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NOV 2010 Issue 06
HEALTH INFRASTRUCTURE IN INDIA
India is the 7th largest country in the world and the 2nd most
populous country after China. A large part of it‘s population
lives on less than Rs.100 a day. The standards of living and
hygiene is very unsatisfactory, especially in rural areas. All
these reasons, coupled with a sub tropical climate, makes
India a hotbed for diseases. Compounding the problem is the
paltry number of beds and qualified doctors available to pro-
vide treatment- 178.7 Hospital beds per 1,00,000 people in
the urban areas, and an astonishingly low 9.87 beds per
1,00,000 people in rural areas.
Making matters worse are the sky high prices of various medical tests (ranging from the basic X-rays, blood tests, to various other com-
plicated tests) and the ever increasing
price of drugs. An average Indian cannot
afford such expensive tests and medi-
cines, let aside the operational costs, and
other expenditures, and is therefore left
with very little options.
We can learn something from Mr. Devi
Sheety, a humble man who has made
world class healthcare services available,
at reduced prices, to everybody. Nara-
yana Hrudayalaya, state-of-the-art
trauma hospital Sparsh, and an ophthal-
mology hospital Narayana Nethralaya are
world class hospitals offering their ser-
vices at affordable rates. He has also
started an Insurance scheme
―Yashasvini‖ which is the world‘s cheap-
est, comprehensive health insurance
scheme at just Rs.5/- per month pre-
mium.
This is a big issue because the life of an
individual is the most valuable asset. If
India is to truly achieve the aim of becom-
ing a developed nation in the years to
come, it needs to put its medical infra-
structure in order before proceeding
ahead, because a nation of weak men
and women cannot deliver.
The Storyteller’s Corner 1
Leaders and Butterflies 2
Leading in Change 3
The Chaos Theory 4
All aboard! 4
Challenges in eGovernance 5
Securing the Unorganised Sector 6
Transforming Lives
THE STORYTELLER’S CORNER
CS KEDAR, DG, ESIC
Over the years, I have developed a habit of making clandestine visits
to my hospitals and move about, incognito. Many a facts, not visible to
the DG, present themselves quite starkly to the common man. It also
brought me face to face with life one day!
Here I was, busy inspecting the hospital, looking for opportunities of improvement and
making mental notes, when I saw another man, doing exactly the same! I was taken
aback and quite literally amused. To my mind, I had a very valid reason for doing so, but
what could be his reason? Deciding to get to the bottom, I quietly observed him. He went
on about the inspection very diligently, looking behind the doors, checking out the toilets,
talking to people, and making notes.
I walked up to him and started chatting to him. His name, he said was Muchkund Pandey
and he was an IP. He worked in a nearby factory and lived along with his family stayed
some distance away. No one from his family was unwell that day and that he had come
here ONLY to inspect the hospital. On further inquiry, he said that he loved his family
and wanted them to have the best of the medical attention. He had been assigned to this
hospital, but wanted to make sure that, if ever the need arose, this hospital would be
able to take care of his needs. He wanted to make up his mind what would be more judi-
cious, coming in here and availing of the IP Benefits, or going to the nearby private hos-
pital, which would surely be very expensive and a burden, yet preferable only because
he would not want to compromise on the quality of medical care for his loved ones!
Ever since that day, I have looked at my hospitals with Muchkund Pandey‘s perspective.
I have understood that irrespective of the financial capabilities, every person wants the
best for his/her family in case of medical emergencies, and that alone is what shall sepa-
rate a good hospital from a preferred one! It is now my dream that if ever the need arose,
Mr. Pandey would give us the opportunity to serve him. After all, he is our VIP!
The Project Panchdeep Journal
The Lighthouse
LEADERS AND BUTTERFLIES
VASUDEV MURTHY, WIPRO LTD
I had attended the ESIC Leadership Conclave, 'Trinetra', in Delhi
a few months ago where I had the pleasure of leading a Busi-
ness Simulation exercise. I began by showing the picture of a
butterfly and asked, quite rhetorically, whether anyone in the
audience had heard of the butterfly effect. The idea was to high-
light to the senior leadership present in the audience the aston-
ishing effect that a single—almost inconsequential - act could
have on the larger system.
