[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:01.34,0:00:02.49,Default,,0000,0000,0000,,Take a minute
Dialogue: 0,0:00:02.52,0:00:05.33,Default,,0000,0000,0000,,and think of yourself\Nas the leader of a country.
Dialogue: 0,0:00:06.57,0:00:09.32,Default,,0000,0000,0000,,And let's say one\Nof your biggest priorities
Dialogue: 0,0:00:09.35,0:00:13.08,Default,,0000,0000,0000,,is to provide your citizens\Nwith high-quality healthcare.
Dialogue: 0,0:00:14.05,0:00:15.93,Default,,0000,0000,0000,,How would you go about it?
Dialogue: 0,0:00:15.95,0:00:17.81,Default,,0000,0000,0000,,Build more hospitals?
Dialogue: 0,0:00:17.83,0:00:19.90,Default,,0000,0000,0000,,Open more medical colleges?
Dialogue: 0,0:00:19.93,0:00:21.93,Default,,0000,0000,0000,,Invest in clinical innovation?
Dialogue: 0,0:00:23.17,0:00:26.61,Default,,0000,0000,0000,,But what if your country's health system\Nwas fundamentally broken?
Dialogue: 0,0:00:27.39,0:00:29.68,Default,,0000,0000,0000,,Whether it's doctor absenteeism,
Dialogue: 0,0:00:29.70,0:00:32.72,Default,,0000,0000,0000,,drug stock-outs or poor quality of care.
Dialogue: 0,0:00:33.45,0:00:35.25,Default,,0000,0000,0000,,Where would you start then?
Dialogue: 0,0:00:36.39,0:00:38.19,Default,,0000,0000,0000,,I'm a management consultant,
Dialogue: 0,0:00:38.21,0:00:40.05,Default,,0000,0000,0000,,and for the last three years,
Dialogue: 0,0:00:40.07,0:00:42.04,Default,,0000,0000,0000,,I've been working on a project
Dialogue: 0,0:00:42.07,0:00:45.57,Default,,0000,0000,0000,,to improve the public heath\Nsystem of Rajasthan,
Dialogue: 0,0:00:45.59,0:00:47.27,Default,,0000,0000,0000,,a state in India.
Dialogue: 0,0:00:48.29,0:00:50.57,Default,,0000,0000,0000,,And during the course of the project,
Dialogue: 0,0:00:50.60,0:00:53.40,Default,,0000,0000,0000,,we actually discovered something profound.
Dialogue: 0,0:00:54.52,0:00:59.49,Default,,0000,0000,0000,,More doctors. better facilities,\Nclinical innovation,
Dialogue: 0,0:00:59.51,0:01:01.05,Default,,0000,0000,0000,,they are all important.
Dialogue: 0,0:01:01.84,0:01:05.85,Default,,0000,0000,0000,,But nothing changes\Nwithout one key ingredient.
Dialogue: 0,0:01:06.34,0:01:07.49,Default,,0000,0000,0000,,Motivation.
Dialogue: 0,0:01:09.16,0:01:11.45,Default,,0000,0000,0000,,But motivation is a tricky thing.
Dialogue: 0,0:01:11.47,0:01:15.09,Default,,0000,0000,0000,,If you've led a team, raised a child,
Dialogue: 0,0:01:15.12,0:01:17.81,Default,,0000,0000,0000,,or tried to change a personal habit,
Dialogue: 0,0:01:17.83,0:01:20.90,Default,,0000,0000,0000,,you know that motivation\Ndoesn't just appear.
Dialogue: 0,0:01:21.66,0:01:24.66,Default,,0000,0000,0000,,Something has to change to make you care.
Dialogue: 0,0:01:25.86,0:01:30.60,Default,,0000,0000,0000,,And if there's one thing\Nthat all of us humans care about,
Dialogue: 0,0:01:30.62,0:01:35.03,Default,,0000,0000,0000,,it's an inherent desire\Nto shine in front of society.
Dialogue: 0,0:01:35.99,0:01:37.99,Default,,0000,0000,0000,,So that's exactly what we did.
Dialogue: 0,0:01:38.74,0:01:41.52,Default,,0000,0000,0000,,We decided to focus on the citizen.
