Women's health

Note to Chandrababu: Family planning is not about class but about women's rights and choices

Andhra Pradesh chief minister Chandrababu Naidu on Friday asked rich people in the state to have more than one child.

Determining the size of her family is every woman’s right. For individuals in leadership positions, to make comments to the contrary is regressive and can push back the country’s progress on many fronts. These include India’s goal for population stabilisation, FP2020 – an international partnership of more than 20 governments on family planning – and the Sustainable Development Goals commitments. The debate is not whether the rich should have more children; it is about choices and rights.

Andhra Pradesh has shown a significant reduction in population growth, which should be a matter of great pride, given that the desired fertility rate for the state, as per National Family Health Survey III, is 1.5, indicating that women wish to have less than 2 children.

A rights-based approach

For many like me who are committed to ensuring women’s health through a rights-based perspective to family planning, it is no longer a matter of numbers. It is an issue of respecting rights and choices and treating women with dignity. Family planning is an effective tool that advances sexual and reproductive health, saves lives and empowers communities, especially women. Family planning methods help avert more than 272,000 maternal deaths per year at the global level and positively affect children’s health and economic outcomes of families.

Reproductive choice is a fundamental human right – it frees women from incessant cycles of pregnancy, breastfeeding and childcare. Family planning and its voluntary use represent a giant step towards gender equality and should not be contraindicated by the recently made remarks on the issue.

The post-2015 world is increasingly moving away from the narrow prism of targets and numbers to enhance sustainability and accountability. The rights-based approach to family planning provides an overall framework and set of universal values including, equality, non-discrimination, participation and accountability, on which to base contraceptive service provision and delivery. FP2020’s implementation is in alignment with the principles of the International Conference on Population and Development programme of action held in Cairo in 1994. ICPD abandoned demographically driven population policies, asserting that people mattered more than numbers. Population is not just about counting people, but about making sure every person counts irrespective of the wealth quintile they represent.

Choice and access to family planning

The current use of any modern method of family planning in the state has increased to 69.4% in 2015-2016 from 67% from in 2005-2006. Interestingly, female sterilisation contributes significantly to this result, as the use of all other methods of family planning has reduced considerably over the same time period.The state’s emphasis within the Family Planning Programme thus needs to prioritise choice and access to spacing methods as opposed to primarily terminal methods.

Family welfare is a mutually shared responsibility where there is an imminent need for parliamentarians, policy makers, civil society organisations, the media and other stakeholders to work together towards the pursuit of a common vision. However, a few uninformed statements can distract attention from constructive work being done at the grassroots by behaviour change communications programmes and campaigns and also the implementation of the national family planning programme. The need is for greater investments, financial and programmatic, in health and family planning nationally, alongside engagement of people’s representatives at their constituencies on reproductive health.

Poonam Muttreja is Executive Director of the Population Foundation of India.

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What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

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Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the Scroll.in marketing team and not by the Scroll.in editorial staff.