Formally, the butterfly effect is a metaphor that tries to show how
a single tiny event - say the flapping of a butterfly's wings - could
have an extraordinary effect on a larger system - say the creation
of a tropical storm or cyclone.
This metaphor has immense significance in organizational dy-
namics. In particular, ESIC's senior management has to keep an
eye of apparently minor events in the external environment at
and understand the effect of those events on ESIC. A new law,
economic changes, a new competitor, an unusual technology -
the slightest blip could have massive implications. If the rate of
change within an organization is faster than the rate of change
outside, the organization will survive and thrive. A satisfied
'settled' organization that is convinced of its permanence will die.
A sense of paranoia - watching for the flapping of wings of the
smallest metaphorical butterfly - is essential in a leader, for he
then works to adapt and morph, not allowing for even a mo-
ment's complacence.
In our context then, change management should not be consid-
ered a single project with a defined start and end, but a continu-
ous strategic imperative.
A sensitive leader can astutely deploy the concept of the butterfly
effect in his environment. The right behavioral inputs create a
cascading positive effect. Rather than dictate change, the leader
exemplifies change and is seen to behave differently. Others
notice these positive changes and unconsciously emulate them.
Changes brought about by one's free will have greater lasting
power than those brought about by diktat.
Of course, there are many leadership styles and all have their
advantages. But all leaders must wear a radar on their heads,
searching relentlessly for the next butterfly to flap its wings. Inter-
preting that event and managing a possible 'butterfly effect' will
distinguish a visionary leader with a three hundred and sixty de-
gree view from a settled manager with tunnel vision.
Do you see a butterfly on your window?
EDITORSPEAK!
This was a happening month for India. Festivals
galore, Diwali, Id and Obamamania. This month
was special for a bigger reason though. The President of a su-
per power nation visited India to boost economy and create jobs
– not for India but for his country. The President may speak of
increased trade between the two nations, but his agenda was to
create or sustain one hundred thousand U.S jobs. According to
analysts, any improvement in the dismal jobs picture in U.S is
welcome but economists have estimated it will take 300,000
new jobs each month to have an impact on an unemployment
rate hovering around 10 per cent.
The core issue here is neither political nor economical; rather it
is the social value of employment. The social security attached
to an employed person and his basic needs met is the real indi-
cator of a Nation‘s wealth. When a person is able to utilize his
day gainfully, is assured of health care and safe environment for
his family, his productivity and social quotient grows. So, when
a super power nation gives priority to job creation, it empha-
sizes the value of employment. Bhutan has integrated the value
of its citizens to its growth indicators and measures ‗Gross Na-
tional Happiness‘! The concept of gross national happiness
(GNH) was developed in an attempt to define an indicator that
measures quality of life or social progress in more holistic and
psychological terms than gross domestic product (GDP).
According social security to an employed person is another
critical factor. ESIC has been playing that key role in meeting
the needs of employees earning below INR15,000 in wages
monthly. The unorganized sector is also being brought under
this umbrella and we look forward to a day when children em-
ployed in Agra shoe factories, child labour in Sivakasi or chil-
dren using pliers to pick off tiny black computer chips from e-
waste also come under the safety net of social security.
In this issue, the story teller recounts his experiences when he
visited one of the ESIC hospitals incognito, highlighting the IP‘s
desire to provide what is best for his family, even though it
might cost him more. Dr Kshirsagar provides an insight into the
Leaders‘ mind, especially in the times of change, and her
thoughts on the necessity to keep learning, keep changing,
keep leading. Mr. Mukhopadhyay from MP succinctly underlines
the importance of a leadership trait of ensuring that everybody
in the team is clear about the project at large, and his own vital
part that needs to be played. Milan Narendra, using his learn-
ings from the immense experience of leading the national team,
shares his thoughts on the factors that must be taken into ac-
count while implementing the eGovernance projects.
