Healthcare CSR should go beyond curing diseases and look at the larger objective of helping people lead a healthier life. Corporate social responsibility in healthcare gives maximum return on investments when it complements the ability of the corporates to mobilize resources with the competency of the on-ground partners, says Dr R. Balasubramaniam, the Founder and President of the Swami Vivekananda Youth Movement (SVYM, www.svym.org) in the state of Karnataka.
“The CSR thinking should shift from ‘my responsibility’ to ‘what can we create together’ for maximum impact. That’s where I believe the more exciting opportunities for innovation lie,” says Dr Balasubramaniam, who has been engaged in the areas of education, public health and food security for over three decades.
Under his vision, SVYM has worked towards achieving health and happiness of displaced, dispossessed, and dis-empowered people in the tribal and rural belts of South India. As a special investigator for the Karnataka Lok Ayukta, Dr Balasubramaniam has investigated corruption in health and medical education and institutional corruption and maladministration in the public distribution system.
Dr Balasubramaniam is a qualified physician with interest in public health issues. He has an M Phil in Hospital Administration and Health Systems Management from the Birla Institute of Technology and Sciences, Pilani and a Master’s in Public administration from the Harvard Kennedy School, Harvard University.
Edited excerpts from an interview with Dr Balasubramaniam on how corporates can partner with non-profits to deliver effective healthcare on the ground.
What are the gaps in the public healthcare delivery system today?
The government is constitutionally mandated to spend on citizens’ health and wellness. While the government professes primary healthcare, it has been spending a lot more on secondary and tertiary healthcare (78 per cent), when it is known that the returns on health are far greater when invested in primary healthcare. Today, 85 per cent of healthcare costs come from the pockets of common citizens; only 15 per cent is the contribution from the government. This denotes a huge shortfall in our healthcare system.
Another big change is the transfer of budget from the Center to the states, making states fiscally responsible for healthcare – this has not translated to action on the ground. With devolving budget and responsibility to the states, the central government has cut back on its spending above 50 per cent, leading to a trap.
What are the various parameters in corporate social responsibility (CSR) in healthcare? How can corporates support public health?
There are three paradigms in healthcare CSR:
* Healthcare is more than medical care
* Healthcare is a collective responsibility (and there are various actors including the state, and corporates)
* Partnerships are critical in order to achieve the challenging goals posed by healthcare
The pattern I see among corporates in supporting medical care includes hospital expenditure, medical equipment and free or subsidized surgeries. While this is much needed, I would urge corporates to examine healthcare beyond curing diseases and look at the larger objective of helping people lead a healthier life.
There are five areas where corporates can play a strong role in supporting healthcare delivery:
1. Affordability of healthcare: About 60 per cent of people routinely slip back into poverty because of a single health shock in their families. This is where corporates can come in, either by being insurers, pooling in for insurance or micro-insurance schemes, providing a social security net or backing state-supported mechanisms to prevent people from falling back into poverty.
2. Focus on integrated healthcare delivery: Corporates must look at the larger dimension of health and wellness that goes beyond treatment and hospital expenditure to exploring holistic ways of providing integrated healthcare through informed partners. These partners must be well-equipped to integrate the social determinants in health, including sanitation, clean drinking water, nutrition, women’s rights and other areas of healthcare delivery.
3. Technology: A country as big as India needs huge innovation in technology to deliver effective healthcare and this is an area of opportunity for corporates, both medical and non-medical, to create products and solutions.
4. Demand-supply match: There is a demand-supply mismatch in public health infrastructure – 80 per cent of India’s public health infrastructure is government-operated. However, only 34 per cent of the population is using the same. We need to investigate and understand these supply-demand issues and work towards creating an ecosystem where both are evenly matched. On one hand, there is a need for building awareness among communities about the government utilities and on the other we need to hold the government systems accountable to deliver quality healthcare.
5. Governance issues: Corporates can invest in funds that look at health ‘systems’. We have very little governance systems in place. Given the existing shortfall in public health spending, this is not at all a priority for the government.
