Monthly Archives: February 2014

Top 12 Challenges Facing India in the Decades Ahead – 06 – Health Care

As per our post on poverty, health care is a substantial problem in India. Not only does India have the 9th lowest life expectancy among the 16 countries outside of sub-saharan Africa that are poorer than it is, but is also has the 10th lowest infant and under-5 mortality rates and the second worst proportion of children under 5 who are undernourished! Then, as per our last post on education and opportunity, at leaset 93% of the workforce has no health insurance in a country leaning heavily towards privatized health care.

And this is just the tip of the iceberg. Almost 40% of all deaths in India are still due to infections! (Source: Health and Health Care in India) The majority of the remainder are due to non-communicable conditions such as cardiovascular diseases, chronic respiratory disorders, and cancers. (Compared to the developed world which manages most chronic respiratory disorders and some of the cardiovascular diseases so well that the patients often die from other causes.) In comparison, the only type of death due to infections to break the top 10 in Canada is death due to influenza and pneumonia which strike down 1.6% of the population to grab the 9th spot. In other words, the number of deaths in India due to easily treatable infections is at least 20 times higher than it should be!

India currently spends about 1.2% of GDP on publicly funded healthcare, an amount considerably less than most other comparable countries. In comparison, health care spending clocks in at 5.1% of GDP in China and Russia and 9% in Brazil! (Total spending on health care, including all private spend, is about 4%, but the private spending is mainly by the rich.) Due to this limited funding, and the substantially insufficient funding allocated to the National Rural Health Mission (NRHM) (as outlined in our post on Poverty), 400 Million to 600 Million of the poorest Indians do not get access to the essential medicines they need. When you also consider that India is now the worlds 3rd largest producer of medicine by volume, the absurdity of the situation really comes into the spotlight.

And progress is slow. Even if the extension of the Government’s National Common Minimum Programme, announced by Prime Minister Manmohan Singh on the country’s 66th Independence Day achieves its goal and provides access to free public health care to over half of the population by 2017 (as opposed to the fifth who currently have access) via the country’s 160,000 sub-centers, 23,000 primary health care centers, 5,000 community health centers, 1,000 sub-district hospitals, and 600 district hospitals, that will still leave hundreds of millions of Indians without access to even the most basic of health care services. (Furthermore, the proposal that the Federal Government would directly fund 75% of the relatively limited cost of extending the generic medicines supply to the public health service doesn’t go far enough. At least one third of the population cannot afford to pay even 25% of the cost of generic medicine, which, as it is produced in India, represents relatively little cost to the Government.)

And even though 160,000 sub-centers might sound-impressive, the requirements for a sub-center is one Auxiliary Nurse Midwife (ANM) and one Male Health Worker. That’s it. Not even a full nurse. You only find those in Primary Health Centers, Community Health Centers, and Hospitals. In addition, the primary health centers (PHC) also tend to be minimally staffed. They are only required to have one medical officer (doctor) who is supported by an average of 14 paramedical and administrative staff, in total, and, at current numbers, support a population base of 50,000 people! Furthermore, a community health center, which has to serve approximately 200,000 people on average, typically only has four medical specialists (a surgeon, general physician, gynaecologist, and paediatrician). Plus, per capita, the number of physicians is quite low. Right now, India clocks in at roughly 6.5 per 10,000 people (and many of the doctors are in the hospitals), while Canada has 20.7 and the United States has 24.2. (Source, KFF) Also, while India has roughly 1,600 hospitals to serve 1,237 Million people, the United States has almost 6,000 to serve 314 Million people. In other words, there are 15 times as many people per hospital in India as there are in the United States. (770,000 citizens per hospital in India vs 52,000 per hospital in the United States)

Health Care is a huge problem and one that desperately needs to be solved. After all, if your population is not healthy, how can you expect to give it a good education if it’s worrying about being well enough to study? And if you cannot educate it, how can you ready it to take advantage of any opportunity that may give it the hope of lifting itself out of poverty, something which must be done to increase the tax base enough to build the required infrastructure to support the fierce competition of today’s global economy?

You Can Have Your Google Chauffeur. I’ll Choose Good Ol’ Alfred Every Day of the Week!

For those of you who thought the doctor was needlessly calling #badwolf last Sunday in response to the automotive industry’s push for autonomous automobiles, SI would like to point out this recent BBC News article stating that Toyota is to recall 1.9 Million Prius hybrids.

