NOV 2010 Issue 06

HEALTH INFRASTRUCTURE IN INDIA

India is the 7th largest country in the world and the 2nd most

populous country after China. A large part of it‘s population

lives on less than Rs.100 a day. The standards of living and

hygiene is very unsatisfactory, especially in rural areas. All

these reasons, coupled with a sub tropical climate, makes

India a hotbed for diseases. Compounding the problem is the

paltry number of beds and qualified doctors available to pro-

vide treatment- 178.7 Hospital beds per 1,00,000 people in

the urban areas, and an astonishingly low 9.87 beds per

1,00,000 people in rural areas.

Making matters worse are the sky high prices of various medical tests (ranging from the basic X-rays, blood tests, to various other com-

plicated tests) and the ever increasing

price of drugs. An average Indian cannot

afford such expensive tests and medi-

cines, let aside the operational costs, and

other expenditures, and is therefore left

with very little options.

We can learn something from Mr. Devi

Sheety, a humble man who has made

world class healthcare services available,

at reduced prices, to everybody. Nara-

yana Hrudayalaya, state-of-the-art

trauma hospital Sparsh, and an ophthal-

mology hospital Narayana Nethralaya are

world class hospitals offering their ser-

vices at affordable rates. He has also

started an Insurance scheme

―Yashasvini‖ which is the world‘s cheap-

est, comprehensive health insurance

scheme at just Rs.5/- per month pre-

mium.

This is a big issue because the life of an

individual is the most valuable asset. If

India is to truly achieve the aim of becom-

ing a developed nation in the years to

come, it needs to put its medical infra-

structure in order before proceeding

ahead, because a nation of weak men

and women cannot deliver.

The Storyteller’s Corner 1

Leaders and Butterflies 2

Leading in Change 3

The Chaos Theory 4

All aboard! 4

Challenges in eGovernance 5

Securing the Unorganised Sector 6

Transforming Lives

THE STORYTELLER’S CORNER

CS KEDAR, DG, ESIC

Over the years, I have developed a habit of making clandestine visits

to my hospitals and move about, incognito. Many a facts, not visible to

the DG, present themselves quite starkly to the common man. It also

brought me face to face with life one day!

Here I was, busy inspecting the hospital, looking for opportunities of improvement and

making mental notes, when I saw another man, doing exactly the same! I was taken

aback and quite literally amused. To my mind, I had a very valid reason for doing so, but

what could be his reason? Deciding to get to the bottom, I quietly observed him. He went

on about the inspection very diligently, looking behind the doors, checking out the toilets,

talking to people, and making notes.

I walked up to him and started chatting to him. His name, he said was Muchkund Pandey

and he was an IP. He worked in a nearby factory and lived along with his family stayed

some distance away. No one from his family was unwell that day and that he had come

here ONLY to inspect the hospital. On further inquiry, he said that he loved his family

and wanted them to have the best of the medical attention. He had been assigned to this

hospital, but wanted to make sure that, if ever the need arose, this hospital would be

able to take care of his needs. He wanted to make up his mind what would be more judi-

cious, coming in here and availing of the IP Benefits, or going to the nearby private hos-

pital, which would surely be very expensive and a burden, yet preferable only because

he would not want to compromise on the quality of medical care for his loved ones!

Ever since that day, I have looked at my hospitals with Muchkund Pandey‘s perspective.

I have understood that irrespective of the financial capabilities, every person wants the

best for his/her family in case of medical emergencies, and that alone is what shall sepa-

rate a good hospital from a preferred one! It is now my dream that if ever the need arose,

Mr. Pandey would give us the opportunity to serve him. After all, he is our VIP!

The Project Panchdeep Journal

The Lighthouse

LEADERS AND BUTTERFLIES

VASUDEV MURTHY, WIPRO LTD

I had attended the ESIC Leadership Conclave, 'Trinetra', in Delhi

a few months ago where I had the pleasure of leading a Busi-

ness Simulation exercise. I began by showing the picture of a

butterfly and asked, quite rhetorically, whether anyone in the

audience had heard of the butterfly effect. The idea was to high-

light to the senior leadership present in the audience the aston-

ishing effect that a single—almost inconsequential - act could

have on the larger system.

