Reflections with Rohit Sahgal

By Gracia Chua and Maple Ee

Rohit Sahgal is the Principal for Global Health in Asia at The Economist Intelligence Unit and the Founder of Sovereign Health, an independent strategy and creative healthcare consultancy. Previously, Rohit had taken on various roles in Ogilvy Health and McCann Health. Having been in this industry for about 24 years, he has established and led health-driven strategies for regions around the world. Rohit graduated from the Lee Kuan Yew School of Public Policy in 2021 with a Master of Public Administration and had served as the Class President during his time at the school.

I have been in this industry for about 23-24 years. While the experience is a mix of advertising and healthcare communications, it is also unique as it involves a lot of policy exchanges and strategies. In the private sector, we find strategies that would help build narrative dialogues. I use compelling communication strategies that would help me better understand insights gleaned from these dialogues. 

I have worked with two networks all my life, one was McCann Health where I set up Asia offices over time. I worked on various different health businesses ranging from USAID, WHO, UNICEF and vaccination programmes all the way into pharmaceuticals i.e. GSK, Avid, Pfizer. I also had the opportunity to work in various geographies outside of Asia which included working in South Africa for the Sub-Saharan Africa region. After that, I mainly worked with Ogilvy Health where I spent about 10 years before joining The Economist. I was head of the Asia Pacific Integrated Health Practice. This involved a lot of market access conversations across different categories.

A couple of years ago, I decided to take a sabbatical to pursue my further education, which was to do my Master’s in Public Administration at the Lee Kuan Yew School of Public Policy (LKYSPP). Following this, I started my own consultancy to do research and that got me connected with The Economist late last year. I now work at The Economist in the role of Principal for Global Health in Asia. It is a very heavy sounding title but it just means that I do the things I love. I go deep into investigating and interrogating the human condition, and how we can bring the public and private conversations together.

I turned 50 in February and when I started on this career path, I always wanted to write. I never knew anything except writing, the interpretation and just going deeper into what was making people think and talk. I used to work in mainstream advertising until the opportunity arose and there was a massive pitch for a WHO program that was running regionally at that time. I was unaware of this side of communications that could help enable the disenfranchised and the vulnerable. They needed that kind of information and I realised I wanted to do more of that. 

I found a way to pursue that. So, after WHO, there was a UNICEF programme on polio vaccination. What happens in one’s career is that once you get tagged as being good at something, you get more opportunities. I began working on things like Nestle but I would put in my little agenda with them. I would start doing things that were market-shaping, such as research on Islamic food and on breastfeeding in Malaysia. 

In my head I was always writing policy, I was a researcher at heart. Just before I turned 50, my agenda was that I cannot face my 50s without having pursued something on the scale of research policymaking. My hope had been that LKYSPP would show me a new side of things, and I can honestly say nothing beats the experience at LKYSPP and further education. It gets you to go back into a space where you consider the principles again instead of trying to be more commercial in nature. I would attribute my position and place to the courage or the confidence in taking on this role after all those years in marketing and communications.  

Both are interlinked but the biggest difference, using Asia as an example, is the disparity in the available data in healthcare. It is pretty shocking. The amount of available data on non-communicable diseases (NCDs) for considered opinion and formulation of policies are very isolated and hard to access. Think about places as large as China and India. It is not easy trying to create an understanding of:

  1. How certain behaviours are leading to certain types of illnesses
  2. What scale of those illnesses are currently monitored
  3. What adherence and compliance factors are coming into place
  4. How our health services within the region are able to write or implement policy 

If you start taking benchmark data that comes from the West or extrapolate data that have behavioural tendencies, not from the country, you get some very mistaken outcomes. This was going on in the late 90s in particular, simply because there was very little funding available or it was done infrequently.  

Most governments have gone down a path of saying that we can no longer live in these siloed worlds of patients living in single hospital scenarios. For example, if I have a certain type of disease I go to one hospital, and all my data stay in that hospital. But suppose if I take my disease to another hospital that is not a part of that same group, I have to repeat it all over again. The public health system is on a very competitive basis so everyone keeps the information to themselves. 

