Subsidiarity & public policy

There are goals which we wish to pursue faster in public interest but often lose track of certain values of subsidiarity in design, action, review and redesign. What does subsidiarity imply in the context of public policy?

For instance, the long overdue goal of removing open defecation through building toilets. I was talking to one of the district level officers recently. I asked whether the design of the toilet pot has been made variable in respect to the water available for cleaning per use in different pockets of the district. It had not been done.

We know the situation about drinking water availability in the country. Situation for sanitation may not be that bad but availability is constrained in many places. If many of these toilets get choked after some time and girls continue to suffer in schools and other places, where these much needed toilets are non-functional, we will have to blame ourselves. Why did not we use public policy space for enough decentralisation, reflection on the design suitable for given water constrained situation, and what remedies are available for mid-course correction. Won’t it be embarrassing if a large number of toilets are found to be not used well because of improper design to begin with?

Can we not combine speed, scale and successful implementation through efficient adaptation of location specific design? What is remarkable is that national policy does take note of this problem very graphically.

 

How do we ensure that we reward innovations in design, delivery, and disposal and reuse of waste material if old design has to be scrapped and replaced by new design? Similarly government issues guidelines to banks to give loans to start-ups recently. Two loans to SC/ST and other disadvantaged clients per branch. Under Start-up India, Stand-up India, massive facilities have been offered by the government.

 

But when one visits the portal (http://pmjandhanyojana.co.in/start-up-india-stand-up-india-scheme/) and looks at the responsiveness, earlier for first few months, at least reply were being given. Of late, the comments are not being responded. Obviously, no senior officer may be monitoring such responses or lack of them to make this well intentioned programme more effective.

 

We surely can make changes in our portal so that if some comment is not responded in reasonable time, the unanswered question or comment is escalated to a higher officer. This will ensure that at least in two weeks, all concerns are responded. When I reviewed the links at http://smallb.sidbi.in/%20/fund-your-business/financing-schemes-various-banks and checked a few schemes of banks, I found that their guidelines still stress on mortgage of immovable assets and other assets, as required earlier for small business loans.

 

The impact of various concessions announced by the government is not visible in these schemes. If this factor, so vital for customer service and success of the start-up movement is supported by user satisfaction surveys and monitoring of changes in these schemes, the results would have been better.

 

We have knowledge. We also have some feeling, but when it comes to translating our feelings into action, we sometimes falter, as I have argued in my recent book: Grassroots Innovation: Minds on the margin are not marginal minds (2016).

I hope we will avoid making a trade-off between values of serving society and velocity with which this service is provided with desirable consequences. This is a movement.

Corridor of creativity: Medical innovations by patients, doctors and nurses

No matter how empathetic a delivery system, there is always a scope to do more, to do better and to think farther.  During my recent visit to Postgraduate Institute of Medical Education and Research, Chandigarh for a foundation day lecture on Doctors as Designers of an inclusive healthcare system, I learnt so much about the innovations involving patients, their wards, nurses and other staff as co-creators.  Somehow, the intellectuals tend to take over far too much responsibility of thinking and doing.  We ignore the contribution grassroots workers within and outside an organisation can make towards a very creative and innovative ecosystem. 

PGI Infusion

During the informal interaction with the Director, Dr. Yogesh Chawla, Dean, Dr. Arunaloke Chakraborti, innovative students and faculty, it was learnt that despite being a premier institute of tertiary research and practice of medical science, PGIMER received about 10000 patients every day.  The more caring they were, more demands were made on them from the entire region.  I was keen to know whether doctors and patients together had developed some innovative solutions.

 

What Dr.G.D.Puri shared is not only an inspiring one but also very relevant for all other hospitals which would wish to learn from their patients and the wards.  Dr. Puri explained that while giving infusion to the patients, sometimes he needed to know when a specific  volume had been delivered, say 200 ml out of 500 ml saline.  The wards keep an eye and then communicate the information to the nurse and the doctor to do the needful.  Dr. Puri being a surgeon had to focus on surgery rather than keeping track of every infusion to critical patients.  He discussed this problem with the wards of the patients and discovered a very innovative possibility.  Mr. Kalia, a technical assistant was attending on his relative who needed such monitoring.  They both discussed the idea and realised that a weight based alarm system would be easiest to design and solve the problem.  Dr.Kalia was working with a company, Clarity which helped him to design a small device with a hook on which bottle could be hung.  At the predetermined level, the alarm would indicate the need for stopping the flow or taking the next step.  When I asked this question in my SMIPR class yesterday, students came out with several ideas such as flow meter, timer and several other possibilities till one student thought about a balance to weigh and signal an alarm.  Mr. Kalia was no less talented than my class at IIMA and that too with far less qualification.  An invention was born [see fig]. 

 

Imagine similar opportunities for redesigning a whole range of devices, delivery systems and other patient monitoring systems in which the patients, their wards and nurses who face the constraint can contribute positively to solving the problem.  These solutions when designed by materially constrained people invariably turnout to be a frugal innovation.  Given the empathetic context in which such a dialogue takes place, the samvedana is inherent in the srijansheelta.   Let me give you another example of Dr. Kusum Sharma who wanted to develop a quick system for identifying TB.  With the help of similar discussion with affected people, staff and students, she has designed a very low cost solution.  Dr. Reddy regretted that many of the terminally ill patients with a need to use feeding tubes could not taste the food.  He wanted the evening of the life of such patients to be more meaningful.  He designed a tubing with corrugated filter inserted in the oesophagus so that food after being tasted went to the inserted tube. 

 

There was another interesting example for monitoring children who sometimes feel uncomfortable and squirm in the cradle.  Generally, we take note only when the child cries.  Some doctors thought about an image processing device on the top of the cradle to indicate the discomfort of the child.  How nice of the doctors and the nurses to be so sensitive to the child’s needs.  There were many other innovations being done at this and many other institutions.  As Dr. Chawla mentioned, they were so occupied with day to day care of the patients that innovations even when tried did not often get catalogued, shared and celebrated.  I requested him to start a corridor of creativity in which such innovations and even the challenges could be displayed.  When patients, wards and the staff walk through the corridor, they feel envious, inspired or provoked to do something different themselves.  Once the seeds of impatience with inertia are sown, the sprout of an innovative idea become inevitable.  The student innovators may note that under BIRAC-SRISTI partnership, SRISTI provides fifteen fellowships of  Rs 15 lac each and 100 fellowships of one lac each for grassroots innovations validated or value added by students,  Apply gyti.techpedia.in. For any query regarding sign up email us at gyti.techpedia@sristi.org .