HUBLI, INDIA—The streets of this south Indian city are still sleepy when Rajnandi calls out in her small cement-walled home.

“The baby’s coming,” she bellows.

Her husband Walter, a labourer at a local factory, bounds through the door and scoops up their 5-year-old daughter Sharon. Within minutes, he’s gunning his scooter through a maze of narrow alleys toward Vaatsalya Hospital, Hubli’s new private health-care centre.

Less than 90 minutes later, 32-year-old Rajnandi is stretched out on a bed, four freshly washed and pressed blankets helping to ease her chills, an intravenous line hooked up to her right wrist.

In the next bed, her newborn daughter — name still not decided — yawns. Her eyes blink open for the first time.

Walter, who like many Indians only uses a single name, says he and his wife decided more than a year ago to have their next baby at Vaatsalya.

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“We knew the care would be good,” he says, beaming as four nurses move from bed to bed, checking on newborns and mothers.

A few feet away, Sudha Lakkannavar murmurs quietly on her cellphone.

Lakkannavar, a 24-year-old first-time mother from the village of Nargund in Karnataka state, has just come out of the delivery room and her nerves are still rattled. Doctors had ordered an emergency Caesarian section because her baby had been breech.

“Everything’s okay now,” Lakkannavar tells her cousin over the phone, her brow still damp with sweat.

It is a different scene across town at the Karnataka Institute of Medical Sciences, Hubli’s government-run hospital. The grimy maternity ward is crammed with more than 60 beds, some of which hold three new mothers and their babies. The floors are sticky, the pink walls are peeling and covered in mould and flies buzz from bed to bed.

Two interns sit at a desk in the middle of the large room. Though five maternity specialists work at the hospital, not one has arrived by early afternoon.

“I don’t know where anyone is,” one flustered intern says.

For India’s public hospitals, it’s a common problem.

India’s public health budget is among the lowest in the world. The country spends $32.71 per person per year on health. Canada, by contrast, spent $5,452 per person in 2009.

What money is committed to health care often disappears. The Indian magazine Tehelka recently reported that much of the $18 billion in federal health transfer payments to Uttar Pradesh, India’s largest state, are unaccounted for. Several medical officers in Uttar Pradesh who publicly complained about corruption have been murdered.

Corruption often starts from birth, literally. Fathers are forced to pay bribes to see their newborns. Others are extorted to get their child’s birth certificate.

Infant and maternal mortality rates are high, even compared with other emerging countries. For every 1,000 babies born in India, 48 die before their first birthday. In neighbouring China, the figure is 16.

“There’s not a lot of trust in the public system now,” says an India-based official with the United Nations. “There are so many stories about doctors at public hospitals skipping off the job, and you even hear about cases where doctors have been burying medicines in the ground so they don’t have to dispense it (having already been paid for the work).”

Enter the private system. Dr. Ashwin Naik founded Vaatsalya in 2004 after recognizing that 70 per cent of India’s 1.2 billion people live in rural settings, but 80 per cent of the country’s hospitals are in cities.

He focused on smaller cities and rural areas. Today the company has 13 hospitals in Karnataka and Andhra Pradesh in southern India.

Vaatsalya keeps costs down by specializing in only three areas — pediatrics, gynecology and surgery. Land for its hospitals is leased not purchased — its hospital in Hubli was converted from a three-star hotel — and private rooms forgo luxuries like cable television.

Most staff doctors are consultants paid on a revenue-sharing model. They work harder than at a public hospital, but also have the potential to earn more.

In a recent Massachusetts Institute of Technology survey in India, 79 per cent said they opted for private doctors or traditional healers rather than government-run hospitals. The respondents said they spent an average 7 per cent of their monthly income on health care.

“People even in rural India don’t mind paying for health care,” Naik said. “But they know that at a government hospital they are often paying for a poor quality of care at best, so they just don’t go. That means you have more home births in places like cow sheds without clean tools or clean water.”

Earlier this year, with funding from a local aid agency and land provided free by a village council, Vaatsalya opened a birthing centre in Kotumuchagi, about a two-hour drive from Hubli.

“Our health-care workers talk to them about iron and folic acid tablets, blood typing, urine checks, all of it,” Naik said. “And if there is a problem, the woman comes in and we immediately know her history. It’s going to be so useful.”

Naik expects to open another 50 hospitals over the next five years. He says at least five other companies in India are copying his business model.

“This is going to have a dramatic effect on our country. Within the next decade, I expect our infant mortality figure will be cut in half.”

Then, most Indians lacked proper clothing and many were emaciated. Life expectancy was about 30 years. Through the 1950s and 1960s, ethnic and religious conflicts racked the young country. Health care was not a priority.

After the economy was liberalized in 1991, Indian health care began changing rapidly. Importantly, its fertility rate for each woman of child-bearing age dropped from six births to three.

Family planning was a sensitive topic. Indian politicians remained loath to tackle the issue of population control after the scandal around former prime minister Indira Gandhi’s forced-sterilization program during the late 1970s.

But the federal government made it — and maternal health — a priority following the lead of several Indian states.

The eastern state of Assam, for instance, has made a breakthrough coaxing men to have vasectomies. In 2009, 15,000 men had the procedure in Assam, up from 1,500 the previous year. A key has been showing Muslim men that the Koran and other holy texts encourage men to father only as many children as they can support.

In Bihar state, the birth rate has dipped thanks in part to activists who have aggressively encouraged young couples to wait at least two or three years before starting a family.

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And in Andhra Pradesh, poor people who are sterilized after two children receive front-of-the-line treatment for benefits such as housing, real estate, wells and government loans.

Life expectancy, meanwhile, has climbed to 64 years.

“It’s so easy to kick India and say, ‘Look how bad their health indicators are,’ but you show me another country of close to our size that has doubled its average life expectancy in half a century,” says a health ministry official, who doesn’t have permission to be quoted.

A company called Medicine Mondial has invented a baby incubator that costs one-tenth the standard model and promises to last 10 times as long in the developing world. World Health Partners, a non-profit funded by the Gates Foundation, is developing remote medical diagnostic tools that can monitor everything from heart activity and temperature to blood pressure.

In Bangalore, a start-up called mDhil is delivering health-care-related messages and videos to customers via cellphone. More than 250,000 subscribers have signed up for daily text message alerts for about 75 cents per month.

Subjects range from family planning and sexually transmitted diseases to diabetes.

“The cellphone is the first truly private screen a teenager has,” says Nandu Madhava, mDhil’s founder. “The TV in their home is in the centre of the room and everyone watches. The phone is a way to actually reach them and discuss subjects they can’t talk about with their family.”

While his company’s videos and stories are in English, Madhava hopes to add regional languages.

“Are we reaching rural Bihari women right now? Probably not,” Madhava says. “But we can say we are absolutely reaching the average 22-year-old in a city who has questions about birth control.”

Knowing about birth control, however, does not make it easy to navigate India’s corruption-riddled bureaucracy.

Naik says he has repeatedly been asked for bribes when applying for a licence to start a new hospital.

Six months ago, he filed for permission to open a new facility in Anantapuram, Andhra Pradesh’s largest district. He’s still waiting.

“I make it clear we don’t do business that way,” Naik says. “If they want to make us wait another year for a licence then we wait.”

For a growing number of Indian women, the wait is worth it.

Data

54

Deaths for every 1,000 Indian babies in 2006

48

Deaths for every 1,000 Indian babies born in 2008

$31.77

Cost of a basic delivery a Vaatsalya private hospital

$105.90

Cost of a caesarean birth at a Vaatsalya private hospital

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