What India can learn from Agile Alliance, USA to provide equitable access to healthcare for its poor?

By Srikrishna Mamidipudi and Professor DVR Seshadri

EHAC – A consortium of virtuous healthcare providers

A knowledgeable group of healthcare professionals gathered on November 12, 2022, to discuss the future for the Equitable Healthcare Access Consortium (EHAC), a group of organisations and individuals working to provide ‘Equitable Healthcare Access to All’ by fostering a culture of cooperation, cross-learning, education, and healthcare transformation.

The gathering included several notable healthcare service veterans who have inspired generations by setting an example of how to build successful healthcare enterprises while providing high-quality care for the underprivileged. The collective included many thought leaders: Dr. Gullapalli Nageswara Rao, Founder of the L.V. Prasad Eye Institute in Hyderabad, who, motivated by social injustice, combined excellence and equity to create a centre for excellence in ophthalmology; Mr. M.P. Vasimalai, Executive Director, DHAN Foundation, Madurai, who, moved by the plight of rural poor, dedicated his life to developing motivated professionals who could work for the poor in villages, tribal areas, coastal areas and urban slums; Dr. Evita Fernandez, Chairperson of Fernandez Foundation, Hyderabad a passionate advocate of normal birthing, who has been instrumental in de-medicalizing pregnancy and birthing; Dr. Chandrasekhar Chikkamuniyappa, a Senior Joint Replacement Surgeon who has been committed to providing free and subsidised medical care for underprivileged patients; and Mr. R. D. Thulasiraj, Director, Aravind Eye Care Systems, Madurai. Additionally, over twenty eminent academicians, entrepreneurs, public health specialists and healthcare industry leaders were in attendance.

Rich discussions on the role of EHAC ensued, with topics that included, ‘How to strengthen primary healthcare in India’, chaired by Mr. Jagdeep Gambhir, Founder, Karma Healthcare; ‘How responsible healthcare can be mainstreamed in the country on a larger scale,’ chaired by Mr. R. D. Thulasiraj; and ‘Offering fellowships/internships for the member organisations and individuals so that they could imbibe the spirit of providing equitable healthcare’, chaired by Dr. Evita Fernandez.

The EHAC meeting can be compared oddly with another significant event in Utah, United States of America, that brought together like-minded software experts to investigate how software business practices may be changed by introducing new working methods.

Agile Alliance as a model for EHAC

Seventeen people gathered in the Wasatch Mountains of Utah from February 11–13, 2001, at The Lodge at Snowbird Ski Resort to converse, unwind, and look for common ground. They all felt honoured to be part of a team of individuals who shared similar values based on mutual trust and respect, supporting organisational models based on teamwork and creating the kinds of organisational communities they would like to work in. The collective crafted a Manifesto containing a set of values, principles, and practices for Agile Software Development. It formed Agile Alliance, a global non-profit organisation disseminating information about Agile, which refers to a group of software development methodologies based on iterative development, where requirements and solutions evolve through the collaboration of self-organising cross-functional teams.

The Agile Alliance organised a two-day conference inviting like-minded software leaders across the country. The Manifesto spurred fierce debates in the software industry, provoking professionals to consider adopting more agile working methods. The Agile Alliance now has more than 72,000 members who provide time, effort, and funds to help them achieve their mission to build a better industry. The group conducts yearly conferences and monthly events for its members. These include Game On! – Applied learning with Agile games, Agile Coaching Network – a webcast and a podcast that enables members to learn and share with other Agile practitioners, BYOC (Bring your own coffee) – an agenda-less meeting for members to share knowledge, discuss options, challenge assumptions, unlearn and learn together, Member Meet and Greet – a virtual lounge creating opportunities for new members to network, and Agile TechTalks – a series of virtual talks and workshops that explore technical topics and grow Agile engineering practices in remote settings. In addition, the Agile Alliance website provides members with all the resources needed to adopt Agile as a practice through videos, conference presentations, research papers, and experience reports. They also have a dedicated career centre for organisations looking to hire aspiring Agile professionals. EHAC can take inspiration from many of Agile Alliance’s initiatives to build a community of virtuous healthcare practitioners in India and abroad.

Taking EHAC Forward: Developing a Manifesto and Disseminating Information

Over the years, the high-calibre group at EHAC thoughtfully designed the consortium's purpose, values, mission, and vision, which is bold, ambitious, and urgently needed in the country, to bring high-quality healthcare that is accessible and affordable to all those in need. EHAC must now scale up to take its valuable ideology to build a robust organisation. While most healthcare organisations have access to the “hardware”—access to trained personnel, infrastructure, and capital—EHAC members can collaborate to develop the “software”—a set of values, principles and practices that healthcare organisations worldwide can adhere to, even in the remotest locations, to provide equitable access to high quality healthcare in a responsible manner.

The core purpose of EHAC is ‘To create and promote a network of organizations who will continually find ways to provide Equitable Healthcare Access to All through outstanding synergies by embracing a culture of collaboration, cross learning, education and transformation.’

EHAC’s core values can best be captured by the five E’s:

Excellence in Healthcare (Enabe excellence and high-quality healthcare to everyone, regardless of race, age, gender, religion, location, caste, community, and socio-economic status, irrespective of their ability to pay.)
Encourage Collaboration (Put in place systems and processes to bring together diverse skills by exploring collaborative and complementary initiatives and leveraging cross-learning to maximize the benefit to the communities it serves.)
Enabling Environment (Create enabling environments that foster creative ways in which different organisations can work together, innovate ways to bring together public health and private practice, facilitate formulation of suitable healthcare policies by the government, assist in devising means to ensure sustainability of the member organisations and explore ways to enhance healthcare inclusivity in the society.)
Ethical Behaviour & Practices (Foster an ethical environment that motivates and supports young and idealistic professionals and organisations in the areas of healthcare, livelihood, and education to work for the vision of EHAC. It shall bring on board members who are ethical both in precept and practice.)
Evidence-based Practice (Leverage and document data, insights, and knowledge, to enable sharing of best practices to deliver healthcare cost-effectively through creating a fast-paced learning environment, thus enabling sound research around evidence-based care through community pilot initiatives and partnerships, etc., and encouraging all healthcare organisations to continually strengthen evidence-based practice.)

As was the case with Agile Alliance, the Manifesto of EHAC, that is anchored in the above Core Purpose and Core Values, can inspire competent healthcare leaders through broad guidelines while they set out to create unique healthcare models that suit their context.

EHAC can also look to the Agile Alliance as a benchmark to create a strong network of healthcare professionals who are aspiring to make a difference. The EHAC community has several role models that medical students and young professionals can emulate. To reform healthcare, a large nation like India needs more hands, hearts, and minds, which EHAC seeks to foster.

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