The risks of buying talent

By Nandini Sharma

Buying talent is a complex process. An analysis on why organisations need to be cautious
For a knowledge-intensive industry like information technology, the ability to recruit, retain, motivate, and develop the people resources is the greatest competitive strength for any organisation.

Companies often resort to aggressive recruitment strategies to meet the demand for talent. Buying talent is a common phenomenon when organisations have to suddenly procure skill sets from the market in response to urgent business needs. The question is: does an organisation always get what it has paid for? The answer is as debatable as the issue whether it indicates lack of career roadmap for key positions within the organisation.

An organisation needs to buy talent when it is in an evolving stage. N Muralidharan, Managing Director & Vice-President, Jobstreet.com India, lists the three situations when such a need arises:

There is an expansion and urgency to hit the market soon and needs "ready-made" staff; "go to market" pressures. It is entering the business late and has no time for building talent from scratch, so poaching from competition is the best option. This, of course, comes at a price.

When internally an organisation does not have the kind of talent that it is looking for and there is an urgent need.
There are a few like Sadhana Somasekhar, Director and Chief Marketing Officer, Future Focus Infotech, who believe that most organisations with a mature recruitment/hiring model do not opt for the "buy" route. They attribute this to the organisation's business conduct or ethics, HR strategy and so on. However, at the grassroots level, the reasons that go against buy-outs appear to be the instability associated with such 'bought-out' resources, both with respect to the candidate and within the team. This also sets a precedence with new hires. Somasekhar adds that when there is a buy-out, it is often masked in the guise of a "joining bonus", which is in truth the reimbursement of the "short or no-notice" compensation borne by the candidate to his last employer.

Getting your money's worth
Buying talent is not as easy as buying a commodity, it is a complex process. An organisation does not always get its money's worth. It is in fact a two-way process. Muralidharan acknowledges that while the person hired could be appropriate, if the work related ambience and the product offering is not up to the mark, it may still not work. "To give an analogy, you might have a popular celebrity endorsing your product but if the offering is not appropriate the returns do not match expectation," he says.

Vikram Bhardwaj, Managing Consultant, Redileon executive search, insists that more than the monetary cost vs benefit comparisons, one has to view this more strategically—the opportunity or hidden costs need to be accounted for.

Talent that is procured directly from the market comes with proven experience, but is expected to differ from the organisation's own situation, requirement and culture. "Such cases will give rise to differentials in expectations and deliverables. What really rides the moment out is the maturity of the hiring organisation in recognising and expecting such events, and preparing to manage interests accordingly," says Monisha Advani, CEO, EmmayHR Services.

The risks involved
Buying talent is not as easy as it seems. There are many risks associated with the process. Advani lists a few key factors:

Price: You can land up paying over market indicators for a specific skill purely on the basis of a short-term analysis of your need to procure and land up with a long-term cost impact that can become difficult to sustain
Compensation expectations may change organisation or department wide on account of this external lateral introduction, leading to employee cost escalation.

Expectations and culture matching are perennial risks applicable to all employment engagement scenarios, only in this case, the cost impact tends to be higher. Culture mismatch is in fact one of the key problem areas, particularly at management levels.

Build or buy
The debate over building vs buying talent has been in existence for a long time. While buying talent has its just-in-time significance, from a long-term organisation development perspective building talent within the company has greater benefits. "The advantage of building talent is that it gives organisations the ability to mould skills the way they want it to be. The other factor is loyalty—you will have this pool locked in with the organisation for a longer period of time as compared to the ones that you buy. The chance that they share the long-term vision of the organisation is high. However, the downside is that there is a huge investment in terms of cost and time required to build talent. Then there is also this uncertainty of losing the talent after investing to build it," says Madan Padaki, Co-founder & Director, MeritTrac Services (a skills assessment company).

Lack of a career roadmap
It is believed that buying talent indicates a lack of career roadmap for key positions within the organisation. Experts are divided over this issue. Bhardwaj concedes that despite most companies progressively implementing robust performance-management systems, this always does not translate into effective career planning that lets people see and evaluate where they could go in their careers, which leads to attrition and then follows the urge to replace from outside since the company is also not clear as to who can take charge of the roles effectively.

There is also an interesting new development in the market. Explains Bhardwaj, "With the increasing business demand for a timely and consistent HR support, what used to be only the 'build' vs 'buy' decision has been expanded to include the 'build' vs 'buy' vs 'borrow' to include the option of temping.

The HR matrix and decision support mechanisms have evolved considerably to account for this change." The "build" vs "buy" phenomenon is all set for change with temping becoming the third alternative.

Reviving Ambedkar's Difficult History Of Caste Conversion

"He saw the universal brotherhood of Islam uniting just Muslims. He was critical of the spirit of aggression of political Islam that takes advantage of the weakness of Hindus and follows gangsterism," declared Prafulla Ketkar, editor of the RSS mouthpiece Organiser, expounding on his publication's controversial edition commemorating BR Ambedkar's 124th birth anniversary.

Ketkar went on to claim that Ambedkar supported 'reconversion', saying, "In a way, he also supported ghar wapsi.

Analysis: Will Jagan Mohan Reddy Be Convicted Soon?

By M H Ahssan / Hyderabad

Leaders of Congress, TDP and TRS firmly believe that Jagan presently lodged in the Chanchalguda jail as remand prisoner, would soon be convicted. The CBI had already filed 7 charge-sheets in connection with the disproportionate assets case against him. Hearing also began on the charge-sheets. Excepting on one or two occasions, Jagan was generally heard by the court only through video conferencing. CBI authorities had recently informed the court that they had completed their investigation with regard to three charge-sheets.

Opinion: Lure Of The Small Screen

By M H Ahssan

Private television channels have acquired a conspicuous presence in the country. They provide news and information, debate and discussion and a great deal of entertainment. They are rumoured to earn vast advertising revenues some of which they devote to the promotion of good causes. Their owners and managers like to say that their main aim is to serve the public interest. Those who work for them also seem eager to make that known to their viewers. At the same time, they also appear to be very dogged in the pursuit of their own commercial interests.

When a young girl dies under suspicious circumstances or rumours circulate about misconduct in high office, television reporters accompanied by cameramen are among the first to appear on the scene. They serve their viewers by providing information instantaneously and continuously. The information is accompanied by commentary and by speculation about the possible causes of what might be happening and why. The information provided is of value to the public, particularly where interested parties seek to suppress it.

But not all the information provided on television is of significant value. Much of it is trivial and ephemeral. The analysis provided is sometimes acute and incisive, but often it is empty and vacuous. There is a strain towards the presentation of information in a striking and dramatic form. Much of what takes place in our public life is ordinary and humdrum, but with some effort even the most banal happenings can be given a portentous air. Television reporters and anchors habitually adopt a breathless manner, which even the most seasoned newspaper columnist or radio broadcaster cannot easily simulate.

Like the other media, television provides both information and entertainment, but it combines the two in its own distinctive way. When Doordarshan held the field by itself, there was very little entertainment, and the information was bland and stereotyped. This has changed with the entry of private television channels into the field. Even Doordarshan is now less dull and stodgy than it used to be. Our newsreaders do not have to be grim faced as in China or Russia, and the women among them do not have to cover their heads as in Iran and Pakistan. It is good to see greater variety in dress and deportment although, personally, one regrets the passing of the sari.

While the media in general combine information with entertainment, private television channels make a special effort to present information and analysis in an entertaining way. The line between entertainment and
information is in any case never clear and, where there is acute competition to hold the viewer’s attention, it is easily crossed. Leaving aside the embarrassment and anguish caused to individuals and households, matters of public security and institutional propriety tend to be given short shrift. Newsreaders and analysts know how to simulate both grief and concern, but this loses something in credibility when their presentation is regularly interrupted by commercial advertisements that are anything but solemn or sorrowful.

