ISBInsight: How did the Development of Humane Action (DHAN) Foundation catch your attention?
DVR Seshadri: The founder and Executive Director of DHAN, M.P Vasimalai, is a classmate of mine from IIM Ahmedabad (1981-83). Though DHAN (which functions in 13 states of India), operates below the radar, it has been instrumental in bringing nearly 1 crore Indians out of poverty through its model of Self-Help Groups (SHGs). DHAN is driven by the idea of the community taking ownership of its challenges. Its impact over the last two decades has been phenomenal and that caught my attention. While I wanted to showcase this to the world, Vasimalai was not keen on having a case written on DHAN. “Let the work speak for itself,” he would say. This encouraged me further to compile a series of case studies on the DHAN Foundation.
What was your objective behind developing a case study on DHAN’s intervention in healthcare?
Healthcare is an important aspect of any stable society. We had already written one case on the SHGs model of DHAN. For the next case, we were keen on writing about DHAN’s healthcare model. DHAN’s foray into healthcare was not a deliberate strategy. It started off when DHAN partnered with three other very high-profile organisations – Apollo hospitals, Philips and ISRO – with a lot of fanfare to anchor project DISHA (Distance Healthcare Advancement) and an aim of bringing state-of-the-art diagnostic services to the rural communities. While there were synergies, things fell apart after a few months, as neither Apollo nor Philips saw any money in it and found it to be a losing proposal. Once both these partners pulled out, ISRO too backed off and DHAN had to face the hard reality of making a decision on what to do next. The case study talks about several options that were considered before DHAN finally decided to go back to the community. While working closely with the community, they demonstrated the value of regular healthcare checkups, early diagnosis and telemedicine. Over a period of 7-8 years, they were able to perfect their model. Through their Sustainable Healthcare Advancement (SUHAM) hospitals, DHAN had set an example by making healthcare affordable to the poorest sections of society.
What inferences did you draw from your interactions with Vasimalai, Rajapandian and other members of DHAN Foundation who were involved in its foray into healthcare?
The power of resilience and community action worked in favour of DHAN. The underprivileged kept aside their communal differences and rallied behind a cause. They built a hospital in the most frugal way, at a minimal cost of INR 9.5 lakhs. Delinking money from well-being is a huge lesson too. Crowdsourcing, partnering, frugal engineering, networking and community ownership are all lessons well demonstrated in this model.
What are the major management takeaways from this case, in your opinion?
The major takeaway is understanding choice versus compliance i.e. the ability to choose without blindly following the industry norms and to innovate. This is not restricted to healthcare; in any industry, people can chart out a different path by being creative. Another takeaway is to focus on frugality. Here is a grass root level organisation saying, “We don’t have money, and therefore frugality is our cardinal principle.”
This case study reinstates the importance of creativity and the importance of community taking ownership. At DHAN, decision-making powers are devolved to the beneficiary community. This model ensures the long-term sustainability of the organisations that DHAN creates.
Can the learnings from this case study be applied to the various innovative healthcare models across India?
One important factor for sustainable healthcare model around the world is that the three layers of healthcare system should be very well oiled, i.e. there must be strong linkages between primary, secondary, tertiary and village level health coaches. In India, healthcare is concentrated at the tertiary hospitals. The secondary hospitals are defunct and primary hospitals non-existent.
In India, the government’s spending on healthcare lies at an abysmal rate of 1% of the total GDP. Whereas in Nordic countries it is as high as 10% or 12%. Total healthcare spend in India is 5% of GDP out of which 4% is in the private sector. For instance, Ayushman Bharat Yojana, though good in its intent, may face implementational challenges due to scarcity of funds. The corporate hospitals cater to less than 1% of the Indian population, the remaining 99% cannot afford treatment in such expensive places. Hence sustainable models are required to deliver healthcare to this 99% of the population and DHAN has created a sustainable model that does not require heavy capital and human resource investment. The SUHAM hospital system created by DHAN is affordable to the poorest people of the country. DHAN is gradually scaling up its operations.
How would you summarise your overall experience while developing and teaching the DHAN case study?
Developing this case study helped us think more creatively about healthcare. I used this case in multiple forums. It is usually a moment of revelation for the participants because it shatters all their preexisting notions about healthcare delivery systems in India. Through telemedicine, linkages and partnership with other hospitals, the community can provide first line healthcare services. There is a pall of hopelessness about healthcare for the poor in India. When I teach this case, there is tremendous enthusiasm and interest among students as it sets them thinking, ‘What can I do to innovate in healthcare?’ They try to come up with innovative solutions to some very tough challenges in the realm of healthcare. For those not aware of the problems plaguing healthcare in India, this case study introduces them to the hard reality. And those who are touched by these realities might do something major to innovate in this space. That is the hope!
About the Writer:
AJ Swapna is a Case Writer at the Centre for Learning and Management Practice at the Indian School of Business.
About the Case:
D.V.R. Seshadri., and K. Sasidhar., 2019. A Holistic Intervention Towards Sustainable Livelihoods and Coastal Conservation: A DHAN Foundation Case. Indian School of Business case. Harvard Business Publishing.