Formally, the butterfly effect is a metaphor that tries to show how

a single tiny event - say the flapping of a butterfly's wings - could

have an extraordinary effect on a larger system - say the creation

of a tropical storm or cyclone.

This metaphor has immense significance in organizational dy-

namics. In particular, ESIC's senior management has to keep an

eye of apparently minor events in the external environment at

and understand the effect of those events on ESIC. A new law,

economic changes, a new competitor, an unusual technology -

the slightest blip could have massive implications. If the rate of

change within an organization is faster than the rate of change

outside, the organization will survive and thrive. A satisfied

'settled' organization that is convinced of its permanence will die.

A sense of paranoia - watching for the flapping of wings of the

smallest metaphorical butterfly - is essential in a leader, for he

then works to adapt and morph, not allowing for even a mo-

ment's complacence.

In our context then, change management should not be consid-

ered a single project with a defined start and end, but a continu-

ous strategic imperative.

A sensitive leader can astutely deploy the concept of the butterfly

effect in his environment. The right behavioral inputs create a

cascading positive effect. Rather than dictate change, the leader

exemplifies change and is seen to behave differently. Others

notice these positive changes and unconsciously emulate them.

Changes brought about by one's free will have greater lasting

power than those brought about by diktat.

Of course, there are many leadership styles and all have their

advantages. But all leaders must wear a radar on their heads,

searching relentlessly for the next butterfly to flap its wings. Inter-

preting that event and managing a possible 'butterfly effect' will

distinguish a visionary leader with a three hundred and sixty de-

gree view from a settled manager with tunnel vision.

Do you see a butterfly on your window?

EDITORSPEAK!

This was a happening month for India. Festivals

galore, Diwali, Id and Obamamania. This month

was special for a bigger reason though. The President of a su-

per power nation visited India to boost economy and create jobs

– not for India but for his country. The President may speak of

increased trade between the two nations, but his agenda was to

create or sustain one hundred thousand U.S jobs. According to

analysts, any improvement in the dismal jobs picture in U.S is

welcome but economists have estimated it will take 300,000

new jobs each month to have an impact on an unemployment

rate hovering around 10 per cent.

The core issue here is neither political nor economical; rather it

is the social value of employment. The social security attached

to an employed person and his basic needs met is the real indi-

cator of a Nation‘s wealth. When a person is able to utilize his

day gainfully, is assured of health care and safe environment for

his family, his productivity and social quotient grows. So, when

a super power nation gives priority to job creation, it empha-

sizes the value of employment. Bhutan has integrated the value

of its citizens to its growth indicators and measures ‗Gross Na-

tional Happiness‘! The concept of gross national happiness

(GNH) was developed in an attempt to define an indicator that

measures quality of life or social progress in more holistic and

psychological terms than gross domestic product (GDP).

According social security to an employed person is another

critical factor. ESIC has been playing that key role in meeting

the needs of employees earning below INR15,000 in wages

monthly. The unorganized sector is also being brought under

this umbrella and we look forward to a day when children em-

ployed in Agra shoe factories, child labour in Sivakasi or chil-

dren using pliers to pick off tiny black computer chips from e-

waste also come under the safety net of social security.

In this issue, the story teller recounts his experiences when he

visited one of the ESIC hospitals incognito, highlighting the IP‘s

desire to provide what is best for his family, even though it

might cost him more. Dr Kshirsagar provides an insight into the

Leaders‘ mind, especially in the times of change, and her

thoughts on the necessity to keep learning, keep changing,

keep leading. Mr. Mukhopadhyay from MP succinctly underlines

the importance of a leadership trait of ensuring that everybody

in the team is clear about the project at large, and his own vital

part that needs to be played. Milan Narendra, using his learn-

ings from the immense experience of leading the national team,

shares his thoughts on the factors that must be taken into ac-

count while implementing the eGovernance projects.