The Lorenz Effect, known as the mathematics of Chaos, has
lent a scientific approach to the study and the art of leading
people, and foreseeing future impacts of actions taken today.
Vasu Murthy, the effervescent master thinker dwells on this,
and simplifies the intricacies of bringing the leaders in us out of
our own confines.
The twin festivals of Diwali and Eid have both rejuvenated, and
reiterated our commitment to the cause of Chinta se Mukti, as
Madhya Pradesh, Gujarat, and Maharashtra prepare for the
Panchdeep roll-out.
LEADING IN CHANGE
DR NEELIMA KSHIRSAGAR
Dean, PGIMSR MGM Mumbai
Director General ESIC Dr. C.S. Kedar and the team at Wipro should be specially thanked and congratulated for
having given us the opportunity to learn about change management. Recently, I was the co-organizer of American College of Clinical
Pharmacology Conference held in Baltimore, USA in September 2010, where the theme of the conference was ―What developing and
developed countries have to learn from each other‖. I was surprised to find that my American colleagues arranged a one day workshop
on change management. Participants for the workshop were from Pharmaceutical Industry, University, Government regulatory organi-
zation etc. The examples/exercises that the convener of the workshop gave consisted of how to deal with change due to merger and
acquisition of companies, new boss joining, outsourcing of manufacturing activities to India etc.
I have just read the book ―Leading Change‖ by John P. Kotter. This inspirational book highlights how when faced with transformation,
change and change problems, developing proper change strategies and leadership can drive the change successfully.
We are often bogged down by issues involved in managing change i.e. by processes that can keep complicated system of people and
technology running smoothly. We need managerial skills and but more so what we need are leadership skills - defining what the future
would look like, aligning people to that vision and inspiring them. In ―brown field‖ projects, where we are overlapping new things on old
things, we are faced with many challenging situations. We can call it something like ―Brahmastra‖ of The Mahabharat War (I am emu-
lating Dr. Mahanty who very effectively gives examples from The Mahabharat).
Computerisation is one major change, but there are multiple changes within the organization such as establishing Postgraduate insti-
tutes, upgradation of infrastructure, taking over and merger of State schemes by ESIC. Trust hospital like MGM with its own trust deed
has challenges of changing superintendent, changes in union. While, there are changes in the organization we have changes in per-
sonal life – I have joined ESIC only a year back. There are changes in environment – changes in Medical Council of India, weather
changes, monsoon disaster, terror threats, so on and so forth. We cannot therefore take a simplistic view of change. The eight point
program by Kotter needs all the more to be carefully planned and implemented. This requires maximum support from all and unfl inch-
ing belief in the organization and its goal and above all faith in leadership . We are very fortunate to have Dr. C.S. Kedar to lead us.
You may remember Dr. Kedar showed a mesmerizing video which illustrated how a group of Software Engineers produced ―3 dimen-
sional virtual reality‖ project. Dr. Kedar as secretary for tourism dreamt that why not King Krishnadevraya himself appear when tourists
visit the ruins of Hampi. The software engineers made this vision possible through technology. I showed this video in Baltimore, USA in
the change management workshop (Dr. Kedar had graciously allowed me to copy it from his laptop). The impact of this video was phe-
nomenal. It is said that ― if you want to go fast, go alone, if you want to go far, go with others‖
Just like ESIC, which has a great vision for future .
ALL ABOARD!
AK MUKHOPADHYAY
RD, ESIC MP
We often use the metaphor of stake-
holders ―being on board‖. However,
how communication is managed on
large projects may not always lead
to this outcome.
If you want all of your stakeholders
to come on board, your train must
depart from where the stakeholders
are. This seems so obvious, yet it is
one of the most common mistakes
made in change projects. We all
approach life from within our
own perspective – each of us have a
unique set of knowledge, assump-
tions, beliefs, values, habits, norms,
personality traits, perceptions, fears,
hopes, quirks, strengths and weak-
nesses. Perspectives can differ so
greatly that it can be extremely diffi-
cult (or even sometimes virtually
impossible) for us to understand the
perspectives that others have.
