is delivered next time, there is a high probability that a local Kirana or Micro entrepreneur has been enabled through technology to do last-mile logistics. Last mile logistics for ecommerce was fairly complicated, challenging, expensive and corner stone for customer experience once. However, technology led process simplification over time enabled an otherwise under-skilled worker to pick and deliver products to the end customer in an experience enhancing way.
A bunch of other social commerce organisations willingly or unwillingly have created massive number of localised entrepreneurs who otherwise were home-makers and had under-utilised capacity which was harnessed.
But, the rate of churn of Kiranas or Home-Makers from these platforms is a reflection of transactional nature of the augmentation. Apart from technology enablement to do this one thing - these semi-skilled players of the system don't get access to a whole lot of stuff that may be required to grow from there and beyond.
To deliver the real value the change needs to be sustainable.
The augmentation needs to not just enable a semi-skilled or under-skilled person to do something new, but also enhance the capacity and bring access to growth levers.
Simply put - the real value will come when a micro entrepreneur selling Puja items in Motihari, is easily able to reach to it's customers in Delhi and eventually outside of India; and is able to grow into other local or non-local specialities through right access of knowledge, resources, network, capital and support - all enabled through technology; and in process creates a lot more jobs than he otherwise could have.
The real value will come when a semi-skilled person is augmented by technology to run day-to-day operations of a mohalla clinic, or secondary school, in rural or semi-urban India while freeing up the nurses/doctors and teachers to deliver specialised services through tele-consultation or live online classes. And, by also bringing access to right set of resources and tools for the individual to grow from one clinic to more, or from one school to more.
And, many more.
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So, are you building for Bharat? If yes, hit me up with what you have been upto. Would love to connect and learn. :-)
And, if the topic excites you and you want to dig deeper on this, would highly recommend the brilliant book - Bridgital Nation: Solving Technology's People Problem.