The Lorenz Effect, known as the mathematics of Chaos, has

lent a scientific approach to the study and the art of leading

people, and foreseeing future impacts of actions taken today.

Vasu Murthy, the effervescent master thinker dwells on this,

and simplifies the intricacies of bringing the leaders in us out of

our own confines.

The twin festivals of Diwali and Eid have both rejuvenated, and

reiterated our commitment to the cause of Chinta se Mukti, as

Madhya Pradesh, Gujarat, and Maharashtra prepare for the

Panchdeep roll-out.

LEADING IN CHANGE

DR NEELIMA KSHIRSAGAR

Dean, PGIMSR MGM Mumbai

Director General ESIC Dr. C.S. Kedar and the team at Wipro should be specially thanked and congratulated for

having given us the opportunity to learn about change management. Recently, I was the co-organizer of American College of Clinical

Pharmacology Conference held in Baltimore, USA in September 2010, where the theme of the conference was ―What developing and

developed countries have to learn from each other‖. I was surprised to find that my American colleagues arranged a one day workshop

on change management. Participants for the workshop were from Pharmaceutical Industry, University, Government regulatory organi-

zation etc. The examples/exercises that the convener of the workshop gave consisted of how to deal with change due to merger and

acquisition of companies, new boss joining, outsourcing of manufacturing activities to India etc.

I have just read the book ―Leading Change‖ by John P. Kotter. This inspirational book highlights how when faced with transformation,

change and change problems, developing proper change strategies and leadership can drive the change successfully.

We are often bogged down by issues involved in managing change i.e. by processes that can keep complicated system of people and

technology running smoothly. We need managerial skills and but more so what we need are leadership skills - defining what the future

would look like, aligning people to that vision and inspiring them. In ―brown field‖ projects, where we are overlapping new things on old

things, we are faced with many challenging situations. We can call it something like ―Brahmastra‖ of The Mahabharat War (I am emu-

lating Dr. Mahanty who very effectively gives examples from The Mahabharat).

Computerisation is one major change, but there are multiple changes within the organization such as establishing Postgraduate insti-

tutes, upgradation of infrastructure, taking over and merger of State schemes by ESIC. Trust hospital like MGM with its own trust deed

has challenges of changing superintendent, changes in union. While, there are changes in the organization we have changes in per-

sonal life – I have joined ESIC only a year back. There are changes in environment – changes in Medical Council of India, weather

changes, monsoon disaster, terror threats, so on and so forth. We cannot therefore take a simplistic view of change. The eight point

program by Kotter needs all the more to be carefully planned and implemented. This requires maximum support from all and unfl inch-

ing belief in the organization and its goal and above all faith in leadership . We are very fortunate to have Dr. C.S. Kedar to lead us.

You may remember Dr. Kedar showed a mesmerizing video which illustrated how a group of Software Engineers produced ―3 dimen-

sional virtual reality‖ project. Dr. Kedar as secretary for tourism dreamt that why not King Krishnadevraya himself appear when tourists

visit the ruins of Hampi. The software engineers made this vision possible through technology. I showed this video in Baltimore, USA in

the change management workshop (Dr. Kedar had graciously allowed me to copy it from his laptop). The impact of this video was phe-

nomenal. It is said that ― if you want to go fast, go alone, if you want to go far, go with others‖

Just like ESIC, which has a great vision for future .

ALL ABOARD!

AK MUKHOPADHYAY

RD, ESIC MP

We often use the metaphor of stake-

holders ―being on board‖. However,

how communication is managed on

large projects may not always lead

to this outcome.

If you want all of your stakeholders

to come on board, your train must

depart from where the stakeholders

are. This seems so obvious, yet it is

one of the most common mistakes

made in change projects. We all

approach life from within our

own perspective – each of us have a

unique set of knowledge, assump-

tions, beliefs, values, habits, norms,

personality traits, perceptions, fears,

hopes, quirks, strengths and weak-

nesses. Perspectives can differ so

greatly that it can be extremely diffi-

cult (or even sometimes virtually

impossible) for us to understand the

perspectives that others have.

