Monday, June 12, 2017

Key Metrics to Measure Functioning of a Healthcare System

Helped a friend some time ago to research key metrics that a government can use to monitor the efficiency of its health system. Thought will share it on my blog as well.

The health metrics used by governments around the world are highly contextual, geared at their specific targets. The presented metrics are based on internet search and can be further improved by conducting country specific research and employing health care professionals. As a disclaimer, I am not a health specialists and have relied heavily on the WHO framework. All sources used are duly mentioned below the post. I have tried to zero down on 10 key metrics as a way to focus on the basics and with a belief that doing everything often means doing nothing. I believe that starting with these would give an excellent start and help put in place a framework to support further improvement.

The aim is to help policy makers save time by presenting a one page memo for key items to focus on that help them create a widespread image of efficiency and transparency (people feel the system is functioning well), aiming for KPI management. While a ground up build up of health system is ideal, the framework would help to address visible change. More fundamental question of how to ensure long term improvement of the health system (e.g. having enough medical staff in the long run, promoting healthy lifestyle, planning investment into beds/ equipment etc.) is not directly addressed by these, though inevitably these would have to be considered to deliver these metrics in the long run. Happy for suggestions to improve this keeping in mind the objective.

Please note that some metrics are measures (need effort to quantify but can be quantified), others are boolean flags (it is done or not done). Use of technology would be critical for measuring success.
My key 10 metrics are:
1. Under 5 mortality rate per 1000
2. % of pregnant women with  at least 4 antenatal care visits during last pregnancy
3. % of 1 year olds fully immunised
4. % of women reported knowing about means of avoiding sexually transmitted diseases/ HIV/ birth control
5. Premature mortality rate (% of people dying before reaching the average life expectancy) with causes
6. Respect for the dignity of the patient (includes aspects of the interaction with providers such as courtesy and sensitivity) using surveys
7. Prompt attention to health needs: time lag between a person identifying the problem & coming to the hospital (distance travelled to get to the facility), being seen by the doctor & provided medicine (promptness of care/ availability of enough doctors & nurses), and cured (effectiveness of diagnosis: segment by disease)
8. Availability of basic amenities for patients: clean waiting rooms, adequate beds, and healthy/clean food when admitted
9. Cost of service delivery benchmarked against a standard cost (calculation methodology to be same), including efficiency of purchasing (cost and quality)
10. Provision for strategic leadership, preparation of financial statements and independent audits

Other metrics that you may want to consider once you have the above in place are:
1. Under 5 chronic malnutrition per 1000
2. Analysis of consumer protection cases to identify problem hospitals
3. State of communication of existing government hospitals with each other so that resources can possibly be pooled
4. Availability of physicians, nurses, community health workers etc. as perceived by patients
5. % of population denied care due to cost (if significant, explore options/cost for social insurance, increasing competition, etc.)
6. Controls in place to reduce shrinkage (theft, corruption) and use resources more efficiently
7. Resource analysis by key health facilities (how much money comes from government, fund-raising, donations, NGOs)


Key Sources:
1. WHO Urban HEART: Measuring Urban Health
2. WHO Framework for Health System Performance Assessment
3. Measurement Framework: Evaluating Efficiency Across Patient-Focused Episodes of Care (NATIONAL QUALITY FORUM, US)
4. European Observatory on Health Systems and Policies (LSE)


Thursday, May 25, 2017

Making Your Meditation Deeper

5 top tips from my experience to help beginners make their meditation deeper:

1. Choose a comfortable time and place
As you become more experienced, you will be able to be more flexible about this. However, when you are just starting it is better to choose a comfortable time and place where you know you will not be disturbed. Put your mobile on silent, wear something comfortable and sit comfortably with your spine straight (cross-legged or on a chair, as you prefer). Use a back support if you need one. The best times that work for me are either early morning or just before sleeping.

2. Have a relatively empty stomach before meditation, stay hydrated
Meditation works better with an empty stomach and a hydrated body. So, if you planning to meditate before sleeping plan to have an early, light/ easy to digest and easy on the stomach dinner. Avoid fried food, red meat, alcohol and very spicy food for dinner. If you experience a slightly heavy head post alternate nostril breathing, it is a sign of insufficient water intake.

3. Avoid caffeine, alcohol, nicotine and phone scrolling near meditation
The aim of meditation is to make your mind sharper and naturally alert. Therefore anything that either makes the mind jumpy, restless or dull needs to be avoided pre-meditation. Besides alcohol, coffee, tea and recreational drugs, this also includes endless Facebook and Whatsapp scrolling and TV binge!