What is worrying about private television is the cut-throat competition between rival channels. The competition affects the manner in which news is presented and, in the end, also its substance. It is natural that when an interesting or important story comes to light each channel should strive to be the first to present it to the public. It is also natural that it should wish to claim that its own story is exclusive. But such a claim serves mainly its own commercial interest rather than any identifiable public purpose.

The urge to stay ahead in the competition for consumer attention finds expression in the frenzy for ‘breaking news’ common among private television channels. When there is a plane hijack, a terrorist attack, a political assassination — or a successful landing on the moon — it is natural for the news editor to wish to break the news early or even to be the first to report it. Here the electronic media have an advantage over the papers and, within limits, competition provides a healthy stimulus for swift and immediate reporting.

What is presented as breaking news is not always very striking or dramatic. It is, in fact, often quite insubstantial. When something has to be shown as breaking news, there is pressure from within to present it in a dramatic way even when the matter is quite ordinary. It is, in any case, very difficult to view an event in perspective when it is unfolding before our eyes, so when there is pressure to present it as breaking news, that is how it will be presented.

I have often wondered what will happen if no momentous event occurs for one whole day or even for two successive days. If there is no breaking news, will it have to be invented? No account of unfolding events can be free from the more or less active use of the reporter’s imagination. Private television channels should not be blamed for seeking to augment their revenues, but they, on their side, should not cut too many corners. Nor should they be blamed for seeking credit for providing a useful service provided they do not make lofty moral claims about being the citizen’s shield against the authorities. It should not be too difficult for the citizen to determine what they do in the public interest and what they do for profit and, further, to see that the two are not always convergent.

GUEST COLUMN: Blowing 'Text Mining' in the Clinical Lifestyle

By Dr. P V Rao (Guest Writer)

Despite increasing use of electronic medical records, much patient data remains in text form, requiring text-mining techniques to make full use of patient information.

The increased use of electronic medical records (EMRs) is supporting widespread data-mining efforts to uncover trends in health, disease, and treatment response data. But a significant chunk of information in EMRs remains stored as text, unusable by conventional data-mining methods. These semi-structured or unstructured data include clinical notes, certain categories of test results such as echocardiograms and radiology reports, and other important documentation. To take full advantage of EMRs, we need to utilize both data- and text-mining techniques to explore patient outcomes.

Text and data mining have much in common; underlying each is the assumption that knowledge lies buried in a scattered mass of information. But whereas data mining predominately relies on statistical methods to uncover trends in structured data, text-mining techniques seek to make sense of information that is unstructured, such as a doctor’s scribbles on a patient’s chart. For example, much of the available clinical data are in narrative form as a result of transcription of dictations, direct entry by providers, or use of speech-recognition applications. This “free-text” form is convenient to express concepts and events, but is difficult to search, summarize, and analyze. Fortunately, text-mining techniques can help code these data for analysis.

'Offline To Online': India's 'Consumer Behavior Evolution'

Contrary to popular belief, the online is not the enemy of the offline: both channels are absolutely complementary from the consumer’s point of view as he uses them according to his needs or at the right moment. 

The “traditional” F&G retailers fear the scale up of pure players as they imagine ungrateful consumers taking advantage of their aisles to do some spotting before rushing to go buy products online to benefit from the most enticing prices.

'Sick Truth' About How Medicines Go To Waste In UAE

By Sharmila Dholakia / Dubai

INN Live investigates how millions of dirhams worth of medicines go to waste due to insurance abuse. Gross abuse of insurance in the UAE is resulting in a shocking wastage of medicines worth millions of dirhams.

A landmark study of 2.7 million claims conducted by Accumed PM, a Dubai-based healthcare consultancy this month, has found that the average value of medicines in an insurance claim is as high as 23.31 per cent.
So the question is, can the high costs of medicines and their wastage be ignored?

Herd panic pushing bourse bounces

By M H Ahsan & Yuang Chow Yo

Asia's stock markets are on a roller-coaster ride, last week dipping drastically on financial contagion fears about the faltering US subprime-mortgage market, and on Monday recovering strongly after the US Federal Reserve in a surprise move cut a key benchmark interest rate by 50 basis points. But are market forces reacting rationally to Asia's underlying profit and loss prospects?

Asian markets tumbled in near-unison last week, with some bourses notching single-day losses not seen since the September 11, 2001, terror attacks against the United States. On Friday, Japan's stock exchange recorded its largest one-day loss in more than seven years, shedding 5.5% of its value. The South Korean bourse recorded its worst performance ever last week over any given three-day period, shedding more than 200 points. On Friday, financial hub Hong Kong's exchange lost more than 6.5% of its total value, while Singapore's stock market dropped 6% on Friday.

Malaysia recorded its largest one-day loss ever, 5.3%, also on Friday. Thailand, Indonesia and the Philippines were similarly all hit hard last week, falling respectively by 6%, 13.5% and 12%. On Monday, regional markets bounced back to varying degrees, propelled up by Friday's sudden US interest-rate cut. Japanese stocks jumped 3%, Seoul's bourse was up 5.7%, and Hong Kong was up 3.6% in late trade. Singapore was up 5%, and other Southeast Asian markets also gained. So what happens next? Some financial analysts argue that the equity-market recovery is a knee-jerk reaction to the gains witnessed in the US on Friday, where the Federal Reserve's announcement drove up the Dow Jones main index by 1.8%.

The stock-market recovery, they say, also prices in widespread expectations of another 50-basis-point cut at the Federal Reserve's next monetary-policy meeting, scheduled for September. Yet if the US subprime-mortgage market continues its decline and begins to transmit financial contagion through the broad US housing market, where median prices appear to outpace widely individual borrowers' underlying earning power, the US economy could in a worst-case scenario slip into recession. Speculation is rife that the global financial order, now through financial liberalization measures more integrated than ever, could be on the brink of a crisis as big as or larger than that witnessed in the 1980s US savings-and-loan meltdown and the bursting of the technology bubble in 2001.

Significantly, last week's contagion effect on Asia's stock markets was driven more by panic selling than any new critical revelations about the region's economic and financial fundamentals. Until last week, Asia's stock markets and currencies had in general this year performed strongly. Apart from Singapore and pockets of China, Asian real estate is frothy but has not experienced the runaway price-inflation rates witnessed in US property markets. Relative to US and European banks and investment funds, regional financial institutions are believed to hold only small amounts of the derivative products that contain securitized subprime US housing loans.

Last week's financial turbulence in Asia was driven more by revised downward expectations that a slowing US economy would consume considerably less of the region's exports. All of Asia's major economies run big trade surpluses with the US. Southeast Asia's major trade-geared economies, including Thailand, Malaysia and Singapore, which export huge amounts of consumer electronics and their component parts to the US, are all exposed to shifts in US consumer sentiment. However, some regional economists argue that that basic analysis is simplistic.

Frederic Neumann, a Hong Kong-based economist at HSBC, argues in a recent research report that "the region has decoupled to a surprising degree from US demand conditions, and that even if the American economy were to slow down further, Asia could be only mildly affected". He argues that the region's "growth drivers" have become more balanced in recent years, with China and the European Union becoming more prominent, and that a deceleration in US economic growth will have a "less severe" impact on Asian than in the past. Recent HSBC sensitivity analysis shows that a 1% decline in US gross domestic product would have an equal or greater impact on only three Asian economies, namely Hong Kong, Singapore and Taiwan. The negative effect on China was surprisingly only 0.2% for each 1% decline in US growth.