Will aligning to the United Nations’ Sustainable Development Goals help design CSR objectives?
While big companies with sizable spends on CSR can look at the broader canvas of integrated healthcare delivery, smaller ones can look at single focus areas that they feel strongly connected to. For example tuberculosis, palliative care, mental health, cancer care and so on. Any project that impacts health of communities, especially over a long period of time will surely have a bearing on the SDGs.
What kind of partnerships should corporates look at?
Corporates need to partner with the government for scale. I would quote the example of a corporate that started working in the Bidadi industrial area outside Bangalore on healthcare. Due to the alarming pollution levels and industrial refuse being dumped in the area, the disease burden is very high among the workers and population here. No single corporate can make a substantial difference in such an issue. My strong recommendation is to come together as a group of companies, pool in CSR funds, have one strong community-based organization as an implementation partner and necessarily partner with the government. The local Panchayaths and other local bodies are constitutionally mandated to deliver on healthcare. Non-profits can play the role of a knowledge or technical partner.
The partnership of corporates, non-profits and the local administrative body can bring about a huge impact. CSR should shift its thinking from ‘this is my responsibility’ to ‘what can we create together for maximum impact’. That’s where I believe the more exciting opportunities for innovation lie.
We see many corporates conducting independent health camps. Are health camps a model for effective healthcare CSR?
Health camps afford corporates a view of community healthcare that seems very tangible. You can mark the number of people mobilized; the repeatability of the same lends itself to showcases. Yet, often there is very little follow-through once the event is over. My strong recommendation for corporates is to conduct health camps only if they are able to follow through with action and support on the diagnosis that emerges from these camps, which then translates to supporting people with medical interventions, surgical or otherwise. Health camps have relatively less impacts if they are seen as standalone events, though they do create a lot of PR and visibility opportunities for the Corporates. They need to be seen as a starting point for long term engagement with local communities and as part of a well thought thru process.
How do you determine the impact of healthcare CSR?
Maximizing the return on investment in healthcare CSR means being able to develop partnerships that match the ability of the corporate to mobilize resources, the emotional connect the corporates have towards the cause and the implementation competency of the on-ground partners that corporates work with.
CSR must base metrics on health outcomes rather than the extent of donations. It is far more effective, in terms of social return on investment, to look at how many people were detected with health conditions like tuberculosis using an X-ray machine in a certain health camp and how many of those cases were then tracked and cured completely over a period of time than to measure an output like ‘one lakh spent on medicines’. There are many standard metrics that can be measured: community engagement in healthcare, medical audits and governance metrics, leading up to the larger goals around infant mortality rate, maternal mortality rate and more. The metrics to be measured must be standard and delivery systems must be relevant to the local context.
What kind of partnerships have you seen working on the ground?
There are 6Rs that are critical to ensuring effective partnership of corporates and non-profits/implementation agencies.
Resources brought to the table by both corporates and non-profit partners. For instance, the corporates may bring in the funds and NGOs may bring in intellectual expertise and implementation competency.
Risks to the partnership must be acknowledged and shared. For instance, will the corporate continue support and will the non-profit deliver effectively on the ground?
Roles: Each partner must have a role clearly defined based on their competencies and skill sets. The partners must be willing to hold each other accountable to play these roles meaningfully. Role definitions should also ensure that there is a sense of fair play, equality in the partnership and that the partners treat each other with respect and dignity.
Responsibilities must be clearly determined and shared. Corporates must participate in more ways than signing a cheque. Non-profits must collaborate to create effective channels for partnership.
Rewards in terms of better healthcare delivery, that are equally shared.
Review mechanisms must be tuned to the processes of both partners and measure all the other 5Rs mentioned above.
As a health professional, I would focus on establishing long-term institutional partnerships, strengthening existing public infrastructure and mechanisms, demand creation and ensuring optimal utilization of existing services. These, I believe, would create programs that have a long-lasting impact on the health of the community.