Dialogue: 0,0:01:42.22,0:01:46.87,Default,,0000,0000,0000,,The people who the system\Nwas supposed to serve in the first place.
Dialogue: 0,0:01:47.76,0:01:48.97,Default,,0000,0000,0000,,And today,
Dialogue: 0,0:01:48.99,0:01:50.59,Default,,0000,0000,0000,,I'd like to tell you
Dialogue: 0,0:01:50.62,0:01:55.72,Default,,0000,0000,0000,,how Rajasthan has transformed\Nits public health system dramatically,
Dialogue: 0,0:01:55.74,0:01:59.55,Default,,0000,0000,0000,,by using the citizen\Nto trigger motivation.
Dialogue: 0,0:02:00.86,0:02:05.09,Default,,0000,0000,0000,,Now, Rajasthan is one\Nof India's largest states,
Dialogue: 0,0:02:05.12,0:02:08.12,Default,,0000,0000,0000,,with the population of nearly 80 million.
Dialogue: 0,0:02:08.93,0:02:11.46,Default,,0000,0000,0000,,That's larger than the United Kingdom.
Dialogue: 0,0:02:12.86,0:02:15.53,Default,,0000,0000,0000,,But the similarities probably end there.
Dialogue: 0,0:02:16.43,0:02:19.69,Default,,0000,0000,0000,,In 2016, when my team was called in
Dialogue: 0,0:02:19.71,0:02:23.76,Default,,0000,0000,0000,,to start working with the public\Nhealth system of Rajasthan,
Dialogue: 0,0:02:23.78,0:02:26.45,Default,,0000,0000,0000,,we found it in a state of crisis.
Dialogue: 0,0:02:27.29,0:02:28.69,Default,,0000,0000,0000,,For example,
Dialogue: 0,0:02:28.71,0:02:30.90,Default,,0000,0000,0000,,the neonatal mortality rate,
Dialogue: 0,0:02:30.92,0:02:36.15,Default,,0000,0000,0000,,that's the number of newborns who die\Nbefore their first month birthday,
Dialogue: 0,0:02:36.18,0:02:39.96,Default,,0000,0000,0000,,was 10 times higher than that of the UK.
Dialogue: 0,0:02:41.07,0:02:43.03,Default,,0000,0000,0000,,No wonder then that citizens were saying,
Dialogue: 0,0:02:43.05,0:02:46.22,Default,,0000,0000,0000,,"Hey, I don't want to go\Nto a public health facility."
Dialogue: 0,0:02:46.88,0:02:51.80,Default,,0000,0000,0000,,In India, if you wanted to see a doctor\Nin a public health facility,
Dialogue: 0,0:02:51.82,0:02:55.62,Default,,0000,0000,0000,,you would go to a PHC\Nor primary health center.
Dialogue: 0,0:02:56.57,0:03:01.80,Default,,0000,0000,0000,,And at least 40 patients\Nare expected to go to a PHC every day.
Dialogue: 0,0:03:02.67,0:03:04.29,Default,,0000,0000,0000,,But in Rajasthan,
Dialogue: 0,0:03:04.32,0:03:06.76,Default,,0000,0000,0000,,only one out of four PHCs
Dialogue: 0,0:03:06.78,0:03:09.45,Default,,0000,0000,0000,,was seeing this minimum\Nnumber of patients.
Dialogue: 0,0:03:09.47,0:03:13.46,Default,,0000,0000,0000,,In other words, people\Nhad lost faith in the system.
Dialogue: 0,0:03:15.35,0:03:17.52,Default,,0000,0000,0000,,When we delved deeper,
Dialogue: 0,0:03:17.54,0:03:22.21,Default,,0000,0000,0000,,we realized that lack of accountability\Nis at the core of it.
Dialogue: 0,0:03:23.51,0:03:24.66,Default,,0000,0000,0000,,Picture this.
Dialogue: 0,0:03:25.15,0:03:27.80,Default,,0000,0000,0000,,Sudha, a daily-wage earner,
Dialogue: 0,0:03:27.83,0:03:30.72,Default,,0000,0000,0000,,realizes that her one-year-old daughter
Dialogue: 0,0:03:30.75,0:03:33.55,Default,,0000,0000,0000,,is suffering from\Nuncontrollable dysentery.