4. Exercise
If you are a naturally very energetic person with a very active mind, settling down for meditation can be difficult. While breathing exercises can help with it, physical exercise would use up some of that nervous energy, allowing you to settle deeper.

5. Be regular
As with most things in life, practice makes perfect. So, don’t give up. There are some serious benefits to be reaped with regular meditation, and simply doing it regularly is the key to both unlocking these benefits and going deeper.

Thursday, December 15, 2016

Demonetisation in India

My take on the current demonetisation situation:

1. In current political climate it is suicidal to accept that you have made a mistake. BJP government will therefore not admit to any failings. Nevertheless, the implementation and benefits at this stage are unlikely to exceed the costs from current point of view.

2. Let this be a lesson for all leaders who think revolutionary changes are cool/ they can change a large entrenched, rotten system overnight with few, big moves. Ideas of Arthkranti (the guys who gave this idea to Modi), while appealing on paper, have no historical precedence of actually working. Changes need to be incremental, systematic and well thought of. Disruption is not always good and change is always slow & painful.

3. Modi has seriously underestimated the will of 97% people to evade taxes and stay out of the system by any means possible. It is not easy to seek people's direct cooperation to act against their self-interest, even if the move benefits the whole society.  

4. If Modi wants to salvage the situation, he can use the chaos and confusion created by this move to push through serious reforms to tackle root problems. Tax raids, pushing digital transactions, stronger anti-tax evasion rules and marginal tax on gold to enable tracking gold transactions are steps in the right direction. Bringing in the right to service act as envisioned by Dr JP + continual shift towards e-governance will stem more corruption than demonetisation. 

5. It is time to bring in laws to prevent disruption of Parliament

6. I still support Modi as I see him as a leader who intends to change the system for good. I have not seen any alternative leadership that I could trust more. I would happily support any national leader who offers a constructive, reasonable intelligent plan and a leadership and is capable of forming a stable government at the centre.

7. The only people who make mistakes are the ones who try to do something. Nevertheless history rewards only success, as highway to hell is often paved with good intentions. Modi may do well to remember this.

Thursday, December 31, 2015

Wishful thinking

The heart is not a friend, my own hands have become foes
The fate seems sealed with no end to woes
As I lie surrounded by darkness, bleeding barely breathing
Thinking about a life unlived, dreams unfulfilled, and promises broken
As life lingers, and pain extends
The mind races on roads that may never be
And I wonder about the million questions that I cannot think of anymore
I do want to fly and float, but here I am… sinking

Dreaming of warmth, o wishful thinking…

Tuesday, October 20, 2015

Narendra Modi's Masterplan for Indian Economy

While I don't actually know what NaMo is thinking, given his actions to date I think his plan for the economy is on the following lines: 

  1. Market India as an investor friendly country to get in FDI
  2. Promote "Digital India" to encourage a part of economy that does not need big infrastructure spend, and use it to promote e-governance
  3. Get manufacturing in India at least for domestic consumption (including defence) to create jobs and positive buzz. Defence export are less likely to be sensitive to transport costs (the penalty of poor infrastructure) and can boost Digital India
  4. Start building the infrastructure required to ultimately enable India to export manufactured goods 

For the first three to be sustainable, reining in bureaucracy to be more business friendly  and judicial reforms to reduce end-to-end judgement times would be needed. We are already seeing steps to make the bureaucracy toe the line. Whether it will work or not is to be seen.

There is no concrete step on judicial reforms, which is a concern. However, as long as NaMo is in power, a compliant bureaucracy in itself will make a world of difference. If Modi goes out of power, most of the gains are likely to be lost without judicial reforms.

These changes are hard, but step 4 will be the hardest. Indian export in manufacturing at global scale is simply not possible without a highly developed infrastructure, including state of the art container ports, express ways for large container trucks, and a functioning fast freight container rail routes. Privatisation of freight rail, strategic layout of roads, and integrated deep water ports are needed to match the logistics advantage for manufacturing in China. To give you a perspective, right now 7 of the world's busiest container ports are in China, who has strategically invested in its infrastructure to brilliantly support exports. Without doing the same Make in India (for export and not just internal consumption) will never be viable, and digital India+defence exports can take you only so far. 

Even if Modi delivers factually, he needs to up his game regarding communication and rein in a lying, agenda based main stream media. It is time that media houses were held accountable for what they publish as factual news. You can't run a lie to tarnish somebody's reputation as main news for 20 hours and then publish the apology as side news for 2 minutes.

