Introduction
This book is a blend of real life stories and their impact on families, society and country along with data, trends related to these stories and the sectors in which they play out. It suggests a framework on how these individual stories as a collective voice of India in collaboration with technology can reshape India’s tryst with the future.
The authors share that India currently faces the twin challenges of creation of Jobs for mid-skilled workers and access to vital services across key sectors.
The Bridgital Transformation
Flashing lights – Through Nikhil Burman’s story, the story of a driver cum medical coordinator, the authors highlight the huge gap in medical care, facilities and empathy that rural areas face today. His modus operandi was to park his car besides the highway, turn on the flashing lights and answer questions of sick people who desperately needed someone who could help.
Playing roles – Nikhil sensed the deep suspicion with which rural patients approached doctors in large hospitals. Besides the issue of language, process, they did not trust the large hospitals, which was akin to a foreign environment and more so if the diagnosis was of life-altering significance.
Wrapping technology around people – India’s lack of market means access will take precedence over efficiency. India faces a perennially limited supply of skilled human resources and physical assets. The demographics demand a different approach to automation and AI.
The access challenge
Calculations – Poor patients from rural areas typically calculate the days of hospitalization, healthcare expenses while getting treatment and more often than not avoid long treatment as it means loss of income. Lack of proper treatment leads to a spiral downfall in standard of living, income opportunities and finally a debt trap.
The great medical migration – India’s public health system is understaffed and underfunded, especially true in rural India’s network of primary and community health centres. The perception built over the years is then to visit large hospitals for treatment of critical illness. This leads to the great medical migration: Millions travelling great distances to large urban hospitals.
Twice exceptional – As per the authors, Barak Valley in Assam is twice an exception: It is a region struck by exceptional rates of cancer and is also shaped by exceptional and dedicated healthcare providers. One such provider is Kalyani hospital which manages to provide high caring standards by being enterprising and relying on jugaad – temporary measures widely celebrated as Indian resourcefulness.
The big disease – The authors highlight the plight of poor families when they are struck by diseases like cancer through the tragic story of 10-year-old Headingson. His family discussed their doubts about the diagnosis. They did not trust the doctor, the big hospital and wondered how a small kid can have a big disease like cancer.
Imbalances – The primary healthcare network is underutilized and widely distrusted. Patients who can afford private treatment bypass the public system altogether, creating a feedback loop where doctors and health workers are drawn into the private system as well. Because of the inefficiency and the distrust of the primary healthcare network, the secondary and tertiary hospitals are swamped with far more patients than they were ever designed to serve.
Outreach – India’s health systems must be fixed from the bottom up, and this must happen with the workers and resources it already has. Informal contributors like Nikhil need to be brought into the formal fold.
Bridging access – India’s access challenge has many faces and affects hundreds of millions, and Healthcare is just one sector. Part of the answer to the access challenge is making better use of the facilities India already has, in ways hitherto unexplored. For instance, to make the logistics sector efficient, digital approaches can reimagine service delivery, and decentralized technologies can shorten the distance between people and systems.
XX Factor – The talent dividend
An unlikely officer – The authors depict the story of Jasleen Kaur, the daughter of a rural daily wage worker, who achieved a high-ranking position at the women’s cell at Bathinda. Giana, the village where Jasleen was born, had a literacy rate of about 57% well below the overall state literacy of 76%. Jasleen’s parents were determined that their children receive education.
The talent dividend – Just 23% of Indian working-age women are in the labour force. If every woman who said they would take up paid work ended up doing so, India’s workforce participation for women could touch nearly 80%.
The spark – Jasleen’s father-in-law knew she had a spark, and despite opposition, helped her graduate. Her failure in clearing the Teacher Eligibility Test did not deter her from applying for the post of Sub-Inspector in the Punjab police. She had to balance both – private academy classes for physical and mental training, as well as nurturing her four month old son to get the job with the Punjab police.
Twice-hit economy – Woman’s participation in the labour force India is impacted by education and age. Women with very low and very high levels of education tend to participate more than other women in the workforce and beyond the age of forty years, more and more women drop out of the workforce permanently. Three broad sets of interwoven issues – unpaid work, safety and mobility and underlying gender norms – play a major role in woman not working.
