Evolution of Indian Insurance Sector: Emerging Work Culture - Amity Institute Of Training & Development

Shaping the future of business in the Digital Economy Speaker: - Mr Prasad Routray, Head Corporate Business and Alliances at Airtel Payments Bank Mr Prasad heads the Corporate Business and Alliance vertical for Airtel Payments Bank. He has 23 years of experience in Sales and Operations and is responsible for P&L at the bank. His key strengths are Business Development, Strategy Planning, Distribution Management as well as Relationship Management. Mr Prasad contributes to furthering the bank's vision by forging relationships and nurturing tie-ups in partnership with Corporate Institutions, Societies etc. by accelerating the banks through the future. He has rich experience in business development B2B, B2C, sales strategy, planning, distribution Management. Q. So, my question to you Sir is that is this the opportune time to build a robust economy through safe secure and accessible digital payment solutions in India? Ans: Let me try to answer your question in two aspects. During this COVID times, I read somewhere if there was a best CTO award this year to go to somebody it's going to be COVID-19 rather than any other CTO. So that's the kind of impact it has got. So, if there was any technology fast-tracking that happened, unfortunately, this was the incident that must happen and therefore everybody got aligned to a digital-first if I really put it. Now to kind of answer your question in detail I think all of us in this room virtually being attending gives an example of how digitally we can take things forward beat your education beat every sector. So, I think digitization irrespective of the sector has kind of really caught up and that has been the primary weapon in the last six months if I had to really put it. Now you used three words in your question saying that is digital the primary, is going to be the accelerated model. Second, you said is it the secured way of looking at it and third is it a primary weapon? So, I think your first two yes, it is one of the biggest weapons second yes digital has been in on the forefront. Secured I think that's the question we must look forward to. I think in this entire story and coming from a banking background now I can tell you that everybody is aware of the UPI success that has happened in the country and possibly one of the biggest stories happening from NPCI. Those of you who do not know NPCI is the National Payment Corporation of India powered by the RBI and it's an answer to global technology on the fintech side. So, UPI is India’s answer to the globe if I put it. So, we are very proud when we use them as a service, we feel proud that it is an Indian made product. But then equally at the same time we have seen a lot of frauds that have taken place, the kind of usage has been immensely high but ask any organization, the security officer's job is a very-very tough job now given that the unprecedented digital economy set up that we have in all set for. So, I think yes, I have a big thumping yes to the digitality but with cautions that with digitally also brings in a work called security and I think a better-prepared country, better-prepared company or better-prepared start-ups or individual that were right now become wanting to get entrepreneurs if this can be taken care of, I think it is certainly a big-big weapon to take care. Now that's ‘Part A’ of my answer to your question the Part B is if you look at our country and I am not responding to the world what's happening I mean we can talk later that I always divide our country into India, Hindustan, and Bharat. Now digitality might have scored its count on India side may be rubbing its effect on Hindustan but to see Bharat in a truly digital way. So, the other day I was asking somebody that while, and by the way, today's news is that by 16th India crossed one billion transactions in UPI. It's an unprecedented digital transaction happening. But the question to ask do we increase the number of digital users or did we only increase the number of digital usages. I would love to see a statistic that says that India has doubled in the number of first-time users. Unfortunately, that's not the news, India has incrementally added digital citizens by 15 to 20% only. So, India remains to be a very-very heavily cash economy if I had to really put it. So just to tell you some RBI statistics 80% of India today is cash still after six months of COVID. Had COVID not happened I don't it could have remained at 85 or 87, 88 that's anybody's guess but I would say Hindustan, Bharat we need to solve so that is the way I would like to kind of respond to your question yes digital is a weapon but miles to go I can tell you miles to go. Q. I would like to know on behalf of viewers how COVID 19 has changed payments and banking behaviours forever and how it has altered the payment landscape in the country or whatsoever digital payments and the transition to a cashless economy, what is the future of cash transactions in India? So just want to have a view on this depending on the data which we are just talking about? Ans: First, what are the three things that were a consumer, let me look from the consumer lens and then we will look from the organizations which we are serving the consumers right. So, let me look at the consumer because everything starts in the business to look at what the consumer wants. First, consumer as much as the organizations got caught into this COVID situation, obviously everybody wanted to change the behaviour. Now culturally people wanted to change the organizations, customers wanted to change the behaviour may be forcefully, maybe they were on the fence and they wanted to do it the first time. The first requirement was that is it convenient enough to really do it because that's always a resistance point that I am used to paying cash which is so good in digital that it will help me do digital. I think the first thing that every consumer wanted was that it must be flawless first time right, ease in which I can do and of course secured, as I, in my first part as I answered. Now I think the payment industry to my mind did have two out of four. The two were that, yes, payments on for example there was always an NEFT there was an AEI, MPS all these banking systems were there but there was UPI out in the corner. It was coming in that UPI was an answer of ease of payment through QR Code Scanning or P2P payments, for example, if I must make you payment, I can just pay you over the phone. So, I think that the convenience of P2P happened so when I am individually transferring to another individual it was always flawless or at least it was easy to do. Of course, there are 45 to 50 as you rightly said wallets, and everybody is fighting his own part of the world but there it will converge probably five-six of you know maximum once, but it has become convenient. The second one is that there were a lot of policy changes that had already happened, but implementation was happening I don't know how many of you recall the situation of Yes Bank vs. Phone Pay and if you recall everybody was ready with UPI, but they never knew when it strikes bad situation what happens. So, I think that was a learning curve for us as a bank to know that look you need to have multiple banks behind UPI. So, somebody rightly asked, and this is a question that was thrown to me by one of the other sessions which said that who is the biggest UPI service provider of India. So, a lot of people answered saying it is Paytm, Phone Pay G-pay and everyone. Actually the answer is ICICI bank because behind all this is ICICI bank, HDFC bank, Yes and finally it is banks and we powered some of them you know large players so we are in the top five but I am just saying the top two so fundamentally we had to power a very-very robust infrastructure to support the UPI from the banking ecosystem and that's why unfortunately Phone pay being such a nice Indian company nobody would have liked to fail, so I would say demonetization moment for infrastructure or technology. I would say in the four parts this was the second part which was taken care or is taken care of by God grace, now every large UPI partner you ask me is having three-four five banks you know behind it. I think that's taken care of, so I think that is the reality of one ease which is now taken care of because fundamentally it's now one click away. There is some work to be done in the merchant for example when you are paying to your nearest Kirana store or you are paying to a retail store or you are paying on amazon you will today find lot of a lot of intelligence has gone to payments right earlier you will agree there are five-six clicks to actually getting a final payment done versus today UPI you have max three minimum one, based on what is the value of the transaction. If it is less than two thousand is one click away So I think that is a big benefit that the industry has kind of pushed to help, grow digitally anybody who is little not savvy to technology. But the two which I still believe, and I have answered already the fourth one which is the security part of it which still definitely an area to watch out for because if anything can go wrong and somebody used to say that cyber-attack is more than even today a bomb or a or a physical war that is something, we must watch out especially when a good number of sides are very vulnerable in that nature. And now we are putting our best to do it for example there are a lot of companies that are on the outside cloud they are not in the Indian cloud. So, there is a lot of work going on or gone behind, today Microsoft or Amazon have brought their cloud to India finally and t transitions are happening as we speak and hopefully the transitions will help us secure our data inside the country for example that's work in progress, so that's I think is one area to watch out for. The fourth area is that how do we help new consumers to come in and what's the effect and effort that both the consumer must put, and we must put, and this is not about just recharges. For example, if you go and ask amazon.com that anything above 10,000 you will find people pay through debit cards they don't pay through UPI, so there is this high-volume payment or high amount payments always safe to be paid through a Debit card Credit card or Net banking and all. Now can that move also into a UPI environment is the question that we must look forward to Know that's a large change that means fundamentally it may trigger a very differential discussion here but we as a bank for example believe that there is no need for Debit cards and Credit cards. We don't believe in that I mean as a new-age bank if you take an account of an Airtel Payment Bank, we don't give you a debit card we give you a virtual debit card. Because now we believe that the phone is the bank now that kind of change. I would say that there are traditional banks and there are new edge banks. Now traditional banks because of the cost associated with what they have done very-very resistant to possibly change into this new a change of No-card, Completely Cashless, Go Automated and Mobile only. Now that is the third pillar that we must attack if you can solve that problem gradually by contactless payments or on tap payments or contactless, card systems and all I think it will make a material difference to every one of us. I am sure most of us who carry modern credit cards has a tap model, but we still hand over the debit card or the credit card. We don't tap it, now people like you and all of us who are so possibly educated and on the right side of the education still don't believe in a card being tapped then you can imagine who's on the fence why will he use a contactless card, or a virtual card. I mean that's a long way to go. So, while the journey has started, I think consumers have started to experiment banks and institutions are coming in a very different manner trying to accelerate the number three