They had degrees from top universities, plum jobs and fat pay packets. Yet, they left corporate rat race and found silver lining in rural healthcare sector.
Kanav Kahol, Swasthya Slate Kanav Kahol isn't your typical US returned researcher. He is an engineer by training, who got his PhD in computer science, when he was merely 26-year-old. And rather than sharing his success stories in US, he likes to talk about empowering rural health workers in the country. When we caught up with him, we were interested in understanding his extremely unconventional choice of leaving his cushy lifestyle and a promising career in US. Kahol was working as an assistant professor in Arizona University with a peer group comprising of Nobel laureates like Lee Hartwell and had secured a research grant of $4.2 million. So what prompted this young geek to comeback to Delhi? "It was a chance meeting with Dr K Srinath Reddy, President of PHFI, which helped me find my true calling, says Kahol, who was already thinking about ways of giving back to his community. What makes him unique is that he joined a public sector enterprise Public Health Foundation of India to fulfil his dream. In July 2011, he took charge of Affordable Health Technologies at PHFI. And soon his research and interactions with rural doctors and healthcare practitioners showed that the real power of mobile based health lies in point of care diagnostics. Being a researcher, he says, has worked to his advantage. "I showed up at five hospitals in Delhi with mild symptoms to understand the workflow of Indian hospitals and how they function. My average waiting time was 3.7 hours and after that the doctor spent 59.2seconds with me, explains Kahol. He soon extended his research to rural areas and started taking random bus trips to villages in various parts of the country." I used to land at the inter-state bus depot and travelled to villages and asked locals to take me to their healthcare practitioners. During these trips, I met several quacks, private practitioners, Auxiliary Nurse Midwives as well as Accredited Social Health Activists. "One of the important takeaways from these trips was the fact that ASHAs and ANMs are doing extremely good work, but they were bogged down by paper work. They needed some device to automate their processes at work and to integrate various activities they have to perform,” explains Kahol. Within a short span of time, he created Swasthya slate, a tablet device that allows users to perform 38 multiple diagnostic tests using an Android phone or tablet. He also points out that most of the interfaces developed for rural sector are not user-friendly. "If a device is fun to use, people would use it. Most of these apps developed for rural people use limited technology that doesn’t give a good user experience, that's why they don't use it," adds Kahol. "Unfortunately an Apple like interface is sold at an exorbitant rate. The more fun it is, the more expensive it,”explains Kahol, who did his engineering in Ludhiana. A solar powered Swasthya Slate kit includes an interface unit, a tablet, a bag containing all the equipment needed to perform the physiological analysis, and disposables like ECG electrodes. The health tablet covers multiple tests ranging from malaria, typhoid, blod grouping to testing purity of water and is priced at Rs 34,500. The project got $5 million grant from Norway India Partnership Initiative. The team also tries to stay ahead of the curve by adding new tests as well as adding multiple apps and features like a referral system for the users, which allows the health workers to sent all the data of a patient to a doctor, who will be informed by an SMS about the new ticket. The health tablet is being deployed in public healthcare facilities of six districts of Jammu and Kashmir, which caters to 25 lakh people, by the government. The maternal and child health statistics of these tribal areas are extremely poor. The government is hoping that the new technology would improve the quality of healthcare in these areas," says Kahol. Since the announcement of project in Jammu and Kashmir, curiosity has built up, word has spread and a willingness to introduce in other states surfaced. The short time in which he was able to lift his product to it's high status also makes him contented. "We want to pursue problems related to reproductive, maternal, newborn, child health and adolescent health, says Kahol. And then he adds happily, “It’s interesting when we go to rural areas for checkups of mothers. It's not only the mothers, but the mother- in-laws as well as father-in-laws who get checked." The Swasthya team also tries to be top-notch at everything that they try to do. "As important as creating a new device was incorporating other featured like referrals as well as suggesting medication for the patient. The rural health sector would transform due to the preventive, proactive and prophylactic approach,” notes Kahol. Currently, preventive care tops the list of priorities of Swasthya team. "Preventive care is the way to go. If India gets number of diabetic patients that International diabetes federation is projecting then roughly we need to spend of .8 percent of GDP to take care of them. Preventive cure is the answer for our problems," says Kahol. Every step in the journey is an accomplishment according to Kahol.”Whether it's getting