Dialogue: 0,0:03:34.34,0:03:36.57,Default,,0000,0000,0000,,So she decides to take the day off.
Dialogue: 0,0:03:36.59,0:03:40.82,Default,,0000,0000,0000,,That's a loss of about\N350 rupees of five dollars.
Dialogue: 0,0:03:41.38,0:03:44.18,Default,,0000,0000,0000,,And she picks up her daughter in her arms
Dialogue: 0,0:03:44.20,0:03:47.74,Default,,0000,0000,0000,,and walks for five kilometers\Nto the government PHC.
Dialogue: 0,0:03:48.65,0:03:50.45,Default,,0000,0000,0000,,But the doctor isn't there.
Dialogue: 0,0:03:51.90,0:03:54.80,Default,,0000,0000,0000,,So she takes the next day off, again,
Dialogue: 0,0:03:54.82,0:03:56.56,Default,,0000,0000,0000,,and comes back to the PHC.
Dialogue: 0,0:03:57.24,0:03:59.31,Default,,0000,0000,0000,,This time, the doctor is there,
Dialogue: 0,0:03:59.34,0:04:01.06,Default,,0000,0000,0000,,but the pharmacist tells her
Dialogue: 0,0:04:01.09,0:04:04.43,Default,,0000,0000,0000,,that the free drugs\Nthat she's entitled to have run out,
Dialogue: 0,0:04:04.46,0:04:07.09,Default,,0000,0000,0000,,because they forgot\Nto reorder them on time.
Dialogue: 0,0:04:07.87,0:04:10.54,Default,,0000,0000,0000,,So now, she rushes\Nto the private medical center,
Dialogue: 0,0:04:10.57,0:04:11.91,Default,,0000,0000,0000,,and as she's rushing there,
Dialogue: 0,0:04:11.93,0:04:16.10,Default,,0000,0000,0000,,looking at her daughter's condition\Nworsening with every passing hour,
Dialogue: 0,0:04:16.12,0:04:18.12,Default,,0000,0000,0000,,she can't help but wonder
Dialogue: 0,0:04:18.15,0:04:20.66,Default,,0000,0000,0000,,if she should have gone\Nto the private medical center
Dialogue: 0,0:04:20.69,0:04:21.86,Default,,0000,0000,0000,,in the first place,
Dialogue: 0,0:04:21.89,0:04:23.100,Default,,0000,0000,0000,,and payed the 350 rupees
Dialogue: 0,0:04:24.02,0:04:26.62,Default,,0000,0000,0000,,for the consultation and drugs.
Dialogue: 0,0:04:28.65,0:04:31.39,Default,,0000,0000,0000,,No one is held accountable
Dialogue: 0,0:04:31.42,0:04:35.04,Default,,0000,0000,0000,,for this incredible failure of the system.
Dialogue: 0,0:04:36.27,0:04:41.51,Default,,0000,0000,0000,,Costing time, money,\Nand heartache to Sudha.
Dialogue: 0,0:04:43.94,0:04:46.68,Default,,0000,0000,0000,,And this is something\Nthat just had to be fixed.
Dialogue: 0,0:04:47.32,0:04:50.32,Default,,0000,0000,0000,,Now, as all good consultants,
Dialogue: 0,0:04:50.34,0:04:53.76,Default,,0000,0000,0000,,we decided that data-driven reviews
Dialogue: 0,0:04:53.79,0:04:56.99,Default,,0000,0000,0000,,had to be the answer\Nto improve accountability.
Dialogue: 0,0:04:57.51,0:05:01.40,Default,,0000,0000,0000,,So we created these fancy\Nperformance dashboards
Dialogue: 0,0:05:01.42,0:05:04.32,Default,,0000,0000,0000,,to help make the review meetings\Nof the health department
Dialogue: 0,0:05:04.34,0:05:06.36,Default,,0000,0000,0000,,much more effective.
Dialogue: 0,0:05:07.26,0:05:08.59,Default,,0000,0000,0000,,But nothing changed.