and the number four. Therefore, give a very sweet spot to the four things that I spoke about. Q. What is digital future-readiness as far as the organizations are concerned? How do companies prepare for the opportunities and challenges of digitalization? What are the major challenges and opportunities for growth? I mean how like as you said it is ultimately the consumer which must come and the more the business, we are moving from tier one to tier two, tier-three cities and we require that time for digital infrastructure as far as payment is concerned, so how do you see the digital future readiness of organizations and how can they tap this opportunity? Ans: So, let me divide your Question in two. One is the new technologies that are expected to come in or are already coming in and the second is how are organizations preparing. I think my view of every organization irrespective you are a Mom and Pop’s store or a very large retail chain or you are an e-commerce company. First, you must be omnipresent. You can't be saying that I am an only e-commerce online company, or you cannot also say that I am only a retail physical company that's gone, that's permanently gone. Any organization today that’s coming in must have a digital distribution and a physical distribution I would say it's a hybrid model because even if the world advances by another five years not everything will still be digital and not everything will still be physical it will always be a hybrid model. The models may change based on which business you are in. For example, if you are in the travel business and you are on the website of travel then it is 90% but you will still have a make my trip physical store just to have a concept about let's say destinations, for example, you would like to sell and so on and so forthright. So, you will be depending on which business category you are in you need to be omnipresent. Second is that you need to really look at if there is an opportunity of becoming a global player on day one. Because today the opportunity of the globe being a market is reality. You don't have to produce in India and consume in India necessarily today. You can produce in India and make it consumed out anywhere in the world and vice versa get it from the world and consume it in India or get it for India and get it consumed in India. I think the second one would be that whatever product and services organizations have any good bold organization should absolutely try the globe as marketing and figure it out for example markets like us are equal to let's say Vietnam, Indonesia, South Africa, Brazil are similar behaviour markets, cultural may be different but overall the economy and the way the ecosystem is, it's something which you can market for example Brazil has so much of commonalities in terms of businesses like their wallet ecosystem is now emerging as ecosystem right. Our wallet systems are now emerging as an ecosystem for example Airtel Money in Africa is the single largest currency of Africa, the single largest currency they change over not currency I would say exchange of financial products and services is single as is vast. So, the world is kind of teaching so imagine Africa ahead of India in terms of digital currency behaviour. Now, this is how the change happens so therefore I would say omnipresence and globe as the market the entire globe as the market should be looked at. And if that is in India, I would put it, we must make products and services in a model that can be distributed successfully and consumed in rural India and urban India and that's a long way to go to my mind. Because we do a lot of rural work and I can come up with an example of how much rural work can be there, not just for a bank like us but for many other services. And I will link this to your first part of the question saying all the other technologies that are coming how it is getting consumed and what's happening. For example, Aadhar as technology and I call Aadhar a technology rather than Aadhar as in service. Now Aadhar as a technology is going to catch us. I mean followed by possibly retain access and all those things because this is the foundation of how India is now seen as a unique right. And both Aadhaar and Retina Scan is a human body linked authentication, which cannot be taken away from somebody. So, it's a zero-defect model anything else that you can create is digitally done can be digitally taken out, but this cannot be cyber attacked and taken. Your fingerprint which must be physically done cannot be taken out. I will just give you some interesting statistics during COVID times Atrial Payment Bank and other Payment Banks have got a license to operate in a rural sector in a big way because that's the way the license is. Surprisingly in the last-to-last month, 47 lakh crores of the transaction took place from a money transfer. Half of it was withdrawn through the Aadhaar ecosystem so if every second money was coming out of ATM which is installed by today's traditional banks, half the second rupee out of this was withdrawn through Aadhar ecosystem. Now how did this happen not 47 lakh crore I think it is 4.7 lack crore. Now look at the benefits that DBT came in you had a 1.47 lakh crore of DBT that came in, this was all withdrawn in the rural sector. Now we were surprised the number of people who queued up in our bank system because fundamentally they never had an identity, they had an account, now how do you take out the money, they had some debit cards or credit cards which was never used for a year or six months, so it is already PIN gone they don't know the PIN and imagine we were telling and one of the videos that got recorded sure that the guy says, “I don’t know what my PIN is” They have written it in English I don’t understand” Now imagine the debit card is printed and young forth English the guy is the absolute regional Guy. He is probably not that educated how will he even read the PIN, forget transacting on the ATM So I am very appalled when people say a Debit card is digital when the guy cannot use it. Whereas this same guy when he comes to an Airtel Payment bank and he says I want to withdraw money out of my State Bank of India account he gives his authentication of his Aadhaar and he puts his fingerprint, and we give him that 500 rupees. So, we became the ATM of the rural part of the world, or I mean during these times. I mean Payment Banks who are into you know Aadhar basis system, so we run a bank which is on Aadhar base. So, we call ourselves as the largest ATM Service Provider of India because we are in two and a half lakh points of results. So, I think technology how you use it, when you use it, how to use, is very important to really kind of know. I think it is each to the organization that they are representing. So that is how I think technology is now coming in. So, retina access or palm-based listing the other day SBI launched contactless watches along with titan. So now from watches you can pay right so if you are wearing a watch you don't want to take out your debit card credit card you scan your watch, and the payment happens. Now that's a brilliant technology and this is very nice and that is a new UPI transaction so who knew that UPI and the watch and SBI today will get you paid. Q. What do you think, if it does so much to organizations top line, how do companies can you know to reap in those profits, higher margins for that because like we do a lot of banking training and we have heard that the cost the moment people go to brick and mortar bank and then they start transacting through ATMs or online banking internet banking, the cost gets reduced with every transaction? It changes from 50 rupees from brick mortar bank transactions to maybe couple of rupees when they do it on internet banking. So, from that perspective I was just asking how this digital system will thrive with so much cost-cutting and profit profitability which is in question? Ans: I think this statistic is right in terms of the way digital kicks you bottom line for sure because infrastructure wise it is more convenient cost benefits are there and of course consumers you don't require much effort to that I have got a customer or get a customer to transact on you. So, platforms for example today Airtel Payment Bank with its airtel ecosystem almost I can tell you we are looking at close to 10 crore transactions on the platform itself and today we almost have six crore customers coming to the Airtel platform itself every month. So, it's an unprecedented large opportunity for banks or any other large app for that matter. I think one thing that you must really watch out for is post-COVID will the numbers remain the same or go up. I think that's the question to really and that will test the Chief Digital Officer or the Chief Security Officer or the Chief Technology Officer and of course the behaviour of the bank or any employees or consumers. And that's the worry I will tell you right now in every organization playing. If we lose the traction of course it's like an elasticity we must have stretched it no doubt about it, but it should not go back to a level where you think now it's going to be another effort. I think currently every organization should try or must try to ensure that if there are let's say additional one crore customers how do these one crore new customers stay digitally forever? If half of them go back your cost goes back, and you also lose loyalty, and many other things happen. So, I think it will be important to find a method to sustain the digital behaviour that has come in. So, I think that's something which we need to really look at and therefore cost wise that will be a big area of focus for CFO also for that matter. The second one I would say as I told you that at the end of the day 80% of India is still cash right. So important for organizations because I mentioned the omnipresence that you must have. For example, how can you get a customer to be first-time digital versus assisted digital versus forcefully digital. I think if you can find the journey cut out, for example, we run an ecosystem where we find out what is the age-wise, geography-wise, behaviour on digitality. So, let's say tomorrow you catch a particular customer who is 25 years below, he is technically a bond digital person, so he should not in some way he must be discouraged to be doing anything else except digital for example I will not use the word discourage but how do you find a way to encourage him to use digital. Otherwise, we are even putting the new India which is young India to even physicality. I think that's the second point that I would say if organizations can manage one is sustain this change, second is bring in the behaviour of young India digitally first. I think if you can achieve that we will do wonders to the entire scheme of thing and therefore profits certainly but mind you one or there is always a caveat to any good thing that happens. Your data points are exposed to the cyber world you may entirely lose your customer base if you are very vulnerable to access to your data. So, I always say that look digital is good till it is not attacked. So, therefore, today it's very important that as we scale the mountain of digitality I hope there is an insurance to cyber-attack created that if we fall, we can really kind of take care of our customers otherwise you will lose the loyalty, you lose details, your customers, you lose so many things. So therefore my sense would be we should behave like a mutual fund that is digitality but keep a physicality keep a backup plan of B you must, for example, we advise all of us, we do intense interaction with customers to know how are they feeling, what is happening we must meet them even if it is over video is very-very important because if you don't see warm bodies, if you don't meet them or if you don't at least interact or see face to face, you might lose something which is possibly visible on body language, but not visible in the words. So, it's very important to kind