On April 26^th and 27^th, South Asia Initiative at Harvard University held its second annual symposium, focusing on Health in South Asia: Lessons for and from the World.  The conference brought together global experts with deep research, implementation and policy experience to learn and find new modes for global exchange.  Harvard Provost Alan Garber noted that care with comparable outcomes is being delivered in India at a fraction of American providers’ models, as a result of the relentless focus on efficiency that results in tough constraints.  Indeed, Sri Lanka, Tamil Nadu and Kerala have achieved health outcomes comparable to advanced economies for a fraction of the health spending, with Bangladesh and Nepal rapidly improving.

While resource scarcity and urgent needs have created opportunities for experimentation and innovation, former Secretary of Health and Family Welfare of India, Sujatha Rao, urged the audience to think bilaterally.  South Asian countries, with increasingly complex systems dominated by the private sector, could benefit from increased incorporation of evidence-based policy development—such as those pioneered by Mexico—and good governance and enforced regulation.  Alan Garber spoke of the resources that Harvard and others are investing in medical training in India to build capacity for leadership in areas of cutting-edge research and development.

Arthur Kleinman spoke of exciting potential in China to tackle mental health, a leading yet highly marginalized cause of disability globally. History offers examples of groundbreaking approaches that have moved from China to South Asia—India’s cadre of a staggering 800,000 community health activists (ASHA) tasked with bringing neonatal care to the doorsteps of rural households, has its roots in China’s “barefoot doctors” model. Joined by Sarah Pinto from Tufts University, and Neil Aggarwal from Columbia, the panel discussed family planning successes in Bangladesh and how the recent decreases in maternal mortality draw on the same principle that continuous community presence is essential. These delivery models also acknowledge the role of non-medical factors and practices. Clean water and food are huge areas of vulnerability, particularly with increasing populations and hyper-dense slums. Social networks and family ties are also influenced by the changing contexts; new inequities, at the micro and macro levels are emerging.

Day 1 focused on understanding the issue, to create a platform for Day 2’s discussion on the solutions.  Speakers included Devi Shetty, founder of one of the India’s largest specialty healthcare providers, and Julio Frenk, Dean of the HSPH and former Minister of Health, Mexico.

Dr. Devi Shetty kicked off Day 2 by an inspiring idea: within a few years, we will see heart surgeries available for $800.  In a world where currently heart surgery, first pioneered over a century ago, remains affordable to only about 10% of the population, this is hugely exciting.  Already his 14 hospitals in India serve thousands annually with high quality, low-cost tertiary services.  His visions are much greater—already Narayana Hrudayalaya Institute of Medical Sciences is involved in establishing a medical education program in the Cayman Islands and advocating for fundamental shifts in how medicine is taught and practiced.  Manpower, not money, he said, was the greatest limitation facing health care delivery today. 

Innovation can mitigate the challenges, as demonstrated by the panel on New Technologies, which brought together Anita Goel, CEO of NANOBIOSYM, Glenn Cohen, Assistant Professor at Harvard Law School, Ramesh Raskar, Associate Professor at MIT and co-founder of EyeNetra.com, and Conor Walsh Assistant Professor of Mechanical and Biomedical Engineering at Harvard School of Engineering and Applied Sciences. Raskar highlighted his low cost technology to accurately diagnose nearsightedness, farsightedness, and astigmatism on a mobile phone, providing an easy convenience for the 2.4 billion people worldwide who don’t have glasses due to lack of access to eye care. Goel discussed the innovations developed by NANOBIOSYM, which brings together fundamental physics, biomedicine, nanotechnology, and information science across traditional boundaries to create transformational impacts to some of the problems of today. In discussing these innovations, the panel also highlighted the ethical obligations of those creating these new technologies. Walsh believes that in order for these innovations to effectively alleviate challenges, developers need to integrate into medical contexts and processes so that they observe “what if” moments to translate into needed solutions.  Under Walsh’s supervision, interdisciplinary student teams from Harvard will spend time at medical institutions this summer, including Shetty’s Narayana Hrudayalaya. On what may be considered the dark side to new technologies, Cohen discussed the ethical landscape of medical tourism and the different kinds of medical tourism that exist. Cohen highlighted the kidney tourism trade in Bangladesh, Pakistan, and India. In Pakistan for example, over 2,000 kidneys have been sold as a result of kidney tourism, with 2/3 of the kidneys being received by foreigners.

In his keynote, Dr. Paul Farmer reflected on experiences from Rwanda and Haiti, two countries that in recent years have been forced to rebuild their health systems, to illustrate what effective design could look like, and what it accomplishes. Fundamentally, the role of the fixed health facilities has evolved: most people don’t need hospital-based services on a regular basis. Health systems should recognize and address the social dimensions of health, such as poverty and gender equity, and include a strong community component.

A panel on Relative Roles of Markets and Government, brought economist Amitabh Chandra, Professor of Public Policy at Harvard Kennedy School, Michael Kremer, Gates Professor of Developing Societies, also at Harvard Kennedy School, and Abhijit Banerjee, of MIT and the founder of the Abdul Latif Jameel Poverty Action Lab. This conversation focused on the economics of healthcare and ways to address the challenges.

Dr. Julio Frenk expanded on the solutions during his closing remarks. A key piece of needed health care reform is innovation in delivery of care.  Increasingly, experts and policy makers in the United States are looking to the Global South for guidance, given their ongoing experimentation with “frugal” solutions, from complex issues like eye surgery at Aravind Eye Hospital to basic preventive care delivered at the doorstep.

Frenk also emphasized that a key strategy for effective health systems is collaboration. Often conversations are framed as “public vs. private,” when in reality these are complementary players.  Similarly, collaborations between South and North institutions can be quite fruitful. Many of the successes shared at the conference were the result of team with diverse expertise and experience that were able to bring global knowledge to bear on a local set of challenges. 

“We were thrilled that many faculty and students with limited exposure to the region joined to learn; their astonishment at the diversity and sophistication of activities was palpable. The willingness of leaders from South Asia like Devi Shetty and Sujatha Rao to participate in the event, made it truly exciting.  It’s clear that South Asia is a bastion of innovation in health care; how we harness the learning to utilize it globally is a formidable but energizing challenge”, noted Tarun Khanna, SAI Faculty Director and Jorge Paulo Lemann Professor at the Harvard Business School.

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