The change has been for electronic health records to stay on one common platform. The ability for the right stakeholders (in terms of its use from a government basis) allows for better capture of data. The relevance of that data is in terms of the real-time capture. This has actually been a benefit because our healthcare industry in Singapore, including the ability for us to trust health data, is almost next to zero. However, we can finally say that there will be actualised data in the next year or so which represents our cohort broken down by ethnicity. These specifics will give us personalised health medicine. The way that technology has changed all of that is in the consumption of that data where we can be more proactive than reactionary. Policymakers can start doing longer-term plans and that can mean huge savings. You have technology data that gives you information to figure out exactly how much you have to prioritise on upcoming disease states. 

Technology is a boon and in some bizarre twisted way, COVID has actually forced technology to really come to the fore because there was no longer the ability to do face-to-face data capture or track patient footfalls in hospitals anymore. Hospital data was very unreliable and doctors themselves have great difficulty in keeping a lot of their own data properly. So, how do you capture that? However, if we can begin to create a more holistic framework and governments begin to take on a role in that, I think that technology-enabling data capture and data inference will be much stronger in the future.

I think we are really blessed that at every point in time, the work that goes on in silence is that we are creating a robust infrastructure. Instead of creating a bureaucratic mess as the public health infrastructure was built, we created a public health system that stays competitive, with both public hospitals such as SGH, NUH and private ones like Gleneagles and Parkway. This separation between public and private is compounded by the fact that even in the public system, a lot of these data points are being kept within themselves. So for example, SGH’s data should be kept within SGH. However, it can be quite troublesome if you are suffering from multiple comorbidities and have to go through different physicians relations tests in different hospital chains and have your data kept thrice over. 

The government has been working on this for a while, and I think it was already initiated before COVID-19 hit. I think it has been a disrupting factor as everyone’s priorities have shifted more towards the pandemic situation. However, behind the scenes, there are people who are still working towards building that. Yet, no system can be worked on by a single player. So you have public and private hospitals which are always talked about by the pharmaceuticals, but the ones who really have a big role to play in Singapore are the insurance peers. We have MediShield and MediSave, among others, but often, you have to top it up with private insurance to ensure that you have access to something better much quicker. That comes at a price.

So how do these factors come into play where governments can sit with payers, insurance providers and hospital services to discuss how they can provide a conducive environment for the population to receive the healthcare treatment they need. Singapore is always held up as being a great leader in innovation but it is to be seen how we can get this moving as fast as possible.

Regulators and government providers are, in some respect, one and the same. The issue is that many times within governments, you have different stakeholders. I remember in policy school, one professor threw a challenge that everyone said “Oh, that’s a healthcare challenge”, and then he said, “Okay, then who’s the stakeholder?” We said “Ministry of Health”. He said “No, if you look at it, actually it’s the Ministry of Transport, Ministry of Finance, it’s your business, it affects the supply chain, its demand…How do you get the right regulators around the table that will debate and dialogue the necessary access?” So, you have to find out how the government and regulators work together.

The other end is the private sector industry and it is not an easy role because, from a profit-making perspective, they are looking at shareholder value. So, they understand the role of innovation. Just put it this way: imagine somebody has a specific unique condition that only affects a few 100 people in the whole population. It is something that you could do a lot of innovation and treatment for and I would say I can produce some compelling treatment that can save people who suffer from this. However, this comes at a cost because I spent a billion dollars to make this and then you bring that over to the regulators and say, how many people get affected by that? 500 out of a population of 6 million?

Policies are always decided on perspective rather than a personal, emotional scale. The conversation always concerns attrition, where private manufacturers, innovators, innovative brands will say that they could create more innovative, better, faster treatment etc. However, it comes at a price and therefore, regulators, governments and other stakeholders have to work up all of the country’s priorities, which are the ones we can afford and are dispensable.

It is a difficult challenge and when you are in that situation, it is not a decision you wish you had to make. The best part is sometimes the agencies, who are responsible for bringing these partners around the team, help service providers and insurance payers try and work out how one can arrive at a certain middle path. If you can somehow find that balance, with trade-offs here and there, you can make some progress, but it is indeed a difficult process to be formed again.

First of all, if the evidence is supported clinically, socially and economically, that the inclusion of this particular treatment or the risk of this particular disease is paramount to something that needs to take a certain chunk of a budget, that is probably the most critical point. Therefore, a lot of evaluation and studies go into that. How do you show clinical impact, current or future risk frameworks that can define how a certain population or economic sectors will be more at risk? As we saw recently, if you don’t protect a certain cohort of foreign workers, devastation can take place just from a pandemic. When you can at least begin to prioritise the value of what this brings together, you are then able to then take other factors in.