of keep that touch from customer service and customer loyalty and customer set up. So, these are the two or three I would look forward to organizations to do in my sense. Q. How does Fintech will have to leverage new technologies and digital innovation to make the customer experience more convenient, that you said about flawless, secure? So how do and what digital innovations are required in the current situation to have the best customer experience for consumers? Ans: It’s now quite overused so-called analytics if I have put it email and all but important more than the analytics which these fintech companies must do or all of us do apart from seeing because you will get a lot of data because of digital behaviour you will get lots of insightful of consumers right and therefore rightly said the world has moved to consumer war versus product war. Product war is a one-month job max or 24 hours minimum. You can match the product. So therefore, that war is settled and so it's now finally consumer war now. Consumer war is therefore today using consumer insights becomes the most important factor for FinTech’s to begin with. For example, there are so many lending companies but during these times it has separated boys from the menu because while NPS you may not be hearing, and we are aware of some of the NPAs. There are a lot of companies very large organisations we are right now sitting on a very high maybe around more than 8% to 10% if not more on NPAs. Why they're sitting on NPAs is that when you acquired a customer what was the tool that you used to really know the behaviour of this customer what kind of tools did you use. So, therefore, there are companies who are very smartly sitting on less than 3% - 4% and there are companies that are sitting on 10% - 12% and that tells me that when you did an AI email platform ecosystem on the fintech who had the better data insight, is the winner on this case and keeping in mind that there will always be customers who will have to intend to pay and not intend to pay. Let's keep that bracket away but the rest of it is a bad loan for example so I would strongly suggest that now analytics and going deeper into analytics when I say deeper into analytics for example we do a lot of transactions on the NPAs which is an Aadhar Enabled Payment System you can easily make out that the migrant labourer who moved from the current jobs that they had before COVID to the rural sector how will the Aadhar Enabled Payment System work and therefore what is the infrastructure that you need to have and therefore what kind of security and ecosystem that you should develop or get prepared for. Now, these are some of the insights that you get when you analyse data, so therefore our infrastructure in Bihar, UP, North East was kind of almost upgraded to two or three times to ensure that the traffic that has shifted to these states must be taken care of. So, I think it's important that we take care of these kind of cuts and analysis in the fintech side when we do lending for example. This second one I would say while there are a lot of lenders who have come in and that will be segment base lending that will be important now. For example, there is micro-lending that is possible some people may say that I would like to lend into the farmers and farming segment because that's the green shoot of India today in agricultural lot of people have bet on agriculture to revive our economy and so forth. The sectorial part of the story, that how do you do lending, and how do you look at opportunities is another way to look at how you prepare yourself for these situations. So, net-net I think depending on which business you are in especially on the fintech side I can fairly tell you that there are sharp winners and sharp losers in this. Some banks will be in very bad shape and some banks will have been in very good shape because they predicted it or so they had prepared the data points in such a manner they could have survived the COVID and some of them are survived are like no customers that. So, kudos to those banks and NBFCs and MFI who have done that and the ones which are not done is clearly states that we have not analysed this data bank. Q. Now it would be more of the cash flows which will decide the microlending part rather than you have the collaterals which normally the banks taking and that is where the NBFC's have had an edge or they have created a niche market because they have major control over the payment collection part and they can tailor-made products for people that is something which is really important and this will I think to lead to that digitalization which we are talking about because some choir banks , if you are able to develop products which are tailor made for the consumers and if you give them kind of ease without going into a lot of paperwork and things like whether “aapke pass hai ye ki Nahi hai, aapke yeh document hai ki Nahi hai” so that will microlending what you're talking about will actually ease and from 80% what you talking about the cash it may take a faster track in terms of digitalization of payment bank system. Ans: You are right actually, today if you look at, we work with 100 plus NBFCs, MFI and some banks we do a large collection management services because of our sheer presence 2.5 lakh points of presence so lot of companies use our infrastructure to make the micropayment done. For example, Ujjivan bank works with us it's a new age small bank. What they have done is that they earlier, every NBFC has an agent-based collection model do you know you they will send an agent, and somebody will collect, and they will deposit cash. The model that they changed for example during these times, and they populated the Airtel points of presence by saying you go to the nearest Airtel payment bank point and just deposit your EMI. They communicated that to the consumers so they eliminated the middle layer and they started pushing consumers by giving incentive that we will deduct a percentage of interest if they go and do it. Now therefore what happened is they smartly got EMI collection done through these physical points of presence by associating with the bank like us. They also kind of illuminated this middle layer of issue during COVID times of his physical distribution. Third is they have incentivised the customers to come in and deposit the money right. This is a classic example of a bank working with another payment bank and combining to give a solution for example. So NBFCs and MFIs who can challenge the traditional 30 years of operation by saying I have an agent so I have a collection manager you have to get eliminate the collection manager now second look why do you need a collection manager either you do an EMI collection on digital and add on to that I'll tell you BBPS ecosystem which some of you to understand Bharat Bill Payment System which NPCI has got 14 categories where you can pay through digitally model. EMI is a category. Now we struggled to tell NBFC's why don't you come on that EMI platform they don't want to come on the EMI platform because understand and there is still cash and there is a bit of grey cash management versus if a customer starts paying digital so there is chicken and egg story here but having said I think they have started to realise that if a customer is wanting to pay digitally what happens then how do you collect money of extra and report why and all that things that normally used to happen is out of the window when you go digital. I think most of the top management or the middle management of the companies have started realizing that BBPS system of digital EMI collections from Government BBPS payment bank plus banks innovating, this is a competition and complementing model coming here and available. Models are available RBI has done a good job by giving hell out of cash to make the economy cash rich back by giving lending. Now unfortunately it is with public sector banks and I'm using the word unfortunate because I mean you give it to private sector; they will tell you what can be done. So, this is where the problem lies you give it to people who cannot take that bold step how do you take that step. Now not that they're not taking now I'm not taking an example of SBI they are obviously much modern, they have a good app. SBI is a very differentiated bank and I have got the highest respect. But imagine the tale, we need to really figure it out, in India, there is a very beautiful where the fintech world is, one is on the extreme side there are Payment Banks Neo Banks, FinTech’s and the other extremes are there are Cooperative banks, local banks ACGs and all. I mean there is somewhere something called as 1950 and there's something called as 2050. So, this is an interesting puzzle to solve but I can tell you heart of it lies with the success storey to those players for the boldness to change permanently. Second go omni channel and third redistribute or revisit their business plans or how to acquire a customer. I think that will be important I have an outlook on it. Q. Digital skill set required for like banking correspondence we have, Mitra which we call in rural areas they try to facilitate these payments. So, this new method of releasing technology to augment human capabilities so what is your view on this. How do we augment human capabilities to accept this and move ahead? Ans: Let me try to answer in three phases here one is for people who are still coming to the world to get the first job if I had to it. First, this is a new world where you need to be prepared to be working from anywhere, for working for any company, for working for any hours. So, the new norm is you can work from anywhere, so I think while there is comfort but there's competition. Today if you look at traditional managers, they used to say I have a position available in Delhi now that's not the line from recruiters anymore. They're saying I have a position available for this job they don't describe which location, so any HR guy who's not practising this is not an HR guy anymore or any companies are not practising will not exist in the world because it gives you unprecedented access to the right talent. So, guy sitting in Kerala maybe at the remotest of Kerala can rewrite your code for example so we must hire him. So therefore, why do you prepare yourself for a global opportunity also prepare for a war to this extent of talent. I call it a war because you are no more the elite class to say okay look if I've done from this college this thing, I am the right set of guys because fundamentally many people are saying look now that there is no constraint of, I am leaving my city I can be the guide to really watch out for. So, I think that's one for everybody coming from any large or reputed institute of yours or for that matter any other institute. So be well prepared that this is a good shock to take into your stride. Second is that you need to be prepared to be ready for new markets. Gone are the days where if you join a consultancy company you will be operating out of her New York office for that matter or Bangalore office or Bombay office that's gone you need to be in the field. This is the traditional Hindustan Unilever Model which we all come from where fundamentally if you need to really know your customer while digitally half of your customers will pay you that is still 50% of customers who don't touch base with you. The only way you can touch bases is physical which is the word you used Phygital. In early times I would say that you must ensure that the market knowledge of physical infrastructure-based services which is necessary to really survive as a company you need to acquire that. So, one skill set you will be global you would be equal receipts in terms of remote place and urban placed manpower opportunity, or talent 2nd is that please know the market faster than others knowing. The third one I would say look this was a word that got coined by one of the founders from Bank side and he generally said that in today's