India accounts for a sixth of the world's population. But only a sixth of India's billion people have access to affordable healthcare. The rest are neglected much like the diseases that afflict them. Medical help is inaccessible and simply beyond their means. In fact, the cost of staying alive pushes one quarter of Indians below the poverty line. Those who require hospitalisation are perennially repaying debts and it is important to note that rural indebtedness caused by illness is far greater than that caused by crop failure.

India's disease profile features 8.5 million patients infected with tuberculosis (TB), 5.1 million people who are HIV+, 2.1 million suffering from malaria and an estimated 35 million diabetics, which makes India the world's largest in all these disease segments. In the area of metabolic diseases and cancer, India's patient profile mirrors that of the Western world. Such a disease burden could bankrupt even the most affluent of nations.

Developing and maintaining sustainable healthcare delivery for people in the poorest countries of the world is, indeed, a gigantic, if not an insurmountable, challenge. There is an urgent need to provide access to affordable healthcare in a sustainable manner. Furthermore, this should be based on an underlying strategy of preventive, rather than curative, medical care if we are to improve India's health indicators. The only viable proposition is an insurance model that will support millions across India's rural hinterland through a large network of hospitals and clinics. Roughly translated, it means "Insuring Affordable Healthcare".

India's demographics reflect a young population with a median life expectancy of 57 years and a median age of 26 years. This has the potential to provide a workable basis for a sustainable and affordable healthcare model. As Winston Churchill said: "Insurance brings the miracles of mathematical probability to the rescue of the masses." This is in sharp contrast to the aging populations of Western economies where healthcare bills are mounting to unsustainable levels.

In recent times, several low cost health insurance models have taken root. The most visible programme is the Yashaswini Health Insurance scheme introduced by the Government of Karnataka in 2003. Under this programme, members of various co-operatives in the state receive an insurance cover against an extensive list of surgical procedures (1,650 in all) for a nominal premium of Rs 120 per annum. Another private initiative, Arogya Raksha Yojana, is a comprehensive health insurance scheme that goes beyond surgeries and encompasses hospitalisation, free medical consultations and low cost medicines all for a modest premium of Rs 180 per annum. Both these programmes rely on a network of established government and private hospitals and clinics (as the case may be), to provide quality healthcare to rural communities. Theoretically, at an annual insurance premium of Rs 180 or approximately $4, India should be in a position to provide basic healthcare to its billion people for an unbelievable $4 billion (Rs 18,000 crore)! This is a hypothesis well worth establishing.

Success in the long-term battle against illness and disease in developing nations is increasingly becoming more dependent on education and efficient infrastructure. It is, therefore, critical to create awareness on health and hygiene and provide efficient systems by leveraging information technology. Preventive healthcare is more sustainable than undertaking the life-long treatment of a disease that has already declared itself. It is often the simplest essentials that are required in order to break out of the vicious circle of infection and ignorance.

Information technology and telecommunications have an increasingly enabling role to play in healthcare management. The importance of telemedicine and electronic data capture in providing enhanced medical information for diagnosis and treatment is key to building an efficient model. Additionally, building databases and disease registries will enable such insurance programmes to evaluate the incidence and diversity of diseases at an epidemiological level and, thereby, allow for better optimisation.

The cost of drugs is another key factor in addressing affordable healthcare. The Indian market is known to offer the cheapest generic drugs in the world. Eliminating marketing and distribution costs reduces this even further. Arogya Raksha Yojana, for instance, sources low-cost generic drugs and makes them available at between 30-50 per cent of retail prices through a network of in-house pharmacies. Spurious drugs are another factor that is severely detrimental to affordable healthcare. Programmes like the one mentioned above are addressing this through a quality control system that aims to create a controlled supply chain that is designed to eliminate any devious intrusion from fakes.

India provides a unique platform for affordable drug development. Up until now, Indian industry has built a globally competitive generic pharmaceutical business. The time has come to research and develop improved and new medicines. This intrinsically challenges Indian industry to balance the high cost of R&D with market affordability. In this context, it is prudent to highlight that patented drugs, especially biotech drugs account for less than 5 per cent of the total market purely on account of unaffordability. The challenge is to provide new and advanced medicines, especially biotech drugs, to patients at the bottom of the pyramid. This will only be possible if Indian pharma and biotech companies step up their innovation-led research programmes and pursue an indigenous development path that allows for affordable and cost effective drug development routes.

Public-private partnerships are integral to building efficient, sustainable and quality healthcare models in rural India. The government's Primary Healthcare Centres (PHCs) are inadequately designed and ill-equipped to deliver such objectives. Today, it is non-governmental organisations, the World Health Organisation and private initiatives like those of Rotary, Lions and others that have addressed mass immunisation programmes more extensively than PHCs. Others like the Gates Foundation, MMV, IAVI, etc., are investing in health education as well as research initiatives in the area of aids, malaria and infectious diseases. PHCs are simply not providing comprehensive healthcare efficiently. India's changing demographics call for changing and contemporary healthcare delivery models. PHCs need to form linkages with the private sector if they are to function as contemporary and effective health providers to the nation. One such initiative involves Arogya Raksha Yojana being entrusted with the management and operations of PHCs on existing government budgetary support. The strategy is to link it to an insurance programme that value adds to the PHC concept.

The backbone of future healthcare programmes needs to rest on hygiene awareness campaigns that cover water, sanitation and personal hygiene. The ultimate goal should be to help people move towards a better quality of life. Good hygiene means good health. There exists a sharp disconnect between urban and rural healthcare in India and if we continue to ignore this deepening divide, we run the dangerous risk of destabilising our social and economic fabric. The time has come to provide basic healthcare to our billion people. Accessibility and affordability need to be integral to this mission and any low cost health insurance model will ensure rural Indians a better quality of life.

The author is Chairman & Managing Director, Biocon Limited