approval from government going through multiple reviews, adding a new feature to the device or even creating the website for the product, everything is a little celebration," says Kahol. Two years in to his mission, Kahol also narrates an interesting story. "Recently, we noticed that healthcare data is not available to workers in languages like Pahari and Gujari. So ANMs started sharing their healthcare information data over social network. Some of the ANMs associated with Swasthya are creating videos and informational material and sharing it to the other members," adds Kahol. While SS is still a work in progress, the early success shows that the key is to create innovative solutions that have the potential to scale up and which can in turn help other players in the sectors. "With the help of the data collected from the patients, we can tell a private player where they should set up a hospital in each of these six districts where we have started working,” concludes Kahol. Zeena Johar, Sugha Vazhvu Healthcare From being criticised for her career choice to being one of the most talked about CEOs in the healthcare industry, Zeena Johar has come a long way. Right now, she’s on the same pedestal as entrepreneurs like Sabahat Asim and Rocky Philip. Last year, her entrepreneurship skill was rewarded, when she won the Ashoka Fellowship. Not only did the work of her company Sugha Vazhvu win her the fellowship, it also got her lot of recognition from the industry. “It feels great to be in the rural healthcare space. When I returned to India, after obtaining my PhD in Molecular Diagnostics from ETH, Zurich, I never thought that I would start a company in the rural healthcare sector. It was 360 degree move that I made, from being an academic to a social entrepreneur,” says Johar. It was her stint with IKP Knowledge Park that actually paved the way for the formation of Sugha Vazhvu Healthcare. “What worked in favour for me was my association with the incubation park of IKP group.IKP was incubating lot of pharma companies and there was direct application of many of my skill sets. It’s primarily due to the support of my mentor Nachiket Mor that I achieved this success. I can probably say that stars aligned on the right side at the right time for me,” says Johar. Even though healthcare in India is one of the thriving sectors, in challenging geographies, the plain vanilla business models dont hold their ground well. Carefully crafted USP of Sugha Vazhvu has helped them contextually evolve their model towards the local needs of the population. “It is true that we had access to a reasonable corpus due to our association with IKP. That definitely made our journey easy. But what fascinated us was how common medical treatments and tests are often considered as a luxury in villages. There was a great opportunity. But it was not a straightforward opportunity, otherwise lot of people would had done it by now,” explains Johar. However, she does not deny the fact that she didn’t have so much clarity about the enterprise initially. “It was a fledgling idea which later grew in to a full- fledged enterprise. We really thought the concept and brain stormed a lot about what we can bring to the table. Even though, the company was launched in 2007, the first clinic was launched only in 2009,” adds Johar. Amidst all that has happened to her during her roller –coaster journey in the Indian healthcare sector, the most crucial are the tie-ups and expansion plans with majors like Apollo. Currently, Sugha Vazhvu Healthcare has set up seven clinics in Tanjavur district of Tamilnadu, where the clinics act as the first point of reference for the locals and offer evidence based primary care. It will shortly launch two more clinics- a mobile clinic and a semi-urban clinic soon and caters to nearly 1, 50,000 people in the area. The social enterprise has also tied up with Apollo Hospitals to replicate their model in Aragonda, a village in Andhra Pradesh. The USP of Sugha Vazhvu is that it trains Indian medical practitioners and have partnered with the University of Pennsylvania, School of Nursing, to develop a bridge course. These alternate medicine practitioners are given training for six months, so that they can offer primary care to the rural population. Currently, the programme is being implemented in the centres of Sugha Vazhvu, where the practitioners are being trained in the new methodology. “The target audience of Sugha Vazhvu is in villages and all our customers have to travel at least two and half hours to reach a registered public healthcare practitioner. As government after government often finds it difficult to recruit staff for their rural PHCs, our solution can be used by the government also. Even the government of Maharashtra has passed an ordinance about training homeopathic doctors to fill the gap of doctors in rural areas,” adds Johar. Johar was also determined to create a platform for integrating all the technical solutions required for a healthcare enterprise. Today, Sugha Vazhva has its own proprietary software, Health Management Information system, which is completely developed in-house. “It does everything from patient record, mobile solutions to supply chain management. It’s a one stop shop for the technological requirement of an enterprise,” says Johar. It’s her unflinching commitment and immersion of herself