At the same time, Asia's financial fundamentals are much improved from the last time financial contagion pummeled the region in 1997-98, hedging substantially the risk of a repeat broad-based economic meltdown. Central banks across the region have stockpiled unprecedented amounts of foreign-currency reserves to defend both their currencies and their banks from speculative offshore attacks. Although not universally, several countries in the region have also substantially improved their debt management, with governments reining in their public-debt profiles and corporations trimming the debt-to-equity ratios that left many of them vulnerable to the sudden shift in foreign-investor sentiment in 1997-98.

Many Asian governments are now in a financial position to prime the fiscal pumps of their economies if US growth and demand tail off significantly. While foreign money last week rushed out of regional bourses to cover subprime-mortgage-hit financial positions in the US, last week's capital flight could be a short-term phenomenon - even if the US slips into recession. Faced with tanking economic growth in the US, institutional money will inevitably seek out higher returns overseas. Asia's comparatively strong fundamentals and, in many business sectors, low price-to-equity ratios represent a natural counter-cyclical hedge against slowing US growth.

Representatives of big US-based hedge funds who before last week's turmoil met with Asia Times Online had been trolling Southeast Asia for undervalued stocks exposed to local consumption rather than global exports. To be sure, there are countervailing concerns that Asia's recent large balance-of-payments surpluses and subsequent buildup of foreign reserves have resulted in buoyant domestic money supplies. Regional central banks have to varying degrees of success attempted to sterilize those capital inflows to avoid a more rapid appreciation of their already rising currencies. Over the past year, domestic monetary aggregates, commonly known as M1 and M2, have soared across the region.

There are at least theoretical risks that, if mismanaged, sterilization of capital inflows could cause new inflationary pressures and asset price bubbles. Economists say that to date, neither is statistically apparent across most of Asia, nor were foreign-investor concerns over recent monetary interventions apparently a contributing factor to last week's financial turmoil. Indeed, HSBC's Neumann notes that in Asia over the past 15 years, there has been a weak empirical link between broad money-supply growth and stock prices. In Thailand and Japan, the relationship has historically been negative, while in Singapore, Malaysia and Pakistan the correlation is stronger but not significant. Neumann notes that in all major Asian markets, money-supply growth historically tends to lag rather than lead asset-price gains.

A recent Asian Development Bank report shows instead that the recent rise in Asian asset prices was driven more by capital inflows than domestic liquidity. Investor risk perceptions, however, are often more subjective than empirical, and herd behavior is still clearly the rule rather than the exception. As such, Asia could still be dragged down in tandem with a US slowdown, whether from underlying financial and economic measures the region deserves to be or not.

It's Time To Think The Unthinkable: Arvind Kejriwal As PM

By M H Ahssan | INN Live

WEEKEND SPECIAL The unthinkable happened in 2013: Arvind Kejriwal became CM of Delhi. What’s the most unthinkable thing that could actually happen in 2014? Kejriwal could become prime minister of India. 
    
Readers may laugh incredulously at the very suggestion. But the revolutionary success of the Aam Aadmi Party in the Delhi election shows it’s time to abandon conventional political logic and think the once-unthinkable. Conventional analysis suggests that the next national government will be headed by the BJP. But if the Aam Aadmi Party can scale up nationally, conventional analysis will become junk. 
    
In Delhi, the AAP won 28 out of 70 seats, with 30% of the popular vote. Skeptics ask, how on earth can you expect AAP to win such a high share of the vote, or of seats, in a general election? True, the AAP cannot hope to do anywhere near as well in a general election.

Bhil Women Fight the Liquor Demons

By Rahul Banerjee

There is a general perception that Adivasi women enjoy greater equality because tribal society is less patriarchal. The reality, however, is very different. Take the situation of Bhil tribal, Ramanbai, of Chandupura village in Madhya Pradesh's Khargone district. She says, "I am suffering from piles and the doctor at Sanawad has told me that I will have to get myself operated. Yet, my husband is refusing to part with the money."

Kesarbai of the neighboring Okhla village also has problems. "I already have three daughters and don't not want any more children, but my husband is insistent on a son. When he gets drunk he does not listen to any reason. If I resist him, he accuses me of being involved with another man."

But spousal abuse is not Kesarbai's problem alone. In Kundia village there was a woman who was beaten up by her husband and forced to spend the night outside the house because her brothers had not looked after him well enough when he went to their village for a visit.

Most tribal women in this belt complain that they neither have the power to take decisions within the home nor do they have control over their bodies. Matters are aggravated by social customs. Bhils have traditionally regarded alcohol as "holy spirit". In fact, even babes in arms are given alcohol. As for the gods, they too have to be propitiated every now and then with drink. This gives the men - and sometimes even women - the license to drink freely. Not surprisingly, alcoholism is rife in these parts with the men going on drinking sprees and doing no work for days on end. This only increases the burden of the women, who have to work themselves to the bone in order to feed their families.

The Bhils, having once been a martial race, have a clear gender division of labor, which is not easily transgressed. The men, even if they want to help out at home, find it difficult to do domestic labor. They also invariably object to their women taking part in organizational activities out of the house that could improve their status and employment opportunities.

Subhadra Khaperde, an activist, who had been working with the Adivasi Shakti Sangathan to mobilize the Bhils in Khargone to fight the oppression of the forest department staff and the 'sahukars' (money-lenders), was moved by the plight of these women and felt that something had to be done.

Initially, she organized a few reproductive health camps with gynecologists coming in from Indore and providing advice and medical care. The analysis of the data collected through such efforts told its own story: Not only were the women here severely anemic, they suffered from reproductive health problems of various kinds. Khaperde, who is currently pursuing higher studies in the field of gender and health so that she is formally trained to help bring about the emancipation of Bhil women, decided to help the women to organize themselves and seek solutions to these problems.

What followed was interesting. Hundreds of Adivasi women in their colorful saris, ghagras, lugras (long colored pieces of cloth that the women wear over their bodies) and doglis (blouses) seated themselves under the shade of the two big mahua trees in Akya village in Khargone one sunny afternoon. It was the first week of May 2006 and in the midst of the marriage season and an Adivasi coming from outside may have wondered why only women were congregated and why there was no drums beating to signify a marriage ceremony. But this was not a marriage. It was the meeting called to discuss the results that had emerged from the health camps.

Here, Khaperde painstakingly explained with the help of colored charts, what the data collected had revealed, and she did this in terms that the women could understand. Then she went on to explain that all the reproductive health problems that they were suffering from were because of patriarchal pressures and that medication alone would not prove to be a lasting solution.

After that, it was as if a dam had burst. Woman after woman got up and said that they could do nothing, as the men would not listen to reason and would impose themselves on them. They then gave their own analysis: Unless the men were made to see reason, things would remain the same. The biggest problem everybody agreed was that the men drank too much and became unmanageable. In an earlier era, they had had to brew their own liquor from the flowers of the mahua tree, which was a laborious and time-consuming task and could be undertaken only occasionally. But now things were changed with the easy availability of illicit liquor from the two distilleries in the area.

The conclusion drawn was that without the men being involved, no change was possible. Male activists of the Adivasi Shakti Sangathan began conducting workshops exclusively with the men on the issues that the women had raised. The group discussions ended with the conclusion that the alcoholism of the men was the biggest problem that the women faced. The men also admitted that it was proving to be a financial drain on them and that something needed to be done.