world you need to have a skill set of journalists and need to have a skill set of specialists both. You can’t say okay by the way I'm an engineer and therefore I'm entitled to engineering or I'm a doctor I am entitled to surgery. Except some very special skills like robotics or spaces and all if you need to be a successful person you need to have both the skills and this will not come sequentially so that's the third ingredient I would say that will be needed and therefore that is something which can only be picked up by experience there are no books which will teach you what is generalist way of actually operating because that is human skills which you bring in terms of your behaviour your set up so maybe organisation behaviour whoever is teaching would possibly help you out, but I'm just generally saying that that is something which we need to be ready with and the biggest one is how can you be fresh I knew with the knowledge that is needed today and not valid for tomorrow. For example, as we speak the world has moved from 2G to 3G to 4G in telecom the world has moved from debit card, credit cards to UPI. Now, who knows that is somebody something called UPI next. So I always tell to people who come from and we have organisations and in which we have people from RBI and other banks and all we tell look I think the guy who is 25 years sitting next to you at the equal stage because with your 30 years of experience in a bank or this thing UPI is new, so this is a new world so how do you take care of the newness in technology, policies, markets and be up open grabbing out there. I think that’s skill is going to be the defining skill. If we miss one of these four you may become a middle manager or possibly a good manager to lead a particular team but if you have 4, I think you are nothing short of an entrepreneur. Under the last one is I would say if somebody must prepare during these times, I will say you couldn't have asked for a better time in India to be an entrepreneur. There are so many opportunities as to become an entrepreneur I can't tell you, I was telling somebody that you know we wish we had this opportunity to the only way one does is that on individual capacity once starts investing into some starters at the only thing you can do when you are in the job but I wish we had a start-up for ourselves I mean for individuals I mean age is not a constraint but in general saying so, therefore, I would encourage in today's world we should have 100 Ambani's created and it’s possible because there is no dearth of an idea there is no dearth of money there is no dearth of support and I would say the government is also wanting to really make it conducive as much as possible. I would say this is an unprecedented opportunity in our country to really say that we possibly are the economy to watch out for in the next 5 to 7 years hence today’s teams or people who are working out or coming out of colleges and campuses must boldly go for entrepreneurship followed by the 3-4 skills that I wish they have and therefore can be of competitiveness. Q. How do you see how you as an organisation do is looking forward to upskilling your Airtel Payment Bank employees? Ans: So, before I answer the upskilling part let me tell you during these times employees who do not love the company, those companies will die. So first forget the upskilling. Are our employees loving the company, because this is a time where the company can respond better so that the employee knows the company standing for me and I can tell you unofficially while a lot of people spoke about that we have done best in during these times, there had been a lot of firing across sectors? Very few companies who kind of stood to the like a man and said that look even if we take the hit on the chin, we're not doing any kind of in a down gradations in terms of staff manpower and all these things because that was one of the biggest things that one any organisation should do or must do. I think during these times I would say stand by your employee saying that your job is safe irrespective of the market we will take care of you. Any company which is done that I can tell you they must have scored pretty high not just from a loyalty what they will get back from these employees what they could have never expected as a return I can fairly tell you that and we work closely with the some of the partner ecosystems I can fairly tell you when we paid, for example, our 25,000 employees who are outsourced and they do work for us and we said we will take care of your payment I can tell you that we must have got so many calls saying that you are one organisation who is going out of the call of your duty to say even if you work for the partner ecosystem we will take care of your salary. We went to the extent of giving COVID care, cover, and everything right. Now that's obviously as a group we did but I think that's very important that psychologically and emotionally are you taking care of the employee or not that's number one. Now let's come to the skilling part that you said I think first thing is that while in this situation while still even if you take care, we will be in flux by saying are how many months how many salaries may be “aaj mil rahe hai Kal nahi milega to kya hoga” and all. The first thing we said what they like they should continue to do what they don't like they should call out so unlearning vs. learning if I must put it. For example, we trained a lot of manpower who didn't have a job on the street because the streets were closed to do the call centre job of calling customers and talking to customers and finding out what they're doing. We reskill them in the call centre saying yeah look we want 100 people or 200 people or 500 people we must reach out to our clients saying Sir we understand that you are in trouble or you are doing well and I think we gained a lot of insights when consumers started writing that you are one company who reached out a stage and said it's fine if you have not paid me this or paid me that but we are calling you for your wellbeing to understand now I know what is the impact of that as the as a bank because we're in the rural sector and the rural sector was the most head, to begin with of course after that the thanks to government and RBI lot of funds and DBTs and benefits you. But I think that unlearning I mean and that's for somebody who was doing a sales job now doing a customer care job is called as upskilling and reskilling if I must put it. So, I think those are some of the things that organisations. I am sure most of the organisation who are agility wise high are flexible are in a very start-up environment would do it. But more importantly, I would say one thing that they must now acquire is everybody should know basics of digitality. So, any people anybody who's kind of doing any kind of course or anything they must know that digital will be either 10%, 20%, 30%, 50% or 80% of any organisation but digital is in. So, any skills which are related to digital behaviour you must acquire. I think that's very important for example I was telling my legal team how I can legally close contracts digital way. They are saying “hamare yahan physical paper chahiye, hamare yahan sign hoga” I said it is not there what I want to do my business. It took a lot of time for them to get convinced now it is a digital signature even if it is authorised and they still went and said whenever COVID goes down can I get the physical paper, so they are still not leaving it. The reality is I'm asking them that why do you need the document it is digitally signed it is Aadhar authenticated signature from both sides it is both organisations standing by. These are two organisations just that two individuals’ signs. So, these are small behaviours, but these are impactful changes that you need to bring. So, it can happen that legal counsellor or illegal ecosystem would say no – no we don’t believe in that. So, in fintech, you would agree that it's a very-very regulated environment. So, to bring saying that digital behaviour in a regulated environment is a very interesting unlearning and learning skill I can tell you. Q. Why I was talking about reskilling part because people also have to move that kind of a pace because if technology is changing and people are moving in that pace then you are there where you are. It has been very-very interesting, and I wish we can go on and on for hours and hours because such interesting insights we are getting from your Mr. Prasad. For the sake of time, we have very few moments which are left so I just take up my last question from you which is from the audience. It is believed that we have seen more innovation in the next five years than that we've seen in the last 30 years So what is the future of payment banks in the next five years that's the question which one of the participants has asked me. Ans: So, I think I love that question because the other day when I was speaking to you a lot of people when they took the licence with a lot of excitement rather than logic. We were very clear that we will stay in this game also I will give you some statistics we will tell you that why this space is going to be the most exciting space apart from many things that are happening in the country. First, despite so many banks and NBFC's. MFIs and Cooperative Banks and all India are only 1/3rd banked. India continues to have two third people unbanked. So that is a large opportunity there. Payment bank licences have some beautiful clauses, a lot of people said that is a restriction I don't think that restrictions at all when I say at all I mean it. First, the fact that you are not allowed to do lending you will have to think innovative, so this is a licence which tells you to innovate. I mean thanks to RBI what other banks couldn't do because they were busy giving lending and taking money and making money they never thought about the consumer or they thought about the consumer, but they thought about the consumer who gives them profit. Payment banks are a company especially like us who are for a cause not that we are not having aspirations to have profit and become equally and Unicorn, but our job is to get the rural side of India banked. I think as I told you now just to give you some stylistics today, we are opening 50,000 bank accounts a day. The entire industry opens close to 30,000 to 40,000 accounts a day so that this so-called X number of banks in today’s like for even today by evening 6:00 PM Airtel bank must have added 50,000 customers and though entire banking industry must have added 30 to 40 thousand accounts. The reason is simple we are in deep rural servicing people who have never seen a human being with a proper in a banking system at all. We are in those pin codes where the government has called out that there are no banks till 10 kilometres so when I say banks that means ATM included so we serve those kinds of terrain that kind of complex zones. So, therefore, we are very clear that five years from now when I'm going back to my first minute when India becomes Hindustan becomes India and Bharat becomes Hindustan will suddenly find a bank which is possibly like SBI saying oh by the way for five years Airtel payment bank has been servicing this village. I think that is such an emotional moment of truth for us and a cause. So, for people who have worked tirelessly in Airtel I mean I worked for 20 years in Airtel, so it plays in our blood. We are very clear we're serving the country for a purpose. Now if you are not an employee or a citizen not thinking on those lines, I think you should not work in the banking sector. You cannot work for a bank for-profit you should work for the country first. The bank will make its money and no customer is trusted to who never like the bank to close they will like the bank to win. I think therefore it's a payment bank has got a great future and the fact that we are opening so much of bank accounts and I told you about 100 NBFCs work with us because they don't have a