in all she undertakes that, have established for long lasting relationships with senior business executives and leaders in the healthcare industry. “There is no organized rural entrepreneurship eco-system in the country. There might be some local players, but other than that there is not much activity. There is no organized / structured effort by the government to encourage entrepreneurship. When you look at rural entrepreneurship from a social angle (health, education micro-finance) there are very few players. It takes a lot to set-up a rural enterprise. We have been able to survive only because of the leadership / board we have. They have helped design the funding strategy, performance evaluation metrics, network extension and policy design aspects,” adds Johar. She also points out the long period between concept to operation in several cases. “It takes a long time to establish your idea. Research and understanding of the market in itself would take about 1-1.5 yrs. Our first clinic took 2 years. Technology investment took around 3 years. The first 3 to 3.5 yrs we were getting our act together,” adds Johar. Talk about her team and she admits that confides that she is emotionally attached to them. “We were fortunate enough to have tie-ups with the key networks very early in the beginning. It was crucial to position yourself and have a strategy in place. And this needs to be articulated to the team,” adds Johar. In India there is a lot of trust bestowed on the doctor. How did she gain the trust of the locals? “We have systematically integrated this need. In our model we have 2 resource persons; there is a doctor and health extension worker (physician extender). This physician extender is someone who is recruited from the local community. To deal with loyalty is a bigger issue. Most of our patients are geriatrics. Considering the cost effectiveness and availability of timely healthcare people would prefer us,” adds Johar. Interestingly, an average customer of Sugha Vazhvu is the member of a middle class family in rural areas, with an annual income of nearly 1.5 lakh. Typical treatments of the enterprise cover geriatric patients. Primarily people above the age limit of 40 to 45 years. The company also has a cohesive business plan. There are three major revenue streams of the company, namely consultation fee, diagnostic fee and prescription drugs. Plus, it also offers packages for diabetes, hypertension where customers can enrol for a yearly package for Rs 1200. “At a clinic level we believe the operational cost will be paid off by the revenue it generates every month. The key is to build many clinics to achieve economies of scale which then at the enterprise level will give cross leverage of revenue. However our model is not always dependent on grants. It is only the initial funding that is required for training and community engagement. Once rolled out the scheme will fund for itself,” says Johar. Now that they have stabilised in the difficult terrain, the team can’t be happier. “It is definitely a tricky terrain. The hope we have is in other countries like the USA is took at least 50 years to get the model right. Our proposal is only for places where there is nothing available. Not for the urban areas. Given the demand we have in rural areas for immediate healthcare, we believe this will be sustainable model. The nurse practitioner model in the US is something we have looked at. The reason we tied up with University of Pennsylvania is for the fact that they were involved in this movement in US,” adds Johar. Ask her whether her company bothers about attrition, pat comes the reply,” We do have attrition as any other new enterprise. And the skill-set differs for different stages. For example the kind of resources you need at the design stage is very different from what you need at the implementation stage. Typically it is during the growth stage that we start building some hierarchy in the team. We brought in senior management at this stage, prior to that we were not structured.” Coming to something more personal, she adds that defining a clear value proposition is critical and deep understanding of the offering is a must for a budding entrepreneur. “You need to know to whom you want to sell, what you want to sell and what the customer can afford and will want,” says Johar, whose company has enrolled 70,000 people in various schemes. Shyam Vasudeva Rao, 3Nethra Taking the plunge in to non-corporate world is not so easy to deal with. It doesn't really matter, how old you are or how matured you are-truth is you can never be quite prepared of it. However, if someone has emerged triumphant from it, it is Shyam Vasudeva Rao. He left a successful career as technical director of healthcare division of Philips to follow his dream of entrepreneurship and founded Forus. "There is nothing like the work of an entrepreneur. The main reason for me leaving a comfortable and high profile job at a multinational company and starting Forus was to get out of this work mode and pursue my passion for reaching out to the society with affordable healthcare and wellness. I am now living my dream day in and day out. The world is going through a big health crisis and engineers like me can do a lot of things to solve this problem. Our effort at Forus is a small example. So, I do not find any time to anything other than