That was when Rajaan, an activist from the community and one of the rare teetotalers, put forward the suggestion that the illegal liquor shop in Okhla village should be closed down. The bootlegger who ran this shop was a notorious goon, as is usually the case. He was part of a liquor mafia that ensured that the whole area was literally flowing with alcohol with an illegal liquor godown in Pandutalav village providing the supplies.

A mass meeting was then held in Okhla and the bootlegger's shop was raided. Not only did the tribals confiscate his liquor, they sealed his shop. After the success of this action, people of Bagli tehsil just across the border in Dewas district, began demanding similar action in their area.

The liquor mafia had appointed a local contractor to oversee the operations in the area. He was known to be ruthless and had on one occasion caught a man selling the liquor of another contractor and had him arrested and beaten up a false charge. With this case in mind, a mass meeting was also scheduled in Pandutalav.

When the contractor got word of this and he came down on the appointed day with a jeep load of his henchmen. However, on seeing the thousands of men and women congregated, he fled the area. The liquor store, with stocks worth some Rs 200,000 was sealed and the keys handed over to the police.

It is indeed ironical that despite a provision in the Fifth Schedule of the Constitution that the state should proactively clamp down on the sale of liquor in tribal areas, officials look the other way while liquor contractors blatantly flout the law.

However, when women become organized, they can force the state to act.

In June 2007, Bhil women from the region took out a rally in Indore to press for their demands. However, when the Commissioner in Indore turned a deaf ear to their demands, Karotibai of Katkut village told him, "If you are incapable of providing good government to us then we will form our own government."

GURGAON - THE MAXIMUM CITY

By Kajol Singh

From a sleepy town in the outskirts of Delhi just a few years back to the hottest destination in North India in terms of employment, investments and consumer experience – Gurgaon has come a long way. Clearly, this city of skyscrapers has emerged as an ideal location to work in or set up businesses — despite poorly planned infrastructure facilities. It comes as no surprise then that an exhaustive comparative analysis by research firm Indicus Analytics places Gurgaon at the top of its list of best cities in northern India.

The last few years have seen some of the country’s biggest multinational and local companies setting up offices in Gurgaon. The large number of BPOs operating in the city has given Gurgaon the status of an outsourcing hub. In addition to proximity to the airport, what also works for this city is facilities such as hotels, schools, hospitals, malls, restaurants, pubs and gyms, that make it the ideal location for the expat population associated with the IT and BPO industries. The metro construction in full swing and the multi-lane expressway between Delhi and Gurgaon is an added advantage.

Microsoft, GE, Genpact, Dell, American Express, Google, Bharti Airtel, British Airways, ESPN Star Sports, Hindustan Unilever, Nestle, Glaxo SmithKline, Brown-Forman, Coca-Cola, PepsiCo, Reckitt Benckiser, JWT, GroupM, Rediffusion DY&R — the crème de la crème of India Inc has offices in Gurgaon. In addition, it is well-documented that how real estate developers such as DLF, Ansals and Unitech have built their empires from residential, office and shopping complexes in Gurgaon.

“New economy clients offer great employment opportunities. Malls, entertainment and residential options offer great standard of living. All of this makes Gurgaon the best place to be in right now,” says Rohit Ohri, managing partner of ad agency JWT.

Apart from officials associated with corporates, independent professionals too vouch for the city. “Gurgaon was a really small town some years back, and it has seen lot of development. Of course, infrastructure-wise, there is a lot of scope for improvement but I like working in this city and will continue to be based here in future as well,” says Dr Deepak Ahuja, a leading Gurgaon-based paediatrician.

But the Millennium city comes with its share of downsides. The infrastructure such as roads still leaves a lot of room for improvement and some plush residence and office complexes are still surrounded by villages which raises security concerns. Power and water are in short supply in some areas, and public transport is completely lacking. Besides, there is some amount of unauthorised construction as well. There is a point of view that cost of living is on the higher side in Gurgaon, but since the quality of services is better, it is considered a minor trade-off compared to living in Delhi.

“I have my factory in Gurgaon and live in South Delhi. But my traveling woes have not eased despite the toll expressway. Even within Gurgaon, congested roads delay travel time significantly. My travel time has not reduced at all and I plan to shift my factory back to Delhi within the next six months,” says architect Payal Jain.

Despite all such problems, Gurgaon has developed into a fairly self-sufficient suburb of Delhi in terms of work, commercial and entertainment options and residential accommodation.

“Though the condition of roads has been improving over the past three months, assistance from the government to improve infrastructure could take the city to another level. Apart from like-minded people working in the city, there are good shopping centres, eating places and clubs — both premium ones such as the DLF golf and country club, and smaller clubs. So the city offers professional and entertainment options for everyone,” says Amrit Kiran, area director of liquor major Brown-Forman.

In terms of vibrancy, the city fares far worse than cultural hubs like Chandigarh and Delhi. “The Aravalli centre for culture and arts and the Epicentre, for example, now regularly organise theatre shows and dance recitals. The way it is going, Gurgaon will start competing with Delhi in terms of cultural options,” says Brown-Forman’s Singh.

The analysis, which captures the performance of cities, details the rankings of northern India’s leading 38 cities. It closely examines economic and psychographic data of cities in the northern India and throws up distinct differentiation between these cities.

Vulnerable Children: On Time Delivery – The Large Blind Spot In India’s Immunisation Policy

By M H AHSSAN | INNLIVE

Only a third of India's children are vaccinated on time under the government immunisation programme. One reason is that families don’t keep proper records.

The majority of children immunised under the government’s universal immunisation programme don’t get their vaccinations on time. New research shows that two-thirds of children under the age of five had either not been vaccinated at all, or received their vaccine shots much later than prescribed.

A Shining Future Of 'Pharm D', A 6-Year Integrated Course

By Dr.Ranganath Reddy (Guest Writer)

There is tremendous scope for research and higher studies in pharmacy and job opportunities are vast. In the last few years, there has been a revolutionary growth in every area of the pharma field. With the increasing number of life-saving drugs and new methods and techniques of manufacturing and analysis of drugs, the responsibility of pharmacists has increased considerably.

Hospital Pharmacy and Community Pharmacy are emerging in India, which involve planning, procuring, dispensing drugs apart from patient counselling.

Novel Genetic Patterns Make Us Rethink Individuality

By Sarah Williams / New York

Professor of Genetics Scott Williams, PhD, of the Institute for Quantitative Biomedical Sciences (iQBS) at Dartmouth's Geisel School of Medicine, has made two novel discoveries: first, a person can have several DNA mutations in parts of their body, with their original DNA in the rest -- resulting in several different genotypes in one individual -- and second, some of the same genetic mutations occur in unrelated people. 

We think of each person's DNA as unique, so if an individual can have more than one genotype, this may alter our very concept of what it means to be a human, and impact how we think about using forensic or criminal DNA analysis, paternity testing, prenatal testing, or genetic screening for breast cancer risk, for example.

With A Speech Every 45.6 Hours, Has Modi Exhausted His Talk-Time?

By LIKHAVEER | INNLIVE

While the prime minister’s supporters may say this is a testament to his inexhaustible energy, his detractors feel he runs the risk of sounding repetitive.

Prime Minister Narendra Modi delivers a speech or makes a public statement every 1.9 days or every 45.6 hours. In reality, though, he takes to the microphone at a rate more frequent than these figures indicate.

Rahul vs Modi: Who Has The Edge in Mahabharat 2014?

Pollsters and psephologists must be smacking their lips in anticipation. With the coronation of Rahul Gandhi at the recent Congress Chintan Shivir, it is becoming increasingly apparent that the title bout in 2014 will be between Narendra Modi and Rahul Gandhi, though both sides will be eager to play down this angle for their own reasons.

