Disrupting healthcare? Entrepreneurship as an "innovative" financing mechanism in India's primary care sector

"Innovation" - whether in the form of digital technologies or business models - dominates imaginaries of global health futures and is often promoted as a "solution" through which the goal of universal health coverage can be achieved. Seemingly disrupting the status quo, it offers the promise of novel and simple answers to longstanding and complex social problems. In this article, I analyze a public-private partnership between the Indian state of West Bengal and an Indian-owned social enterprise. One of its defining features is an "innovative" financing mechanism based on loans and entrepreneurship. The project employs young people from marginalized communities as health entrepreneurs, who market digital healthcare in rural areas in order to provide access to affordable and high-quality biomedical care. Although the model promises sustainable modes of financing healthcare, it shifts financial risk to low-income groups. As health workers resisted attempts to be turned into self-reliant entrepreneurs and continued to make demands on the developmental state, frictions emerged during project implementation. The question of how healthcare should be made accessible and affordable, in what manner the state should be involved in financing it, and what role innovation should play in this regard was all contested. Although an entrepreneurial business model to deliver primary care is seen as an innovative solution at a time when government expenditure in the social sector remains low and levels of un- and underemployment are high, this paper complicates prevailing claims about its disruptive powers in India and argues that its effective role for equitable social change has to be critically examined.

Digital health for all: The turn to digitized healthcare in India

In India, the use of digital technologies has become the key to the everyday operation of the welfare state in terms of accessing essential and life-sustaining entitlements. In this context, our article explores the genesis of India's digital turn in healthcare and maps the characteristics of a 'digital health for all' policy, based on empirical analysis of India's first digital-based universal health coverage programme - Rashtriya Swasthya Bima Yojana (RSBY) - with fieldwork material from the states of Jharkhand and Chhattisgarh. Being a smart-card-centred programme, RSBY marks the genesis of a digital approach to healthcare in India. The experiences of this scheme hold crucial implications for the digital healthcare landscape in India, as in the past its promoters pitched for its use to provide quality healthcare at lower cost. The technological design of the programme illustrates the construction and politics of a digitalized public-private welfare policy intended to meet the health needs of the poorest. By examining data on digital access to healthcare in the RSBY programme, as propounded and sustained by public health policies and a public-private model of governance, our article raises questions about the construction of new digital health policies and their contribution to private health markets. In doing so, it explores the key question of how digital technologies are transforming access to healthcare in India.

India @ 75: Science, Technology and Innovation Policies for Development

India was perhaps the only country among the developing world with a colonial past to have organised and established national science community much before it attained its independence. Nehruvian science and technology (S&T) policy in India’s formative years left a distinct imprint in the post-colonial and post-independent India. With a huge population of nearly 1.35 billion people, India is not dependent on food on outside countries since the 1960s. Green and White Revolutions have made immense contribution to develop scientific and technical capacities in agriculture. India’s innovation system, including higher education, has given her some comparative advantage through ‘human capital’ in information technology, biotechnology, pharmaceuticals, space research and so on. In export promotion and economic competitiveness in technology-based industries, we lag compared with East Asian ‘Dragons’. India’s informal sector poses a formidable challenge with more than 95% of the total labour force, about 550 million, 90% of which is 8th class dropouts. When we begin to assess our national innovation system, one feature that stands out to research observers is few islands of excellence and vast ‘hinterlands’ of underdeveloped research potential. There is clearly a gap between theory and practice of science policy in India. Our gross expenditure on research and development as a proportion of gross domestic product remained relatively stagnant and, in fact, receded from 0.8% in the 1990s to 0.7% in 2020. In this period, our neighbour, China, left us far behind in S&T for development.

Between Tech and Trade, the Digital Turn in Development Policies

The 'digital turn' that took place in development policies since the early 2000s is characterized by the growing use of digital devices as development and governance tools, and by the growing use of large sets of data that goes hand in hand with it. This article points to three major changes that accompany this evolution. The first is the diversification of economic strategies that are permitted by the multiplication of markets dedicated to technological devices and data management in the developing world. The second is the evolution of relations between public and private institutions in the Global South; the interactions between public and private sectors have indeed been renewed through the kind of technological development partnerships allowed by digital devices. The third is the reconfiguration of issues as crucial as control, inequalities, exclusion at the individual and population level-digital devices don't make these issues disappear, rather they take an important part in their reformulation.