Medical Tourism Industry in India -- A Systems Problem

Alamgir Pasha looks on as his fourteen children play cricket in the sprawling lawns of his mansion which more or less resembles a medieval fort. Alamgir is happy with his two wives, fourteen children and one daughter-in-law. He lives in Mirpur near Dhaka, Bangladesh. Alamgir owns a rice mill and exports rice to different countries. He is 53 years old.

Alamgir wanted to celebrate Edd with all his family members. This year he had been successful in bringing all his sons together. Some of them had been studying in England for higher studies. Tears rolled down. It was tears of joy. As every member came to Alamgir for their “Eddi”, he was filled with pride. As he was doling out gifts and presents he felt a sharp pain on the back of his shoulder. Next Alamgir was in ICU at a local hospital. It was diagnosed as a cardiac arrest. He was unable to move his feet and arms. He was paralyzed. The local doctors suggested an operation. Alamgir’s family did not want to take the risk. They applied for a medical visa to India. As medical visas is open to residents of countries including Bangladesh, Sri Lanka, Pakistan and China with a validity of one year they had no problems. Why the Alamgir family opted to treat him in India? India offers medical treatment at between half and one third of the cost of similar treatments in neighboring medical tourism countries such as Singapore, Thailand and Malaysia.

Alamgir family calculated only the cost and the language factor. Why? Singapore is two to three times more expensive than India. Thailand is eighty percent more expensive while Malaysia has just started from the running blocks. They had felt comfortable in India in their last trip as they spoke their own language and not English or Mandarin to express them but what lay for them is another story. The Alamgirs did not have the considerable amount of time researching the destination and its facilities on their own and had not shown a degree of initiative. They were left totally at the mercy of the hospitals and their touts. In countries like Thailand and Singapore the governments goes out of their way to attract medical travelers as it has now become a lucrative revenue earner.

India never thought medical tourism as an industry which can give you high revenue and a number of employment opportunities for a host of people connected peripherally with this business. Putting advertisements like “incredible India” and touts and law enforcers running after one’s wallet, with no proper place to relieve yourself, getting beaten up by a taxi driver in the mid way of your journey, rouges throwing you out from your legitimized train berths and on checking up with the flight schedules in the internet you end up sitting like a frog in the airport as your flight was long away reschedule --- the tourist in you pops out “incredibly”. So India was never serious in her attempts to recognize any unorganized sector as “industry”. Medical tourism is also suffering from the same official apathy, and continues to do so.

Medical tourism is related to three ministries--- Tourism Ministry; Foreign Ministry and the Health Ministry. The Tourism Ministry has no plans for its “Incredible India” market leave alone formulating any plans for this niche market. The Foreign Ministry after issuing visas to medical travelers is oblivious to other sectors. Though they are very particular that medical travelers cannot re-enter the country sixty days after one exit post operative or cure. This hinders any post operative care. But they sometimes issue visas to black listed dreaded international criminals. They have no time to think about themselves what to think about a person on a wheel chair. The Health Ministry has enough complexities to sort out like curbing the polio, H1N1 virus, distributing condoms, ORS packets, iodized salt packets, AIDS control, sterilization and also other medieval aged diseases like malaria, diphtheria, small pox which comes to India at regular intervals. Getting into the intricacies of attracting medical tourists doesn’t suit them.  The credit for getting six lakhs patients to India and spending more than Rs.4,500/- cores in getting treated in India is purely because of private enterprise with a few corporate hospitals, pharmaceuticals companies, freelance agents all working in tandem to build a thriving ecosystem that educates, facilitates and ferries medical tourists from Africa, Europe and neighboring countries.

Alamgir Pasha got treated from Christian Medical College, Vellore (Tamil Nadu) and is now able to move around and carry on his business. Before leaving India he went to Ajmer Sharif (Rajasthan) to pray for his wellbeing and his family at the “Dargarh” of Kwaja Moinuddin Chisti.

 

Sitendu De is the author of this post.

Assessing Customer needs vs Collaborating to Co-create Wealth

Owens is a world leader in glass. It had ambitious plans in India. So it set up a few modern plants across India to produce glass bottles.

Its operation was ‘world-class’. They did everything by the book. No mistakes. But soon Owens lost out to its local rival Hindustan National Glass (HNG), a privately held Indian firm. And in a few years it was forced to sell its entire Indian business outfit except one plant to its rivals. Why?

The issue was inventory of finished goods. Owens went by the copy book style of having the minimum possible inventory, producing just what is needed as much as is needed at any specific point of time – all decided by their excellent management tools. But HNG held obscene levels of finished goods inventory, which other called – ‘insanely absurd’.

