Ravi Kumar, Chairman of ZANEC, on Healthcare and Innovation in India

ZANEC is a software product development company that has developed applications used in over 20 countries across the world. Among other product offerings, ZANEC has taken a special focus on healthcare, with services that range between technology exploration and adoption, portfolio management and rationalization, product engineering and support, application services, and product testing services. Through their healthcare services, ZANEC aims to transform the way that healthcare information is stored and processed to enable medical institutions to deliver the best quality of care to their patients.ZANEC Chairman, Mr. Ravi Kumar, has been involved in the healthcare industry since the early 1990s when he was living in the UK. During this time the British government was looking to foster internal competition within the National Health Service (NHS) system. To do this, different NHS bodies were looking to build software systems to combine and streamline the clinical and administrative processes of their organizations. Ravi, at the time a management consultant for KPMG, helped develop a software application to serve the needs of these NHS organizations. The management software was well received by British hospitals, and soon was being adopted by hospitals around the world.

“The key was understanding the way the business of healthcare was conducted in specific regions,” explains Ravi. “Once we built an app in England, we started expanding to regions that previously fell under the British Commonwealth. Wherever the British systems were introduced, the systems and processes were similar, give or take a few small differences, but the core 70-80% of the way healthcare is delivered and the way the healthcare as a system is established is very similar in those regions.”

Ravi has taken his experience in healthcare to ZANEC, where, as Chairman, he is helping to conceptualize and develop systems that will create a more quality and inclusive healthcare ecosystem in India. We recently caught up with Ravi Kumar to get some insights on his experience in the Indian healthcare system and his work with ZANEC. Edited excerpts:

SocialStory: You have worked in the healthcare markets in the UK and US, and now you are working in the Indian healthcare market. What has to been a key point to understand about the Indian market?

Ravi Kumar: India is going to be an interesting market because it is a mix of the US and UK healthcare markets. Once upon a time India followed a lot of British systems, but post independence there has been quite a lot of US influence, particularly when it comes to consumerism. Health consumerism in particular is quite high here, and it’s in a kind of cusp for a few reasons. First of all, healthcare is still in the process of being established. In India you have a socialized delivery of medicine with the government hospitals, but then you also have a huge private healthcare market which is used pretty much by the middle class. It’s a balance and one has to cater to both aspects of it, and that is what makes it interesting and much more challenging. The key in India is the price point. From a price perspective it behaves like socialized health, but it terms of the choice it behaves like you are in the US as you have a lot of choices.

SS: Price point as a key aspect, how do you think India is going to be able to provide healthcare to the rapidly growing population India when a majority of it is living in rural areas?

RK: Governments need to invest and stimulate the establishment of a system. Once it is established, then the private sector can take the system and work through that. In India, per capita investment is still significantly low because the infrastructure is still low and that’s causing a great deal of challenges. Reaching the rural population is quite challenging here, and trained medical staff doesn’t particularly want to go and live in those rural areas. That causes a challenge of access to healthcare, but then that’s where the great opportunity for innovation is here.

The challenges of remote healthcare, telehealth, telecare, or remote management systems are where I think India lends itself to technology. You can use technology to create that remote access in rural areas by connecting the urban centers or regional centers to remote locations. Doing that kind of triangulation of connections is something, but I think there is also some work that the government needs to do in order to fundamentally facilitate the infrastructure. If you want to do a remote monitoring or telehealth program, then access to power, telecommunications, Internet, and broadband are an important part of this development. This is still in its infancy, and there is a lot of opportunity to improve and establish processes here to build out technology there.

SS: You’ve been around the world, have you seen any innovations in India that you are excited about or something that is helping to build the infrastructure and solve the healthcare problems in India?

RK: To stay afloat in India on a daily basis you have to innovate. A common man here is innovative and constantly has to innovate everyday to survive and get through the day. Entrepreneurship is in the Indian blood. There are some fantastic examples of delivering the right quality at a price point because India is a low cost economy for all practical purposes. It maybe emerging, growing, or one of those Tiger economies, but it’s still a low cost economy. A common man here looks for value for money in everything they do, and you have pretty much anything that you can think of.

There are some fantastic examples in the healthcare systems, such as Aravind Eye Hospital, and the way they deliver eye care for a fraction of the price of others. They do cataract surgeries and can do them for under 20 to 30 dollars, which I think is a fantastic innovation. Aravind started in the rural communities in Tamil Nadu, and they can deliver everything from diagnosis to surgical procedures with a very different price point than anywhere in the world. I see those innovations as something that everyone in the world can learn from.