A project team therefore tends to
develop overlapping areas of shared
perspective, and also advances
quite rapidly ahead of where the bulk
of stakeholders are, creating a large
gap in relative understanding and
relative acceptance with regard to
the project. This might make it very
difficult for the project team to effectively engage with stakeholders. Project teams tend to be passionate (and therefore to communicate)
about what is important to them (the business case, project phases and key milestones, the composition of the project team, the impor-
tance of buy in and support from stakeholders) instead of what is important to stakeholders.
Most project teams rapidly develop a specialised ―language‖ which is different to what most stakeholders are used to. Acromyms
and specialised terminology present a significant barrier to stakeholders who are not part of the project team and therefore have not
learnt to the new ―language‖. The attitudes of project team members toward the project are usually very different to the atti tudes that
most stakeholders have. Project team members may overestimate the extent to which stakeholders will support the project, and may
feel resentful when stakeholders assign a low priority to the project, show poor support and commitment or even resist the project. From
the stakeholder point of view, project team members might appear to be unrealistically optimistic, to act in their own self-interest or as if
they have a hidden agenda, and be regarded as being manipulative.
In the project world, plans change often and with little notice, it is taken for granted that people will go to extraordinary effort to get things
done in time, and it is acceptable to schedule meetings after hours and at the last minute. This same behaviour normally is regarded as
being inconsiderate and disruptive. This may result in a situation where project members see business resources as being lazy, uncar-
ing and uncooperative, and business resources see project members as being arrogant, pushy, rude and self-important.
The challenge is not only that there tends to be a large gap between the point of departure of the project team and the point of departure
of stakeholders who are not part of the project team – a further complication is that perspectives will change over time, and what might
be an entirely appropriate strategy for stakeholder engagement at one point in time may not be appropriate two months later. As stake-
holders progress with regard to their understanding of the project and its consequences, their information needs will change and they
will require increasing amounts of personal interaction.
Chaos theory is a field of study in mathematics, physics, economics, and philosophy study-
ing the behavior of dynamical systems that are highly sensitive to initial conditions. This sen-
sitivity is popularly referred to as the butterfly effect. Small differences in initial conditions
(such as those due to rounding errors in numerical computation) yield widely diverging out-
comes for chaotic systems, rendering long-term prediction impossible in general. This hap-
pens even though these systems are deterministic, meaning that their future behavior is fully
determined by their initial conditions, with no random elements involved. In other words, the
deterministic nature of these systems does not make them predictable. This behavior is
known as deterministic chaos, or simply chaos.
An early pioneer of the theory was Edward Lorenz whose interest in chaos came about acci-
dentally through his work on weather prediction in 1961. Lorenz was using a simple digital
computer, a Royal McBee LGP-30, to run his weather simulation. He wanted to see a se-
quence of data again and to save time he started the simulation in the middle of its course.
He was able to do this by entering a printout of the data corresponding to conditions in the
middle of his simulation which he had calculated last time.
To his surprise the weather that the machine began to pre-
dict was completely different from the weather calculated
before. Lorenz tracked this down to the computer printout.
The computer worked with 6-digit precision, but the printout
rounded variables off to a 3-digit number, so a value like
0.506127 was printed as 0.506. This difference is tiny and
the consensus at the time would have been that it should
have had practically no effect. However Lorenz had discov-
ered that small changes in initial conditions produced large
changes in the long-term outcome. Lorenz's discovery,
which gave its name to Lorenz attractors, showed that even
detailed atmospheric modeling cannot in general make long-
term weather predictions. Weather is usually predictable
only about a week ahead A plot of the Lorenz attractor for values r = 28, σ = 10,
THE CHAOS THEORY—
THE BUTTERFLY EFFECT EXPLAINED MATHEMATICALLY!
E-GOVERNANCE: NOTES ON CHALLENGES IN IMPLEMENTATION
MILAN NARENDRA, WIPRO LIMITED
―Electronic Governance (e‐Governance) is the application of information & communication technologies to trans-
form the efficiency, effectiveness, transparency and accountability of informational & transactional exchanges.