Nobody can, of course, predict how the next general election will pan out – there is simply too much time between now and 2014 or even late 2013. But it is not unreasonable to presume that Modi and Rahul will be their parties’ respective standard bearers, even if they are not officially declared their prime ministerial candidates.

It is thus worth speculating on how such a battle will be fought, and what strategies the two sides will adopt.

A preliminary Swot analysis is in order: Rahul Gandhi starts with an initial advantage, for in his party there is no challenger. The Congress’s refusal to allow any alternative power centre to emerge – whether in the youth wing or in the central leadership or in the states – will ensure that he has a free run.  Rahul will get whatever he asks for.

Modi has strong grassroots party support, and is certainly first among equals in the party, but unlike the Congress, the BJP is not a single-power-centre party. Every BJP Chief Minister is a power centre, and the party is India’s most federated organisation. Plus, there is parental interference – from the RSS. Modi will have more challenges before the anointment than Rahul.

So score 1-0 for Rahul on his initial challenges.

But Rahul is no match for Modi as a communicator. Modi will probably make mincemeat of Rahul when he is in form.

Score 1-1.  

Modi and Rahul also have similarities of a sort. Neither Congress nor BJP is likely to announce their candidatures in advance – for the former because it does not want to saddle Rahul with any defeat, and the latter to avoid deterring potential allies. It is more than probable, therefore, that both Rahul and Modi will be their parties’ chief campaign managers with a major say in who gets to run and who does not in the next elections. They will also crucially determine campaign strategies.

Scores still level. But next come the crucial differentiators.

There is no doubt at all that the Congress will make communalism its major plank to overcome anti-incumbency. After making a mess of the economy and facing serious corruption charges, the Congress is hardly in great shape to defend its record in governance. Its best chance is to shift the focus of the debate to communalism, where it believes it has a natural advantage. The entry of Modi will allow this to happen naturally.

Home Minister Sushil Kumar Shinde’s remarks on BJP-RSS terror camps were not an innocent slip of the tongue. The decision to include the BJP (and not just the Sangh) in his linkage with terror is deliberate. What he is trying to do is to force the BJP on the defensive on terror, even if it means giving Pakistan a free ride on this propaganda self-goal. It will also allow him to defer a decision on the hanging of Afzal Guru – something Shinde does not appear keen to do.

The Congress strategy on communalism will thus be two-fold: while Rahul will take the high ground and talk about meeting the aspirations of youth, development, etc, party’s political attack dogs – the likes of Digvijaya Singh, Shinde, etc – will go hammer and tongs at the BJP-RSS connection and try to force Modi and his supporters to hit back in ways where there can only be further complications.

The Congress will harp on this theme outside Gujarat, and especially in UP and Bihar, in order to polarise the Muslim vote. The central idea will be to put the BJP permanently on the defensive on communalism, and force it to make dangerous statements to polarise votes further. For the BJP, communalism is a no-win game, for the harder it tries to defend itself, the more it will get caught in the same perception that it is communal.

Modi may himself be tempted to play a subtle communal card in the hope that there is a reverse Hindu polarisation in states like UP, Bihar, Telangana and Assam to the BJP’s advantage, but the task is more complicated since there are serious regional players in the game.

The score now tilts 2-1 in favour of Congress, unless Modi is able to force a focus on different issues. Modi’s best hope must be to keep absolutely quiet on communalism and focus only on development and governance in the hope that the Congress will lose credibility by attacking the BJP too much.

Next, it’s worth looking at the youth factor. In theory, a 42-year-old Rahul should be streets ahead of a 62-year-old Modi in garnering the youth vote, which will be very significant in 2014.

But in practice, Modi demonstrated in Gujarat that youth is about an attitude of mind, not age. Rahul is far behind in understanding the aspirations of the middle class and the youth – as the BJP’s sweeping victories in Gujarat’s urban centres showed.

Rahul looks youthful, but has an old feudal mindset. His party is even more feudal, and believes in old-style freebies and sops to win votes. Modi entices youth with his energy and understanding of what they want. But in his recent Chintan Shivir speech, Rahul did acknowledge the importance of looking at the causes of urban anger and disenchantment. One assumes he will address their concerns.

On balance, both Modi and Rahul will perhaps draw level on this count. A lot would depend on how the two parties try to woo the urban, youth and middle class vote – and both parties will probably have strong manifesto promises for youth and urban India. Modi probably has a small edge on the youth vote.

Scores:  3:3 at this stage.

Now, let’s look at the strategy that could come from the Modi camp. If there are real strategists here, their best bet would be to focus on the Congress governance record and economic failures of UPA-2 – where Modi stands out as a performer in his home state.

Modi’s could focus on economic governance where he scores over the Congress record at the centre. However, success in Gujarat is not easily going to rub off in other states. In fact, too much talk of the Gujarat model will only irritate voters outside Gujarat as they would want to know what is in it for them and their state.

Given the strong undercurrent of regionalism, Modi should articulate his Gujarat model and development policies in regional terms rather than a repeated invocation of his own state’s approach.

As against this, the Congress will continue to hold the high card of rural empowerment, freebies and cash transfers – which may continue to give Congress an edge in rural areas while Modi gets an edge in urban areas.

Scores 4-4.

The most important element in the Rahul-Modi clash will not about ideas or policies, but their ability to tailor state-level strategies that will work for them. A Lok Sabha general election is often a bunch of state elections aggregated as a national vote.

Here, Rahul has the advantage of not raising hackles among any sort of ally – from Nitish Kumar to Navin Patnaik, the Congress would be an acceptable option at the centre.

For Modi, the search for allies has to be more strategic. The general assumption that he will find it tougher to get allies is not founded on any realistic assessment of post-poll political realities, even if pre-poll rhetoric needs allies to keep their distance from him.

If he is hoping for a reverse Hindu consolidation, Modi has to seek it through proxy – for example, in Assam, he could talk of the Bangladeshi influx. In UP, he can talk of Hindu-Muslim unity to build the Ram temple in Ayodhya.

But one point is important: at 150-plus seats, the Congress can still form a government like UPA-1, with outside Left support. At 150-plus seats, the BJP will have to provide a leader other than Modi to run a government. At less than 140 seats each, we are more likely to see a Federal or United Front of regional parties in power with outside Congress support.

This arithmetic implies that Modi has a higher hurdle to cross than Rahul. Without 180 seats, Modi is a not a realistic contender for PM.

This tilts the final score at 5-4 in favour of Rahul.

However, a purely neutral analysis is unlikely to be anywhere close to a realistic assessment of what will happen in 2014. Too many things can change, and too many new imponderables may emerge out of the blue.

As things stand now, the following conclusions seem likely.

One, secular versus communal will be a major campaign element in this battle. One cannot rule out a bitter and dirty fight over this issue.

Two, rich versus poor will be a major issue while discussing development. The Congress will try to paint Modi as pro-rich, while the BJP will try to tie Rahul to the Congress’ actual economic track record.

Three, Modi’s personality will be both a plus and a minus, but Rahul’s will be neutral.

Four, governance will be a bigger issue than corruption, now that both Congress and BJP seem tainted by it.

Five, the key to 7 Race Course Road will run through state capitals – Modi will have to have a viable state-level strategy, both to get the BJP more seats in hitherto weak states (UP, etc), and to create future allies. Rahul has the luxury of making his plans after the elections and choosing allies with the right numbers. He also has the option of anointing a PM – like his mother did with Manmohan Singh.

Even if Rahul has a theoretical edge, all bets are off when it comes to the final battle where guts, grit and gumption count for as much as elevating rhetoric.