perceiving my passion." There were few incidents which led him to take the decision. The first incident which clearly stood out was when he was awed by a talk of eminent eye surgeon Dr Aravind, who is also the chief administrator of Aravind Eye Care. "The story of how the world's largest eye care hospital reached out to a large section of society through their products and services, was not only inspiring but also a eye opener for me," says Rao. Even after Dr Aravind finished his talk, Rao thought about how he can strike a balance between his current responsibilities and his own space in the world. After the talk, he walked up to him and asked many questions related to scaling up the model. Dr Aravind told him that eye care needs lot of test and diagnostic equipments and 90 percent of these costly equipments are imported. The essential problem at hand was equipments, without which very few eye problems could be addressed, especially in rural areas. "Chronic problems of eye like diabetic retina, glaucoma, maculla degeneration require expensive and portable equipment for screening alone. People having such chronic eye problems do not realise this until the disease condition has gone worse and then when they come to the hospital, we can only arrest the problem from getting worse and getting blind, there is no cure for any of these chronic problems and the only solution is to catch them early. This led me to think of an all in one eye screening device. And by combining several appropriate technologies together, we invented this device 3nethra," says Rao. 3nethra is an eye screening device which can be taken to the field or used in OPD of large eye hospitals to screen people for any eye problem. The device is so simple that even a trained technician can operate this device and through the tele-ophtalmology platform get the specialist / doctors to report. The product soon won over the minds of patients who got the right doctor, who can solve his/her eye problem. It uses Cloud computing, image processing, mobile computing, communications engineering, intelligent and self learning systems and data analytics for decision support. Remembering about the heady early days of 3nethra, he tells about how it was like to provide care at the door step of the villagers. "Without doctor travelling to these places, we were in a position to connect the patients to the doctor via the mobile network with our 3nethra and tele- ophthalmology software Forus Care. It was extremely exciting to change the paradigm and make making eye care really affordable and accessible. In line with the tag line created by my partner and CEO of Forus K Chandrasekhar we were "Democratizing eye care," says Rao. It took almost two years for Rao and his team to reach eureka moment. Little did he know in the beginning that 50 percent of the solution was in defining the problem and rest was technology, which he puts as 3Cs, computation, collaboration and communication. What helped him survive was the vast experience and research capability of his team. “The solution is a well knit combination of utilizing PC /Laptop standard computer for image acquisition and processing information. On the device we only have an image sensor and lighting electronics, rest is all driven by the PC and with a simple USB interface. This is the most rugged, cost effective and universal mechanism for the compute part. We adopted the mobile technology to reach every nook and corner of this country. One big problem all hospitals faced was data storage and management.. We adopted cloud computing and with that we are in a position to offer large data storage space. Our application also encapsulates patient’s confidential information and we have incorporated a simple EMR system with unique patient ID. This will also be made National UID compatible when it is rolled out across the country. The last bit of the puzzle was who will operate this equipment as the doctors or trained paramedics are always in demand and quite expensive. The only way is to get the user interface intuitive and easy to use. Some amount of intelligence is also put into this and the images captured will be immediately graded and any trained technician can manage getting diagnostic quality images. By using some of the "user centric design" design principles we have come up with a very easy to use and ultra low power consumption device which is not only easily portable but also a locally trained person can operate it and send across the images to the specialist in the city for diagnostic reporting,” explains Rao. Today 3nethra-stamp of care is palpable everywhere and has dealer and distributor networks all across India. What makes Rao proud about the device is that Forus has sold out equipment to 14 neighbouring countries and developing economies."We are now looking at how we can take this product and services to Europe and US. The initial response has been very encouraging, we see this also as a big opportunity to take this Indian technology to international markets," says Rao. When one looks at how the product has fared on the sales front, both in India and abroad, China has the highest number of installations of the product. "In the last few years, the company has to its credit 275 installations all over India and 50 in 14 countries, among them 12 installation are in China. Now we see even the