A project team therefore tends to

develop overlapping areas of shared

perspective, and also advances

quite rapidly ahead of where the bulk

of stakeholders are, creating a large

gap in relative understanding and

relative acceptance with regard to

the project. This might make it very

difficult for the project team to effectively engage with stakeholders. Project teams tend to be passionate (and therefore to communicate)

about what is important to them (the business case, project phases and key milestones, the composition of the project team, the impor-

tance of buy in and support from stakeholders) instead of what is important to stakeholders.

Most project teams rapidly develop a specialised ―language‖ which is different to what most stakeholders are used to. Acromyms

and specialised terminology present a significant barrier to stakeholders who are not part of the project team and therefore have not

learnt to the new ―language‖. The attitudes of project team members toward the project are usually very different to the atti tudes that

most stakeholders have. Project team members may overestimate the extent to which stakeholders will support the project, and may

feel resentful when stakeholders assign a low priority to the project, show poor support and commitment or even resist the project. From

the stakeholder point of view, project team members might appear to be unrealistically optimistic, to act in their own self-interest or as if

they have a hidden agenda, and be regarded as being manipulative.

In the project world, plans change often and with little notice, it is taken for granted that people will go to extraordinary effort to get things

done in time, and it is acceptable to schedule meetings after hours and at the last minute. This same behaviour normally is regarded as

being inconsiderate and disruptive. This may result in a situation where project members see business resources as being lazy, uncar-

ing and uncooperative, and business resources see project members as being arrogant, pushy, rude and self-important.

The challenge is not only that there tends to be a large gap between the point of departure of the project team and the point of departure

of stakeholders who are not part of the project team – a further complication is that perspectives will change over time, and what might

be an entirely appropriate strategy for stakeholder engagement at one point in time may not be appropriate two months later. As stake-

holders progress with regard to their understanding of the project and its consequences, their information needs will change and they

will require increasing amounts of personal interaction.

Chaos theory is a field of study in mathematics, physics, economics, and philosophy study-

ing the behavior of dynamical systems that are highly sensitive to initial conditions. This sen-

sitivity is popularly referred to as the butterfly effect. Small differences in initial conditions

(such as those due to rounding errors in numerical computation) yield widely diverging out-

comes for chaotic systems, rendering long-term prediction impossible in general. This hap-

pens even though these systems are deterministic, meaning that their future behavior is fully

determined by their initial conditions, with no random elements involved. In other words, the

deterministic nature of these systems does not make them predictable. This behavior is

known as deterministic chaos, or simply chaos.

An early pioneer of the theory was Edward Lorenz whose interest in chaos came about acci-

dentally through his work on weather prediction in 1961. Lorenz was using a simple digital

computer, a Royal McBee LGP-30, to run his weather simulation. He wanted to see a se-

quence of data again and to save time he started the simulation in the middle of its course.

He was able to do this by entering a printout of the data corresponding to conditions in the

middle of his simulation which he had calculated last time.

To his surprise the weather that the machine began to pre-

dict was completely different from the weather calculated

before. Lorenz tracked this down to the computer printout.

The computer worked with 6-digit precision, but the printout

rounded variables off to a 3-digit number, so a value like

0.506127 was printed as 0.506. This difference is tiny and

the consensus at the time would have been that it should

have had practically no effect. However Lorenz had discov-

ered that small changes in initial conditions produced large

changes in the long-term outcome. Lorenz's discovery,

which gave its name to Lorenz attractors, showed that even

detailed atmospheric modeling cannot in general make long-

term weather predictions. Weather is usually predictable

only about a week ahead A plot of the Lorenz attractor for values r = 28, σ = 10,

THE CHAOS THEORY—

THE BUTTERFLY EFFECT EXPLAINED MATHEMATICALLY!

E-GOVERNANCE: NOTES ON CHALLENGES IN IMPLEMENTATION

MILAN NARENDRA, WIPRO LIMITED

―Electronic Governance (e‐Governance) is the application of information & communication technologies to trans-

form the efficiency, effectiveness, transparency and accountability of informational & transactional exchanges.

