Tanya Spisbah, Director with Australia India Institute, Delhi is a renowned and influential expert on Australia-India relations, particularly with respect to health and sustainable development. A career diplomat with the Australian Department of Foreign Affairs and Trade for more than a decade, Ms. Spisbah served from 2014-17 at the Australian High Commission in New Delhi, specializing in health and technology diplomacy for inclusive, sustainable growth. She notably led the health agenda resulting in the Australian and Indian Prime Ministers exchanging an MoU for Health and Medicine, paving the way for cooperation on digital health.

Upskilling Existing Medical Practitioners through Online Courses could Strengthen Our Health Systems – A Case Study in Anti-Microbial Resistance

Health innovations are necessary to alleviate the global burden of disease and the suffering and mortality that ensues. We generally think of innovations in health as advances in medtech, digital health and pharmaceutical discoveries. While in many areas, these kinds of technological advances have led to increasing enhancements in health outcomes, in some areas we have slipped backward through overuse of these medical interventions, threatening the gains in health from the Millennium Development Goals and negatively impacting the Sustainable Development Goals. Antimicrobial resistance is one such example. This article explores the notion of short-term online education as an innovative intervention to address unmet needs in the Indian health system as it affects antimicrobials.

Antimicrobial resistance (AMR) refers to the mutating ability of microbes – including bacteria, fungus and viruses – to adapt to pharmaceutical treatments and become resistant, reducing or eradicating the effectiveness of medicines as treatment of bacterial infection or disease. This means perceived advances in healthcare, such as treatment of tuberculosis, have faced setbacks as the bacteria causing tuberculosis becomes multi-drug resistant, leading to increased deaths. It is estimated that AMR will be the cause of 10 million deaths per year by 2050 – causing greater mortalitythan cancer.The issue is a global one and has led to the World Health Assembly adopting a Global Action Plan on AMR, requiring each member country to adopt National Action Plans.

The issue is a global one and has led to the World Health Assembly adopting a Global Action Plan on AMR, requiring each member country to adopt National Action Plans.

India has a complicated health environment – one of the highest burdens of infectious diseases, coupled with one of the lowest public expenditures on healthcare in the world. India is also the highest consumer of antibiotics, with the trend only increasing – in part due to the need to treat bacterial infections and to cover prescription, misuse and availability of antibiotics without prescription.

This health crisis requires a multipronged effort – a multidisciplinary approach by multiple actors in government, industry and educators. India’s National Action Plan identifies that key challenges to AMR include inappropriate prescribing practices and misuse of antibiotics by humans. India is working to set in place stronger health systems and has invested in a stronger primary healthcare system with the implementation of the National Health Policy 2017 and the establishment of the Ayushman Bharat. These national policy responses will go a long way in establishing a framework for primary healthcare strengthening but are not able to provide for a holistic solution to gaps in the health system. While the Indian government is also working to reform the MBBS through amendments to the Medical Council of India legislation and changes to the curriculum, the results of these interventions will take years to work through the system and won’t be able to make material impact today.

Short courses as a medical intervention for AMR Inevitably, interventions are required from a wide range of actors. While national and state governments and industry are often called upon for innovative responses, given that unnecessary prescriptions or misuse by patients is a major identified problem incontributing to AMR, a largely untapped resource is the role that educators can play in the upskilling of existing medical practitioners to respond to immediate weaknesses in the health system to address such global health challenges. While online education interventions may be potentially smaller in scale, it could have far greater direct and local impact in localities across India, particularly in smaller cities.

As an example, the Australian Institute of Medical Administration and Compliance (AIMAC) has developed courses to facilitate good prescribing and dispensing practices. Designed for health professionals, Seema Gupta and Veena Sehgal have created short courses that in just one hour would assist general practitioners in following proper prescribing processes. Courses are written to address an unmet gap that exists between longer term academic courses and the practical issues faced by doctors every day. There is pressure by patients to come away from a doctor’s visit with a prescription, instead of sound advice for medical treatment, which may include simple rest rather than a drug prescription. The courses provide GPs with a quick and easy suite of information and tools about where to obtain further information to increase the quality of their prescription methods and improves collaboration between doctors and pharmacists by having them better understand their respective roles and the instructions being provided to the patient.

Often, it is the social dimension that is underestimated and undervalued when delivering healthcare. While there is a greater focus on patient-centric care and the experience of patients in thehealthcare system, short online courses offer one way of improving awareness of the role each actor undertakes in the prescription process and builds a sense of teamwork between the different members of the healthcare team to provide optimal health outcomes.

Interventions like these may be small in scale, but by empowering our frontline health workers, GPs and pharmacists to better understand the role overprescription and poor use of antibiotics can have on global challenges like AMR, such local interventions can have immediate impact on the lives and health of individual patients, in their respective cities and panchayats, and on the health system as a whole.

Innovations in upskilling to increase the quality of health services to improve, not only patient care, but address gaps in the health system will go a long way to addressing global health challenges such as antimicrobial resistance.