developed economies like Europe, USA and Australia are facing severe problems due to raising healthcare costs and they are very interested in working with companies like Forus, to see how they can get healthcare costs under control. The choice is very simple, it is all driven based on demand and we package our solutions in India and developing countries as preventive eye care and in developed countries call the same as convenience screening, with the same products and services," says Rao. Forus caters to two categories of customers, one is the conventional market like eye care centers and optical stores and other is non ophthalmology which is the unconventional one. "Under conventional market, we have sold our products to large eye hospitals like Aravind Eye Care, LV Prasad Eye Hospital, Shankara Nethralaya, Narayana Nethralaya, Adaty Jyot Eye Hospital, Sharoff eye hospital. We have also sold our product to optical stores like Essilor, Lens cart and have also installations at medical colleges and teaching hospitals like KMC Manipal, "says Rao. In the non conventional segment, Forus has Diagnositc centers, Diabetic centers and Dialysis centres. "There is also a rural entrepreneurship model where we attach these trained technicians to large eye hospitals and they rent our device and screen people in their small tows/ villages and send the patients who need treatment to these hospitals and charge a small fee for the screening services. Our products and services are designed in a manner that it is affordable for all types of customers and intern the service is made affordable for all sections of the society. The big cost savings come from the fact that there are no consumables to carry out the tests, not even an eye drop as our device is designed such that it works without any pupil dilation (non-mydriatic). The simple and intuitive usability will help trained technicians to do the imaging in the field or Hospital OPD and we do not require paramedic or doctors at the screening stage. Large Hospitals and diagnostic centres can afford purchasing this device and small ones or individuals can get this on a pay per use model. Each screening is charged between Rs.100 to Rs.250 depending on the situation and in a day more than 200 patients can be screened as each screening takes less than 5 minutes," says Rao. He also goes on to trace the value proposition of his product. "We are trying to eradicate needless blindness and act as technology enablers for solving this problem. Ultimately, it is the medical fraternity which solves this and we provide them with the right technology, products and tools. We are very different from rest of the players in this market by the fact that, we are offering a end to end solution and the device or software is just a consequence of this solution. Other medical device manufacturers first get their device out and then try to fit the solution around their product, which is not always sub optimal or feasible. The very concept of preventive care and the paradigm of hospital go to patients has attracted a lot of people and in the last 2 years we have screened more than 7, 50,000 patients. This number is just growing with more and more installations and we expect to screen more than a 1.5 million patients this year and 4 Million in next 2 years," says Rao. Right from tying up with hospitals, where their device was used in OP departments, to their tryst, with small towns and villages, Forus had its own set of trials to reach its target audience. "We tried to reach out through regular eye camps and mobile vans fitted with our 3nethra. They also set up small screening centres equipped with 3nethra in slums," says Rao. He also reveals that they have regular screening camps at factories, schools, Hostels, Book exhibitions, shopping mauls, IT centres and even wedding halls. The appreciation that he received from the various corners of the world has even made Hillary Clinton to take notice of 3nethra. "We have bagged awards like DST Lockheed Marten Gold medal for Technology innovation, Sankalp award for social innovation and Anjani Mashalkar Inclusive award for Inclusive innovation,”says Rao. Ask him about the challenges and he says briefly, "There are several problems and challenges reaching out to rural masses." He confides that healthcare organisations cater only 7-10 % of rural population and treat mostly cataracts and refractive errors." These constitute to 60% of the eye problems which need just one time correction/ intervention. The burden is high when it comes to the other 30% which require special instruments and chronic in nature like diabetic retina, glaucoma and AMD. This calls for a special device which can test all these problems in few minutes." He also doesn't want to ignore the problem of scale in the country."We have only 20,000 eye doctors and 50 % of them are anterior segment doctors, basically catering to cataracts and infections of the cornea. If we are talking of preventive care through screening large population with the eye doctors, then one eye doctor needs to attend to 70,000 people. This is humanly impossible. The obvious choice is that the doctor will need to be at most densely populated area, i.e., cities and towns rather than going to less populated rural areas. Hence there is a need for technologies which can extend the reach of these eye doctors to rural