Addressing the health care needs of India’s poor

SAS Poorna Arogya uses Cutting Edge Technology, Total Quality Management and Robust Corporate Responsibility to Meet Health Care Challenges in India

The company works in the spirit of Nobel Peace Prize winner Dr. Muhammad Yunus


© 2015 R Mena / David Veg
Sudhananda Poorna Arogya Scheme is a programme designed and implemented by the SAS Poorna Arogya Health Care (SAS) Mysore, a community based private and NGO sector joint venture which provides low cost health care services to the urban and rural poor in collaboration with NGOs, NGO-MFIs, Cooperatives, and a network of recognized hospitals. SAS has been selected to receive the BID Quality Crown Award for 2015.

Currently, health insurance does not reach approximately 200 million urban and rural poor in India. SAS was created to implement innovative solutions in order to address the socioeconomic conditions of this population. Its stated goal is “to provide health care services to 5 million urban and rural poor by 2020.” SAS is also an organisation founded on the principle of self help and auto-sufficiency. In the words of Professor Mohammed Yunus, the Nobel Peace Prize winner, “The poor themselves can create a poverty-free world… all we have to do is to support them in freeing themselves from the chains that they have put around themselves.”

Helping the Poor through Microfinance


Dr. Yunus was born in 1940 Chittagong, Bangladesh, studied at Dhaka University in Bangladesh, then earned a Ph.D. in economics from Vanderbilt University. After teaching in the United States, he returned to Bangladesh to head the economics department at Chittagong University in his home town.

It was while he was there that he began to make small personal loans to women basketweavers. Eventually, he decided to found the Grameen Bank in 1983 with the express purpose of providing very small loans to the poor and at the same time giving instruction to them in the basics of money management. The idea of microlending has grown to such an extent that there are now microfinance institutions in more than 100 countries worldwide. Dr. Yunus has also won numerous humanitarian awards and has served on United Nations bodies since 1993.

Microfinancing was Invented to fill a Need


The worldwide banking system is huge, but it has limitations. Because of the overhead that most banks must pay in order to keep the doors open, they cannot effectively provide services to small scale borrowers. The effect is to exclude about 50% of the world’s population from traditional banking. In fact, in sub Saharan Africa and parts of southern Asia, less than 20% of the population have access to banking services.

Microfinance is the term used to describe organizations which serve the population which cannot access typical banking services. It provides a means for low-income individuals to lift themselves out of poverty through small loans and other financial services.

Since they do not have a bank account or the ability to take out a loan from a traditional bank, the poor are forced to improvise in order to obtain the financial services they need. Instead of saving cash, they tend to hold assets such as animals, tools of the trade or small amounts of precious metals that they can turn into cash. The problem is that these items may be stolen, lost or destroyed, or they may lose value through deterioration or fluctuation in market price. They also may not be liquid, and in a time of need a poor person may be forced to sell them at a discount. Also, many times the owner of the asset needs it in order to make a living, meaning that borrowing against it would be much more useful than selling.

The Nobel Peace Prize was awarded in 2006 to Dr. Mohammad Yunus for his pioneering work in microfinance in Bangladesh. He founded the Grameen Bank there in 1983 and quietly began a revolution in the way that financial services are delivered to the poor. The World Bank estimates that today about 160 million people in the developing world benefit from microfinancing.

The biggest challenge to microfinancing is that transaction costs for loans are more or less fixed. This means that staff time needed to process and document a $100 loan is roughly the same as it is for a $1000 loan. However, if that cost is $25, it represents 25% of the first loan, but only 2.5% of the second. These amounts must be added to the interest rate charged in order for the lender to stay in business, meaning that interest rates charged on very small loans are much higher than on bigger loans.

The good news is that when poor people have access to banking services, the community at large wins. Families and business enterprises they start become more stable, they are able to plan more effectively because they have the security of a rainy day fund, they earn more and therefore consume more and consume more regularly.

© 2015 R Mena / David Veg
Poor families with access to microcredits are also better equipped to send their children to school, leading to a more productive workforce, and are healthier, reducing the strain on the health care system. Studies from all over the world have shown dramatic improvements in living conditions, spending, savings, and nutrition for participants in microfinancing.

Applying Microfinance Principles to Health Care


Just like the challenges faced by Dr. Yunus’ clients were great, so are the challenge that SAS has taken on. Both are also committed to using small amounts of money in the hands of individual poor people to gain access to a system that traditionally has excluded them. Thus, the principles of microfinance are directly applicable to the work SAS does, and the company has taken much inspiration from his work.

Because of the lack of adequate health care, approximately one million people, mostly women and children, die in India every year. In addition, 700 million people have no access to specialist care while only 20% of specialists can be found outside of urban areas. The infrastructure is poor, and there is an acute shortage of medical personnel, especially in rural areas. The public health care system is inadequate to meet the needs of the people, while high quality health care provided by private providers is cost prohibitive for a large portion of the population.