cash management service, for example, we do a lot of micro loan management services we do a lot of for example we are right now launching a current account on video KYC over Internet right the first time in the industry current account will be opened in half an hour. It takes a lot to open a current account because we do video KYC and now, we have a C KYC available, and you can do it in half an hour. Now imagining somebody is opening a small shop and he would like to have a current account it is to take months in that area or 15 days to get an account opened, so those are some of the problems that we are solving and therefore I would say it's a very exciting side. The last one on the urban side the Neo bank is making this our rural side of the story. You would argue no customer’s that what is a Neobank now Neobanks are the banks of our nature who will challenge the traditional behaviour of bank saying there is something called a Savings Bank account. Now I hate this word personally called Savings Bank account I am not here for saving the new generation is not there for saving. They are here to create wealth. Now wealth is not created by saving, wealth is created by rotating money. Now companies or banks who help knew it’s consumers or knew it’s teenagers or new age banking first-time digital bankers to take care of wealth, will make an important differentiator to lives of youngsters. I think we're in that business. So, my request to all of you are on the call is if you have never used Airtel Payment Bank give it a try. You'll be surprised the way the urban proposition and the rural proposition for every possible opportunity that India produces, Hindustan or Bharat produces we take care of him. I look forward to an Association I will come back to you especially for Amity as a proposal for a contact list campus solution across India and you must experience that. https://www.youtube.com/watch?v=y3QtnhNn2RM

Healthcare in the Pandemic War: Overwhelmed or Rising to the Challenge? A Conversation with Sumeet Aggarwal Sumeet Aggarwal is a governing council member of the Healthcare Federation of India (NATHEALTH) and a member of the Young President’s Organisation. He has worked in the past with organisation’s like Fortis Healthcare at the forefront of health delivery in India and Singapore, World Economic Forum, Deloitte Consulting and Monitor Group in the United States. He is currently the Managing Director of Midmark (India), partnering healthcare in meeting customers needs for more efficient and effective patient care. Sumeet has been recognized by the Asian American Business Development Centre amongst the Outstanding 50 Asian American in Business. About: Sumeet Aggarwal is a governing council member of the Healthcare Federation of India (NATHEALTH) and a member of the Young President’s Organisation. He has worked in the past with organisation’s like Fortis Healthcare at the forefront of health delivery in India and Singapore, World Economic Forum, Deloitte Consulting and Monitor Group in the United States. He is currently the Managing Director of Midmark (India), partnering healthcare in meeting customers needs for more efficient and effective patient care. Sumeet has been recognized by the Asian American Business Development Centre amongst the Outstanding 50 Asian American in Business. Q. What's your reading on these huge numbers? Has the healthcare industry risen to the challenge? What do you think? Ans: Talking about numbers start with India, out of the 26 million or so cases which are globally there, where India is at about 4 million, it's about to touch 4 million as of today. It will be number two as a nation in the list of countries which are impacted by this pandemic. And if you look, I think, just to answer that question, that India has definitely risen to the challenge of COVID-19. If you look at our front-line workers, whether it be the doctors, whether it be nurses, paramedics staff, they have all put in their best effort to contain this pandemic. If you look from a policy standpoint, the government is also very quickly realised that this would spread and bought sometime early on by having on imposing the first lockdown and then followed by two or three more lockdowns which happened. I also want to recognise here that a lot has been done by not only the healthcare community but if you look at the policymakers, which is the government, if you look at the supply chain which is there, whether it when it comes to delivering health care, it's important to have a good supply chain and have the ability to mobilise stuff, which includes ventilators and hospital equipment and medical furniture, and even personnel. So India has done a fantastic job. Now, if you look at just the numbers, we are talking about 4 million cases in India and the number of deaths are standing at about 65,000 as of today. So, if you look at the rate, the death rate or mortality rate from COVID-19 stands at about 1.77% which is actually half of what it is at a global level. So if you see globally, the mortality rate would be over 3%. So again, that just showcases that India has really risen up to the challenge and if you look at the way we have ramped up there are a couple of things that has happened. If you see there was only one lab which was accredited by ICMR to take on COVID testing when we had our first lockdown and today there are over 70 Labs in the country which are able to conduct those tests. Then when we look at PPE equipment, I remember Prime Minister Modi touched upon it as well from the Red Fort on 15th August that PPE equipment in every area, if you think about it from gloves to masks to just gowns, we have so many factories that are able to produce it and when we started with the pandemic or the onslaught of it, we had very little access to PPE. So from that perspective again India has done fantastic and so has the ancillary industries which would support healthcare. Q. If I was to dive in on what's going well, you talked about innovation, you talked about the front line and the healthcare services, the whole healthcare services setups stepping up to the challenge, are those the two things that you would recognise as going well or is there a third? Ans: So I think the other part of it is, the mobilisation of resources was quick, so whether it be healthcare or otherwise, it happened very quickly. And I think people during the first lockdown obviously were very much supportive of the policy around it. And then eventually, obviously things were out. And I think a lot of people are now understanding that there is a good reason why one should wear masks when in public and try to avoid social contact and maintain social distancing. So I think that has also helped quite a bit, is the awareness of this disease. Because if you think today, the digitization that has happened in India has allowed people to really embrace this change of behaviour. And I think behavioural change is very important in any kind of healthcare delivery to be successful. And I think by having the channels of technology, we were able to spread the message faster. And I think compliance by people has helped and I think the other part one should be aware of is that we just don't want people to be more callous around it. The prevention is the best cure, as we hear, and I think that is something which we need to follow up on. And I think a lot of people including celebrities have come and done a lot to build that awareness. The government has also very quickly launched the Aarogaya Setu app which allows for contact tracing. And I think just recently, Google and Apple have also just announced this week, that contact tracing would be something they will do together as technology companies. So I think there is that technology element which has also played a big role in preventing the spread and really rising up to the challenge. Q. Do you think India’s healthcare system has risen to the challenge? Majority of us actually said yes, and some people said no. So, for the cynics amongst us what could have been done better? What's not gone that well, as it should? Ans: I think when you think of the pandemic and specifically COVID here, there was no playbook there, everyone around the world was taken by surprise. Yes, there were some early indication from China that there is a disease of this sort but everyone again thought that it's like Ebola or SARS or something on those lines, which allows for you to eradicate it very quickly or contain in that region. But epidemiologists very quickly realised that this is something which is not going to be contained with the travel and movement. And I think if we look at it today, even the WHO declared it only as a pandemic in late February. So again, many governments were grappling with the situation and if you look at it with no playbook in hand, you really have to do a dip stick approach in terms of responding, and you can be. Many times, the cynics amongst us will think that we were very reactive. Yes we have to be reactive at times because without a playbook you will be reactive and if you had a playbook you could be responsive to something like this. But if you just look at the pure statistics, let me indulge you in some numbers out here. The number of people who die in India is around about 11 million annually and in that 60% by of, what they call NCDs or Non-Communicable Diseases and about 40% of are Communicable Diseases deaths. And if you look at that, about 3.7 million, about 35% of the people who are dying of cardiac diseases, about 1 million are dying of cancer, then about 200,000 are going to be die because of liver related ailments and other 1.5 lakhs or about 0.15 million will die of road accidents. So, if you look at COVID and you look at over the last eight months, since COVID has been prevalent in India, we have only had about 65,000 deaths. I mean, if you put that in larger perspective, the number of COVID deaths is minimal. And what I fear is that we are spending disproportionate amount of resources of the Healthcare towards COVID and its containment. And my fear is that we, in these seven months have not been able to provide the care, the much-needed care that was required for the seriously ill in the other categories. And they have not been able to access hospitals at times, they have not been able to get the care that is required on a continual basis. So I think that is where we see a disproportionate amount going and more attention going to COVID and the stigma around it is creating that. But I think that's where healthcare has to do the next phase of responding to this challenge will require us to actually look at the sick who have been ignored during these six months. Q. Do you think we should not be worrying about COVID and going about business as usual because we have bigger diseases to worry about? Or is this a wakeup call for us to learn something from COVID and do something for those bigger challenges, those bigger life-threatening diseases that have been troubling us and holding our country back? Which perspective are you taking here? Ans: I believe that this pandemic and COVID-19 is a wakeup call for the healthcare industry globally and also in India. I also think that we cannot ignore it. I think by stating the numbers, I was just saying that it's miniscule as compared to the disease burden in India. We are 17% of the world's population and we have 20% of the disease burden in India sitting out here. So it's disproportionate anyways to start with and now if you think about it, our spend in the global health care, which is about 12 trillion dollar, we are spending somewhere over 100 billion dollars in health care annually. And if you think it's only 0.8% of global healthcare spent with 20% of the disease burden and 17% of the world population. Now, even if I was to adjust that with PPP - Purchasing Power Parity, because we are talking about US dollars, even then it will remain miniscule. And I think that's what we need to fix. So if we come to where the