These exchanges can be within government (G2G), between government and government agencies of National,
State, Municipal & Local levels, citizen & businesses (G2B), and to empower citizens through access & use of
information (G2C)‖ e‐Governance is the application of Information Technology to the Government functioning in
order to bring about Simple, Moral, Accountable, Responsive and Transparent (SMART) Governance.
To initiate any e-Governance project, the capacities required are much more comprehensive and holistic than a conventional Software
Development Life Cycle (SDLC) project. E-Governance initiatives entail policy development/refinement, Financial Management, Pro-
gram Management and warrant a higher emphasis on Change Management. Apart from this, creation of Institutional structure which
brings continuity to a project. However traditionally these have not been areas of focus. Hence while initiating any e-Governance pro-
jects there is an urgent need to develop capacities in all these areas at all the levels of Governance – Centre, State and Local Bodies.
Based on Wipro‘s prolific experiences in executing, and implementing e-Governance Solutions in all capacities – Consultant, System
Integrator or Implementing Agency, it gives me strength to identify the potential issue as being classified under five broad categories –
Ownership
Overall ownership of the initiative at State Level
Ownership of the line departments
Ownership at district / sub-district levels
Change Management
Acceptance of e-forms / suggested changes by employees
Capacity / skill enhancement
Awareness / acceptance among citizens
Legal and Regulatory
Government orders for implementation of changes
Service delivery based on electronic submission
Acceptance of database for reference for service delivery
Technology/Infrastructure
Backend integration
Maturity of State initiatives / SSDG
Integration across Departments
Connectivity / readiness of departments
Implementation and Sustenance
Continuity of key project champions
Project reviews and escalation procedure
Adherence to SLAs in view of manual workflows
Budgets for sustenance( AMC, Consumables)
Fading away of the initiative in the absence of back-end automation
Coordination between stakeholders
E-governance projects tend to redefine power equations within departments. Stakeholders outside government are also often im-
pacted. Some people lose power, some people gain. This leads to stresses and strains within and outside the organization, which if not
managed with finesse, lead to early demise of the project. The challenge is to clearly identify all internal and external stakeholders in a
project, their goals, the extent to which these can be harmonized and factored in, the likely impact on all stakeholders and their likely
reaction.
These issues can be addressed by ensuring continuity of the program and project in the event of change in key persons / project cham-
pions, during the course of the project
Providing ―capacity ramp-up‖ plan for manpower scaling
Providing full ownership to the State Government and Government Departments for implementing the projects
Catalyzing administrative, process and legal changes required within the State Government
Providing stronger focus on change management through efficient communication, workshops, etc.
Alignment of interests of the key stakeholders (Central Line Ministries, State Governments, Department of IT at entre and State,
etc. thereby synergizing various efforts
NEW PROJECT ON SOCIAL SECURITY IN INDIA – THE UNORGANISED SECTOR
The Long Road to Social Security: Assessing and Monitoring the Implementation of Social Security for the Working Poor in
India's Informal Economy is a knowledge project on social security provisions for workers in the informal sector of the economy in In-
dia. This project is a cooperation between the Amsterdam School for Social science Research, the Centre for Development Studies in
Trivandrum, India, and Hivos, a Dutch non-governmental organisation guided by humanist values. The project focuses on monitoring the
implementation of minimal welfare provisions in India for workers in India's informal
economy.
Until the end of 2008, providing a modicum of social security to the workers in In-
dia‘s informal economy that overwhelmingly comprises of small farmers and casual
wage workers in rural areas and the self-employed and casual wage workers in
urban areas did not receive adequate national priority either in terms of policy or
legislation. However, this became a national agenda following its incorporation in
the election manifesto of the present Government in 2004.