On the other hand, we also need to capture and focus on the fundamentals. If you go to a typical healthcare clinic here, you won’t have an effective documentation system. You go and see a physician, you are given a prescription, and you leave. You don’t see a collection or maintenance of the health record, which doesn’t happen anywhere in a developed economy. You go to the US or UK and you see a system for keeping healthcare records. Here only a few established organizations would give you a record. You go to one hospital then you go back a year later and you start all over again. This is a huge challenge, but also another huge opportunity for something to be done here.

SS: What do you think is the most prevalent hurdle that needs to be overcome in order to increase and improve infrastructure in India?

RK: I think that it’s the ratio between the population and the availability of the healthcare professionals. I see that as a huge, huge hurdle. That’s where the investment in healthcare education or investment into other disciplines such as healthcare assistants, nursing staff, and other healthcare professionals needs to increase. The setting up of the healthcare systems needs to be incentivized from a tax perspective or entrepreneurial perspective. I think there needs to be incentives for people to accelerate their establishment in the affordable healthcare system, which is much more focused on the rural as opposed to urban areas. You constantly see hospitals being set up to serve the urban populations, but you don’t see the same rate being duplicated in rural areas where 70% of the population lives. Those are the two fundamental things I have seen that need to be improved.

SS: You have had the opportunity to experience a lot of new cultures and trends through extensive travel. What trends in health & social innovation have made an impact on you?

RK: Healthcare itself has made a huge impact on me, and particularly the way different systems are built around the world with the way care is coordinated. I lived in England for 20 years and I came back to India primarily because between my wife and I we have about 7 family members between the ages of 74 to 94. This age range accounts for the maximum number of users of healthcare. There is a huge issue here when you are that age and no one is coordinating your care. In the UK, in contrast, you have a general practitioner who acts as a care coordinator and your point of care is coordinated through that.

In most systems the trend is more on integration between the social, physical, and mental healthcare. Established economies have figured out that the cost of treating people when they get sick is unaffordable, particularly inside acute care settings, and to reverse whatever the person is suffering from would cost too much money. Innovations are being designed to keep people away from the hospitals, either by delaying the onset of the disease itself by concentrating on wellness and preventative medicine or even to keep the sick person in the hospital less by treating them more in the community hospital or at home. The concept of medical homes is developing more in the US and community care is a lot more prevalent in the UK. The idea is, don’t bring people into the hospitals, and if you have to bring them into the centers then bring them in for a shorter period of time. I think that’s actually setting up a trend to develop a new culture. Particularly, they are now reaching out to the youngsters and giving them more education about their health and setting up changes so a new culture evolves.

SS: With ZANEC and your experience it’s clear you believe in innovation and building new technologies to impact the future. How would you advise new entrepreneurs to hone their innovation in healthcare?

RK: Fundamentally innovation has to be part of the DNA. Innovation isn’t structured or prescribed. I fundamentally believe that if you are an entrepreneur you either do something that’s perfect or you innovate faster and get something into the market quickly. I subscribe to the latter. If you are going to innovate, innovate faster and bring it to the market quicker and allow the market to shape it. Focus on something very specific. If you take healthcare in India, there are so many opportunities. Simply things like access to healthcare – there are so many people who don’t have access to healthcare.

The diversity in India is huge. If you take each Indian state they practically all speak a different language, so even if there is one particularly solution in one particular language, I think there is room for innovating and changing that into the different languages. The cultures are different, the food habits are different, and the disease patterns in India are very different. If you are concentrating on even one disease area then you can reach maybe 10 million people. Concentrate on that one niche, in any one aspect of it, and work as a part of an ecosystem, because no one person can take on and solve the entire challenge of health in India. What’s important is that entrepreneurs come together and operate as part of the ecosystem here.

SS: Which part of the Indian healthcare system do you think has the biggest room for improvement?

RK: I fundamentally think that India needs a better primary care and a family physician system. If you go to the US you have primary care physician (PCP). Here you immediately go to the hospital. There are a lot of specialists and specialist hospitals here from oncologists to doctors focused on diabetes. However, I don’t see enough investors establishing these primary centers where a person or a family can go and maintain a history and record of their health rather than to receive treatment for a particular episode they come into. I think that India needs to focus on primary care and also education on preventive care issues.

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