Dakshas Foundation

Bharat Linkedin profile

Dr. Bharath Sharma is an orthopedic surgeon and the founder of Dakshas, a not-for-profit organization that provides affordable care to the marginalized population through a scalable model.

Prior to his engagement with Dakshas, Bharat Sharma completed a 1-year program in Entrepreneurship from IIM-B (Indian Institute of Management, Banglore). He founded  ‘Medrite’, a consultancy services to design innovative healthcare delivery solutions for various hospitals across India. 

He completed his D(Ortho) from the prestigious JIPMER(Jawharlal Nehru institute of PostGraduate Medical Research) and DNB in Orthopedics at Southern Railway HQ Hospital. This was followed by clinical fellowships at  ‘Instituto Orthopedico Rizzoli’ (IOR) in Bologna, Italy and Singapore General Hospital for two and half years. He was awarded the “Young Investigator Award by ISAKOS” in 2017 for his work at IOR.

Dakshas Foundation

Approximately 55 million Indians become poor because of healthcare bills every year. And there maybe no count of the number of people who suffer without access to equitable healthcare.

I have identified gaps in current financial systems that promote such un-sustainability. These prevent "social work", which sustains life and helps marginalized, join mainstream economic activity. The same gaps have widened due to COVID-19. A minor shift in accounting practices can correct this error, monetize sustainability and reconnect humanity.

Dakshas is an expression of this theory of change. It has unfolded in healthcare as I have technical expertise in that area. It is a healthcare nonprofit project to deliver Universal Healthcare, without financial constraints or conflicts, by

• Transfer care from specialists to primary, hospital to clinics

• Demand-Supply Aggregation : tap into free healthcare capacity to treat marginalized patients.

• Plug resources gaps in charitable/trust hospitals

• Embed best practices in technology

Business Management doesn't follow Human Centric Design and Scientific Principles. Economy is focused on capital, not on sustaining life:-

• Is another’s liability my asset? Humans are porous bodies, inseparably interconnected, inextricably embedded in the environment. Another’s liability is my liability too. Painfully evident as ecology erodes in COVID-19 Pandemic.

• We neglect cost of production of natural resources, accounting only for distribution. This is unfair to society, who owns these resources, undermines conservation and children.

• Human Body's depreciation finds no place on balance sheets, hiding the cost of unsustainability. Human beings then suffer accelerated aging, deprivation and disrupted quality of life. If we don’t book the cost, how will we mitigate it.

• Level of Evidence - Management case-studies are Level IV evidence. Economics only recently completed a RCT. Healthcare, however, has Level II evidence since the 1930s. Shouldn’t business management practices face scientific rigor?

• Licensed Profession- Business Management controls most professionals. Yet it is not a professional. It does not have a code of ethics, State Licensing Laws or local supervising bodies. In short it is not responsible to the society it lives in. Shouldn’t business managers be accountable to society’s health, Sustainability, just as doctors are to a patient’s health?

Dakshas ensures marginalized patients are not denied healthcare. It currently delivers orthopedic care at 16% of primary private healthcare cost and 30% of tertiary healthcare costs.

1. Identifies and partners with community embedded healthcare units, where marginalized patients already present.

2. Creates protocols and training sessions that transfers 95% of planned care from Specialist to Generalist and Hospital to Community Clinics.

3. Identifies and transfers skill-sets from Specialists to Generalists.

3. 5% of marginalized patients are matched to existing free capacity of specialists and hospitals, creating a win-win situation. Promotes use of any public health service or insurance system

4. Plug resource gaps at variable cost, in hospitals willing to support marginalized patients.

5. Bridge funds whatever funding gap that remains after all these measures.

6. Transfers post-hospital care back to community clinics, so hospitals and specialists focus on

While, Dakshas Foundation, is directed towards marginalized patients, it impacts every stakeholder. The marginalized patient generally is below poverty line. Often a migrant from another region, without documents to access public healthcare. Sometimes, a destitute elderly in a nursing home, abandoned and bed-ridden. Other times a farmer or a daily wage earner. They barely make it from one day to the next, with no buffer to absorb a healthcare shock, triggering a negative spiral. They all come to "community-embedded organizations" - nonprofit entities, charity clinics, rural health clubs and/or government clinics, which often are not clinically enabled to serve healthcare. Having a team in place in such nodes for over last four years allowed Dakshas to understand their needs directly, as the project evolved. The project also up-skills general practitioners, saves specialists valuable time and reassures hospitals that their valuable resources would be used efficiently. Dakshas also engages with business management alumni, funders and intermediaries. The whole ecosystem that cherishes the ecosystems realignment that Dakshas brings to healthcare delivery. Dakshas adopted the program from to old age homes, elderly rescue, telemedicine and rural camps.

