Professors Gregory Clark & Susan Wolcott (2003) analyse the Indian state level growth experience from 1878 to 2000 and find that there has been little or no convergence in terms of per-capita incomes between states even over such long periods.
They conclude that "encouraging migration of workers to high productivity areas within India is the only policy we know will improve overall income per capita" but find that current rates of migration are a fraction of those observed in Europe and US: faculty.econ.ucdavis.edu/faculty/gclark…
Sep 26, 2020 • 4 tweets • 2 min read
As they have in other sectors, we believe that better rules & regulations will help us in healthcare as well. Sadly, given patient-privacy issues, & the continuing need to empower the actual provider to "act-in-the-moment" without fear of reprisals, these are not effective tools.
The most powerful instrument of "control" is payments which impact incentives "on-average" and nudge providers and hospitals to act in the best interests of the community of patients that they serve. Insurance regulators & providers therefore have a bigger role in this.
Aug 3, 2020 • 4 tweets • 1 min read
Non Performing Assets (NPAs), particularly Gross NPAs, are an indicator of the in/ability of a bank to allocate credit in a manner that maximises growth and development in the economy.
Permitting banks to put-off recognition / disclosure of true asset quality so that they can continue to lend does not help growth but instead allows lower-quality institutions to continue to perform this function and to continue to hurt economy-wide growth and job-creation.
Aug 1, 2020 • 5 tweets • 2 min read
An important debate in these times has been the relationship between the strength of, and the funding allocated to, the country's health system and the mortality rate per million (population) due to COVID-19.
While it may be premature to attempt a full analysis at this time, the potential relationship and the policy-signals emanating from it may not be quite as straightforward, and the choice of the national COVID-19 response strategy may have a strong and independent bearing on it.
Jul 25, 2020 • 4 tweets • 1 min read
In many developing countries, perhaps because of the long shadow cast by historical choices, governments still view themselves in a corporate mould, focused on gathering revenues, on borrowing money, and on the operation of multiple schemes and departments with these resources.
They seem less comfortable in their governance role and in the use of several other tools such as their unique ability, to convene diverse interest groups & help build consensus, and to address failures brought on by information asymmetries & distorted preferences of consumers.
Jul 19, 2020 • 5 tweets • 2 min read
Driven by the twin challenges of information symmetry and non-convex preferences, market forces almost always fail to generate Pareto-Optimal outcomes in healthcare markets.
One only has to look at the high and growing C-Section epidemic in high-income states of India (including in Government hospitals), and the low demand (and supply) for screening and hypertension management services, to be convinced of this.
Jul 4, 2020 • 4 tweets • 4 min read
A new campaign informed by behavioural insights launched by the @NITIAayog informed by outstanding work on behavioural science by @CSBC_AshokaUniv:
It's core approach is to empower us to remind each other, in a somewhat in-your-face way, to wear a mask. Interestingly the posters and the lovely anthem are aimed not at those who do not wear a mask but at those who do, asking them to prompt those who do not. Powerful!
Jun 29, 2020 • 4 tweets • 1 min read
An important new paper authored by Dr @CristineLegare and others, has just been published which, in its study of the cultural ecology of health, carefully examines both traditional and modern birthing practices in Bihar. royalsocietypublishing.org/doi/10.1098/rs…
It argues that: (i) only a comprehensive understanding of both sets of practises and how they connect with each other can improve the efficacy of health interventions and improve outcomes;
Jun 25, 2020 • 4 tweets • 2 min read
In talking to policy makers I have repeatedly heard the view that they do not wish to overreact and that they have things well under control. Graphs like the one for Arizona should give us pause and make us wonder if we indeed do have everything under control. @Atul_Gawande
Also if we took the advice of Dr Frenk (@julio_frenk) and implemented "diagonal strategies" (a vertical focused response which also strengthens the entire "horizontal" health system) then does it really matter even if we do end up "overreacting"?
Jun 16, 2020 • 4 tweets • 2 min read
Thank you for sharing this very personal and very moving account Haresh. I have had the concern from the very start of the crisis in India that we are, perhaps guided by the European responses, too focused only on the mantra of centralise-hospitalise-ventilate.
