Author Archives: lahuja

About lahuja

Lipika Ahuja is a second year Masters student at the LBJ School of Public Affairs. She is also founder-director of a non-profit based in urban Delhi. She actively looks for pursuits which would make possible good policy making and implementation possible. Her focus lies in the south-east Asian countries where she believes there is an abundance of good ideas but a lack of support mechanism to realize them. She lives in Austin with her 6 year old son and her husband.

Making the Case for a Family Doctor

Kriti (name changed), my co-resident in an apartment I am renting out during the internship is a typical young professional working in the booming software industry in India. The neighborhood we live in is serviced by the best amenities possible including services for health care that range from clinics, secondary hospitals and super-specialty centers. Two weeks into my stay here, Kriti developed a recurring back pain that almost affected her mobility. She knew she had to see a doctor but needed answers to many questions before she chose one – which doctor/ specialist will be right for the problem, how expensive will the services be, will the doctor have time to hear about her entire medical history before he/ she prescribes her a treatment.

Incidentally my study during the internship was looking at this very issue – the rising cost of healthcare resulting from a lack of preventive care as well as lack of information. For example, a lot of Kriti’s problems could be sorted if she could see a family physician. The family physician would perform a preliminary investigation helping Kriti diagnose the problem and also prescribe the preliminary treatment. While the specialists look only at the specific cause of concern, the physicians would view Kriti’s health concerns from a holistic point of view and provide a more comprehensive line of treatment. If need be, he would direct Kriti to the right specialist. On top of all this, seeing a family physician would be much less expensive than seeing a specialist in the first place.

The problem is that the presence of family physicians has significantly dropped in India.  Fewer medical graduates want to follow the stream of family medicine as against super-specializations like cardiology, neurology and urology etc.  More and more people are changing cities frequently for their jobs making it difficult to have a dedicated family doctor. Further, with a rise in income levels and easier access to specialists, there has been a surge in demand for their services. With a diminishing supply of providers, and an inconsistent demand for general practice, the breed of family physicians is nearing extinction in the country.

At the same time, lifestyle related and non-communicable diseases are rising in India. According to a 2010 World Bank report, the percent of out of pocket expenses incurred by households in the country on non-communicable diseases rose from 31.6 percent in 1995-96 to 47.3 percent in 2004. Family physicians who take on the role of health managers and promote preventive health can significantly improve health stats of the population.

A handful of providers are doing just that. Nationwide Healthcare in Bangalore, Ross clinics in Gurgaon and Healthspring in Mumbai are amongst some of the providers trying to revive the family physician model. They are all multi-clinic chains servicing communities in urban and peri-urban areas and working to reestablish the trust for a family physician as the first point of contact for any health concern. More importantly, they are reinforcing the importance of preventive rather than curative care. They are all in the first few years of their operation, and while it may be hard to assess their success at this stage, they offer an interesting study as innovative health care models that are striving to improve the population’s health indices.

ACCESS Health International (AHI), the agency I am interning at is taking an active interest in these models and others similar to them. While here, I am conducting a study of these models to understand their delivery model, document their success stories, and identify challenges they face including support for replicating and scaling up. Going forward, AHI will be working to build a community of practice that will facilitate a collaborative environment amidst the different players interested in the field.



Summer Internship with ACCESS International

Life has taken me back 12 years. It was in year 2000 when a few years after having graduated as an engineer and working as a software developer I landed in Hyderabad (India). Part of a start-up dreaming to make it big during the dot com boom. From the moment I was here, I fell in love with the city. The coconut palms, the southern breeze and great work. After a few months and having exhausted all avenues of keeping myself busy and entertained on weekends, I ended up in a hamlet right behind Golconda fort. I was looking to volunteer, and the community here – especially women – were looking for support. After a few conversations, we settled on a long-term action plan. I would give the women the money to buy raw material and the tools, and the women would do what they were best at – Hand embroidery, weaving and knitting. That’s how Fateh (meaning victory) was born. The size of the group grew and so did our confidence. Now I was convinced that projects helping the poor were possible, and you needed no charity for that. With the Fateh women on their own, I moved back to Delhi where my family was. It took me some time but finally everyone gave in to my plans of starting a non-profit. So in the fall of 2001, The Vigyan Vijay Foundation (V.V.F) came into being. The grassroots organization is chugging along, having touched more than 10,000 lives in its 11 years.

In 2006, I gave up my Program Director’s job in V.V.F, though I am still on the Board. It is always heartwarming to see how much good V.V.F is doing in its community, but there is still something missing. There are many V.V.F’s in India, all working tirelessly and incessantly to make the lives of those around them better. But what we are able to do is only a miniscule part of what the country really needs. How much difference can grassroots organizations like V.V.F make without changing the system? For a few years I went around working with other non-profits, talking to thinkers, doers and academicians. Slowly, the idea of going to school took root. I learned about the graduate programs in public policy in various schools in the United States, and one of them had me hooked. Its tag line said – What happens here changes the world. That’s how I came to LBJ.

In the first year of the MPAff program, I struggled – trying to always apply what I am learning in the context of my country and in the rest of the developing world. Without ever planning, my interests and my work drifted towards the field of health care and health care policy. It was fitting since health care has become the biggest challenge not just in developing countries but also in the most developed ones. When looking for my internship, I knew I had to be in an organization working in the developing world with a focus on health care.

ACCESS Health International is everything I was looking for. It is closely working with the government of India, state governments, the World Bank in India and other international development organizations like Results for Development. It is actively working on building a knowledge base that will bring to the foreground various innovations happening in the health sector in India and the rest of the world. At the same time, it is working to build a community of practice that will bring together different stakeholders in the sector to share their resources and expertise. Most importantly, it is building up as an interface to government at different levels, and becoming the government’s go-to for finding data on different aspects of health care access and delivery.

In my 10 weeks here, I am studying specific for-profit models in primary care that have a scope for adoption by the public sector. We will also be studying the scope of public-private partnerships (PPP) in health care that can be based on these models, as is or with some modification. In a team lunch, Sofi Bergkvist, executive director of AHI, shared her experience from a conference she had been to. There were participants from Brazil­ and South Africa. They were talking about PPP’s being implemented in their countries over the last few years and the structural framework they have built to implement and support these partnerships. India has had PPP’s for over a decade now, we are still lacking however a standard institutional and structural framework in the field. It’s about time we shift our focus from grassroots innovations and work to build a policy framework that will take the best of these innovations and reach the whole country. That’s the mission AHI is following, and I am lucky to be part of this crusade.