These exchanges can be within government (G2G), between government and government agencies of National,

State, Municipal & Local levels, citizen & businesses (G2B), and to empower citizens through access & use of

information (G2C)‖ e‐Governance is the application of Information Technology to the Government functioning in

order to bring about Simple, Moral, Accountable, Responsive and Transparent (SMART) Governance.

To initiate any e-Governance project, the capacities required are much more comprehensive and holistic than a conventional Software

Development Life Cycle (SDLC) project. E-Governance initiatives entail policy development/refinement, Financial Management, Pro-

gram Management and warrant a higher emphasis on Change Management. Apart from this, creation of Institutional structure which

brings continuity to a project. However traditionally these have not been areas of focus. Hence while initiating any e-Governance pro-

jects there is an urgent need to develop capacities in all these areas at all the levels of Governance – Centre, State and Local Bodies.

Based on Wipro‘s prolific experiences in executing, and implementing e-Governance Solutions in all capacities – Consultant, System

Integrator or Implementing Agency, it gives me strength to identify the potential issue as being classified under five broad categories –

Ownership

Overall ownership of the initiative at State Level

Ownership of the line departments

Ownership at district / sub-district levels

Change Management

Acceptance of e-forms / suggested changes by employees

Capacity / skill enhancement

Awareness / acceptance among citizens

Legal and Regulatory

Government orders for implementation of changes

Service delivery based on electronic submission

Acceptance of database for reference for service delivery

Technology/Infrastructure

Backend integration

Maturity of State initiatives / SSDG

Integration across Departments

Connectivity / readiness of departments

Implementation and Sustenance

Continuity of key project champions

Project reviews and escalation procedure

Adherence to SLAs in view of manual workflows

Budgets for sustenance( AMC, Consumables)

Fading away of the initiative in the absence of back-end automation

Coordination between stakeholders

E-governance projects tend to redefine power equations within departments. Stakeholders outside government are also often im-

pacted. Some people lose power, some people gain. This leads to stresses and strains within and outside the organization, which if not

managed with finesse, lead to early demise of the project. The challenge is to clearly identify all internal and external stakeholders in a

project, their goals, the extent to which these can be harmonized and factored in, the likely impact on all stakeholders and their likely

reaction.

These issues can be addressed by ensuring continuity of the program and project in the event of change in key persons / project cham-

pions, during the course of the project

Providing ―capacity ramp-up‖ plan for manpower scaling

Providing full ownership to the State Government and Government Departments for implementing the projects

Catalyzing administrative, process and legal changes required within the State Government

Providing stronger focus on change management through efficient communication, workshops, etc.

Alignment of interests of the key stakeholders (Central Line Ministries, State Governments, Department of IT at entre and State,

etc. thereby synergizing various efforts

NEW PROJECT ON SOCIAL SECURITY IN INDIA – THE UNORGANISED SECTOR

The Long Road to Social Security: Assessing and Monitoring the Implementation of Social Security for the Working Poor in

India's Informal Economy is a knowledge project on social security provisions for workers in the informal sector of the economy in In-

dia. This project is a cooperation between the Amsterdam School for Social science Research, the Centre for Development Studies in

Trivandrum, India, and Hivos, a Dutch non-governmental organisation guided by humanist values. The project focuses on monitoring the

implementation of minimal welfare provisions in India for workers in India's informal

economy.

Until the end of 2008, providing a modicum of social security to the workers in In-

dia‘s informal economy that overwhelmingly comprises of small farmers and casual

wage workers in rural areas and the self-employed and casual wage workers in

urban areas did not receive adequate national priority either in terms of policy or

legislation. However, this became a national agenda following its incorporation in

the election manifesto of the present Government in 2004.