A concern in my mind has been that #COVID19 responses of developing countries have relied perhaps too much on the strategies of centralise-hospitalise-ventilate being followed by more developed nations, even though health systems have been overwhelmed for several of them.
We need to rely much more on our strengths which comprise strong communities; a highly distributed base of primary care providers, nursing homes, clinics, and maternity homes; and technological prowess. I write about this here: brookings.edu/blog/future-de…
Jun 11, 2020 • 4 tweets • 2 min read
If you or any of your relatives have cold, cough, fever, or difficulty in breathing, and are worried about #COVID19 symptoms, no need to step out. Consult doctors for free from the comfort of your home through audio and video calls at swasth.app.
Visit swasth.app or call on 08061933193. A trained and verified doctor will consult with you via audio/video and you will receive a prescription at the end of your consultation.
Jun 7, 2020 • 4 tweets • 1 min read
One question that I keep getting often is: what should we do inside crowded slums. The best set of ideas that I have found are here: lshtm.ac.uk/newsevents/new…
The disease is droplet transmitted and not vector borne and a safe isolation / quarantine area can be created very quickly inside a small room / community-space which even densely populated communities can come together to enable.
May 28, 2020 • 8 tweets • 2 min read
There has always been a digital divide in India which sits on top of all the other divides.
Many countries (see this blog for the US: federalregister.gov/documents/2020…) are waking up to the fact that completing the work of getting broadband connectivity to every nook and corner of the country is an important first step in bridging that divide.
May 21, 2020 • 6 tweets • 1 min read
The phrase "shadow bank" is often used in India to refer to NBFCs and also to imply that there is something shadowy associated with them. It may be important to delve a little bit deeper into the definition of this phrase so that we can be more precise in its application.
The Financial Stability Board and the IMF refer to "shadow banks" as entities that perform bank or bank-like functions but are not regulated by the banking regulator.
May 10, 2020 • 4 tweets • 2 min read
Our entire health system is focused on addressing the COVID-19 epidemic. While this may be a necessity right now, there is a real danger that patients with chronic diseases such as hypertension and diabetes are ignored, with potentially disastrous consequences for their health.
Many countries have worked with pharmacies to address chronic diseases (fip.org/files/content/…). In these troubled times this is a large resource that we in India need to fully tap into, potentially using simple protocols and tele-consultation from the pharmacy.
Apr 15, 2020 • 6 tweets • 2 min read
From reading the news and talking to people I get the sense that we think this is a short-term phenomenon, and that a rapid-aggressive-response strategy of the type we have currently deployed, will see us through and then life can go back to normal.
I worry that this is not going to be the case that we have to be prepared for a slow-burn evolution of this epidemic and that the more aggressive the current response the slower the burn because it will "flatten the curve" but may not do much to change the total area under it.
Apr 7, 2020 • 4 tweets • 2 min read
These are times of enormous strain for all concerned but in particular for healthcare providers personally and for their patients. There are two sets of resources that would be very valuable for you to explore using:
1. wysa.io/healthcare: this a highly rated behaviour therapy chat-bot that is approved by the UK National Health Service. This is currently English only. They are exploring the possibility of launching this service in multiple Indian languages.
Mar 18, 2020 • 5 tweets • 2 min read
Even the IMF's orthodox position on fiscal discipline seems to have moved to accommodate this point of view: imf.org/en/News/Articl…
"And the second area of fiscal measures that we recommend are those that are well-targeted to address the supply and demand shocks. Measures of that nature are already being put in place in different countries."
Mar 18, 2020 • 5 tweets • 1 min read
India has a very wide variation in Cesarean Section (C-Section) rates across the country. While in several Districts, the rates are extremely low, in some of the Districts in the richer States of India, they are particularly high.
Exceeding, for example, 75% in the Karimnagar District of Telangana. And, while the rates within the private sector are generally higher, they are also well above acceptable levels, in the public sector in these Districts.
Mar 10, 2020 • 4 tweets • 1 min read
That primary care, particularly in the Indian context, is important is well known. This note goes into its five essential components, including: (1) comprehensive care offered using a set of well-defined protocols, (2) empanelment of a defined population,
(3) risk stratification of the empanelled population & a proactive outreach to high-risk patients, (4) concierge services & care-coordination, and (5) landscape epidemiology.
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