problem is, I think it's a wakeup call to say that are we spending enough on health care. Is it an area which needs to come into focus and has the spent been adequate over the years? I definitely think not. So we really need to look at this in a more focused approach and really think of a pathway of how to get into even universal coverage which we are talking about. How do we do that. Without funding we are not going to go anywhere. Q. What do you think is the kind of impact, financial distress, the healthcare sector has gone through and what can be done to support healthcare sector now at this time? Ans: In this time because of the stigma around COVID, a lot of people chose to remain at home and again not go to the hospital. So we saw almost a 80-90% drops in OPDs or Out Patient footfalls in hospitals in private hospitals and even in government hospitals for that matter. So if you think about it, during the first two or three lockdowns people didn't end up going to the hospital. So, obviously for admissions in an hospital, they depend on the outpatient flow as well because a lot of the outpatient consults will eventually result into an inpatient admission. So today if we look at it, the financial situation of our hospitals is definitely burdened, the cash flows are under pressure. And I have heard in industry bodies that there some hospitals are even close to just going bankrupt because they are running out of cash very quickly. And if you think about it, a hospital has a lot of cost. The cost structures are very-very heavy and it requires people to really work on thin margins. So while many people and the cynics will think that private hospitals are money making machines, I just wanted to let you know that there's a lot of overhead costs and there's a lot of operational costs which make it very difficult for a hospital to even make it in margin. And that's what is happening. Now there is, as time has passed we have seen more and more footfalls happening in the OPDs and people are a little bit more willing to go for elective procedures within the hospital. So that has helped. But I think if we look at a country like United States and we look at Europe, a lot has been done by the government in terms of funding the healthcare by doing some emergency funding and unfortunately in India we have not seen that happen. So the backbone of Indian Healthcare is the private sector. If you think about it, 4% of GDP gets spent on health care in India, 3% of it comes from the private sector or private health sector contributes that 3%. And that's something which is getting compromised right now. And the government could step in and boost this spending on health services and making sure that private hospitals are able to deliver care. And also in the government hospitals, I think it has to take a holistic approach and really help both the private and the government sectors. The other part, which is a little bit being difficult is that in certain cases, state governments have put a rate card on private sector hospitals to provide care for COVID and other ailments as well. So they have not consulted the private sector and really put a rate card which is at a fraction of what their cost of delivering care in these settings is. So obviously, if you are accessing high quality care, there's a cost to it. And unfortunately, I believe that the health care sector has been a soft target in that because as health is a social subject and it is an essential for human life so is food, for example. And I want to ask if you look at the food industry during the pandemic, obviously that was also important for sustaining human life but was there any Cost Caps or capping in terms of pricing going on in the food industry. Did Parle-G have to put the price of biscuits at 2 rupees for their 10 rupees biscuit because that's exactly what happened in healthcare in the private sector. So that's the conundrum that we face right now. Q. What are the innovative solutions that are on the horizon in India that we could look forward to? Ans: This was a wakeup call. But what is amazing about India is that it always rises to the challenge. So whatever problems are thrown to us, we somehow figure it out. And I think that has happened in many industries and I love the example of the telecom industry, which has actually today connected so many Indians and done a grassroot level change in India. But when I look at what should be there when it comes to paucity of labs and diagnostic equipment and other things, again resources are mobilised very quickly. So as I said from one lab to more than 70 Labs today are able to do the test. Again, factories are producing PPE, we were able to very quickly look at innovative ways of manufacturing ventilators and even providing for them from various parts of the world. But I think if we were to look into the future, I think technology will play a very big role because surveillance systems, disease surveillance systems are going to become very-very important in near future. So how do we leverage technology in a way where we are able to get to learn about spread of diseases which are happening? So at a community level, what are some of the interventions that we can make and then at a city level or a town level. So can wearable devices create a cloud system or cloud gathering of data, which will allow for crunching in the backend and say that Mumbai has had flash floods, for example. And we are seeing people's blood pressure rising, and we really need to look into this and kind of intervene out. So this is just an example. But there are so many things that can be done in terms of technology and again, technology can be leveraged for skills because again India has a huge shortfall of doctors. We today require 200,000 more doctors, 400,000 more nurses and 800,000 more paramedic staff, but how do you ration them? The only solution, because we are only able to produce 50,000 doctors a year which are joining the workforce in India, the only way to do effective outcomes and care is to use technology through which doctor patient can interact. And that is something which will allow for the care to be delivered without having doctors all over in the remotest parts of India, which is very difficult. So, I think again technology has to play a role in this, in a big way. Q. How does a healthcare provider harmonise the space, technology and workflow for better outcomes and this is one area I think you are in a particularly good position to answer this question? Ans: Yeah, I think, again with this crisis of COVID, we have realised that there is a way where we have to segregate some of the patients which are high risk in the COVID category and highly infectious and continue the services of the hospital in a place where we are able to assure that there is no infection possible. So, I think when we look at, when we look at these spaces, it is essential to look at ways in which we have a step-up procedure. So, in COVID facilities, it is important that we look at isolation obviously, for those who are not that sick and then step them up if they require ventilation or not and there has to be separate entry procedure and exit procedure for that and a lot of hospitals have already done that in India. But we have to look at again bringing the cost down for certain pieces of furniture or of certain things which are there in isolation facility because those patients do not require that much medical, I would say, supervision, so, we can look at ways in which we can have lower cost solutions for them, whether it when it comes to furniture or other things, but when we look at the space which is required for ICU care, there are certain protocols that need to be followed. So, obviously that will add to the cost. But there is also again, something called the RTLS which is the Real Time Location Services, which is something which our company Midmark does in the United States, we don't have that solution here in India, but that allows to track personnel within the hospital space and see what is their compliance. Where have they moved within the hospital? Where have they washed their hands? How many times have the nurses wash their hands how many times a doctor has spent time in a room or moved around in a facility? So, this is something which helps in bringing better efficiency into the healthcare system because there's a lot of wastage which goes on in healthcare to be very honest, out of the $12 trillion spend globally, I think about $3 trillion is wasted, which can be prevented with better tracking systems and better billing systems and that is something which we are making a difference in, at Midmark by bringing in better speeds management. And I think that is something which will continue to bring the cost down. And I think we have to bring that into India and implement it. Q. Does this really signal the end of private investment and innovation in India? Ans: think, you know, what is private sector in any country thrive on? A private sector will always thrive on returns right return on investment and if you look at the hurdle rate in India and the kind of interest rates that are there, it's around 8%. And if you're lucky, you are at 8%, otherwise business loans standard about 11% and if you add the weighted average cost of capital, which is !^&, it's much higher and for a private sector to be successful. You really need to pass that hurdle rate, right and that's something which is in the north of 15%. So if you're getting that kind of return or a return on invested capital of over 10%, obviously, private investments will go down and the way today, healthcare is structured in India, it's becoming more and more difficult to extract that kind of return because of increased cost pressures and if we look at private equity investments, while there has been a lot of activity in this space in the healthcare arena for a while, I think they'll start rethinking because with the ROIC's and the VAT numbers where they are, it's going to be very difficult. And if you look at innovation the cost is always on innovation, because a lot of the returns are then redeployed into getting better equipment or spending on R&D, whether it be in a company like mine or whether it be in any other multinational? And f you're not going to get that return, you're not going to be able to allocate money into R&D and others innovation measures which are required because disease patterns are changing, and we require more and more innovation. Actually, the minimum spend on R&D in healthcare has to be around 3%. But it should be much higher than that and that is getting compromised, if we do not see a return and they will retreat Yes, the private sector will retreat innovation will be stemmed. And already am seeing a lot of pressure from multinationals not able to get the price that they need out of India, so they are actually looking to exit from the Indian markets. Q. Do you think the price of healthcare in India is unreasonably high? We have our responses in, about roughly about 66-70% of us saying they are unreasonably high. There is a sense that the margin is too high. There is a sense that the cost on the family wallet keeps going up unreasonably year after year. What would your response be for that kind of sense that some of us may have? Ans: This is interesting because I know that there's a lot of cacophony around health care costs and then it is also a lot of mistrust between which has been created between the healthcare system and the patient and that has led to also many times violence, right. And I think the Supreme Court just passed a rule now that, if you're going to be violent to anyone in the healthcare system while they're delivering care, they can you can be put behind bars. I mean, I am just talking about the amount of mistrust that they are, you end up losing your temper, once you start taking things in your own hand, patients have done that. But nonetheless, I think when we start thinking about healthcare costs, Now, again, I'll