Dialogue: 0,0:05:09.60,0:05:11.63,Default,,0000,0000,0000,,Discussion after discussion,
Dialogue: 0,0:05:11.66,0:05:14.08,Default,,0000,0000,0000,,meeting after meeting,
Dialogue: 0,0:05:14.10,0:05:16.37,Default,,0000,0000,0000,,nothing changed.
Dialogue: 0,0:05:17.24,0:05:19.33,Default,,0000,0000,0000,,And that's when it struck me.
Dialogue: 0,0:05:19.36,0:05:21.34,Default,,0000,0000,0000,,You see, public systems
Dialogue: 0,0:05:21.36,0:05:24.89,Default,,0000,0000,0000,,have always been governed\Nthrough internal mechanisms.
Dialogue: 0,0:05:24.91,0:05:27.14,Default,,0000,0000,0000,,Like review meetings.
Dialogue: 0,0:05:27.68,0:05:29.12,Default,,0000,0000,0000,,And over time,
Dialogue: 0,0:05:29.14,0:05:32.79,Default,,0000,0000,0000,,their accountability to the citizen\Nhas been diluted.
Dialogue: 0,0:05:33.56,0:05:37.09,Default,,0000,0000,0000,,So why not bring the citizen\Nback into the equation,
Dialogue: 0,0:05:37.12,0:05:40.54,Default,,0000,0000,0000,,perhaps by using the citizen promises?
Dialogue: 0,0:05:40.56,0:05:42.69,Default,,0000,0000,0000,,Couldn't that trigger motivation?
Dialogue: 0,0:05:44.46,0:05:48.70,Default,,0000,0000,0000,,We started with what I like to call\Nthe coffee shop strategy.
Dialogue: 0,0:05:49.45,0:05:53.05,Default,,0000,0000,0000,,You've probably seen\None of these signs in a coffee shop,
Dialogue: 0,0:05:53.07,0:05:54.32,Default,,0000,0000,0000,,which says,
Dialogue: 0,0:05:54.34,0:05:58.15,Default,,0000,0000,0000,,"If you don't get your receipt,\Nthe coffee is free."
Dialogue: 0,0:05:59.24,0:06:02.47,Default,,0000,0000,0000,,Now, the cashier has no option
Dialogue: 0,0:06:02.50,0:06:05.22,Default,,0000,0000,0000,,but to give you a receipt each time.
Dialogue: 0,0:06:06.72,0:06:11.03,Default,,0000,0000,0000,,So we took this strategy\Nand applied it to Rajasthan.
Dialogue: 0,0:06:11.90,0:06:13.71,Default,,0000,0000,0000,,We worked with the government
Dialogue: 0,0:06:13.73,0:06:18.47,Default,,0000,0000,0000,,on a program to revive 300 PHCs\Nacross the state.
Dialogue: 0,0:06:19.18,0:06:24.58,Default,,0000,0000,0000,,And we got them to paint very clear\Ncitizen promises along the wall.
Dialogue: 0,0:06:25.72,0:06:29.54,Default,,0000,0000,0000,,We assure you that\Nyou will have a doctor each time.
Dialogue: 0,0:06:30.30,0:06:33.56,Default,,0000,0000,0000,,We assure you that you will get\Nyour free drugs each time.
Dialogue: 0,0:06:34.30,0:06:35.53,Default,,0000,0000,0000,,We assure you
Dialogue: 0,0:06:35.55,0:06:38.47,Default,,0000,0000,0000,,that you will get\Nyour free diagnostics each time.
Dialogue: 0,0:06:39.21,0:06:42.61,Default,,0000,0000,0000,,And finally, we worked\Nwith elected representatives
Dialogue: 0,0:06:42.63,0:06:45.83,Default,,0000,0000,0000,,to launch these revived PHCs,
Dialogue: 0,0:06:45.85,0:06:49.19,Default,,0000,0000,0000,,who shared the citizen promises\Nwith the community
Dialogue: 0,0:06:49.21,0:06:51.17,Default,,0000,0000,0000,,with a lot of fanfare.
Dialogue: 0,0:06:52.21,0:06:55.99,Default,,0000,0000,0000,,Now the promise was out there in the open.
Dialogue: 0,0:06:56.89,0:06:58.82,Default,,0000,0000,0000,,Failure would be embarrassing.
