21. Estimates based on analysis by Tata Sons from various sources.
22. ‘Statement showing Approved Strength, Working Strength and Vacancies of Judges in the Supreme Court of India and the High Courts’, Department of Justice, Ministry of Law & Justice, 01 July 2019. Available at: http://doj.gov.in/sites/default/files/Vacancy%20%2801.07.2019%29.pdf; Rajya Sabha Unstarred Question No. 2153, answered by the Ministry of Law & Justice on 11 July 2019. Available at: https://rajyasabha.nic.in/rsnew/Questions/QResult.aspx
23. See ‘Interim budget 2019-20’, Ministry of Finance, Government of India. Available at: https://www.indiabudget.gov.in/ for the proposal to streamline clearances for the film industry. Boosting the textile and garment industries has been a consistent focus of government. For instance, the ‘Economic Survey 2016-17’, Ministry of Finance, Government of India, had an entire chapter titled, ‘Clothes and Shoes: Can India Reclaim Low Skill Manufacturing?’ Available at: https://www.indiabudget.gov.in/budget2017-2018/es2016-17/echap07.pdf
24. Estimations based on analysis by Tata Sons and McKinsey and Company. See the section ‘Bridgital in Action’, for more detail.
25. Referring to XX chromosomes (used in a 2006 Everstone Capital study, authored by Roopa Purushothaman).
26. Based on analysis done by Tata Sons and Dalberg Advisors (‘Dalberg’). See the section ‘XX Factor—The Talent Dividend’, for more detail.
27. Micro enterprises employ less than ten people; small enterprises employ between ten and fifty; and medium enterprises employ between fifty and 250. Self-employed individuals (that is, those who have no additional employees) are also considered micro enterprises. Estimate of the share of private sector employment in SMEs is based on analysis by Tata Sons and Dalberg. The benchmark SME share of private sector employment is based on OECD data for 2014. Countries included in the benchmark set are Brazil, Czech Republic, Hungary, Israel, Poland, Romania and Turkey. See the section ‘Everywhere Entrepreneurship’, for more detail.
28. Based on analysis done by Tata Sons and Dalberg. See the section ‘Everywhere Entrepreneurship’, for more detail.
29. The Tata Group’s companies reach 600 million people every year, and Tata Trusts is among India’s oldest and most established philanthropic organizations. The group implements projects on health, livelihoods, literacy, water, sustainability, culture and governance. It also funds research and analysis on a range of topics from India’s languages to how Indians save and spend, and how they work.
CHAPTER 2: PLAYING ROLES
1. Tripura is a small, remote state in the north-east of India. The third smallest of India’s twenty-nine states, it is bounded on three sides by the neighbouring country of Bangladesh. Silchar, the nearest Indian city to Tripura’s capital of Agartala, is twice the distance compared to Bangladesh’s capital city of Dhaka.
CHAPTER 3: WRAPPING TECHNOLOGY AROUND PEOPLE
1. The Pradhan Mantri Jan Dhan Yojana (PMJDY), launched in 2014, is an ambitious financial inclusion initiative that targets universal access to basic financial services. The programme provides affordable access to no-frills savings bank accounts, credit, insurance and pension facilities. Headline results have been impressive with nearly 80 per cent of adults estimated to have bank accounts as of 2017, up from 53 per cent in 2014. However, 48 per cent of these accounts did not register a transaction in the preceding year. This may perhaps be on account of insufficient time for the newly included to access and use their accounts. Data sourced from the 2017 World Bank Global Findex Database.
2. Amolo Ng’weno et al., ‘Let’s Be Real: The Informal Sector and the Gig Economy Are the Future, and the Present, of Work in Africa’, Centre for Global Development, 2018. Available at: https://www.cgdev.org/publication/lets-be-real-informal- sector-and-gig-economy-are-future-and-present-work-africa
3. For details on doctor density, please see the explanation in the ‘The Access Challenge’.
Hospital beds (per 1,000 people), World Health Organisation. Available at: https://data.worldbank.org/indicator/SH.MED.BEDS.ZS?most_recent_value_desc=false
India’s skew between urban and rural: ‘Report on healthcare access initiatives’, KPMG and the Organisation of Pharmaceutical Producers of India, August 2016. Available at: https://www.indiaoppi.com/sites/default/files/PDF%20files/Report%20on%20healthcare%20access%20initiatives%20%28For%20web%29.pdf
4. All figures sourced from ‘World Population Prospects – 2017 Revision’, UN DESA. Available at: https://www.un.org/development/desa/publications/graphic/wpp2017-global-population. The medium fertility variant was used for projections.