There is a price for this whole thing. So, how do you arrive at a price point? A treatment pathway is not a single thing. Unfortunately, illnesses have to be treated and have to be recovered from and this has various different components to them. At what point in that disease pathway does this particular treatment cost? You will have to weigh up those costs against all the other factors.

However, we are still missing the most critical component – the healthcare professionals. You need training and skills. If we want something that is much more accurate in removing a tumour, we will need the infrastructure set up, maintenance and someone who is trained in robotic surgery. There are many factors along that sequence that become more complex for many policymakers to decide upon. 

Then, it is again about how you create partnership value. What is it that your private partner will bring to the table that is going to enable the promise of improvements in socio-economic movements, savings etc? Insurance providers will always pass a certain component on to their customers, hospitals and health service providers. Ultimately, there are only two parties who have to foot the bill, either us or the government. The government can only take on so much and we only have so much in our MediShield and MediSave. 

Lastly, take an example like Japan. Japan’s ageing population is the reason why it has been in recession for the last 20 years. Even though the economy is doing so well, its expenses on its ageing population are reaching somewhere around 16-18% of GDP. These are the traps that Singapore must be wary of. Obviously, that is what the thinking is – how do you make sure that it does not swell up like a balloon where more and more burden is realised and how will we then become successful?

I do not know where you stand on this but the fact is that there is never going to be a happy population. One population will say exactly this – that we are becoming a nanny state, and that the government takes on all the responsibilities and risks, unlike the US. Another example will be France, where healthcare is absolutely 100% subsidised. You can walk in, say that you are sick and they will give you the treatment with no payment at all. Now, taking other factors into consideration, we can then look at Australia which has a very good balance between very high taxation rates of roughly 50% and you are then, in a way, paying for the access to the free healthcare that you enjoy. In this case, it creates a disincentive for individuals to work. Essentially, fewer people will work since they are the ones subsidising those that do not work. I think that there has to be having an element of independence.

Singapore has to consider the wellness aspects, productivity, and ensuring that there is easy access to health. However, in reality, that comes at a certain cost. I do not believe that there is a perfect solution right now. There are still some gaps between insurance providers and health service providers. In particular, there is a need to define the services in the essential list that insurance providers cover. So there has to be an evolution of what the right thing is but there is not one specific solution. 

What is true today will no longer be true a year from now. When we look at the origins of MediShield and Medisave, it was to help supplement a population that was emerging to the first world, but that required the government to look at a process that worked. However, I think there are so many different factors. There is such a complex ecosystem of what is required fundamentally to allow someone to get health care without worry and panic. 

Frankly, I think Singapore has done a great job when it comes to essential things including the coverage that it provides in public hospitals, especially from my experience having travelled and lived in different parts of the world where I have seen the absence of coverage and a safety net. There really is no one specific answer and I think one can only give opinions, but that is the closest I could get.

I was not the most attentive in school. I did not necessarily value education because I was creatively inclined and more interested in writing. I always said that I went to the school of hard knocks, in the sense that my work was my education. I was apprenticing in my early years in advertising, and I learned the way that could not be taught by schools or institutions. However, I had always felt that everything I was doing was self-limiting. 

Back then I thought I was writing strategy documents when in reality, I was writing policy documents. However, I did not know the difference then. I do not know how to write consensus papers, how to frame arguments or take things to a certain analytic process. It was simply relying on repeated action, and finding the perfect formula through trial and error. 

I think what education has done for me is pressing the reset button. I realised that I am putting forth arguments, conversations and innovations and I am now also able to process situations in a more articulated way that I could not have achieved a couple of years ago. I truly believe it when I say this to everybody who is near the age of 50 to do what I did to be able to stand from an MBA point of view. 

Nothing should hold us back. There are things like SkillsFuture which encourages us to go back to school, not through subsidising the school but also subsidising our income especially if you are over 40. Additionally, those who are in the public sector get to do so with a paid year away from work once in their career. The ability to give such access is phenomenal. These policies are also targeting people over a certain age to enable them to be more skilled and productive. As opposed to sitting back and expecting the government to care for them, Singapore has given individuals the opportunity to reset themselves, which was something that blew me away.