masses.” Where power supply problems are concerned, having been operating in rural areas, he is still searching a solution for the power problems. The third challenge in rural "During day time there is hardly power supply to these villages, so if I have a equipment which needs more than 200 watt power to operate, it becomes very difficult, back up batteries or generators will only add up to cost and not easy to use and maintain. So we need devices which operate on low power or no alternate sources like solar power," says Rao. How did he feel about the initial resistance from hospitals? He takes a minute, and replies, "Yes, we had lot of reluctance from the eye hospitals to accept and use this product which costs less and does lot more functions. People were looking at this a bit sceptically. Once we got this clinically validated at world class hospitals like Aravind eye care and KMC Manipal and we also got device certification like CE and ISO, they started using it and now we have lot of demand." All this has only made Rao positive that the going is only going to get better. But what is the price of 3nethra? "We have 2 models of our product 3nethra called classic and Royal. This is bundled with our tele- ophthalmology software called Forus Care and auto -detect software. 3nethra classic costs approximately Rs 5 to 8 lakh and Royal Rs 6.5 to 9 lakh. This is less than a third of any imported or equivalent system in the market. The product idea, patents, concept, design, 75% of the components are all locally made and with the cost of developing the software and manufacturing being less compared to western world, our costs are lower," says Rao. While he may be happy about bright prospects of his device, he continues to set new targets for the company. “There is a fortune at the bottom of the pyramid as Prof. CK Prahalad says, but in addition there is a lot of satisfaction if you do that for making people’s lives better by enabling better health care. It is not just doctors and medical professionals who carry the healthcare burden of the society, even engineers can help and we can act as enablers,” concludes Rao. Pradeep Nakhate, Head India, EyeNetra Calling Pradeep Nakhate an entrepreneur would be an understatement. The India Head of EyeNetra is not a fresh face for the Indian healthcare sector. He has been an entrepreneur for over 16 years and prior to which was in leading positions in MNC healthcare companies. In his words, he has been involved in the medical devices, software, health and human services for the last 26 years. And the most recent addition to the many feathers on his cap is the fact that he has been involved in bringing EyeNetra’s products to life and to India for the past two years. Talking about the genesis of EyeNetra, he says, “EyeNetra was born at MIT while experimenting with mobile phones and optics which finally resulted in a PhD thesis by Vitor Pamplona that formed the foundation of EyeNetra. After a few months of discovery and trials, EyeNetra was incorporated and an effort to develop and commercialise the technology began with the help of Khosla ventures as our investors. During its formative period, EyeNetra and its founders won many awards and accolades.” He mentions that idea behind EyeNetra is simple. “Can a mobile phone which is ubiquitous, all over the world, be used to detect refractive error (power of the eyes) of the human eye? The phone being portable and easy to use would require very little skill to conduct an eye test. Currently, across the globe, eye-care equipment is expensive, not so portable and requires highly skilled people to use. In addition, globally, there is shortage of trained personnel to do the tests. Due to poor awareness and lack of access to testing, more than 4 billion people have limited or no access to eye testing and glasses. EyeNetra aims to be part of the solution to provide access to eye testing and eyeglasses.” The senior executive who is gearing up for the launch of the product notes that it is now nearly fully developed, uses many patented technologies to conduct and interpret the test. “It uses an android phone for the purpose of testing and an android tablet that is used to guide patients how to do the test, as well as collect their relevant information for the purpose of e-health records, analytics etc. The test is presently a guided test, guided by a Netra trained vissionaire (Netra operator). The test takes about 4-5 minutes,” says Nakhate, who also mentors lot of young professionals and budding entrepreneurs. So, what is his definition of NetraG? “It is a portable, inexpensive, accurate device, connected to the web and requires minimal training (even a high school graduate can do it) to conduct the test. The data is collected and stored on the cloud for analytics etc.” Having handled various enterprises, he knows that the product cannot be slotted only for a specific target group. “EyeNetra team imagines that Netra-G will be used in various settings. Just about anywhere where there are people. In work place settings, airports and train stations, shopping malls and colleges, Primary Healthcare Centres, pharmacies, dispensaries and clinics, eye hospitals and also in optical shops and other retail spaces,” explains the senior executive. And what would be the profile of a NetraG customer like? “Our customers are global and