indulge you in some numbers of years, if we go back to early 2000s, right, and if you look at the cost of a CABG, or a open heart surgery of sorts, the cost would have been in the private health care system say around 300,000 rupees or three lakh rupees, right, is what they would have quoted you at that time. And you would be surprised that today also, if you were to get that quote from a private health system, it would be about 300,000 to 400,000 rupees, right? If you were to look at inflation from then and now, you know, how much inflation has been in India, is that 300 times procedures should have been maybe costing more than a million rupees. But actually, it's only moved up maybe 20 to 25%. Right. And otherwise it should have been maybe 300%. But what has led to that cost containment is the fact that there has been a lot of efficiency that has been brought into the healthcare system. We have been able to cut contain costs; we have been able to increase the number of procedures which has again made it possible to pass those efficiencies to the patient. But the mistrust continues, and It is very sad to see that because actually, if you were to go in and dig into the cost structures, you will realize that the price of health care delivery hasn't changed. Now, what has changed, I also want to acknowledge that there is the diagnostics have improved significantly right over the last two decades. So now your doctor will ask for more tests, right? And sometimes that's taken as a negative because we will say, they're just prescribing more and more tests and now there is a cost to it because the technology has changed. I just had a back injury recently; I am giving my own example. They asked me to do a Lumbar Spine MRI, I did that I got some disc bulges which were there. But then my radiologist said “that you know, what I want you to also get a Cervical Spine MRI done because I want to rule out something I see something, I just want to rule out”. Now there's a cost to that right. And it's not cheap and MRI is not cheap and it's up to me now, right? Because the diagnostics have improved so much. The call is on me that you know, you want to get a peace of mind you want to get another test done and just say that, you know, can I actually eliminate the cost on the healthcare system by knowing early on and preventing disease which will take course later on, is something there but I could look at it another way and say that, you know, am I being asked, I am over prescribed on the diagnostics part and it is costly. So then comes the mistress or look at it in a positive way, and say, you know, the diagnostics has improved, and this could help me in the long run. So, that's the kind of debate that has to be there, but overall, I can assure you that from a cost structure perspective, hospitals have looked at it in bringing about efficiency and have tried to pass it on to the patient. And yes, the other cost structure which is being changing is the skills, right, so doctors and nurses and what we pay them obviously is increasing, the payments are increasing, but that's also required because we are just keeping them at par with inflation, and that is necessary in any job that you do. So that's my take. I don't know if I fully answered the question. Q. What do you see as the change in the structure over the next five to 10 years? Or what do you see the overall trends that are the tailwinds that are going to drive healthcare sector one or the other? Ans: I think the government has realized that health is important for having a productive nation, a healthy nation is important and that is something which they are working on. And they have recently committed that they are going to increase the spend on health from 1% of GDP, which is the public expenditure of health to 2.5%. And I think what you touched on Nitin is he crux of how a healthcare system can be successful and that is primary healthcare. Primary healthcare in any successful health system has to be robust. If that is robust, It is not about health care, it is about health actually. And our objective has to be to keep people out of the hospital. So we don't want people to end up in secondary or tertiary care, we want them to be sorted out at the primary care level. So something which the Delhi Government did for example, is the Mohalla clinics which was started by Arvind Kejriwal. Very good way the interventions are required, right at that level, because your burden and the price of healthcare increases as soon as admission in the hospital happens, right. And that's where we want to drive our attention towards is that we don't want people ending up in the hospital. We want to keep them out. But how do we do that? Now I was very fortunate to have my early experiences at Kaiser Permanente, which is one of the large US Healthcare systems and they run their hospital system on something called Population Health Management, right, which is in public health it’s studied widely. Population Health Management is to see that how we create interventions to a large set of a population to keep them out of the healthcare system, right. And Kaiser has done that beautifully because they had, I think about 40 hospitals and 10 million members or people who were in Kaiser, now Kaiser is in a unique situation that they have both the insurance and they have the hospitals. So it is in their you know, best interest to keep the insurance and hospital admissions balanced, obviously because there's a cost to keeping anyone in the hospital and it is paid by their own insurance which they offer to the members. So but 10 million members are managed through 14 hospitals, how beautiful is that? Right? So can we leverage something like that? How have they done that? They have done that through technologies. They encourage all their members to have primary health care checks on a yearly basis. And they are able to just pick up the segments which are the highest risk. So, the any given population will have about 10% of the population, which is at high risk because of maybe smoking because of just their lifestyle because of previous history of theirs. So, how do I actually come and counsel them and keep them out of the hospital and educate them and create awareness? I think those are the things that Kaiser has done a fantastic job in focusing on and I think that is something which India is just starting on, through something like the Mohalla clinics and the primary health care has to become robust. Now. The other thing which I have a suggestion is that in India, our health insurance, which is offered never covers primary health care, right. It only covers secondary and tertiary health care. So when you're in the hospital is only when your insurance gets activated. So there is a disconnect, there's a big disconnect from primary health care. And that is why you know it because there is no incentive for the insurer to keep you out of the hospital here, right when that incentive is built, or if they are taking charge of primary health care where they have to reimburse for primary health care, they themselves will become very intelligent to keep people out of the secondary and tertiary system. And that's something which I think India needs to change about how health care insurance is provided by the private sector and even by, say schemes like Ayushman Bharat, which the government has just started because they also only cover secondary and tertiary health care, why aren't they playing an important role in primary health care? I fail to understand. Q. So, you see a huge disconnect with the size of primary health care. You know, we have some statistics, that we have gathered as part of this exercise where we look at India as to India right, there is 37% of rural population. Only 37% of rural population have access to any health facilities. Only 2% of doctors in rural India. So that's 700 million of our fellow citizens. That's one doctor in every 40,000 people. So I wouldn’t say primary health care system is broken. I think it's not. So is that one trend you see or a necessity you see, picking up? Ans: It is definitely a necessity and needs to be addressed at war footing . We cannot afford to not have primary health care at the grass root level or the last mile level because this is really, really going to change how India will be in the next decades right India is a young, we always say that India is a young nation we have the largest number of youngsters here, but think about it in 10 years, they are also going to get older, the disease will change and you know, there's a huge onslaught of new things are coming in from a disease standpoint but the calling is now, we really need to step up and we need to focus on spending more on health care and health I should say not even health care I should reframe the word is health, and we need to look at ways in which we can bring about change and also contain costs, I think that's something which has to go hand in hand for a country like India. But right now, it's a minuscule spend 1% is not adequate at all. And I think, just to give you another statistic on preventive healthcare, which is primarily driven on the outpatient or from the primary healthcare standpoint on preventive health care is an outcome of primary health care checks. Only 9.8% is spent annually on preventive healthcare. So, if you look at the most successful systems will spend 25-30% of the resources on primary health care and on preventive healthcare and that’s something where India is lacking again big time. Q. So the other trend or necessity you're pointing out is health, which is so far the structure is healthcare dependent once I'm sick, how do I get well. But how do I avoid getting sick and for that, you know the approach you're recommending is a community approach is that what I get right. Ans: That’s absolutely right, community is essential and then from a community standpoint, it then goes to a town city level and then may be at the district level but the first level intervention and accountability lies in a community. I mean look at what COVID has done, this is just amazing right now in my building for example where I live here in Mumbai, it's a community decision how many people can visit you. How many people will be led into our building, should there be a paper deliver, should there be, you know, milk delivery happen or certain things like there are, so the community has taken accountability of healthcare. Look at how powerful that is because everyone is following those norms and the community level you know, policy making has helped. Everyone get better outcomes in terms of not having the infection spread right. So this is what I'm talking about this is where it happens the change happens and the behaviour change happens at that level, we have to drive all the way to that community. And, you know, a classic example is what Dharavi did I mean some amazing recognition has come from the WHO and on how we have contained the spread because awareness was increased the testing was increased. So if we look at Dharavi from a standpoint of Mumbai it would be wrong because that's a micro set of Mumbai. It has its own challenges its own problems its own density So we need to tackle this at that community level, not at Mumbai level and Mumbai cannot be tackled at Maharashtra level. So that's, that's why community is so important. Q. Now I want to combine a question of Ayushmann Bharat which as for the benefit of viewers I'll just say that it's a National Health Protection Scheme and it cover about 10 crore poor families, each family gets a cover of five Lac rupees per year in secondary and tertiary. Now so on one side we have the government stepping in with insurance cover which of course increase and in this case the private sector hospitals can also be approached by a patient that they doesn't have to go to government sector hospital only and the other aspect is the low penetration of insurance which is only hospitalisation cover and no OPD cover. Now