5. Between 1900 and 1920, electricity saw rapid adoption, going from 5 per cent of business usage to more than 50 per cent in 1920. Adoption reached 75 per cent by 1935. Between 1920 and 1935, productivity growth was nearly five times higher than the average from 1900 to 1920. For a detailed treatment see Zaki Wahhaj and Martin Brookes, ‘Is the Internet Better Than Electricity?’, Goldman Sachs Global Economics Paper No: 49, 2000.
6. Vasudevan Mukunth, ‘Instead of Reaching the Sky, Aakash Ends Up Six Feet Below’, The Wire, 15 July 2015. Available at: https://thewire.in/education/instead-of-reaching-the-sky-aakash-ends-up-six-feet-below
7. H. James Wilson and Paul Daugherty, ‘Collaborative Intelligence: Humans and AI Are Joining Forces’, Harvard Business Review, July-August 2018. Available at: https://hbr.org/2018/07/collaborative-intelligence-humans-and-ai-are-joining-forces
8. Ibid.
CHAPTER 4: CALCULATIONS
1. Swagata Yadavar and Ojaswi Rao, ‘Bankrupt, Poorly Educated, Desperate: Cancer Patients on Mumbai Footpath’, IndiaSpend, 5 September 2017. Available at: https://archive.indiaspend.com/cover-story/bankrupt-poorly-educated-desperate-cancer-patients-on-mumbai-footpath-54419
2. ‘Tracking Universal Health Coverage: 2017 Global Monitoring Report’, World Bank, 13 December 2017. Available at: http://www.worldbank.org/en/topic/universalhealthcoverage/publication/tracking-universal-health-coverage-2017-global-monitoring-report
CHAPTER 5: THE GREAT MEDICAL MIGRATION
1. World Bank, World Development Indicators. The phrase ‘communicable diseases’ is shorthand for communicable, maternal, neonatal and nutritional diseases (CMNNDs).
2. India’s public healthcare system has three levels—primary, secondary and tertiary. Broadly, these levels offer patients access to healthcare of increasing sophistication and specialization. Primary care is the first level of contact, providing basic and essential services. For instance, this includes the treatment of common diseases or injuries, mother-and-child services such as immunization and family planning, and preventive interventions for locally endemic diseases. Primary care is administered through a network of sub-centres and primary health centres (PHCs) spread throughout the country. Secondary care offers more specialized services and, ideally, is supposed to be accessed via referral from primary care. It is administered through hospitals located in the capital of a particular district, and community health centres (CHCs) at the level of a ‘block’ (administrative units smaller than districts). Tertiary care has specialized medical personnel and offers advanced services, such as intensive care and surgeries. Tertiary care facilities are typically located in towns and cities, or large district capitals. They often function as medical colleges and advanced research institutes as well.
3. The Tata Trusts have pioneered cancer care and research since the 1940s, and recognize the need to shift focus from curative to preventive programmes for early cancer detection. The Trusts envision a distributed cancer control model to create patient-centric cancer centres for delivering uniform, high-quality, affordable care closer to patients’ homes. The National Cancer Grid is a key part of this model—the grid is a network of 140 cancer centres, research institutes, patient groups and charitable institutions working in the area of cancer care across India. It has the mandate of establishing uniform standards of patient care for prevention, diagnosis, and treatment of cancer. These institutes provide
specialized training and education in oncology and facilitate collaborative basic, translational and clinical research in cancer.
4. India’s hospitals have been identified as case studies in efficiency and frugal innovation. Consider this: At the Tata Memorial Centre, 188 staff treat over 42,000 patients a year; in comparison, at the University of Texas M.D. Anderson Cancer Centre, 1,700 staff treat about the same number of patients in a year. See Bhawna Sirohi et al., ‘Developing institutions for cancer care in low-income and middle-income countries: from cancer units to comprehensive cancer centres’, The Lancet Oncology, Vol. 19, No. 8, 1 August 2018. Available at: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(18)30342-5/fulltext
CHAPTER 6: TWICE EXCEPTIONAL
1. ‘Cancer Burden in India’s North-East States’, National Centre for Disease Informatics and Research, 2017. Available at: http://www.ncdirindia.org/All_Reports/Reports_Ne/NE2012_2014/Files/NE_2012_14.pdf
CHAPTER 8: OUT OF REACH
1. ‘Report of the Health Survey and Development Committee, Volume Two’, Government of India, 1946, pp. 37, 39. Available at: https://www.nhp.gov.in/sites/default/files/pdf/Bhore_Committee_Report_Vol2.pdf
2. Meenakshi Gautham and K.M. Shyamprasad, ‘The “Basic” Doctor for Rural India: A Failed Promise?’, Economic and Political Weekly, Vol. 45, No. 38, 2010. Available at: http://www.jstor.org/stable/25742090
3. ‘Report of the Health Survey and Development Committee, Volume Two’, Government of India, 1946, p. 340. Available at: https://www.nhp.gov.in/sites/default/files/pdf/Bhore_Committee_Report_Vol2.pdf
4. As of 31 December 2017, there were 1,062,398 allopathic doctors registered in India. With a population of 1.33 billion, this works out to 8 doctors per 10,000 population. Figures reported in ‘Lok Sabha Unstarred Question No. 1728: Shortage of Doctors’, Government of India, 27 July 2018. Available at: http://164.100.47.190/loksabhaquestions/annex/15/AU1728.pdf
The Medical Council of India (MCI) was, until recently, the apex body responsible for establishing and maintaining the standards of medical education, and the recognition of qualified medical practitioners. Recent legislation has seen it in the process of being replaced by a National Medical Commission. The MCI’s registries are still, however, the primary source for data on the number of doctors in the country.