When the government was voted to power, one of the first steps taken was to ap-

point a National Commission for Enterprises in the Unorganised Sector (NCEUS)

that was mandated, inter alia, to examine and recommend social security measures

for the workers in the informal sector. The Report on Social Security for Unorgan-

ised Workers was the first report submitted by this Commission in 2006 that con-

tained a comprehensive National Minimum Social Security scheme along with a

draft bill for consideration by the Indian Parliament. A considerably watered down

version of this bill was subsequently introduced by the Government in Parliament

that was thoroughly examined by a Parliamentary Standing Committee (PSC) con-

sisting of representatives from all major parties in the parliament. The Parliamen-

tary Standing Committee not only amended the draft bill by restoring all the recom-

mendations of the NCEUS but also added a few more to enlarge the coverage with

a strict time frame for implementation. However, the government did not accept any

substantive recommendations of the PSC and preferred to reintroduce the original

version with some minor amendments that was subsequently passed by the parlia-

ment and entitled the Unorganised Workers Social Security Bill.

While national legislative framework has come into place, the initiative is now left to

the agencies and departments of the central government to introduce social secu-

rity schemes for the welfare of the huge workforce and to reduce their vulnerability

and create the beginning of a safety net which these people require in order to bet-

ter cope with health risks and old age in particular. Interestingly, a health insurance

scheme covering only the households below the officially determined poverty line

has been enthusiastically responded to by the states for implementation in their

respective regions.

The aim of this knowledge project is not to get engaged in large-scale surveys but

to operationalise the project in a number of case studies in different parts of the

country (Punjab, Gujarat, Orissa, Andhra Pradesh and Kerala) both in urban and

rural locations of the informal sector economy. The research is meant to be action-

oriented and will focus on findings which can be fed back in the policy process of

official agencies and civic stake-holders such as trade unions and civil society or-

ganisations. Thereto the researchers will actively dialogue with these stakeholders

throughout the process. Generating knowledge is an important objective of this

research project and is part of a comprehensive approach to knowledge processes

including dissemination, strategy formation and application.

PEOPLESPEAK!

Thanks for sending the Newsletter . I liked many things about it… Firstly it is nice to get it on email , with good font and easy scrollability , easy to read! …The idea of news letter is excel-lent , it is good to know how others are handling various issues …you may include time table of events acclivities , training programs in the months ahead, in the newsletter

Dr Nilima Kshirsagar Dean PGIMSR MGM, Mumbai

Heartiest congratulations for October issue of the lighthouse. it is really a source of inspiration and great pleasure to have this noble thing. i wish all my best wishes for hundred and one percent success of Project Panchdeep and assure that every efforts shall be made to bring this great thought into realty.

Rakesh Chauhan

Dy. Director, RO Jammu.

I went through the rich and varied contents of the e-mag. What makes it pleasantly different from other such initiatives is that it not only gives food for the thought and action but also highlights results and the evolving best prac-tices.

Narendra M. Ojha , New Inductee Dy. Director, on e-mail

Very encouraging OCTOBER story by our DG Sir, definitely will touch all the persons who work with open mind.

Dr AK Sharma

MS, ESIH, Adityapur

Sir, I am very thankful to you for your Newsletter. I hope to receive more information. I am trying to ensure the success of PANCHDEEP

Dr. Atul Nath.

Thanks for lighthouse magazine. It was infor-mative as well motivating. It provided new in-sight about Project Panchdeep. Stories were quite motivating and giving new way of thinking towards work.

Rakesh Kumar

New Inductee Dy. Director, on email

"Twenty years from now you will be more disappointed by the things you didn't do than by the ones you

did do. So throw off the bowlines. Sail away from the safe harbor. Catch the trade winds in your sails.

Explore. Dream. Discover."

Mark Twain

esic.cm2@wipro.com

www.wipro.com

EDITORS

Vashima Shubha

Sandeep Srivastava

WIPRO LIMITED

Plot 480-481

Udyog Vihar Phase - III

Gurgaon

Change, The Inevitable!

Change is the moving of the hourglass sands, It's the coming of dawn after dark.

Change is taking one step at a time, The emotion in each persons heart.

Change is to one man the death of a friend,

To another the birth of a child.

Change is the shifting of soft winds of spring,

to a hurricane deadly and wild.

But change in the end, will not change at all

The one constant in everyone's lives

Change is the light at the end of the tunnel

The healer who opens our eyes.