Dialogue: 0,0:07:00.07,0:07:02.41,Default,,0000,0000,0000,,The system had to start delivering.
Dialogue: 0,0:07:04.21,0:07:05.92,Default,,0000,0000,0000,,And deliver it did.
Dialogue: 0,0:07:06.95,0:07:09.19,Default,,0000,0000,0000,,Doctor availability went up,
Dialogue: 0,0:07:09.21,0:07:11.07,Default,,0000,0000,0000,,medicines came on hand,
Dialogue: 0,0:07:11.10,0:07:12.58,Default,,0000,0000,0000,,and as a result,
Dialogue: 0,0:07:12.61,0:07:17.05,Default,,0000,0000,0000,,patient visits went up by 20 percent\Nin less than a year.
Dialogue: 0,0:07:18.25,0:07:22.24,Default,,0000,0000,0000,,The public health system\Nwas getting back into business.
Dialogue: 0,0:07:24.02,0:07:26.48,Default,,0000,0000,0000,,But there was still a long distance to go.
Dialogue: 0,0:07:26.95,0:07:28.48,Default,,0000,0000,0000,,Change isn't that easy.
Dialogue: 0,0:07:29.54,0:07:32.62,Default,,0000,0000,0000,,An exasperated doctor once told me,
Dialogue: 0,0:07:32.64,0:07:36.58,Default,,0000,0000,0000,,"I really want to transform\Nthe maternal health in my community,
Dialogue: 0,0:07:36.60,0:07:39.07,Default,,0000,0000,0000,,but I just don't have enough nurses."
Dialogue: 0,0:07:39.43,0:07:41.84,Default,,0000,0000,0000,,Now, resources like nurses
Dialogue: 0,0:07:41.87,0:07:45.36,Default,,0000,0000,0000,,are actually controlled\Nby administrative officers
Dialogue: 0,0:07:45.38,0:07:47.12,Default,,0000,0000,0000,,who the doctors report to.
Dialogue: 0,0:07:47.73,0:07:50.16,Default,,0000,0000,0000,,And while the doctors were now motivated,
Dialogue: 0,0:07:50.19,0:07:54.05,Default,,0000,0000,0000,,the administrative officers\Nsimply weren't motivated enough
Dialogue: 0,0:07:54.08,0:07:55.70,Default,,0000,0000,0000,,to help the doctors.
Dialogue: 0,0:07:57.33,0:08:00.23,Default,,0000,0000,0000,,This is where the head\Nof the public health department,
Dialogue: 0,0:08:00.25,0:08:03.39,Default,,0000,0000,0000,,Ms [unclear] Gupta, came up\Nwith a brilliant idea.
Dialogue: 0,0:08:04.19,0:08:07.81,Default,,0000,0000,0000,,A monthly ranking of all districts.
Dialogue: 0,0:08:08.30,0:08:12.29,Default,,0000,0000,0000,,And this ranking would assess\Nthe performance of every district
Dialogue: 0,0:08:12.32,0:08:14.18,Default,,0000,0000,0000,,on each major disease
Dialogue: 0,0:08:14.20,0:08:16.19,Default,,0000,0000,0000,,and each major procedure.
Dialogue: 0,0:08:17.12,0:08:18.84,Default,,0000,0000,0000,,But here's the best part.
Dialogue: 0,0:08:18.87,0:08:21.11,Default,,0000,0000,0000,,We made the ranking go public.
Dialogue: 0,0:08:21.65,0:08:23.72,Default,,0000,0000,0000,,We put the ranking on the website,
Dialogue: 0,0:08:23.74,0:08:26.08,Default,,0000,0000,0000,,we put the ranking in social media,
Dialogue: 0,0:08:26.11,0:08:29.01,Default,,0000,0000,0000,,and before you knew it,\Nthe media got involved,
Dialogue: 0,0:08:29.03,0:08:32.62,Default,,0000,0000,0000,,with newspaper articles\Non which districts were doing well
Dialogue: 0,0:08:32.65,0:08:34.18,Default,,0000,0000,0000,,and which ones weren't.
Dialogue: 0,0:08:35.40,0:08:37.92,Default,,0000,0000,0000,,And we didn't just want\Nthe district the rankings
Dialogue: 0,0:08:37.94,0:08:40.91,Default,,0000,0000,0000,,to impact the best and the worst\Nperforming districts.