I am of the opinion that one should never stop learning and that your work and career will define who you are. I was honoured to be given the Dean’s Leadership Award, and the one thing I said was that we should not be known by our titles and we should not be chasing those titles. It is important to remind others about this because everyone can become someone whom they have yet to become. I think that is an important factor in anyone’s career – to never start chasing down the titles just because you are measuring yourself against what someone else is telling you about you and your work.

I have faced a lot of crossroads and decision-making, partially because I am doing something that is not a mechanical career, such as a scientist or somebody who is very much aware of the precision of my work. In my field, there is a rather amorphous area of service, insights and research and I really had no one to benchmark against to see where I should head to. 

More often than not, the crossroads came in the form of horrible imposter syndrome – the sense that you are not feeling like you can be accompanied by the sense of impending failure. You do not really know if this is going to be scalable or consistent, and because of that, one makes a very short term decision. So during the early part of my career, prior to settling into IPG, for the first 8 or 9 years, I was jumping between companies. I was uncertain whether I was doing it for the reasons that I thought I was or I was just not feeling like I was able to become who I wanted to be. 

However, I think the biggest concern for me is to find a place that I just love so much. For me, that moment hit when I was in South Africa, working for McCann. Every single day I woke up with a spring in my step, and I believed that it would change the world – until an opportunity came my way which offered much higher pay. However, it may not have necessarily provided the same level of fulfilment. 

Essentially, it meant going back to working simply for the money. I chose that and moved to Shanghai. I loved every bit of Shanghai, but it was nothing compared to what I was experiencing or possibly going into with my public health work in South Africa. My wife and I have always asked ourselves what would have happened if I had rejected the offer 11 years ago. Where would I be today? – since I was still going to do my masters in South Africa and I still wanted to go into the whole development and multilateral sector. It is not that I was unhappy later on but I always look wistfully back and wonder if my current role at The Economist is to go back to where I was 11 years ago in some shape or form and be able to live that experience all over again. 

I think the skill set crucial in my field is inquisitiveness. More than the ability to go through reams of data, it is more important to be able to pinpoint trends and come out the other end. Fundamentally, the best analysts that I have known are there not because the data is telling them what they want to do. Rather, they are there because they have seen something in that topic that the team approaches, and now the data will work for them to build a stronger, more evidence-based report. I find that the people who look at it the other way tend to struggle. 

Thus, I think one of the key criteria is the ability to find the reason why you’re in an organisation that looks at analysis and research as opposed to being a data provider. This means that there is a need to actually elevate yourself from that to become a provider of insights, provider of truth or provider of human quality etc.

When I was younger, I used to do primary research and experienced it for myself before writing on the topic. Today, most folks do not do that. They rely on secondary data to inform them. So, they will be peering at their laptop containing the reams of clinical data and they will try to decipher the meaning of the data without understanding their value.

Another important quality is to be able to build a narrative or a story. So, always read – anything that is nonfiction, or even anything of the sort. While reading, focus on the sentence constructions to learn about the surprise elements. By forcing yourself to read, it helps create this mental narrative in your head which will help you when you are trying to construct a certain approach to things. These are the things that I always impart on anyone who is coming on board.

We are debating on what is very different from traditional journalism but in short, yes. I think it is journalism without any bias, or spinning it as an agenda that I want to try and uncover, or as a research analysis. You have to be a moral vacuum and basically not have an absolute neutral point. Then you will have to see what you are learning and then start all over again on something.

I wish I was 20 years younger because this generation is being given a once in a lifetime opportunity – the opportunity to restart and re-evaluate who they are and what they want to be. I have a son who is graduating from university and he is very full of trepidation about what the future holds considering what school has trained him for, which may be irrelevant. 

However, I think that as long as you have got this future ahead of you, you can think about all the opportunities present now which many people before you did not. In the past, many people could claim to be experts in their field and command your respect. However, now that technology has disrupted most industries, most who have had years of experience are just as unsure of how behaviours are going to change. It is akin to starting from ground zero again. That means that fresh minds have a chance since everyone is thinking of new concepts. Therefore, I trust that the glass is half-full. In spite of all the fear we hold for the future, those entering the workforce have a great chance – particularly as we get past this year into next year. It will be awesome.