they include first world and developing country citizens. Creating a suitable testing experience along with providing access to eyeglasses for each kind of customer and use case is our aim. For this we shall work with various customer access channels, try and test them so that we can give the best access and service to our customer – the person who needs eyeglasses,” says the serial entrepreneur. Pradeep is also excited about the product trials in rural areas. “In the second phase of our product roll out, we shall access rural populations through non-governmental, governmental agencies and by creating livelihood opportunities among rural youth. We shall begin with product trials in the rural setting shortly,” says Nakhate. He also knows that introducing their flagship product won’t be an easy task.. “By and large, in India, the concept when shown and discussed, has met with positive response. We have noted the expectations of our users and customers and are making sure that the product has excellent usability qualities,” says Nakhate. “Largely in India, people don’t pay for eye testing. The cost is subsidized through the sale of spectacles. This is true in many parts of the world but not everywhere. We have therefore, for markets like India, are looking also at various ways to subsidise the cost of the test so that by and large the test is free or at a negligible cost,” adds Nakhate. Pradeep also sheds some light on the founding members of EyeNetra. It was first incorporated by three founder members - Ramesh, Vitor and David. Khosla Ventures and Khosla impact fund invested initially. The enterprise is almost 2 years old and it will need another few months to get into a position where can bring this product to market commercially. Pilots are already underway,” says Nakhate. Currently, EyeNetra is based out of Somerville, Massachusetts. “In the US, we have a lead technical and engineering team and a product and market development team. In India, through a technical services arrangement, we have design and engineering and an independent product and market testing team along with consultants and associates for clinical trials etc. Both teams are small but are fast expanding,” explains Nakhate. He also talks about the learning that came out of his association with the project. “EyeNetra is a true representation of how good science can result in spawning various technologies which can have, in a very significant way, a direct impact, both socially and economically, in solving real world problems faced by a large number of people, across the globe,” concludes Nakhate. Myshkin Ingawale, Biosense/Inter Institutional Inclusive Innovation Centre Myshkin Ingawale could have become a jet-setting business consultant in McKinsey &Co. Yet, he chose not to succumb to peer -pressure and rather focused on creating a social impact in his country. He might have names like MIT or IIM Calcutta in his resume, but when it comes to the crux, he is a simple Mumbai boy. He points out that it is a great time to start enterprises in India. “Small scale enterprises have always been understood to account for most of the jobs in an economy- and at present, the Indian economy is at the stage where there is aspiration and demand from many sectors. Any entrepreneur or government agency with a vision, and a clear idea of which consumer demand they wish to address, have a wonderful opportunity at present with a right confluence of local skill sets and funding complimenting increased buying power and evolution in the mindset of consumers in India. The key determinant of success would be the managerial excellence of teams who set out on new ventures,” says Ingawale. The mention of healthcare delivery has him beaming. And he tells that the main obstacle to healthcare delivery in India is lack of access to appropriate technology. “The key word is appropriate-just importing the same tools and devices used in the West do not work because of the difference in personnel available on the ground in India. The tools and devices have to be developed for field conditions, by use by ASHA workers and other relatively low-skilled non-medical personnel, and that too, optimized for the population that we have. The challenge is for India's engineers, designers and entrepreneurs to come up with solutions,” says Ingawale. Myshkin has been on a high with variety of challenges that he has accepted as an entrepreneur from Biosense to Inter Institutional Inclusive Innovation Centre. His first big break came, when he founded a for-profit company - Biosense - with Dr Abhishek Sen, Dr Yogesh Patil and Aman Midha - medical doctors and designers who had a vision to solve the problem of lack of access to appropriate technology. Biosense now has 15 employees and multiple distributors across different states in India. Today, the company develops game-changing medical tools and devices are designed for and work for the Indian healthcare system. Notable examples are uChek, the Android based platform for urine and blood testing, that is helping thousands of patients manage diabetes and its complications, pregnancy related complications as well as critical liver and kidney problems. This device is built on top of the popular Android platform, and can monitor more than 17 body vitals, and is capable of providing diagnostic assistance for more than 25 medical