Dialogue: 0,0:08:40.93,0:08:44.68,Default,,0000,0000,0000,,We wanted the rankings\Nto motivate every district.
Dialogue: 0,0:08:45.72,0:08:48.60,Default,,0000,0000,0000,,So we took inspiration\Nfrom soccer leagues,
Dialogue: 0,0:08:48.62,0:08:52.24,Default,,0000,0000,0000,,and created a three-tiered ranking system,
Dialogue: 0,0:08:52.27,0:08:54.80,Default,,0000,0000,0000,,whereby every quarter,
Dialogue: 0,0:08:54.83,0:08:57.73,Default,,0000,0000,0000,,if a district's performance\Nwere to decline,
Dialogue: 0,0:08:57.76,0:09:00.56,Default,,0000,0000,0000,,you could get relegated to the lower tier.
Dialogue: 0,0:09:00.94,0:09:03.80,Default,,0000,0000,0000,,But if the district's performance\Nwere to improve,
Dialogue: 0,0:09:03.82,0:09:06.86,Default,,0000,0000,0000,,you could get promoted\Nto the premiere league.
Dialogue: 0,0:09:07.54,0:09:09.67,Default,,0000,0000,0000,,The rankings were a big success.
Dialogue: 0,0:09:10.08,0:09:12.46,Default,,0000,0000,0000,,It generated tremendous excitement,
Dialogue: 0,0:09:12.48,0:09:17.11,Default,,0000,0000,0000,,and districts began vying with each other\Nto be known as exemplars.
Dialogue: 0,0:09:18.29,0:09:21.00,Default,,0000,0000,0000,,It's actually very simple\Nif you think about it.
Dialogue: 0,0:09:21.33,0:09:26.22,Default,,0000,0000,0000,,If the performance data\Nis only being reviewed by your manager
Dialogue: 0,0:09:26.24,0:09:28.30,Default,,0000,0000,0000,,in internal settings,
Dialogue: 0,0:09:28.32,0:09:30.59,Default,,0000,0000,0000,,it simply isn't motivating enough.
Dialogue: 0,0:09:31.38,0:09:34.06,Default,,0000,0000,0000,,But if that data is out there,
Dialogue: 0,0:09:34.08,0:09:37.51,Default,,0000,0000,0000,,in the open, for the community to see,
Dialogue: 0,0:09:37.53,0:09:39.66,Default,,0000,0000,0000,,that's a very different picture.
Dialogue: 0,0:09:40.85,0:09:43.58,Default,,0000,0000,0000,,That just unlocks a competitive spirit
Dialogue: 0,0:09:43.60,0:09:46.73,Default,,0000,0000,0000,,which is inherent in each\Nand every one of us.
Dialogue: 0,0:09:47.73,0:09:50.55,Default,,0000,0000,0000,,So now, when you put these two together,
Dialogue: 0,0:09:50.58,0:09:54.62,Default,,0000,0000,0000,,the coffee shop strategy\Nand public competition,
Dialogue: 0,0:09:54.65,0:09:57.33,Default,,0000,0000,0000,,you now had a public-health system
Dialogue: 0,0:09:57.35,0:10:00.13,Default,,0000,0000,0000,,which was significantly more motivated
Dialogue: 0,0:10:00.15,0:10:02.50,Default,,0000,0000,0000,,to improve citizen health.
Dialogue: 0,0:10:03.56,0:10:07.09,Default,,0000,0000,0000,,And now that you had\Na more motivated health system,
Dialogue: 0,0:10:07.11,0:10:10.88,Default,,0000,0000,0000,,it was actually a system\Nthat was now much more ready for support.
Dialogue: 0,0:10:11.23,0:10:13.78,Default,,0000,0000,0000,,Because now, there is a pull\Nfor the support.
Dialogue: 0,0:10:13.81,0:10:17.71,Default,,0000,0000,0000,,Whether it's resources,\Ndata or skill building.
Dialogue: 0,0:10:18.67,0:10:20.27,Default,,0000,0000,0000,,Let me share an example.