In the ultimate analysis, both Modi and Rahul will try and convince the electorate that they are more than their past – or their parties’ past.

Rahul will try to distance himself from his government’s recent record. Modi will try to get the electorate’s mind off 2002. The winner will be whoever succeeds  more in making voters forget their past.

Analysis: Asad Owaisi's AIMIM Stirs Up A Hornet's Nest

By SYED AMIN JAFRI | INNLIVE

The decision of All India Majlis-e Ittehadul Muslimeen (AIMIM) to enter the Assembly poll fray in Bihar, albeit on a limited scale, has stirred up the hornet's nest. More than the political parties, the media appears to be perturbed and upset by AIMIM's move. TV channels and print media unleashed the propaganda that AIMIM's entry would help BJP at the cost of the Grand Alliance of “secular parties."

Rahul vs Modi: Who Has The Edge In Mahabharat 2014?

Pollsters and psephologists must be smacking their lips in anticipation. With the coronation of Rahul Gandhi at the recent Congress Chintan Shivir, it is becoming increasingly apparent that the title bout in 2014 will be between Narendra Modi and Rahul Gandhi, though both sides will be eager to play down this angle for their own reasons.

Nobody can, of course, predict how the next general election will pan out – there is simply too much time between now and 2014 or even late 2013. But it is not unreasonable to presume that Modi and Rahul will be their parties’ respective standard bearers, even if they are not officially declared their prime ministerial candidates.

It is thus worth speculating on how such a battle will be fought, and what strategies the two sides will adopt.

A preliminary Swot analysis is in order: Rahul Gandhi starts with an initial advantage, for in his party there is no challenger. The Congress’s refusal to allow any alternative power centre to emerge – whether in the youth wing or in the central leadership or in the states – will ensure that he has a free run. Rahul will get whatever he asks for.

Modi has strong grassroots party support, and is certainly first among equals in the party, but unlike the Congress, the BJP is not a single-power-centre party. Every BJP Chief Minister is a power centre, and the party is India’s most federated organisation. Plus, there is parental interference – from the RSS. Modi will have more challenges before the anointment than Rahul.

So score 1-0 for Rahul on his initial challenges.

But Rahul is no match for Modi as a communicator. Modi will probably make mincemeat of Rahul when he is in form.

Score 1-1.

Modi and Rahul also have similarities of a sort. Neither Congress nor BJP is likely to announce their candidatures in advance – for the former because it does not want to saddle Rahul with any defeat, and the latter to avoid deterring potential allies. It is more than probable, therefore, that both Rahul and Modi will be their parties’ chief campaign managers with a major say in who gets to run and who does not in the next elections. They will also crucially determine campaign strategies.

Scores still level. But next come the crucial differentiators.

There is no doubt at all that the Congress will make communalism its major plank to overcome anti-incumbency. After making a mess of the economy and facing serious corruption charges, the Congress is hardly in great shape to defend its record in governance. Its best chance is to shift the focus of the debate to communalism, where it believes it has a natural advantage. The entry of Modi will allow this to happen naturally.

Home Minister Sushil Kumar Shinde’s remarks on BJP-RSS terror camps were not an innocent slip of the tongue. The decision to include the BJP (and not just the Sangh) in his linkage with terror is deliberate. What he is trying to do is to force the BJP on the defensive on terror, even if it means giving Pakistan a free ride on this propaganda self-goal. It will also allow him to defer a decision on the hanging of Afzal Guru – something Shinde does not appear keen to do.

The Congress strategy on communalism will thus be two-fold: while Rahul will take the high ground and talk about meeting the aspirations of youth, development, etc, party’s political attack dogs – the likes of Digvijaya Singh, Shinde, etc – will go hammer and tongs at the BJP-RSS connection and try to force Modi and his supporters to hit back in ways where there can only be further complications.

The Congress will harp on this theme outside Gujarat, and especially in UP and Bihar, in order to polarise the Muslim vote. The central idea will be to put the BJP permanently on the defensive on communalism, and force it to make dangerous statements to polarise votes further. For the BJP, communalism is a no-win game, for the harder it tries to defend itself, the more it will get caught in the same perception that it is communal.

Modi may himself be tempted to play a subtle communal card in the hope that there is a reverse Hindu polarisation in states like UP, Bihar, Telangana and Assam to the BJP’s advantage, but the task is more complicated since there are serious regional players in the game.

The score now tilts 2-1 in favour of Congress, unless Modi is able to force a focus on different issues. Modi’s best hope must be to keep absolutely quiet on communalism and focus only on development and governance in the hope that the Congress will lose credibility by attacking the BJP too much.

Next, it’s worth looking at the youth factor. In theory, a 42-year-old Rahul should be streets ahead of a 62-year-old Modi in garnering the youth vote, which will be very significant in 2014.

But in practice, Modi demonstrated in Gujarat that youth is about an attitude of mind, not age. Rahul is far behind in understanding the aspirations of the middle class and the youth – as the BJP’s sweeping victories in Gujarat’s urban centres showed.

Rahul looks youthful, but has an old feudal mindset. His party is even more feudal, and believes in old-style freebies and sops to win votes. Modi entices youth with his energy and understanding of what they want. But in his recent Chintan Shivir speech, Rahul did acknowledge the importance of looking at the causes of urban anger and disenchantment. One assumes he will address their concerns.

On balance, both Modi and Rahul will perhaps draw level on this count. A lot would depend on how the two parties try to woo the urban, youth and middle class vote – and both parties will probably have strong manifesto promises for youth and urban India. Modi probably has a small edge on the youth vote.

Scores: 3:3 at this stage.
Now, let’s look at the strategy that could come from the Modi camp. If there are real strategists here, their best bet would be to focus on the Congress governance record and economic failures of UPA-2 – where Modi stands out as a performer in his home state.

Modi’s could focus on economic governance where he scores over the Congress record at the centre. However, success in Gujarat is not easily going to rub off in other states. In fact, too much talk of the Gujarat model will only irritate voters outside Gujarat as they would want to know what is in it for them and their state.

Given the strong undercurrent of regionalism, Modi should articulate his Gujarat model and development policies in regional terms rather than a repeated invocation of his own state’s approach.

As against this, the Congress will continue to hold the high card of rural empowerment, freebies and cash transfers – which may continue to give Congress an edge in rural areas while Modi gets an edge in urban areas.

Scores 4-4.
The most important element in the Rahul-Modi clash will not about ideas or policies, but their ability to tailor state-level strategies that will work for them. A Lok Sabha general election is often a bunch of state elections aggregated as a national vote.

Here, Rahul has the advantage of not raising hackles among any sort of ally – from Nitish Kumar to Navin Patnaik, the Congress would be an acceptable option at the centre.

For Modi, the search for allies has to be more strategic. The general assumption that he will find it tougher to get allies is not founded on any realistic assessment of post-poll political realities, even if pre-poll rhetoric needs allies to keep their distance from him.

If he is hoping for a reverse Hindu consolidation, Modi has to seek it through proxy – for example, in Assam, he could talk of the Bangladeshi influx. In UP, he can talk of Hindu-Muslim unity to build the Ram temple in Ayodhya.

But one point is important: at 150-plus seats, the Congress can still form a government like UPA-1, with outside Left support. At 150-plus seats, the BJP will have to provide a leader other than Modi to run a government. At less than 140 seats each, we are more likely to see a Federal or United Front of regional parties in power with outside Congress support.

This arithmetic implies that Modi has a higher hurdle to cross than Rahul. Without 180 seats, Modi is a not a realistic contender for PM.

