No Frills on this Salad: Vinegar, Staying Awake and Cost Cuts

Health care delivery is an integral part of any health system. But delivery means different things in different health systems: So what’s all the fuss about?



 That’s what these technologies are called[1]. Invented in the developed world; Re-designed and formulated in cheaper and custom made ways by LMIC’S for LMIC’s. The examples abound.

And hold your breath, because some may not be palatable!

In recent news, there has been a plethora of articles announcing the arrival of a method that uses a simple household product, found easily on the shelves of most supermarkets, used in cooking, cleaning, polishing and even in laundry: Vinegar for Cervical Cancer Screening. Pioneered by Professor Surendra Srinivas Shastri[2], the test was based on a 12 year randomized study on women mainly in slums in India and was shown to reduce cervical cancer mortality by 31%. Results are yet to be confirmed but the test has been widely adopted by several LMIC’s like Nigeria, Ghana, Thailand, etc. It is used widely in the detection of cervical cancer by countries whose health systems are unable to afford the pap smear. The comparison in costs for vinegar testing versus pap smears is mind boggling[3].

US$ 1 v/s US 15 per individual (respectively)

currency globe

An HBR report says that hospitals in India are delivering care in cancer, eye, orthopaedics, kidney, maternity care and heart problems at :   5-10% of the costs in the U.S. The rates are adjusted for quality of care, wages and medical outcomes. Dr. Devi Shetty has brought down an artery-clearing coronary bypass surgery to $1,555—half of what it was 20 years ago. The

same procedure, it is estimated would cost, $106,385 at Ohio’s Cleveland Clinic[4].

So what the hitch?

Things like buying low cost scrubs, using air-conditioners in Intensive care units and operation theatres only, cutting on pre-op testing. Controversial? Yes but wait till you hear this:  the ‘beating heart’ surgery , a method that has been pioneered at Wockhardt in India, to perform open heart surgery with minimal pain, no anesthesia or blood thinners and faster recovery with lesser time in hospitals[5] . Dr Jawali was ridiculed for even thinking that “awake surgery” was possible , several years ago, now he is celebrated as an innovative pioneer.

The argument, it goes, is the following: in low LMIC’s, health systems are faced with two major problems, poverty and population. Health systems have to come up with innovative new ideas of how to reach poor populations at large numbers and deliver efficient health care. In this scene then, innovation may not mean the adoption of key hole surgeries or a new equipment but rather something else.  Lifesprings[1], another for-profit hospital in Hyderabad delivers C-sections for about  U.S.$ 140 and normal deliveries for us $ 40. The means to do this: no canteens/cafeteria’s and outsourcing of lab tests and pharmacy tests.

Will the next step be packaging them and selling them back to the health systems of richer countries?


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