Overall, these steps, if executed reasonably, can provide India a significant boost and actually turn it into a world power. However, it is a difficult battle against entrenched socialist practices/culture of non-performance, corruption, and protectionism. Add in a biased, lying, agenda based main stream media and desperate fight for survival by the existing corrupt order, and this gets even more interesting. Of course some of out neighbours would like to see us derail as well. NaMo alone can do only so much. I just hope it is enough...

Wednesday, June 17, 2015

Thinking about Game of Thrones Season 5

WARNING: if you have not seen Game of Thrones season 5, potential spoilers ahead

I love Game of Thrones for its realism and randomness, that very well mimics the harsh realities of the world and the games of power struggles. With each passing episode, the TV adaptation is finding it more and more difficult to depict Geroge R. R. Martin’s complex Song of Ice and Fire saga. Up until season 4 it was still alright, but season 5 has seen some big time misses that are a big-big let-down. Is budget an excuse? Seriously? Millions of people watch this series. Logically, with such a big established fan-base, funds should be the last concern. I guess it boils down to desire to make a certain amount of profit at all costs, probably due to a badly negotiated contract with HBO. Or maybe it was plain stupidity, hubris, or laziness by the producers. Whatever it was, the quality of season 5 has been the worse till date. As a fan, I am not happy. I would still watch season 6, but it would be so much better if George R. R. Martin comes out with his books instead…

My key gripe is losing the sense of realism and ignoring character build-up, which was not the case earlier. For example, when the sword fell on Ned’s neck, it was the end of story. Similarly the Red Wedding was unapologetically brutal. There were a few reality bloopers, but overall the story held. In the current season, however, I think that the following elements were done pretty badly:

Dorne:
Of course. The cartoonish sand snakes with absolutely no idea about intrigue was the worst possible addition to the show. The last scene when they poisoned Myrcella knowing that Trystane is going to be with Jaimie shows that they are so blinded by the desire for revenge that they are willing to put Trystane in harm’s way. Not very smart, are they? The overall character build up through the season was horrible, and Dorne was easily the worst part of the show.

Unsullied and the Fighting Pit:
Aren’t unsullied supposed to be elite fighters, known for their discipline and fighting in formidable formations? In this season they came across as normal soldiers, even sitting ducks. A little effort to show their class during their ambush in the alley and in the fighting pit would have helped. And while we are talking about fighting pits, what the hell were the Son’s of Harpy thinking? They threw so many spears at Drogon and none at the Mother of Dragons? They even let her key advisors escape once she flew away. Pretty lame and unrealistic.

Sansa:
Until the last moment Sansa had no clue where Littlefinger is taking her. Even then, she enters the situation without a concrete plan, trusting Baelish. And how does it turn out to be? Some people feel she is growing a spine and doing something. To me, it appears that she got short-changed by Littlefinger, and has no clue how to deal with the situation. Ultimately she has been forced to flee by jumping over the wall. Vale story line is lost for sure, and this compromise shows Sansa as a victim rather than a protégé. If that was the intention, then it has worked fine.

Stannis:
Stannis is known as one of the best military commanders in Westros. Therefore the last scene of him blindly walking into an ambush was unreal to say the least. And then, despite being at the front of the army, he ends up in a random jungle away from Ramsay and near Brienne. Seriously? It appears that the show runners were too tired and drained by this time to keep it real.

Other gaffes:
  • Tyrion bought by the slaver for a pittance. What happened to the fortune for a dwarf’s cock?
  • In the fight between the White Walker and Jon Snow, Snow is dealt many non-lethal attacks even though no such consideration is given to the Thenn. A blip in an otherwise well made battle


Wednesday, June 3, 2015

एक याद

वह पल थे जिन में हसरतें थीं,
मोहब्बत थी, जुनून था
वह पल थे जब इक नाम में दुनिया सिमट जाती थी,
जब मन्नतों में सिर्फ एक सूरत नज़र आती थी
वह पल थे जिन में हम ने इबादत सीखी,
चाहत सीखी, मोहब्बत सीखी
वह पल थे जब आँखों में नूर था,
दिल में मासूमियत थी, दीवानगी का सरूर था
उन पलों में बेचैन रह कर आँसू भी बहाये,
ज़र्रे-ज़र्रे में ढूँढा उसे, न किसी के करीब आये
वह पल कभी नहीं आएंगे वापिस,
वह पल कभी नहीं आएंगे
इस कसक को याद करेंगे हम भी कभी-कभी,
वह पल जब याद आएँगे