This tilts the final score at 5-4 in favour of Rahul.

However, a purely neutral analysis is unlikely to be anywhere close to a realistic assessment of what will happen in 2014. Too many things can change, and too many new imponderables may emerge out of the blue.

As things stand now, the following conclusions seem likely.

One, secular versus communal will be a major campaign element in this battle. One cannot rule out a bitter and dirty fight over this issue.

Two, rich versus poor will be a major issue while discussing development. The Congress will try to paint Modi as pro-rich, while the BJP will try to tie Rahul to the Congress’ actual economic track record.

Three, Modi’s personality will be both a plus and a minus, but Rahul’s will be neutral.

Four, governance will be a bigger issue than corruption, now that both Congress and BJP seem tainted by it.

Five, the key to 7 Race Course Road will run through state capitals – Modi will have to have a viable state-level strategy, both to get the BJP more seats in hitherto weak states (UP, etc), and to create future allies. Rahul has the luxury of making his plans after the elections and choosing allies with the right numbers. He also has the option of anointing a PM – like his mother did with Manmohan Singh.

Even if Rahul has a theoretical edge, all bets are off when it comes to the final battle where guts, grit and gumption count for as much as elevating rhetoric.

In the ultimate analysis, both Modi and Rahul will try and convince the electorate that they are more than their past – or their parties’ past.

Rahul will try to distance himself from his government’s recent record. Modi will try to get the electorate’s mind off 2002. The winner will be whoever succeeds more in making voters forget their past.

Can Telemedicine Alleviate India's Health Care Problems?

Chakrajmal village, in the Bijnor district in the North Indian state of Uttar Pradesh, got its first doctor in 2008. He was not based in the village, though. The villagers had access to the doctor via a telemedicine project launched by World Health Partners (WHP) to provide health care services to 1,000 villages in Uttar Pradesh's Bijnor, Meerut and Muzaffarnagar districts.

Set up in 2008, WHP, a U.S.-headquartered international nonprofit, provides basic health care and reproductive health services by harnessing local market forces to work for the poor. According to Gopi Gopalakrishnan, founder-president of WHP, the organization's model is to draw on private sector capacity through social franchising, innovations in labor management, and low-cost technologies to develop a scalable and sustainable health care service delivery model.

WHP's Uttar Pradesh telemedicine network now comprises around 1,200 local individuals called Sky Care Providers and 120 entrepreneur-run centers branded as Sky Health Centers. The Sky Care Providers are given training and low-cost mobile solutions by WHP to perform diagnostics, symptom based treatments, tele-consultations and, wherever needed, referrals to the Sky Health Centers.

These centers use remote diagnostic devices for measurement of basic parameters such as blood pressure, heart rate, electrical activity of the heart and pulse rate. The patients are connected to doctors at WHP's central medical facility in New Delhi via computers and webcams. The entrepreneurs have the option of leasing the equipment from WHP. For the patients, consultation charges vary from 20 U.S. cents for below poverty line households to US$1 (at the exchange rate of Rs. 50 to a U.S. dollar).

Patients who require surgery, inpatient care or specialized procedures that cannot be delivered via telemedicine are referred to the nearest WHP franchised health care clinic. Currently WHP has 16 such clinics in Uttar Pradesh. Since 2008, WHP has provided villagers in Uttar Pradesh with around 35,000 tele-consultations for common ailments such as fever, indigestion and gynecological problems.

Gopalakrishnan is now replicating this model in Bihar. Currently there are 104 telemedicine centers up and running in 13 districts of the state. He hopes to expand to 400 centers across 25 districts (covering a population of 70 million) by end of 2012 and 1,250 centers over the next three years. Apart from treating basic ailments, Gopalakrishnan now also wants to focus on detection and treatment of tuberculosis, visceral leishmaniasis, childhood pneumonia and diarrhea.

"There's a huge, unmet health care need in our rural hinterlands. The challenge is to make health care affordable for the masses and attractive to the providers at the same time," says Gopalakrishnan. "Telemedicine is a good strategy to strengthen the existing human resources available in health care. The scale, however, will come only through effective government intervention."

According to Rana Mehta, executive director and leader of health care practiceat PricewaterhouseCoopers (PwC), access to health care in India "gets limited by the affordability factor and hence telemedicine -- or the remote diagnosis, monitoring and treatment of patients via videoconferencing or the Internet -- has a very important role to play. It is at a fairly nascent stage right now having started only about a decade back, but it is undoubtedly a fast-emerging trend, led by growth in the country's information and communications technology sector."

K. Ganapathy, president of the Apollo Telemedicine Networking Foundation, past president of the Telemedicine Society of India and adjunct professor at the Indian Institute of Technology, Chennai, is categorical that telemedicine is the way ahead. "We can't go far with conventional brick-and-mortal hospitals,' he says.

Vijay Govindarajan, professor of international business at the Tuck School of Business at Dartmouth College, not only sees India as one of the early adopters of telemedicine, he also notes that the country has the potential to develop innovations that can be adopted in other parts of the world, including developed nations like the U.S. "In the United States, we are thinking of IT [information technology] as just electronic medical records," Govindarajan says. "This shortchanges IT's full potential. Driven by extreme need, India is inventing new ways to use information technology to improve health care."

Govindarajan lists the reasons why telemedicine will take off first in India: A severe shortage of doctors, especially in rural areas; very high patient volumes; widespread availability of mobile networks; rapid growth in the availability of low-power, hand-held medical monitoring devices, and the shift away from the proprietary, local area network-based medical image archiving and communications systems to a networked tele-enabled system. "Innovations in telemedicine will accelerate in India, where access and cost are critical issues. These telemedicine innovations will be adopted in the U.S., where cost and access are becoming increasingly talked about. This is a classic reverse innovation story," he adds.

Potential for Growth

A January 2012 report titled, "Global Telemedicine Market Analysis," by RNCOS Industry Research Solutions, an India-based market research and information analysis company, projects that the global telemedicine market will grow at a compound annual growth rate (CAGR) of around 19% from 2010 to 2015. An earlier report in 2009, titled "Global Telemedicine Market: 2008-2012" published by Infiniti Research, a London-based market intelligence firm, pegged the size of the global telemedicine market in 2008 at US$9 billion. According to this report, Asia is the fastest growing region for the telemedicine market with India and China leading the growth.

There are no clear numbers, though, on the current size of the telemedicine market in India. Murali Rao, associate vice president for health care at the New Delhi–based research and consultancy firm Technopak Advisors, estimates the current size of the Indian telemedicine market to be around US$7.5 million. "This is expected to grow at a [compound annual growth rate] of 20% over the next five years," he says. That would take it to around US$18.7 million by 2017. Mehta of PwC on the other hand notes: "Studies indicate that the size of India's telemedicine market is expected to be US$500 million by 2015." (This is a nascent area and estimates vary widely.)

Ganapathy of Apollo points out that 80% of India's population has no direct, physical access to specialist health care and gives some back-of-the-envelope calculations: "Estimates suggest that the telemedicine market is at least for 800 million Indians. Even if half of these 800 million need to consult a specialist once a year, [that still amounts to] 400 million specialist consultations per year. Even if 10% of these are enabled through telemedicine we are talking about 40 million consultations per year from rural India alone…. The market potential for telemedicine is obviously enormous."