Dialogue: 0,0:10:20.92,0:10:25.32,Default,,0000,0000,0000,,I was once at a district meeting\Nin the district of Ajmer.
Dialogue: 0,0:10:25.35,0:10:28.48,Default,,0000,0000,0000,,This is one of the districts\Nthat had been rising rapidly
Dialogue: 0,0:10:28.51,0:10:29.66,Default,,0000,0000,0000,,in the rankings.
Dialogue: 0,0:10:30.35,0:10:32.47,Default,,0000,0000,0000,,And there were a group\Nof passionate doctors
Dialogue: 0,0:10:32.49,0:10:36.57,Default,,0000,0000,0000,,who were discussing ideas\Non how to better support their teams.
Dialogue: 0,0:10:37.48,0:10:40.92,Default,,0000,0000,0000,,One of the doctors held\Nupscaled health workers
Dialogue: 0,0:10:40.94,0:10:43.68,Default,,0000,0000,0000,,to tackle the problem of nurse shortages.
Dialogue: 0,0:10:44.30,0:10:47.92,Default,,0000,0000,0000,,Another doctor was using WhatsApp\Nin creative ways,
Dialogue: 0,0:10:47.94,0:10:52.08,Default,,0000,0000,0000,,to share information and ideas\Nwith his frontline workers.
Dialogue: 0,0:10:52.10,0:10:53.31,Default,,0000,0000,0000,,For example,
Dialogue: 0,0:10:53.33,0:10:57.15,Default,,0000,0000,0000,,where are the children\Nwho are missing from immunization?
Dialogue: 0,0:10:57.17,0:10:59.06,Default,,0000,0000,0000,,And how do you convince the mothers
Dialogue: 0,0:10:59.09,0:11:01.80,Default,,0000,0000,0000,,to actually bring their children\Nfor immunization?
Dialogue: 0,0:11:02.51,0:11:06.36,Default,,0000,0000,0000,,And because their teams were now\Nsignificantly motivated,
Dialogue: 0,0:11:06.38,0:11:08.89,Default,,0000,0000,0000,,they were simply lapping up the support,
Dialogue: 0,0:11:08.91,0:11:12.24,Default,,0000,0000,0000,,because they wanted to perform\Nbetter and better.
Dialogue: 0,0:11:14.20,0:11:20.16,Default,,0000,0000,0000,,Broken systems certainly need\Nmore resources and tools.
Dialogue: 0,0:11:20.88,0:11:23.42,Default,,0000,0000,0000,,But they won't drive much impact
Dialogue: 0,0:11:23.44,0:11:26.98,Default,,0000,0000,0000,,if you don't first address\Nthe motivation challenge.
Dialogue: 0,0:11:27.77,0:11:31.20,Default,,0000,0000,0000,,Once the motivation tide begins to shift,
Dialogue: 0,0:11:31.23,0:11:33.64,Default,,0000,0000,0000,,that's when you get the real returns
Dialogue: 0,0:11:33.66,0:11:36.24,Default,,0000,0000,0000,,off resources and tools.
Dialogue: 0,0:11:38.27,0:11:40.64,Default,,0000,0000,0000,,But I still haven't answered\Nthe key question.
Dialogue: 0,0:11:41.33,0:11:45.18,Default,,0000,0000,0000,,What happened to the performance\Nof Rajasthan's public health system?
Dialogue: 0,0:11:46.54,0:11:49.97,Default,,0000,0000,0000,,In 2016, when our work began,
Dialogue: 0,0:11:49.100,0:11:53.08,Default,,0000,0000,0000,,the government of India and the World Bank
Dialogue: 0,0:11:53.11,0:11:55.51,Default,,0000,0000,0000,,came out with a public health index.
Dialogue: 0,0:11:56.37,0:12:01.41,Default,,0000,0000,0000,,Rajasthan was ranked 20th\Nout of 21 large states.
Dialogue: 0,0:12:02.35,0:12:04.05,Default,,0000,0000,0000,,But in 2018,
Dialogue: 0,0:12:04.08,0:12:06.22,Default,,0000,0000,0000,,when the next ranking came out,
Dialogue: 0,0:12:06.24,0:12:09.04,Default,,0000,0000,0000,,Rajasthan showed one\Nof the highest improvements
Dialogue: 0,0:12:09.07,0:12:11.47,Default,,0000,0000,0000,,among all large states in India,
Dialogue: 0,0:12:11.49,0:12:14.18,Default,,0000,0000,0000,,leapfrogging four positions.
