India has some of the world’s most abject health outcomes. There are known solutions, but the challenge is in delivering these at scale. Delivery is fundamentally a management issue. Public health programmes often approach it as a technical challenge. The marriage of public health know-how and business management principles makes perfect sense.
When I left McKinsey 15 years ago, it was a step into a strange new world. With time, I found that my grounding in business stood me in good stead. Five common, interlinked business concepts are relevant in public health—scale mindset, strategic focus, front-line capability, proximity to consumers and start-up mentality.
Scale mindset: Even a small grocery-shop owner dreams of having a superstore. Public health programmes often get caught up in perfecting solutions, piloting them and hoping that someone else will scale these up. This type of thinking is often simplistic, overly clinical, even devoid of passion. Polio was eradicated in India because every last trace of the virus was hunted down, health workers literally climbing mountains and battling flood waters. It is all about a mindset that is instinctive in business, and that public health delivery can learn from.
Strategic focus: With a mindset of scale, businesses are very focused about the strategy to get there. They try hard to understand what the consumer wants, and develop the best ways to deliver relevant products. They use methods like customer segmentation, supply chain management and sales force effectiveness. Many of these can be applied in public health. However, it is also true that public health strategy can be far more imaginative and sophisticated than in business. Avahan, the Gates Foundation’s India HIV prevention programme, found ways to reach sex workers who were hidden, always on the move, and often not wanting the “prevention product" (they had bigger problems to deal with). Businesses can learn from certain exemplar public health delivery programmes.
Last mile capability: Good business delivery often boils down to that last crucial transaction between the salesperson and the prospective customer. In public health, front-line workers’ effectiveness depends upon the quality of training and the data they are equipped with. A pharmaceutical salesman’s pitch to a doctor is backed with data about his patients, preferences and competing products. In public health, front-line workers also need to use data, and be persuasive. The Akshada programme in Rajasthan is improving front-line effectiveness by creating data-sharing platforms at the village level. Front-line health workers share information, identify critical beneficiaries and provide focused delivery.
Close to the consumer: Successful businesses develop relevant products based on a nuanced understanding of the consumer’s needs. Hyundai Motor India Ltd has adapted to local aspirations—smaller, affordable cars that offer value for money. Public health programmes often take the customer for granted, with programmes tilted heavily to the supply side. Good public health programmes though, involve consumers in developing solutions. Some go one step further and look for solutions from consumers themselves. Businesses rarely go that far and can get breakthrough ideas from the best public health programmes.
Start-up mentality: Great businesses strive to preserve a start-up culture. Despite its size, Google is known for encouraging innovation and ownership through strategic hiring, generous compensation and merit-based rewards. Public health organizations often end up being slow and bureaucratic. The crux of a start-up culture—irrespective of the organization’s size—is to create an overwhelming sense of mission. That should be easier for a public health organization, surely! How to build and retain a start-up mentality is something public health can absorb from business.
Business offers a lot for public health to draw from. Public health challenges sometimes go well beyond business. Outstanding public health programmes tackle these in ways that businesses can themselves learn from. It is indeed a marriage waiting to be arranged.
There is a message here for corporate managers considering a move into the public health sector—go for it! You may well find, as I did, that your business thinking is at a premium. For those who manage public health, think more broadly about recruiting—that person may have a pure business background, and be just as useful to your organization as another doctor.
Ashok Alexander is founder-director of Antara Foundation. His Twitter handle is @alexander_ashok