Waiting for a role model – Jasleen’s success motivated villagers to educate their daughters and daughters-in-law. The school’s principal sought her out to speak to students. Jasleen wanted her own children to move out of state for higher education and dream big.
Releasing the talent gridlock – Building a leading-edge 21st century care economy could be a key step to ease the tall, invisible barriers that keep women from work. Millions of jobs can be created to build care centres for children, older people, creches. Another key step is relooking at policy measures such as maternity bill, Equal Remuneration Act that resonate with ground realities. Finally, it is critical to amplify the counter narrative.
The easiest fix – Making work work for Indian women is paramount; this is a rare chance for India to go beyond statements of intent and prove that it truly wants more inclusive growth.
The job challenge
Puzzles – Bhoomi left her village in Karnataka for Pune because of poverty. She wanted to study but she was also expected to do household work and manage the vegetable stall at night. She lived with the persistent expectations of family members who were torn between the distant benefits of good schooling and the immediate need for extra hands. This was a puzzle that many families like Bhoomi’s faced.
Jobs count – The informal work encompasses a huge range of occupations like farming, construction, car repair shops and so on. India’s great search for work though is really about a pursuit of stable work in the formal sector and moving out from informal sector.
Waterproof – The authors portray the helplessness of Bhoomi’s father Rajappa Biyali who joined his uncle as a construction worker in Pune because of drought induced poverty in Karnataka. Later, he started a waterproofing business. Lack of rainfall impacted his business leading to a never-ending chase after contractors for more work and then chase for them to pay up.
A two-track economy – Talented workers like Rajappa are locked out of India’s formal economy, which requires levels of education and skills beyond their reach. This reflects a country that runs on two tracks. At one end is the organized sector, intensely productive, well-paying, high-skilled, with fewer workers. Marked by large numbers of less qualified and lower-paid workers in an unorganized sector.
Twice exposed – Rajappa’s entire family shifted in Pune in 2012. There were agricultural loans to repay for bore wells he had built back home in Karnataka. He had to take a bank loan for a surgery on his right hand. The conditions are best expressed by the lines, To pay the price for raising three teenagers, meeting household expenses, managing the rent and avoiding defaulting on bank payments, the Biyali household juggled its finances endlessly. The agricultural loans in Karnataka and the debt in Pune had left him twice exposed.
Escalator sectors – GDP growth in India has been powered by industries that prize skill and capital. This chapter clearly emphasizes that India needs to create an environment for other sectors, which are abundant in unskilled and inexpensive labour, to flourish as escalators. Only then will workers step up from low productivity industries to intermediate and more productive work.
The Saju Mini supermarket – Rajappa’s younger son Saju shared the idea of selling vegetables to boost the family income. The entire family chipped in as and when time permitted. Sangamma, Rajappa’s wife, wanted her children to study.
Investing in fundamentals – Through this chapter, the authors highlight the fact that the country needs to look harder at productivity. The need is for better jobs and not just jobs. It implies building sectors that can drive employment as well as the nature and size of the country’s firms.
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Everywhere entrepreneurship
The entrepreneur’s tale – The authors reflect the rigour, the perseverance and the courage that an Indian entrepreneur must have through the story of Amit Singh. While pursuing his graduation, Amit joined as an intern at a company selling embroidery and screen-printing machines to know the nuances of the textile industry. He slept on the factory floor, attended duties from eight in the evening till two in the morning, while attending a manufacturing course during the day.
The end of the shift – Amit found the course dissatisfying and focused more on his work at the factory. He soon found a job at another manufacturing house. He married Niyati, a budding fashion designer and wanted to quit work to start business with her. Niyati advised patience and after five years since their marriage, they started a textile business.
The great skew – India’s skewed employment profile is best illustrated by the fact that the average firm in India employs just over two people. Most micro enterprises are simply self-employed individuals running their own business – say, a paan or a kirana shop. These enterprises make up more than 70% of India’s firms.