Dialogue: 0,0:12:14.20,0:12:17.66,Default,,0000,0000,0000,,For example, it showed one\Nof the highest reductions
Dialogue: 0,0:12:17.68,0:12:19.26,Default,,0000,0000,0000,,in neonatal mortality.
Dialogue: 0,0:12:19.97,0:12:24.58,Default,,0000,0000,0000,,With 3,000 additional newborn lives\Nbeing saved every year.
Dialogue: 0,0:12:25.75,0:12:31.55,Default,,0000,0000,0000,,Typically, public health transformations\Ntake a long time, even decades.
Dialogue: 0,0:12:32.05,0:12:34.85,Default,,0000,0000,0000,,But this approach had delivered results
Dialogue: 0,0:12:34.87,0:12:36.61,Default,,0000,0000,0000,,in two years.
Dialogue: 0,0:12:38.39,0:12:40.14,Default,,0000,0000,0000,,But here's the best part.
Dialogue: 0,0:12:40.16,0:12:44.49,Default,,0000,0000,0000,,There is actually nothing\NRajasthan-specific about what we learned.
Dialogue: 0,0:12:45.20,0:12:47.27,Default,,0000,0000,0000,,In fact, this approach
Dialogue: 0,0:12:47.29,0:12:50.48,Default,,0000,0000,0000,,of using the citizen to trigger motivation
Dialogue: 0,0:12:50.51,0:12:53.57,Default,,0000,0000,0000,,is not even limited\Nto public-health systems.
Dialogue: 0,0:12:54.97,0:12:57.25,Default,,0000,0000,0000,,I sincerely believe
Dialogue: 0,0:12:57.28,0:12:59.78,Default,,0000,0000,0000,,that if there is any public system,
Dialogue: 0,0:12:59.80,0:13:01.40,Default,,0000,0000,0000,,in any country,
Dialogue: 0,0:13:01.42,0:13:03.31,Default,,0000,0000,0000,,that is in inertia,
Dialogue: 0,0:13:03.33,0:13:06.13,Default,,0000,0000,0000,,then we need to bring back the motivation.
Dialogue: 0,0:13:06.60,0:13:09.74,Default,,0000,0000,0000,,And a great way to trigger the motivation
Dialogue: 0,0:13:09.77,0:13:13.06,Default,,0000,0000,0000,,is to increase transparency\Nto the citizen.
Dialogue: 0,0:13:14.38,0:13:16.29,Default,,0000,0000,0000,,We can do this with education,
Dialogue: 0,0:13:16.32,0:13:19.65,Default,,0000,0000,0000,,and sanitation and even\Npolitical representation.
Dialogue: 0,0:13:20.86,0:13:25.40,Default,,0000,0000,0000,,Government schools can compete publicly\Non the basis of student enrollment.
Dialogue: 0,0:13:26.14,0:13:29.22,Default,,0000,0000,0000,,Cities and towns\Non the basis of cleanliness.
Dialogue: 0,0:13:29.24,0:13:31.91,Default,,0000,0000,0000,,And politicians on the basis\Nof a scorecard
Dialogue: 0,0:13:31.93,0:13:35.13,Default,,0000,0000,0000,,of how exactly they're\Nimproving citizen lives.
Dialogue: 0,0:13:37.12,0:13:40.72,Default,,0000,0000,0000,,There are many broken systems\Nout there in the world.
Dialogue: 0,0:13:41.24,0:13:43.84,Default,,0000,0000,0000,,We need to bring back their motivation.
Dialogue: 0,0:13:44.84,0:13:46.89,Default,,0000,0000,0000,,The citizen is waiting.
Dialogue: 0,0:13:47.40,0:13:49.56,Default,,0000,0000,0000,,We must act today.
Dialogue: 0,0:13:50.10,0:13:51.44,Default,,0000,0000,0000,,Thank you very much.
Dialogue: 0,0:13:51.47,0:13:53.60,Default,,0000,0000,0000,,(Applause)