This article provides insight to the entrepreneur, starting their new venture, about thinking process of the investor so that entrepreneur can select the venture accordingly. The business proposal having the traits discussed in the article will be favoured by the investor. The two examples from real life makes this concept explicit. Even though the investor has invested in the venture considering all the aspects, the venture can be made successful only with passion and focused approach of the entrepreneur.

Introduction

Ever since the corporate entities have come into existence, raising capital for apparently viable business proposal has been possible. The entrepreneur can raise the capital from the investor initially and later on with proven track record can go for IPO (Initial Public Offer) to raise the capital from public for further growth. In this article the basic traits of the business proposal are discussed which attract the investor.

The investor favours the businesses, which are

• Sustainable
• Scalable
• And having corporate governance in place

SUSTAINABLE BUSINESS

Sustainability of business depends upon the product or the services creating value for the customers, ability to achieve breakeven within the reasonable time, competition, and efficient operations and last but not the least customers’ satisfaction.

• Value proposition

Any product or the services, provided by the businesses should be the part of value chain. The customers must feel that by using the product or services they are getting the values worth for their spending. Any business proposal which fit this criterion will have lasting future. The customer and the company should be in a win-win position.

• Breakeven

When business achieves a stage where it neither gets profit nor loss, technically it is known as breakeven point. From here with increase in volume the business starts getting profit. At breakeven point business stops burning cash. Different business takes different times to achieve the breakeven point, but for the investor sooner is better. Sometimes investor do not mind longer period to achieve breakeven, burning the cash, in anticipation of large scale volume compensating with higher profit at the later stage.

• Competition

Business should be capable of withstanding the competition. Either the business with very difficult entry barrier or business with complex operation requiring specialize skill will face less competition. Business with unique selling proposition will race ahead in competitive scenario. If promoters are agile they can beat the competition.

• Efficient operations

For long term sustainable business operations, efficiency in operation is inevitable. Inefficient operation increases the cost of goods and services and ultimately it reflects in end prices. Higher prices may be a big deterrent in competition. Efficiency leaves sufficient profit in the business to survive.

• Customers’ Satisfaction

In any business customer is king. Without customers’ satisfaction, customers can not be retained affecting business adversely. A satisfied customer brings more business through words of mouth, which is very important for sustainable business. The real test of customer satisfaction is a gain to a customer by using goods or services and not the lower price only.

SCALABLE BUSINESS

The business model which is scalable brings lot of opportunity for

all the stake holders. In a business life cycle, growth phase create the maximum wealth. The businesses which are profitable but not scalable do not attract investor as there is less room for creation of wealth.

The investor is even ready to burn the cash initially, if business model is highly scalable Walmart, Flipkart, Snapdeal & Amazon are some of the examples of highly scalable models. Only time tells when highly scalable model are successful in creating wealth.

CORPORATE GOVERNANCE

From the day when corporate entity came into existence, the corporate governance became very relevant as the ownership and management of the business rest in different hands. The transparency between all the stake holders is very important when business grows under corporate entity. The management should take various decisions in the business balancing the interest of all the stake holders. Since investors are not involved in day to day management of the business they like the companies where corporate governance is at place.

LIVE EXAMPLE OF SCALABILITY ATTRACTING THE INVESTOR

In healthcare sector Practo has set a live example of attracting high profile investors like Russian billionaire Yuri Milner, when business model is scalable.

Seven years ago, twenty-year-old engineering graduates, Shashank ND & Abhinav Lal from National Institute of Technology, Suratkal, Karnataka, founded an online health service platform, which assist patients to fix appointment with doctors. They built a software platform to digitize their health records and have online consultations as well.

Practo today scaled up to an impressive level of clientele comprising of two Lakh doctors, 10,000 hospitals and 5,000 diagnostic centers based in 35 cities in four countries and still counting.

The online service has made rapid strides, raising $124 million so far, the biggest by any healthcare start-up.

LACK OF SCALABILITY RENDERING BUSINESS UNVIABLE

TalentPad was founded by IIT and IIM alumni Mayank Jain, Nikhil Vij and Raghav Jain. They were into hiring space where a clear opportunity lies because of requirement by new businesses as well as existing businesses. It is not easy to offer a clear value proposition for long term sustainability and hence many players struggle to survive. TalentPad was in the same category and hence it has to shut down less than a year after it raised funding from Helion Ventures.

They used efficient marketplace model based on analytics to serve their customers by providing suitable candidates. In pursuit of increasing their delivery capacity it had acquired Optimized Bits, a Bangalore-based rival company. But months after that it abruptly shut shop with the remark: “We helped a lot of companies hire from some of the best tech talent in India and played a crucial role in their growth, while delivering the best customer experience. But, we failed to figure out a scalable business for a big enough market.”

CONCLUSION

Business models which are sustainable, scalable and having corporate governance definitely attracts investors but it does not mean that they will always be successful as success depends upon so many other factors as well, mainly the execution of business plan. The focused approach and promoter’s passion are the ingredients without which success cannot be spelled out.

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