SAS is the brainchild of Dr. Arjun Sachidanand and Dr. Schidananda Murthy, who decided that innovation and technology were needed to address the problem. The result was the use of high tech software to streamline processes and lower the costs of administering health care services, making them available to a wider population. SAS takes advantage of web based software and innovative design in health care delivery in order to provide poor families with low cost hassle free health care by collaborating with Non-Governmental Organizations and network of selected hospitals.

Health care is a field where Quality is not only important, but it can mean the difference between life and death. In order to ensure quality at SAS, a Health Trust was created and which partners with other experienced experts such as NGOs, NGO-MFIs, and Cooperatives to issue Health Cards to their urban and rural beneficiaries, most of whom are poor. Then, local hospitals sign agreements to be part of the network and provide services to the card holders. Premiums are low and copays are kept small enough so that members are able to seek care within their budgets. Hospitals have also chipped in by providing discounted diagnostic procedures to members.

Card Holders are entitled to visit network hospitals, where they are met by specially designated Help Desk Executives who will help them obtain timely, appropriate, and quality health care services. The Help Desk Executive has access to Web based software, reducing costs and waiting time, and streamlining paperwork procedures. In addition, SAS uses Web Based Medical Claims Processing Software, a mobile app for processing medical claims, cashless inpatient care, and Area Wise Disease Prevalence Mapping and Reporting. The BID Committee was particularly impressed with SAS’s use of cutting edge technology to serve the poor. The program started modestly enough, with 5000 members in one district of Karnataka, but through hard work and an unswerving dedication to customer service has now grown to serve 22 districts of Karnataka and 8 districts of Assam and has provided its services to 650,000 members to date.

Quality that is Measured


There is a common expression in the world of Total Quality Management that posits that if you can’t measure it, it doesn’t exist. At SAS, Quality is measured consistently and judged against written standards that are verifiable. These are broken down into a number of substantive areas:

1. Accessibility to Quality Health care at Hospitals
SAS identifies potential facility partners through rigorous inspections and semiannual reviews of statistics pertaining to members.

2. Affordability
Costs to members are continually evaluated in relation to their ability to pay and continuous quality improvement has allowed a reduction in treatment costs while maintaining set quality standards.

3. Quality & Scalability Parameters
Measured aspects include the number of awareness meetings for MFI clients, Quarterly Measured Ratio of members to total number of MFI clients, Yearly Measured Ratio of insured women and children to the total number of insured members, and Yearly Measured Ratio of renewals at the end of cycle to the total enrolled member in that cycle

4. Client Delivery and Satisfaction
These parameters include Quarterly Measure Percentage of members availing OPD Care in the treatment year, Quarterly Measure Percentage of outpatient members availing inpatient services during the treatment year, and Quarterly Measure Ratio of claims settled to the total premium collected

Doing Well by Doing Good


SAS takes Corporate Social Responsibility -- a key component for selection by the BID Committee -- very seriously. In addition to its stated mission of improving health care services to the poor, SAS runs multiple health care camps and performs free health care check-ups for the poor. They have also partnered with other charitable and socially responsible organizations such as Grameen Koota Financial Services Pvt Ltd in Karnataka, World Bank Market Place Development in Assam, and RGVN (North East) Microfinance Ltd in Assam.

SAS also been recognized by third parties for their good work, winning the Action for India Silicon Valley Challenge for Good Mentee, the Vodafone Mobile for Good Award, and an award from the World Bank, India Development Marketplace. Because of its commitment to continuous quality improvement, customer service, and betterment of the community, SAS has been selected to receive the BID Quality Crown Award for 2015 at the convention in London.

ABOUT BID AND THE INTERNATIONAL QUALITY CROWN AWARD:


BID is a private and independent organization founded in 1984, whose primary activity is business communication orientated towards quality, excellence and innovation in management. A leader in the broadcasting of Quality Culture, BID recognizes those companies and organizations which lead the most important activities in the business world, and is considered the founding organization in the broadcasting of the Culture of Quality, Excellence and Innovation in 179 countries. The trophy symbolizes a pledge to the principles of Quality Culture. The QC100 Total Quality Management Model, together with the Quality Mix program, media coverage of the convention and its impact on the community and business sector, create an unmatched platform for continuous improvement within the organization and awareness of the achievements of the company at an international level. Awards are given only to those who are committed to improving their Quality Culture based on the principles of the QC100 Total Quality Management Model. Candidates are proposed by the leaders of previously awarded companies who they consider worthy of the award. Especially meritorious candidates may also be nominated. The International BID Quality Award Selection Committee then chooses the winning companies who will receive the award in New York, Paris, Geneva, Frankfurt, Madrid and London.