The data on density of physicians for all other countries comes from ‘Global Health Observatory’, World Health Organization, 2017. Available at: https://www.who.int/gho/health_workforce/physicians_density/en/
5. Basant Potnuru, ‘Aggregate Availability of Doctors in India: 2014-2030’, Indian Journal of Public Health, Vol. 61, No. 3, 2017. Available at: http://www.ijph.in/article.asp?issn=0019-557X;year=2017;volume=61;issue=3;spage=182;epage=187;aulast=Potnuru;type=0
6. The target levels of doctor and nurse density are based on the norms of ten doctors per 10,000 population and three nurses per doctor, established in ‘Report of High-Level Expert Group on Universal Health Coverage’, Planning Commission of India, 2011. Available at: http://planningcommission.nic.in/reports/genrep/rep_uhc0812.pdf
7. Mohandas K. Mallath et al., ‘The Growing Burden of Cancer in India: Epidemiology and Social Context’, The Lancet Oncology, Vol. 15, No. 6, April 2014. Available at: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70115-9/fulltext?
Mental health workforce in India (per 100,000 population) includes psychiatrists (0.3), nurses (0.8), psychologists (0.07) and social workers (0.07). ‘Mental health workers’, World Health Organisation, 2016. Available at: http://apps.who.int/gho/data/view.main.HWF11v
8. Anup Karan et al., ‘Size, composition and distribution of human resource for health in India: new estimates using National Sample Survey and Registry data’, BMJ Open, 2019. Available at: https://protect-eu.mimecast.com/s/97JKCZY8nI88GjjIjWqIS?domain=bmjopen.bmj.com; https://bmjopen.bmj.com/content/bmjopen/9/4/e025979.full.pdf
CHAPTER 9: IMBALANCES
1. According to ‘Indian Public Health Standards (IPHS) for Primary Health Centres (PHCs)’, Government of India, 2006, the population coverage norms required from PHCs is one per 20,000 population in hilly areas, and one per 30,000 in plains. Available at: http://www.iapsmgc.org/userfiles/4IPHS_for_PHC.pdf
A recent government study found that some states in India had far fewer PHCs than recommended, resulting in far poorer coverage ratios. For instance, the state of Jharkhand had one PHC per 84,077 population and Bihar had one PHC per 48,626 population. See ‘Rural Health Statistics 2018’, Ministry of Health & Family Welfare. Available at: https://nrhm-mis.nic.in/Pages/RHS2018.aspx?RootFolder=%2FRURAL%20HEALTH%20STATISTICS%2F%28A%29%20RHS%20-%202018&FolderCTID=0x01200057278FD1EC909F429B03E86C7A7C3F31&View={09DDD7F4-80D0-42E3-8969-2307C0D97DDB}
2. To get an accurate picture of the reality on the ground, we culled information from a variety of sources. These include: ‘Rural Health Statistics 2017’, Government of India. Available at: https://data.gov.in/catalog/rural-health-statistics-2017; Sumitra Debroy, ‘Rural Areas Face Shortage of Essential Drugs: Survey’, The Times of India, 14 April 2011. Available at: https://timesofindia.indiatimes.com/city/mumbai/Rural-areas-face-shortage-of-essential-drugs-Survey/articleshow/7976627.cms; and Afshan Yasmeen, ‘Only One Doctor in Most Primary Health Centres’, The Hindu, 1 April 2018. Available at: https://www.thehindu.com/news/national/only-one-doctor-in-most-primary-health-centres/article23408696.ece
On average, 40 per cent of doctors and healthcare providers are absent from work on a typical day. Karthik Muralidharan et al., ‘Is there a Doctor in the House? Medical Worker Absence in India’, Scholars at Harvard, 12 April 2011. Available at: https://scholar.harvard.edu/files/kremer/files/is_there_a_doctor_in_the_house_-_12_april_2011.pdf
3. Jishnu Das et al., ‘Quality and Accountability in Health Care Delivery: Audit-Study Evidence from Primary Care in India’, American Economic Review, Vol. 106, No. 12, 2016. Available at: https://www.nber.org/papers/w21405.pdf