While the numbers may vary, what is undisputed is the potential that telemedicine holds. A major driver of telemedicine in India is the dismal state of health care in the country. India's government spending on health as a proportion of the GDP – currently at around 1% of the GDP - is among the lowest in the world. Even in other Asian countries, it is higher. The corresponding amount is 1.8% in Sri Lanka, 2.3% in China and 3.3% in Thailand. Despite the launch of the National Rural Health Mission in 2005, India continues to grapple with a 33% shortage of rural hospitals, which are called Community Health Centers (CHCs). Even in the ones present, there is an acute shortage of staff. According to the Ministry of Health and Family Welfare, there is a shortage of 50-70% of physicians, specialists, lab technicians and radiographers at the CHCs. And around 10-15% of them lack even basic amenities such as water supply and electricity.

Experts have time and again suggested that if the vision of "Health for All" is to be achieved by 2020, India will have to pump in 6% of its GDP in the health care sector. At the same time, technology-enabled health care networks can play a huge role by bridging the distance between doctors and patients through Internet and other telecommunication technologies.

Ground Realities

Some of the major players in telemedicine in India at present include Narayana Hrudayalaya, Apollo Telemedicine Enterprises, Asia Heart Foundation, Escorts Heart Institute and Aravind Eye Care. Devi Prasad Shetty, a leading cardiac surgeon based in Bangalore and founder of Narayana Hrudayalaya Hospitals, predicts that it is only a matter of time before we see a huge spurt in the use of telemedicine. "In the early days, satellite was the only means of managing the telemedicine program and keeping satellite connectivity was not very easy," he notes."However, now with Skype and other ways of videoconferencing there are many options available. With the stabilizing of technology platforms, technical problems are extremely rare."

Shetty is at the helm of one of India's earliest and largest telemedicine programs. Launched around 10 years ago, the initiative is managed through satellite connectivity provided free of cost by the Indian Space Research Organization (ISRO). Presently, the Narayana Hrudayalaya telemedicine network is connected with about 100 telemedicine centers across India. Outside India, as part of the PAN African satellite network, it is connected to 55 cities in Africa. The connectivity also extends to some other places like Iraq, Malaysia and Mauritius. Since its launch, it has conducted around 53,000 tele-consultations in the areas of cardiology, neurology, urology and cancer. Narayana Hrudayalaya also has an electrocardiogram (ECG) network wherein general practitioners in remote locations are given a trans-telephonic ECG machine that helps transmit ECGs. Narayana Hrudayalaya gets about 200-300 ECGs daily. These are interpreted by its doctors and then communicated to the local doctors at the remote locations.

Shetty points out that telemedicine is not just about connecting remote locations. Six years ago, when Narayana Hrudayalaya started performing liver transplants on babies, its cardiac anesthetists did not have adequate experience for this procedure. So Shetty turned to telemedicine. Narayana Hrudayalaya's operating room in Bangalore was connected to the Children's Hospital of Philadelphia and the anesthetists there. "After hand-holding for about five to seven liver transplants, our anesthetists acquired the knowledge," says Shetty. He goes on to add: "In the coming years, most of the medical treatment will be through telemedicine either in the same city or in other countries. There will be enough gadgets available at home to check blood pressure, blood sugar, ECG, oxygen saturation, even ultrasound. Patients will consult the doctors through mobile phones or videoconference through cellphones."

Some of this is already happening. Recently, leading telecom player Airtel tied-up with Healthfore (a division of Religare Technologies) and Fortis Healthcare (a Religare group company) as the knowledge partner to offer Mediphone services to its customers. This service allows subscribers to access basic medical guidance on non-emergency health problems over the phone. The service is available around-the-clock at less than US$1 for each consultation.

Other telecom players like Aircel and Idea have launched similar services in collaboration with HealthNet Global, a Hyderabad-based emergency and health care management services firm. The subscribers who call to seek health advice are visited by paramedics who come with a laptop and medical diagnostic equipment and conduct consultations via video conferencing. This is also gaining traction among insurance companies. "We have already conducted 1,000 sessions since our launch in September 2011. We are currently present in Chennai, Mumbai, Delhi and Hyderabad. We plan to expand our services to all the metros," notes Rahul Thapan, global head of marketing & sales for HealthNet Global.

In December of last year, microfinance firm Equitas also launched tele-health care delivery centers in association with HealthNet Global. The project is funded by Fem Sustainable Social Solutions (FemS3), a nonprofit company operating in the social business space. Equitas' Consult 4 Health and Call 4 Health products, developed exclusively for the firm by the Centre for Insurance and Risk Management at the Chennai-based Institute for Financial Management and Research, allow its members to consult physicians from Apollo Hospital over video for a charge of US$1 a consultation. The patient's data is also stored for any further diagnosis and treatment in the future. 

"It is our endeavor to improve the quality of lives of our members and their families," says P.N. Vasudevan, managing director of Equitas. "Health care is a source of significant financial stress for this segment. The initiative with HealthNet Global using physicians from Apollo Hospital will bring a revolution by providing health care to the doorstep of our members and the best medical care anytime, anywhere. We will roll out our services from Chennai and gradually go pan-India." Currently, Equitas has three tele-health care centers operational in Chennai.

Other new models are also emerging. Take Mumbai-based MeraDoctor (My Doctor) founded in 2010 by Gautam Ivatury, who was earlier working in the area of mobile phone-based services, and Ajay Nair, a medical doctor with a master's degree in public health management from Harvard. A phone-based medical advice service, MeraDoctor works on a membership model. The company offers family membership plans for three months and six months; during this period, members are entitled to unlimited phone consultations with MeraDoctor's team of doctors. Members can also avail of discounts at select diagnostic centers that MeraDoctor has tied up with.

There are new products, too. Dartmouth's Govindarajan points to General Electric's innovative low-cost ECG machines, which were developed in India and can take digital images that can be emailed to cardiologists in the U.S. "[This gives] poor patients in remote rural areas access to world-class care," he says.

Another example is 3nethra from Bangalore-based Forus Health. Developed with the aim of enabling mass pre-screening outside the hospital environment, 3nethra is a portable, non-invasive device that helps in early detection of eye diseases like cataract, diabetic retina, glaucoma and cornea related issues. The digital information taken by 3nethra can be easily transmitted electronically. The device won the Samsung Innovation Quotient award in 2011. "At 3nethra, we wanted to work with the system and its limitations," notes K. Chandrasekhar, founder and CEO of Forus Health. "Even a minimally trained technician can operate it. The idea was to develop a solution that was cost effective. The device that we have developed is available for one-sixth the cost of present diagnostic devices. Also, it uses only 10 watts of power. It can run for four hours on a UPS, making it ideal for rural areas [which face enormous shortage of power]."

Challenges Remain

But even as the telemedicine scenario in India is seeing significant developments, challenges still remain. According to Narayana Hrudayalaya's Shetty: "The greatest challenge is getting enough medical specialists to see patients in remote locations and also to get the patients to trust the opinion by the doctors, virtually."

Healthnet Global's Thapan points out that India will soon have a billion phone connections and the network will not be a problem. "It's now about finding the right linkages," he says. Thapan notes that ASHA (Accredited Social Health Activists) workers, for instance, can be trained to aid the doctors. "It will help spread the network," he adds.

Apollo's Ganapathy suggests that the potential of telemedicine in India is still under-realized because of lack of awareness among the masses and lack of a business model that caters to all the stakeholders. "Telemedicine will never reach the critical mass for take-off until doctors are excited about it and unless people clamor for it as a cost-effective method. We need public-private-partnerships to drive telemedicine [in India]."

Mehta of PwC says the entire ecosystem needs to be strengthened. "Ten years ago, there was the technological barrier," he notes. "That has gone away. However, the economic barrier stays. The ecosystem, in terms of incentives for the hospitals, the broadband service providers and the patients, needs to be defined. That is the tipping point of the telemedicine market in India."