A Primary Care Upgrade for India

by JHI Staff on November 8, 2012

One of our newest projects just got off the ground, and it’s one that a lot of us here are very excited about. I’m particularly excited about this venture as it promises to be a model that can significantly improve the health care options for some large, underserved populations around the world.

This project is based in India, whose population of more than one billion people is the world’s second largest. It’s a country that has long struggled to make high-quality, modern medical services accessible to most of its population. Over the last decade, India’s economy has been one of the fastest growing in the world, creating a rapidly expanding middle class that has become well educated and has higher expectations of health care. Meanwhile, as India’s population ages, more citizens than ever are in need of good health care. All of this means that there’s a growing demand for high-quality health care, a demand with which their system hasn’t been able to keep up.

In the U.S., and in other highly industrialized countries considered to have high-quality health care systems, the great majority of visits to physicians involves a fairly routine outpatient visit—either seeing a family doctor for a check-up or a referral (primary care), or seeing a specialist for preliminary tests or a relatively routine treatment (secondary care). But in India, there’s an acute shortage of family doctors. Most of those who do practice primary care are doing so with only a bachelor’s degree, or a degree in alternative medicine, or no degree at all. As a result, when someone needs to see a qualified physician—even for the most routine care—they often end up having to go straight to the hospital, which can involve long waits, tremendous inconvenience, and outsized costs. And most medical expenses are paid out of pocket.

The project we’re collaborating on involves opening a large string of primary- and secondary-care clinics throughout India. The plan is for these clinics—150 of them over the next ten years—to make available high-quality, easily accessible primary care and diagnostic services to a significant swath of the population. We believe the clinics will be able to provide the sorts of comprehensive services, professional and comfortable environments, reasonable waiting times and moderate prices that patients in the U.S. and many other countries often take for granted—but that will be a revelation to many people in India.

As is true for all our projects, the most critical element is aligning our mission with the right collaborator. In this case, the organization behind the ambitious plans is the Bharat Family Clinic, an Indian company owned by Pradeep K. Handa. Mr. Handa is well-known to us—he’s the vice chairman and CEO of the KAPICO Group, Johns Hopkins Medicine International’s local sponsor in our groundbreaking Kuwait project. I’ve spent a fair amount of time with Mr. Handa, and I’ve long been impressed with his dedication to having a positive impact on health, his visionary thinking, his organizational acumen, and his feel for the needs of the population, as well as with his enthusiasm for and commitment to close collaboration.

The first clinic opened this month in the Delhi area, and more should follow shortly in other regions. Though each of the clinics will be adapted to local needs, the services they offer will all be based on the model of the Johns Hopkins Community Physicians clinics. We’re working closely with Bharat to help set up and oversee the clinics’ processes. We’ll even be able to offer their patients second opinions from our own staff here in Baltimore, via phone, video and other electronic communications.

Bringing a higher standard of routine health care to India is of course a hugely worthwhile goal in its own right. But there’s an important potential bonus. We’re hoping that these clinics present a good model for improving health care in many other developing countries with limited options for routine care. Our work until now has usually concentrated on building and improving hospitals, and while that will certainly continue to be an important focus for us, we’re eager to have an impact on community-based, outpatient primary and secondary care.

Johns Hopkins Medicine has made great strides in recent years in doing exactly that in the Baltimore area, and now we’d like to do the same on a more global scale. As attention in medicine continues to shift toward the prevention and management of cardiovascular disease, diabetes and other chronic conditions, it may be that we ultimately can do more for health via primary-care clinics than through hospitals.

What’s more, we’re always interested in learning from our collaborations and fellow collaborators, not merely providing them with our existing expertise. And I’d be surprised if our experience with the India clinics doesn’t end up feeding back to some extent into the way we do things here in Baltimore and elsewhere in the U.S. Yes, the U.S. health care system is one of the best in the world—our high costs aside—but there’s plenty of room for improvement, especially in primary care. Working with others to figure out how to do it better in other countries, where the need may be more acute, will likely help us figure out how to do it better here.

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