4. The numbers across nineteen states are estimated at between 50 and 80 per cent. Karthik Muralidharan et al., ‘Medical Advice Quality and Availability in Rural India’, The World Bank, 15 April 2015. Available at: http://pubdocs.worldbank.org/en/161151429125257286/13-Medical-Advice-Quality-and-Availability-in-Rural-India-MAQARI-Karthik-Muralidharan
5. Haidar Naqvi, ‘Unnao Quack, Accused of Infecting 58 People with HIV by Using Same Syringe, Arrested’, Hindustan Times, 7 February 2018. Available at: https://www.hindustantimes.com/india-news/unnao-quack-accused-of-infecting-58-with-hiv-by-using-single-syringe-arrested/story-UA5D7m3Amihmax1LI6b4iP.html
6. ‘Medical Tourism in India to Touch US$8 Billion by 2020’, Grant Thornton, 31 October 2015. Available at https://www.grantthornton.in/news-centre/medical-tourism-in-india-to-touch-us$-8-billion-by-2020-grant-thornton/
7. The epidemiological transition is described in detail in ‘India: Health of the Nation’s States’, Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation, 2017. Available at: https://www.healthdata.org/sites/default/files/files/policy_report/2017/India_Health_of_the_Nation%27s_States_Report_2017.pdf
CHAPTER 10: OUTREACH
1. ‘About Pradhan Mantri Jan Arogya Yojana (PM-JAY)’, National Health Authority. Available at https://www.pmjay.gov.in/about-pmjay
CHAPTER 11: BRIDGING ACCESS
1. Learning outcomes: ‘Annual Status of Education Report (ASER) 2018’, ASER Centre, 2018. Available at: http://img.asercentre.org/docs/ASER%202018/Release%20Material/aser2018nationalfindings.pdf; ASER 2018 covered 596 districts in rural India and surveyed a total of 354,944 households and 546,527 children in the age group three to sixteen.
Enrolment rates: ‘Educational Statistics At A Glance’, Ministry of Human Resource Development, Department of School Education & Literacy, Statistics Division, New Delhi, 2018. Available at: https://mhrd.gov.in/sites/upload_files/mhrd/files/statistics-new/ESAG-2018.pdf
2. Sumant Banerji, ‘The Case of the V
anishing Drivers’, Business Today, 22 May 2016. Available at: https://www.businesstoday.in/magazine/features/road-transport-decline-due-to-high-demand-for-truck-drivers/story/232028.html
3. On pending cases: ‘3.3 crore cases pending in Indian courts, pendency figure at its highest: CJI Dipak Misra’, Business Today, 28 June 2018. Available at: https://www.businesstoday.in/current/economy-politics/3-3-crore-cases-pending-indian-courts-pendency-figure-highest-cji-dipak-misra/story/279664.html
On vacancies: Vishnu Padmanabhan and Sriharsha Devulapalli, ‘India’s next generation reforms must begin in courts’, Mint, 18 June 2019. Available at: https://www.livemint.com/news/india/india-s-next-generation-reforms-must-begin-in-courts-1560838699823.html
On use of judges’ time and the duration of resolution: ‘Time-and-Motion Study of Four District and Sessions Courts in Bangalore, Karnataka’, DAKSH, November 2016; Siddharth Mandrekar Rao, ‘Another New Tool For An Age Old Problem?’, DAKSH, 2018. Available at: http://dakshindia.org/another-new-tool-for-an-age-old-problem/; ‘India’s judge-population ratio goes up marginally’, The Economic Times, 7 January 2018. Available at: https://economictimes.indiatimes.com/news/politics-and-nation/indias-judge-population-ratio-goes-up-marginally/articleshow/62400461.cms
India’s ranking on Ease of Doing Business 2019 (on the metric of ‘enforcing contracts’): ‘Doing Business 2019’, World Bank, 31 October 2018. Available at: https://www.doingbusiness.org/content/dam/doingBusiness/media/Annual-Reports/English/DB2019-report_web-version.pdf
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