Why is Toyota recalling 1.9 Million Prius hybrids? A software fault that may cause the vehicle to slow down suddenly. To date it has identified more than 400 reports of the problem, with the bulk of them occurring in (the heavily congested streets and highways of) Japan and North America. According to Toyota in limited cases, the hybrid system might shut down and the vehicle will stop, perhaps while being driven.

In other words, all a hacker has to do to cause multiple fatal multi-car pileups is hack the OnStar network and send a signal to all Prius’ vehicles to execute that specific part of the code. They don’t even have to break the OS and figure out how to craft a small virus that will hijack the control system or execute a dangerous set of commands — the hacker just has to send a signal telling the OS to execute the set of commands already there.

Now, presumably, this would (hopefully) result in the brake lights being triggered and the outcome may not be as deadly as it would be otherwise, but what about the other 99 Million Plus lines of code. How many similarly dangerous, untested, and, as-yet, unexecuted code sequences are also in the Prius? And every other electronically controlled car on the road?

They’ve yet to release a personal OS that isn’t riddled with more holes than there are potholes in Canada’s winter roads*1! I’m all for technological advance, but until we figure out how to write more bullet-proof, and secure, operating systems, let’s keep the OS out of the car and on the desktop where it belongs.

Now if you’ll excuse me, I have to go help LOLCat tell some meddling kids to get off my lawn!

*1 A slice of swiss cheese is quite solid in comparison!

Think China Trade is New? Think Again!

The first ship to trade with China, the Empress of China, set sail from New York 230 years ago today, transporting the first official representatives of the American government to Canton.

The outsourcing craze to China may be relatively recent, but American trade with China began a mere 8 years after they declared independence and within a year of Great Britain accepting that the United States was an independent nation.

The (Board) Gamer’s Guide to Supply Management Part VIII: Agricola

It’s 1671, the plague that has raged for the last 323 years has finally been overcome, and you and your spouse are a simple farming couple living in a two-room hut somewhere in (very) rural Austria. Your goal is to improve your quality of life by improving your home, expanding your fields, and multiplying your animals (to sell in the nearby markets).

In Agricola, you do this over a 14-round game where each of your family members can take exactly one action (that has not yet been taken) in a round. In this round you can acquire resources such as wood and clay, harvest your crops, acquire livestock, or expand your family. Each of these actions will need to be taken, but must be timed appropriately You cannot expand your family before you can house (and feed) another mouth (or one or more family members will have to beg), but you cannot plant and harvest more crops without more family members. As a result, some actions will almost need to be paired and you will have to plan action sequences in order to not only survive the game, but win. The winner is the player who builds the best overall farmyard (which is judged on a variety of factors which include fields, pastures, stables, crops, animals, homestead, and improvements).

In this post we will discuss the basic “family game” play, which leaves out some of the more advanced components, as you will need to master the basic game before moving on to the more advanced one. (Just like you have to master the basics of multi-round sourcing sourcing negotiations before trying to do real-time optimization-powered auctions after a multi-round RFX to qualify the final bidders.) The difference is that occupation and minor improvement cards are left out and only the major improvement cards are used.

You start the game with 2 units of food if you are the starting player, and 3 otherwise. You can get more food from the harvest that comes at the end of rounds 4, 7, 9, 11, 13, and 14. (Just like in the real world, crops take time and you can’t harvest immediately after planting.) Food is produced from raw grain and vegetables, and grain and vegetables can be converted to food one-to-one at any time. (If you have a hearth, you can convert vegetables at better than a 1 to 1 ratio.)

Each round without a harvest has four phases:

  1. Begin: Flip over a new round card that makes a new action available.
  2. Replenish: Acquire new goods and food from any previous actions that have a recurring result.
  3. Work: In sequence, each player puts a family member to work by assigning an available action to them, which they will take. The action may yield an immediate or future result.
  4. Go Home: At the end of the round, the family members have finished their assigned tasks and go home.

If the round has a harvest, there are three more phases:

  1. Field: players remove one food unit from each sown field and places it
    into their personal supply
  2. Family Feeding: each player must feed each family member who was born in this round 1 food and each other family member 2 food; a player who does not have the food has to beg and borrow food, but that comes at a cost of 3 points (think 3 food units) in the future
  3. Breeding: any player with at least 2 animals of the same type may breed 2 animals to receive exactly one additional (baby) animal of the same type, provided there is space in that person’s farmyard for the animal

The following actions are always available:

  • Extend Your Hut or Stables : you can extend your wooden hut, ore renovate your wooden hut into a clay hut or your clay hut into a stone house if you have enough reed and wood, clay, or stone to do so. Alternatively, you can build stables to keep (more) animals
  • Extend Your Family: if you have more rooms in your hut than you have family members, and less than five family members, then you can add one offspring to your family (to put to work in later rounds)
  • Tend Your Fields or Bake Some Bread: you can plow an unplowed field, sow one or more plowed fields with grain or vegetables, or (if you have a fireplace, hearth, stone, or clay oven) convert grain to food
  • Raise Your Animals: in order to raise animals, a player must fence pastures or build stables (in a pasture),

Additional actions that may become available during the game (in the form of major improvement cards) include:

  • The Well: produces extra food (as your fields are better irrigated you produce more crop that becomes food)
  • Fireplace: allows you to convert grain, vegetables, and animals to food
  • Cooking Hearth: allows you to convert grain, vegetables, and animals to food
  • Basket Weaver: allows reeds to be converted to food
  • Stone Oven: bake bread from grain
  • Cabinet Maker: makes cabinets from wood that are traded for food
  • Pottery: makes pottery from clay that are traded for food

It’s just like managing an industrial farm at the back-end of agricultural supply chains. The amount of crop you can produce depends on how many fields you have, how many people you have working those fields, and how capable you are at optimizing the output, but the amount of fields you have available and the amount of people to tend those fields depends on how many of those fields need to be used for, or grow food for, the animals you are raising to supply meat to your customers who want grain, vegetables, and meat to stock their shelves and freezers. A field can only be used for one thing at a time, a person can only do one farm task at a time, and those farmhands need to be paid and fed. You have to balance supply with demand with profit and need. If you train your people, they can be more productive, but it costs time and money to do so (and maybe they’ll quit and go work for your competitor). And if you go into debt, the interest accumulates quickly because you’re essentially borrowing from legalized loan-sharks due to your low profit margins and limited clout.

And winning isn’t just profit, it’s sustainability and depends on a number of complex factors that influence your performance over time.

Are you the best agriculture supply chain manager? Play Agricola, challenge (up to four of) your teammates, and find out!

Acquiring e-Sourcing and e-Procurement Technology: What Questions Should You Be Asking?

Join Sourcing Innovation and the doctor for the next NLPA Members-only webinar on Acquiring e-Sourcing and e-Procurement Technology; What Questions Should You Be Asking. Taking place next Wednesday, February 26, at 8:30 am Pacific, 11:30 am Eastern, and 16:30 pm GMT (London) time.

This webinar, which follows Novembers webinar on Making Sense of e- in Sourcing and Procurement, will outline the critical questions
that must be asked when searching for an e-Sourcing or an e-Procurement solution.

In our last webinar, we clearly defined the sourcing and
procurement cycle, indicated where each technology
(e-Sourcing, e-Negotiation, e-Procurement, e-Invoicing,
e-Auction, e-RFX, e-Contract, e-Payment, Procure-to-Pay,
Source-to-Pay, etc.) fell, outlined what each technology
did, and indicated the conditions that needed to exist for
each solution to potentially be appropriate for your
organization. This provided your organization with a set of
questions it could ask to determine what technologies it
needed to focus on as it looked to acquire new sourcing and
procurement technologies to support it in its Supply
Management Journey.

However, just knowing that your organization needs a
solution is not enough, especially if its biggest need is
a basic e-Negotiation suite that is theoretically available
from over two dozen vendors. Which solution, or solutions,
are right for your organization? Depending on the needs of
the organization, it might be the case that only two out of
twenty solutions will appropriately address the
organizational needs, but unless the right questions are
asked, it might look like six meet the needs and the
organization will have a 66% chance of selecting the wrong

That’s why the doctor of Sourcing Innovation is hosting
this follow-up webinar on Acquiring e-Sourcing and e-Procurement Technology; What Questions Should You Be Asking.
You’ll learn the critical questions
that must be asked when searching for an e-Sourcing or an
e-Procurement solution, some important questions
that should also be considered for each major module, and
how to structure a (multi-round) RFX for Success.

To register for this free event, login to the NLPA
and navigate to the “Webinars” tab where you’ll find a
registration link. Be sure to enter a valid email address
as attendance details will be sent to you by email.
Registration is free (as is basic NLPA membership,
register here) but attendance is limited,
so sign up soon to ensure access to this event. (If you have forgotten your
NLPA password, please visit the NLPA password reset page.)

See you next Wednesday, February 26, at 8:30 am Pacific, 11:30 am Eastern, and 16:30 pm GMT (London) time.