Dakshas has the potential to be the undercurrent of the entire healthcare system all over the globe. It can ensure every healthcare providers does their core job and that every marginalized patient is matched to an unused asset. Healthcare may become as simple as booking a cab.

That is just the start. If Dakshas can prove that economy is circular, with two transactions and one entry, for the provider and consumers, it would have solved for sustainability.

It would combine for-profit and non-profit sector into one, achieving sustainability with each transaction. Shift humans from monetary to Time Economy.

Cost account in money, I was told. But I think I spend time. So began a decade long search on how to earn time. Time was invested working in for-profit model, medical research, clinical fellowship; in South-East Asia, Europe and Singapore. Experiences, inferences and expositions came together to suggest how may one earn lifetime.

I realized money can be earned in isolation, but life is earned together. I realized that I may earn a monetary profit, yet lose lifetime if the transaction over-burdened my customer. If the surgeon's fee that I collect proved too much for a farmer, s/he will be forced to use more pesticides to grow more crops. I am my customer's customer, and transactions are not linear. I disagree with linear accounting where one transaction is two entries.

The world is round and economy is circular. It is two transactions and one entry. How much I charge my customer influences how much s/he will charge me, either in money or in environmental damage. And both of us will together make one net positive or negative book entry. The fact that we do not depreciate our own bodies on our balance sheet seems lost on everyone.

I have come to believe that unsustainability is an accounting error. We can easily achieve sustainability with every business transaction. And Dakshas is an attempt to test that thought.

Booking the depreciation of our own body on our balance sheets links the monetary economy that we built to the time economy that we experience. Unsustainable business practices produce money at the cost of ecological damage. With the erosion of ecological buffers, these costs are now directly transferred to human biology, accelerating aging and shortening lifespan. There are economies where it doesn't matter how rich one is, one ages just as fast as the rest.

Booking body's depreciation onto our balance sheet books the cost of our unsustainable business practices. A surgeon who wishes to mitigate this own biological depreciation will be careful not to overcharge a farmer, so the farmer in turn won't have to use excessive pesticides. By ensuring that my customers are not burdened and no one is marginalized in my environment mitigates my biological depreciation.

We need to shift to a circular economy, wherein two transactions (my surgeon's fee and the farmer's pesticide use) make a single positive or negative entry for both of us.

From the final year of my orthopedic residency I have pursued a model for "sustainability". After orthopedics, I spent a year at business school, learning new venture creation. Working in the commercial hospital industry made me aware of its many limitations. A research fellowship in Europe allowed me to explore a different culture, where people live together, probably because there is plenty. A clinical fellowship in Singapore showed me how systems and processes can create abundance. I began to realize that the quality of life, slow aging and extended youth experienced in these cultures is not dependent on the money earned. It is because their live in a sustainable economy.

While it may be easy to earn wealth in unsustainable economies, that wealth does not seem to protect its owner from accelerated aging that comes with a damaged ecology.

Combining my skills of business management and orthopedic surgery, I decided to experiment with universal healthcare delivery. What would happen if I ensure that my patient gets the healthcare I need without financial constraints. A I am surprised how it empowered me. The amount of support and ecosystem that gathered to enable this journey has strengthened my belief that all one needs to do is to align oneself to everyone else. Unlike what business management believes, we are not sealed bodies, living in vacuum. We are porous, inextricably interconnected and inseparably linked. And it is only by aligning our good to the larger good can we live long and prosper.

Surgery is a high dependency exercise. And my fellowship training was in high-dependency units. However, when I moved to India to charity hospitals, these support systems were absent. The work culture was rather different. The hospitals had not even done these surgeries before. Equipment was non-existent, staff was not familiar with procedures and there was no fall-back mechanism.

Expect all plans would fail. The machine will not work. The consumable will not be delivered. The report will be adverse. And then replan for failure. Redundancy was the solution. Two surgeons work together so team unfamiliarity is bridged. Two sets of equipment. Two set of consumables, ordered from two different suppliers. And plan each step of surgery as if it will need an alternative.

And then one does that at 1/3 of regular surgeon's fee, because the patient one treats cannot afford to pay anything. Surgery is done in what the public healthcare system can afford to pay. And the system cannot pay for consultation, so one provides free consultation for three years. It is only in the fourth year that I got paid 30% of a regular consultation fee. While managing the program that scales six times over two years.

I began as an individual doctor with an idea to match poor patients to free capacity. I used to see 30 patients per week. By Dec 2019, Dakshas was seeing 200 patients across 10 clinics with a 30 people medical team. Now we have developed a technology platform that can do the same for every nonprofit that adopts it.

Then COVID-19 arrived in India. Overnight we entered a lockdown phase. All regular programs were shut, because Dakshas was into planned medical care. Over 15 days of March I could pivot Dakshas to three new COVID-19 interventions - Protect vulnerable, Predict ahead and Practice online.