Theory informs that holding such insane levels of stock means death of the company. While Owens believed this, HNG didn’t. But in the end HNG won the race.  

HNG understood that their customers simply did not have a way of predicting and knowing how many bottles they might need and when they would need them. But there were certain times of the year when demand shot through the roof and stayed high for a few days.

HNG capitalized on this phenomenon. When such booms came HNG was ready with the necessary stock while Owens simply could not figure out a way to deliver the huge requirement in such a short time.  

Naturally customers preferred HNG to Owens and even paid the premium HNG demanded during such crisis periods. And they kept making obscene amounts of profits year on year.

Acquiring the Owens outfits made HNG still stronger and almost monopolistic in the market.   

Morale: Ship as much as possible and as quickly as possible when customers demand.

Are we collaborating with the customer to create wealth for both?

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DESERT STORM

Like most people in Rajasthan, Hiralal Maheswari also holds the “lota” up in the air, tilts his head a little and drinks water without putting the utensil in his mouth. The hot, dry wind flowing across the Thar Desert in the middle of the Indian summer makes Hiralal uncomfortable. But he still carried on. He was instructing the group of middlemen in his business of hand embroidery. These middlemen also known as “Thekedars” are usually responsible for smooth running of the business. Hiralal’s business turnover was a little over 32 crores rupee.

He was seven years old when he came with his father to India from Umarkot (Pakistan). His father, Brijlal Maheswari acted as a “guide” for the Indian Forces in the India - Pakistan war in 1971. They along with other Hindu refugees   crossed the border and settled in Gadra Road. The small hamlet of Gadra Road in Barmer district of Rajasthan is located almost on the Indo-Pak border. It has a population of nearly 1000 and consists mainly of migrant Hindus. Gadra Road is roughly 92 Kms from district headquarters, Barmer.

 After Hiralal’s secondary examination Brijlal egged his eldest son to join the embroidery business he started in 1971. Hiralal joined the business otherwise he had to leave his home for higher studies in either Jodhpur or Jaipur.  Hand embroidery became a livelihood provider for the Hindu migrants who otherwise had nothing worthwhile to do except for the three and half months of agriculture which also depended on scanty rainfall. Traditionally confined to their respective households and communities, embroidered products of remote rural Rajasthan found places in the international market.

This hand embroidery cluster has its genesis in the migration of Hindu refugees to Rajasthan, India during the 1971 India-Pakistan War. The amalgamation of the necessity of refugees to eke a living, of foreigners to take advantage of the exotic and ethnic tradition, and the entrepreneurship of the trading community, gave birth to this sector. Today, with an annual turnover of approximately 130-150 cores rupees, it provides livelihood opportunities to roughly 60,000 women in rural western Rajasthan.

The sector is controlled by around 180-200 manufacturing units concentrated around the Barmer district wherein 70-75 percent of the sector’s production takes place at  Gadra Road, Dhanau, Binjiasar, Chohtan, and Barmer city are some of the prominent clusters around which the sector is organized. Chohtan, another bordering hamlet   is the biggest centre and have 50 percent of the production units concentrated there, followed by Barmer which harbors 23 percent of such units. These manufacturing units are a misnomer in fact, as the entire production of the sector is highly decentralized and takes place in individual households in remote hamlets and villages. In terms of size, micro firms whose annual turnover is less than 10 lakh rupees dominate the production landscape with 53 percent of firms belonging to this category. However they contribute only 8 percent of the volume of the sector. On the other hand 7-10 large firms, which account for only 4 percent of the total firms, capture 51 percent of the market share.

Caste based kinships networks are the most powerful governors of the sub-sector. 70 percent of the manufacturers belong to Maheswari community while 20 percent to the Jain community, both are trading communities according to the traditional caste hierarchy. Thekedars (Agents/ middlemen) are from other communities such as Meghwals, Rajputs, Brahmins, and Baniyas. Woman embroiders especially belonging to a lower caste Meghwals community are the best in this trade.

Hiralal’s younger brother lives in Jaipur and looks after their export division. All handicrafts and embroidery items are sent to the European market especially to Germany. Hiralal still lives in that remote desert hamlet where electricity is only available for 12 -15 hours in a day. He still attends the evening “aarti” in the local Ram temple. He still mixes with the government officials and often sits for a drink after he closes his “embroidery manufacturing unit” after dusk. He still roams in a 4 x 4 jeep among the sandy terrain. He still watches soft pornography films. He still hasn’t prepared himself for a passport. He still gets intoxicated during Holi. He still has his benevolent nature.   But he has admitted his two sons and daughter in an English medium school in Jaipur.

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