Goldilocks entrepreneurs – Government schemes tended to encourage and further the growth of businesses that were already established or else catered to micro entrepreneurs. Amit was too small for some and yet, not small enough for others – a Goldilocks entrepreneur. The authors observe that it is in between these two extremes that the country will have to invest. And they need to be spread across the country – not just in the major economic centres. This is the “everywhere entrepreneurship” movement.
A solitary enterprise – Facing these challenges can be a solitary endeavour for business owners like Amit. Successful entrepreneurs are rare. Encouraging everywhere entrepreneurship would mean allowing more people to be successful without requiring the heroic levels of resourcefulness and courage that Amit and Niyati were forced to muster.
Embracing everywhere entrepreneurship – The challenge to entrepreneurship in India is to provide a Bengaluru like support system to someone who has nothing in common with the typical tech start-up founder – a person much like Amit. Bridgital clusters can spur Everywhere Entrepreneurship. Creating a Bridgital cluster will need a crucial piece of information – a “platform of platforms” that provides entrepreneurs with an easy way to access services.
Small business, large impact – This chapter covers a theme that comes up throughout the book – the plan for the 21st century in India should renew the focus on entrepreneurship to move the needle towards formal employers. Also, renewed efforts need to be undertaken to make paid work attractive for women in order to address the participation gap; and ultimately, this plan will need to be anchored by a Bridgital approach that marries the gap between skills and jobs.
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Bridgital in action
New aims – Minister Kumar wanted to transform healthcare in Karnataka. It started with the establishment of Digital Nerve Centre or DiNC transformation system. By redefining certain roles and responsibilities, and creating a new class of Bridgital workers, time-consuming administrative pressures were taken off valuable medical staff. And with the added mesh of technology, the system sorted patients at the very beginning and brought more people into healthcare’s purview.
ASHAs – Aminah Sheikh signed for ASHA during a recruitment drive and earned commissions for every child she got immunized, and every new and expectant mother she sent to a doctor or followed up on. Via DiNC, she got a tablet that not only made her access into households easier but also she could now register people on the healthcare system that the tablets were already connected with.
The clinicograph – Patient records were viewable on an app called the clinicograph, which provided doctors a comprehensive view of the patient’s medical history. The clinicograph’s back-end system, the Concentric Data Repository (CDR), captured all: maternity cards, scanned images, doctor prescriptions and test results. DiNC’s technology elements are a harbinger to what is possible when the combination of data, connectivity and AI is deployed in context.
Ubayakushalaopari – DiNC’s approach reminded Minister Kumar of a Kannada letter writing custom, Ubayakushalaopari – The well-being of both of us. The authors showcase the story of two DiNC workers, Sister Karuna, a caller at DiNC and Chanda, a patient care coordinator who provided timely help to patients across the region of Kolar, Karnataka.
Recovery – The story of recovery of Shireen Junaid, pregnant with haemoglobin deficiency, through persistent calls from DiNC and on time care is a validation for a new approach to healthcare – one that emphasizes staying in touch with patients.
The Bridgital model – The last two chapters culminate the research across various sectors and bring forth the framework of Bridgital model. As per the authors, it is a world in which work is demystified – disaggregated and redistributed through the aid of the cloud, AI and related technologies.
Bridgital more broadly – To apply Bridgital principles, data privacy is a necessity and the first step. Second, industries and organizations would benefit from freedom to experiment with existing roles and create new ones. Third, technology can help overcome old apprehensions by redefining how services are delivered. Fourth, digital skilling needs official recognition. The authors believe that a Bridgital approach will directly impact 30 mn workers by 2025.
Conclusion
This book outlays the challenges of jobs and access faced by a nation and its people towards becoming a superpower by 2030. It clearly demonstrates the role of technology-driven solution to build human bridges and facilitate women empowerment and education, entrepreneurship movement and thereby close the burgeoning gap between supply and demand.
This book has also shown the true potential of India and must read to create interface between the digital and people as the future is not only technology, it is about people and their emotions! India’s future depends on how we imagine, develop, test and adopt.