Enough funding was raised. We covered 305 institutions over last three months, protecting 7000 vulnerable individuals like elderly, homeless and migrants. We got data scientists from four central universities to launch a predictive model that tell us number of cases a week in advance. We launched two online practice platforms by 1st of April 2020, though no one in Dakshas team knows anything about technology.

It is true the ecosystem unreservedly supported COVID-19 interventions, but we could pivot with it.

Dakshas is able to deliver healthcare at 16% current market rate, without spending anything on additional infrastructure. And it is rapidly scalable across the globe.

It is three simple steps

1) Transfer 95% care to primary physician

2) Match poor patient to free capacity

3) Plug resource gaps at variable cost

These are all being codified into a technology platform to scale across geography and specialty.

Dakshas hopes to be the undercurrent that ensures healthcare is delivered to marginalized patients, and not denied. And doing so is as easy as booking a cab today.

The project is based in "time economy", where the provider seeks to earn (life)time and not money.

The provider ensures that healthcare is delivered, and not denied, to marginalized patients. In turn, so unburdened, it is hoped these patients will strain the environment less in order to survive. Improved environmental quality will in turn reduce the physical depreciation of the provider's human body.

While ecology may have absorbed impact our unsustainable practices this is no longer the case. Ecology stands eroded and biology is exposed. We suspect money no longer preserves the biology of the rich in unsustainable economies. Rich age as fast as the rest in such economies. We believe booking human depreciation on our balance sheets is the way to account the cost of our unsustainable business practices that accelerate our aging.

And
is the first step to mitigate human depreciation and earn lifetime. It
would also combine mainstream business and social/nonprofit ventures
into one, redefining business transaction to achieve sustainability in
each transaction

Current Number 50000

One Year 250000

1 year Goal: Affordable orthopedic surgery and treatment of dengue across India

5 year Goal: Re-define "business transaction" and combine for-profit & nonprofit sectors into one.

Next year

1) Funding to expand the core team three times

2) Capacity building within the organization

Five Years

1) Access to networks to scale the solution globally

2) Platform to research and advocate a circular economy

Nurture ecosystem

Codify solutions and scale through tech platforms

Achieve scale to become the norm in healthcare transactions

Study relationship between frailty index (pace of aging) and corruption rating to test if monetary wealth protects in unsustainable economies.

• Implementation Partners 

  • Elder Spring, Vijayvahini Charitable Foundation

  • You See

• Clinical Partners 

  • Urban Community Health Centres, Pannipura  

  • Vasavi Hospital, 

  • Durgabai Deshmukh Hospital, 

  • Vivekananda Health Center, 

  • Ramakrishna Math

• Human Resources 

  • Pratham : Care Givers

  • Volunteers: 

    • IIT-KGP

    • dAjax

    • Microsoft, 

    • Smartbots, 

    • Ncompass, 

    • ProEngage, TATA Group

    • Volunteer Portals : Chezuba, iVolunteer, CSR Box

• Certification

  • Guidestar

  • CSRBox

  • NGO Darpan

• Technology Partners 

  • Virtusa 

  • Fylfot Software 

  • NASSCOM Foundation

• CSR Partners 

  • EPAM 

  • Sonata 

  • HELA Systems 

  • TATA Advanced Systems Limited 

  • TATA Boeing Systems Limited 

  • LIC Housing

• Funding 

  • TATA Trusts 

  • Give India

• Free Software Packages

  • Microsoft Business Intelligence

  • AWS

  • Slack

  • Notion

  • Trello

Dakshas is a Nonprofit project, delivering end-to-end healthcare to marginalized patients.

Partner with other healthcare establishments with free space and/or capacity, who are willing to deliver healthcare at near variable cost.

Dakshas supplies healthcare protocols, trained healthcare human resources, technological platforms so 95% of planned healthcare is delivered in these clinics by general physicians. 5% of patients are escalated to partner hospitals and specialists, when required. At all stages patients who cannot afford any element of care of provided so against part, or pro-bono. Dakshas then clears all pending payment through funds raised.

Now Dakshas is codifying all its medical and program best practices onto technological platforms, so these could be adopted by other nonprofit organizations.

Dakshas is itself a nonprofit organization and its core team is supported through grants. The technical teams are part of Corporate Social Responsiblity and/or volunteers. Currently Dakshas also raises grants to help bridge fund patients for treatment.

However, once the technology platform is develop, Dakshas suspects that it will also be of interest to for-profit healthcare sector to save specialist and hospital time. It is hoped it will be licensed to them, also generating revenue through a per transaction fee model.

These funds could be used to support the patients who cannot afford to pay for their own treatment. Over time we hope that the whole program will be self-sustainable, wherein each healthcare transaction will fund the treatment of poor patients.

Various sources of non-profit funding as restricted and unrestricted grants, through foundations, corporate social responsibility programs and individual donations.