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  Date / Time: 3/9/2009 9:39 PM UTC

  The Walmartisation of healthcare
  

  Don't look now, but capitalism – maligned in these bailout-ridden recessionary days – is reshaping Africa inexorably. What is different today is that it is emanating from China and India, rather than from the conventional bastions of capitalist prowess.

  Devi Shetty, a celebrated cardiac surgeon in Bangalore, brings health relief to India's masses through his Narayana group of hospitals. Some years ago, I witnessed his early experiments with rural telemedicine (where proceedures are carried out using phone or internet communication between professionals), especially in the Indian states of Karnataka and West Bengal. In my visit last month, the wall was adorned by a large map of Karnataka festooned with coloured pins, to indicate that he now served most district capitals in the remotest parts of the state. Moreover, a world map showed outreach to rural areas of east Africa and southeast Asia, and the room has been upgraded to reflect a still-expanding global reach.

  All this comes from carefully acquired experience – technical and sociological – with delivering expert medical advice through teleconference facilities, aided by satellite links. Shetty's team has successfully participated in telemedicine consultations – multi-specialty, non-stop availability, and supplemented by continuing education – with hospitals in 14 African countries. This effort is part of India's then President APJ Abdul Kalam's ambitious pan-African e-network project to link all 53 African capitals to tertiary care facilities across India.

  Shetty is a healer, first and foremost. But he is also an entrepreneur, and this is the latest in his many efforts to create successful, low-cost, but cutting-edge medical ecosystems in tough locations worldwide. He aspires audaciously to what he calls the universal Walmartisation of healthcare – a reshaping of medical care that the world's indigent need, and in Africa more than most other locations.

  Cynics say that India's e-network is currying favour with Africa in exchange for natural resources. Perhaps. But in that effort, India must contend with its neighbour, China, which speaks with a louder voice and carries a larger stick.

  China's President Hu Jintao's peripatetic diplomacy across Africa has ensured that the Chinese are omnipresent there. China has traded much investment in physical infrastructure in places otherwise shunned – Angola, Sudan and Zimbabwe – for access to natural resources.

  Witness also an unprecedented convening of 48 African heads of state and senior officials in Beijing in 2006 to signal unequivocally that China would speak with the loudest voice. India tried to mimic the event with an India-Africa summit in New Delhi in 2008. Fourteen countries attended to discuss food-price inflation, energy needs, and so on. Alas, India's voice was drowned out, not by China's attempts to provide medicine and education to Africa, but by the sheer magnitude of Chinese state-owned enterprises' investments in physical infrastructure.

  But loud voices need not be the most effective. Indian influence will no doubt exploit assets less available to others, particularly the Indian diaspora in countries like South Africa, Kenya, Tanzania and Nigeria. India and Africa have been linked over the centuries by trade, religion, and post-imperial political consciousness. Gandhi and the Non-Aligned Movement remain important symbols. Indians are more part of Africa's social tapestry than are the Chinese, a fabric that has been strengthened through opportunity and adversity through the ages.

  Consider Olam, a Singapore-headquartered but Africa-centric global agribusiness company. From the soybean farms of Brazil's Matto Grosso to the granaries of Ukraine, Olam is prized for its ability to add value in disparate conditions.

  Olam was started by Indians in Nigeria and remains a world-beating trader in cotton, coffee, cashews and the like. To succeed, Olam has had to work "up country" – a euphemism for difficult conditions far from comfortable port cities – requiring it to rely on Indians' familiarity with, and willingness to work in, Africa's interior. Indeed, so competent is Olam that when Wilmar, a Southeast Asian firm run by overseas Chinese and a force in its own right in China and across Asia, sought to expand in Africa, it sought out Olam in a joint venture.

  The connection between Nigerian cashew farmers and Devi Shetty's pediatric cardiac surgery is that they both represent decentralised private activity, undertaken through the market, unlike the operations of the China National Petroleum Corporation, Sinopec, in Darfur. They all add value, but decentralised, market-based activity appears likelier to engender additional goodwill.

  But there is more reshaping to come, again fostered by mutual self-interest rather than by fiat. The Olam and Wilmar joint venture is, in a sense, symptomatic of the combination of assets from across Asia that can catalyse productive change in Africa. It is fitting that Olam, in Hebrew, means "transcending boundaries".

  Such symbiosis requires a healthy disregard for convention. Failures will result, surely. But, to my mind, for the most part, decentralised experimentation beats Africa's partial addiction to aid.

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