When the government was voted to power, one of the first steps taken was to ap-
point a National Commission for Enterprises in the Unorganised Sector (NCEUS)
that was mandated, inter alia, to examine and recommend social security measures
for the workers in the informal sector. The Report on Social Security for Unorgan-
ised Workers was the first report submitted by this Commission in 2006 that con-
tained a comprehensive National Minimum Social Security scheme along with a
draft bill for consideration by the Indian Parliament. A considerably watered down
version of this bill was subsequently introduced by the Government in Parliament
that was thoroughly examined by a Parliamentary Standing Committee (PSC) con-
sisting of representatives from all major parties in the parliament. The Parliamen-
tary Standing Committee not only amended the draft bill by restoring all the recom-
mendations of the NCEUS but also added a few more to enlarge the coverage with
a strict time frame for implementation. However, the government did not accept any
substantive recommendations of the PSC and preferred to reintroduce the original
version with some minor amendments that was subsequently passed by the parlia-
ment and entitled the Unorganised Workers Social Security Bill.
While national legislative framework has come into place, the initiative is now left to
the agencies and departments of the central government to introduce social secu-
rity schemes for the welfare of the huge workforce and to reduce their vulnerability
and create the beginning of a safety net which these people require in order to bet-
ter cope with health risks and old age in particular. Interestingly, a health insurance
scheme covering only the households below the officially determined poverty line
has been enthusiastically responded to by the states for implementation in their
respective regions.
The aim of this knowledge project is not to get engaged in large-scale surveys but
to operationalise the project in a number of case studies in different parts of the
country (Punjab, Gujarat, Orissa, Andhra Pradesh and Kerala) both in urban and
rural locations of the informal sector economy. The research is meant to be action-
oriented and will focus on findings which can be fed back in the policy process of
official agencies and civic stake-holders such as trade unions and civil society or-
ganisations. Thereto the researchers will actively dialogue with these stakeholders
throughout the process. Generating knowledge is an important objective of this
research project and is part of a comprehensive approach to knowledge processes
including dissemination, strategy formation and application.
PEOPLESPEAK!
Thanks for sending the Newsletter . I liked many things about it… Firstly it is nice to get it on email , with good font and easy scrollability , easy to read! …The idea of news letter is excel-lent , it is good to know how others are handling various issues …you may include time table of events acclivities , training programs in the months ahead, in the newsletter
Dr Nilima Kshirsagar Dean PGIMSR MGM, Mumbai
Heartiest congratulations for October issue of the lighthouse. it is really a source of inspiration and great pleasure to have this noble thing. i wish all my best wishes for hundred and one percent success of Project Panchdeep and assure that every efforts shall be made to bring this great thought into realty.
Rakesh Chauhan
Dy. Director, RO Jammu.
I went through the rich and varied contents of the e-mag. What makes it pleasantly different from other such initiatives is that it not only gives food for the thought and action but also highlights results and the evolving best prac-tices.
Narendra M. Ojha , New Inductee Dy. Director, on e-mail
Very encouraging OCTOBER story by our DG Sir, definitely will touch all the persons who work with open mind.
Dr AK Sharma
MS, ESIH, Adityapur
Sir, I am very thankful to you for your Newsletter. I hope to receive more information. I am trying to ensure the success of PANCHDEEP
Dr. Atul Nath.
Thanks for lighthouse magazine. It was infor-mative as well motivating. It provided new in-sight about Project Panchdeep. Stories were quite motivating and giving new way of thinking towards work.
Rakesh Kumar
New Inductee Dy. Director, on email
"Twenty years from now you will be more disappointed by the things you didn't do than by the ones you
did do. So throw off the bowlines. Sail away from the safe harbor. Catch the trade winds in your sails.
Explore. Dream. Discover."
Mark Twain
www.wipro.com
EDITORS
Vashima Shubha
Sandeep Srivastava
WIPRO LIMITED
Plot 480-481
Udyog Vihar Phase - III
Gurgaon
Change, The Inevitable!
Change is the moving of the hourglass sands, It's the coming of dawn after dark.
Change is taking one step at a time, The emotion in each persons heart.
Change is to one man the death of a friend,
To another the birth of a child.
Change is the shifting of soft winds of spring,
to a hurricane deadly and wild.
But change in the end, will not change at all
The one constant in everyone's lives
Change is the light at the end of the tunnel
The healer who opens our eyes.