what do you think is going to be impact of the Ayushmann Bharat scheme, how do think that Universal insurance health cover will it ever be coming to India, may we have your thoughts on that. Ans: I'll just start with allocation to healthcare public allocation to the healthcare in India so the health ministry has an allocation of 64,000 crores and 1/10th of that which is 6400 crores is spent on Ayushman Bharat, that’s the funding Ayushman Bharat has during this financial year. Now if you look at that and you said 10 crores families, which is great and if I multiply just saying that it is 5 individuals in that family on an average that comes out to be about 500 million people or 50 crore people and if you look at 50 crore people I say that they get sick 5% of the population requires hospitalisation of this 500 million. The math around it comes out about Rs. 2500 per person is what the allocation for just the sick is for Ayushman Bharat Rs.2500 right and Rs.2500 today is the cost of maybe in a year two times a family of five can dine at Pizza Hut or something on those lines is what I'm trying to get there but how is a hospital in the private sector even a Government hospital able to provide care for ₹2500 and I'm only taking 5% of the people fall sick out of the 50 crore or 500 million people. So this is where I see that there is a big gap in the funding again. Now defence is important, it's great, we are spending on defence about 2% of our GDP which is again on public health expenditure recently we have bought Rafale jets at 59,000 crores which is equivalent 36 Rafale jets were 59,000 crores allocation to the health ministry 64,000 crores so you can think yes we have to protect our borders we have to also protect our citizens, I just want to bring a comparison out there, but Ayushman Bharat is a good step I'm saying it’s something it's in its second year or about 2 and half years I think it's the right step I feel that the way we need to take it is bring some owners why do insurance companies have a co-pay, we cannot dove out free stuff, we should also make everyone accountable whether we take 2% or 3% of the hospital bill we need to bring that accountability in Ayushman Bharat where people are also held accountable for their own health and they are responsible to pay, one) a certain amount of the bill, second) Ayushman Bharat should cover primary healthcare is my take because without primary healthcare we know that it has it brings more people into the healthcare system in the secondary and tertiary levels and I think a universal healthcare path is being started out for sure the government has announced the National Health Digital mission which was just announced by the Prime Minister. Again, very miniscule allocation of 400 crores has been made for that I think to digitise health records for every citizen in the country a much higher allocation is required but I think the will is there by the Government. They have just embarked on this it's been only 2.5 years but I see the forward path, we just need to increase the funding, we need the willingness is there the other part which I want to also bring about is that skilling is very important we are lacking we can create as much infrastructure as we want we can put as much money as we want into healthcare but without having people which are the doctors the nurses and the paramedic staff we're not going to achieve anything and today we have brain drain out of India for people going abroad because they get better opportunities because possibly they're not getting paid enough or they seek better opportunities over there. A critical shortage of manpower 200,000 doctors, 400,000 nurses, 800,000 paramedics are required as of today and we have built capacity in the medical Education Trust by 50,000 graduates coming out every year from the medical arena or MBBS degree but that’s still is not going to cut it for us. So, these are some of the things which I think we need to work on. Q. What's your sense about the alternative treatments, whether it's Ayurvedic hospitals, Naturopathy are these going to take off and contribute to health in the country. What do you think? Ans: I think that these treatments are definitely something which one cannot look at, I mean allopathic cannot be looked in isolation because Naturopathy and other alternative therapies are essential and many countries actually many people come to India seeking that. Ayurveda is very popular for people travelling so medical tourism if you see is there a lot of people seeking care into India because one it is cheap but also the fact that there is a holistic approach to healthcare we have in India, so they look at many alternative therapies like Ayurveda, anything between that bit of Ayush is looked at and I myself today you know to be very honest after my back issue I have taken Naturopathy kind of things where I'm not actually taking any medication but I'm letting myself heal naturally and it's working wonders. Many times allopathy is a quick fix but if you have the time and the ability to wait it out sometimes naturopathy works and some of these alternative treatments are just proven wonders so and in India you can tell that many of the companies which are doing work in this space have done well whether it be Patanjali or Dabur or others which are trying to foray into the space so the belief systems of Indians lies in these therapies and it has proven to be good and I see a lot of private equity activity in that so I'm sure there are some good prospects coming along. Q. How do we ensure safety and support of healthcare workers and you as a leader of cutting edge healthcare service provider for the healthcare industry, how you ensuring safety in your frontline? Ans: So for us safety for any institution whether in the healthcare industry or otherwise any industry there this is very important and I think what we did early on is build awareness and also a response mechanism which allowed for us to see that what is when I say surveillance we did our own little surveillance system where we are checking our workers as and when they enter our premises and we're trying to look at technologies which will help to do a mass screening because right now obviously it's time consuming and that takes certain things then we are looking at ways in which we can constantly sanitize our factories and office spaces so that we can keep the safety of the people intact. Obviously PPE plays a big role but I think we have also asked that people voluntarily tell us that there is something which they're not feeling well or they have come in contact with someone and one thing is not to make them feel like there is anything that they will be penalised because people feel like or there's a stigma around it, we need to remove that and that's the approach that we have taken. So if you're supportive we give them more time off, actually in our factory cases have been where people have fallen sick and they say that we want to come back to work and we say you just take your time, just be at home, isolate yourself if need be, take the medicines, or vitamins and minerals and whatever. But we give them time off we do not hold them accountable during that time to come to work or even inform us so those are things which have worked out well. I think because everyone requires that emotive support and I think that's if you were able to provide that I think that's half the battle won right. I mean that was what has helped us in a big way, and we do not say that you need to take time off from your accumulated leaves and what not and there's a lot of counselling that happens. So that's something which has worked out well and I think that's the future for any company to be or anywhere for it to be successful is that emotive intelligence I think that EI will play a big role in this. Q. What are the suggestions for young entrepreneurs that wish to enter healthcare so if there are one or two or three areas where, I'm a young person, I have limited resources but I have boundless energy, enthusiasm and a will to contribute back to my society what should be those platforms that young entrepreneur should think about. Ans: For that I always think about value-based healthcare. So value based healthcare define beautifully by Harvard Professor Michael Porter is outcomes plus quality divided by cost. So my suggestion to any entrepreneur ,young entrepreneur is to really look at this equation take it to heart, outcomes + quality divided by costs, now that can be not only in healthcare you can take it to any industry so our objective as an entrepreneur should be to continue to bring the cost down because it is inversely proportional which will boost value so value is inversely proportional to cost and it is directly proportional to quality and outcomes. So if you keep on looking at ways in which I can bring out better quality of care or better access to care and continuously bring out better outcomes when delivering care or doing anything which is related to the healthcare supply chain for that matter or the care supply chain or the care continuum I should say that will be so whether it be Netmeds for example which is just I think Reliance is going to acquire because it provides better access, it brings more convenience and if it is really about outcomes if we are thinking of quality let's say in both cases quality and outcomes if you look at AI role in radiology for example analysing radiology images it does a better job, it's proven to do a better job than many radiologists, because they could be fatigue and what not but there's a 99% accuracy in analysing radiology images by artificial intelligence the computer can do that and similarly WATSON initiative by IBM so these are some of the things which are happening which is really reducing costs and boosting that healthcare value equation and I would urge every entrepreneur to look at it and see where they can contribute on this. Q. How the Indian healthcare industry standing up to the challenge you spoke about what's going well you spoke about what are the trends in the future and you listed out your urgent needs for the healthcare market which need to be done at war footing specially the resurgence or the rise back of the GP that friendly neighbourhood GP that sees you first that's what you're emphasising you're talking about alternative therapies being in the future as well for us and your message for entrepreneurs is think hard about outcome think hard about quality and think hard about lower costs if you want to contribute in this sector. Great any final thoughts that you'd like leave to our participants with? Ans: I think the only final thought that I want to leave everyone is that let's take owners of our own health. I think if we are able to do that there is a lot that we can put or blame or put our finger towards and say the government didn’t do this, the private sector is not doing that or whatever that all starts with us and we can also blame the community for that matter because it's a collectively we can it's easy to blame but are we ourselves putting owners on our own health is something which should be lies and this is something which can be a big change and can really really unburden the healthcare system and this can be done through awareness which can come yourself about the things that you can do to your own health and hold others accountable for that matter and I think that is something which is necessary right that community intervention which we were just discussing is something which we can think about there will be always temptations, we have temptation from the food industry, we have temptation from the gaming industry we have to sit around from Netflix to be in front of our and be couch potatoes but I think it all starts with us and it all starts with taking that on us and holding ourselves accountable and our near and dear accountable for health. https://www.youtube.com/watch?v=62zY3KMIzcQ

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