conditions. It was developed in collaboration with the Department of Science and Technology, and Indian Institute of Technology, Bombay. “I personally got involved in this, because my friends Abhishek and Yogesh had seen the big problems in healthcare in the "real India" - in villages where they had interned as part of their MBBS course. I think there is a tremendous opportunity for technology to solve big problems - and even do so profitably and sustainably,” says Ingawale. He is currently also involved with a non-profit organisation called the Inter Institutional Inclusive Innovation Center - I4C - set up under the guidance of the Governor of Maharashtra. “I am trying to address the challenge of how we can get our engineers and designers to work with success on big problems, and encourage, nurture, promote inclusive innovations that can benefit large sections of society. Last year, this initiative promoted 150 innovators from across the country. The Expo organized by this organisation - called the Inclusive Innovations Expo, was the largest of its kind in India - and attracted more than 1,50,000 visitors,” says Ingawale. Several social entrepreneurs have pointed out quacks as one of the biggest problem in Indian healthcare sector. Mention this to Myshkin and he begs to differ. “Quacks have been a problem earlier. However, increasing education levels are to some extent making a difference. In many areas the problem remains strong, however, I can see already that in other areas, people have grown sceptical, and are moving to evidence-based medicine. Basically - people are not stupid. A repressed, uneducated population can be fooled for large periods of time, but increasingly, increased education and media exposure are ensuring that knowledge of what is good and what is bad is out in the open, and old assumptions are being openly challenged. Again - the change will not be overnight, but I do think we will move most of India out of the dark ages in this decade.” Be it evidence based medicine or a new delivery model, getting people to understand healthcare is a step-by-step procedure is not an easy task. Ask him about this and he replies, “Healthcare is not only about doctors but also about engineering, about finance, about marketing, about quality and everything else that is interconnected to it. A successful operation depends not only on the skill of the surgeon but also on everything that preceded and will superseded it - starting from the right and timely diagnosis, the right pre-operative care, the right and high quality equipment and medication, the right post operative advice, adherence by the patient, family support and of course financing.” It’s no wonder that the non-conformist thinks that compared to US Indian healthcare sector is doing a fair job. “The best way to address the health system would be to look closely at failure - look at the problems currently facing the US, UK systems, and at the same time, look at some of the failed experiments in Africa, and learn from them. There are many good things going for us, and the Indian health system may not be perfect but to some extent, it works. So we should not be clamouring for radical changes until we have established which parts of our system are working to the best of their capabilities and which can be improved further,” concludes Ingawale. Shelley Saxena , SevaMob For someone who has been in toppers list of Ivy League institutes for most of his academic life, Shelley Saxena is appallingly simple. Post IIT and Cornell, he started a mobile technology company in 2009. The company thrived selling mobile solutions to customers and the turning point in the entrepreneurs life came, when he decided to market a knowledge base to farmers in UP. However, selling his product to sleepy little hamlets of UP soon turned out to be an uphill task. He soon figured out what was wrong with their model. The farmers were not able to operate mobile device. The trick is to give people who can explain things to them. He knew this because, when SAASMOB conducted surveys, several farmers suggested need for a primary healthcare model in their locality and their inability to use complicated devices. The first thought that crossed his mind, when he came across survey results for a mobile knowledge base for farmers in UP, was opportunity. The second was how to develop a primary care delivery model. The third thought, was how to recover the cost. Once he and his team brainstormed about this idea, they pursued this idea with gusto and eventually led to the formation of Sevamob. "The tag line of our company is transforming primary healthcare," says Saxena. He says, earnestly, "It offers primary healthcare and insurance via mobile clinics to groups on a monthly subscription model. Sevamob also offers an online health exchange that connects patients with healthcare providers.” The mobile clinics which operate in rural districts of the country are manned by BDS doctors, helpers as well as nurse practitioners. The field team offers primary care and in-case the patient needs advanced care, the doctor raises a ticket addressed to the back office or the call centre. In addition to farmers, it also offers primary care for schools, orphanages, old age homes as well as NGOs. The social enterprise approaches their customers by partnering with not-for profit organizations already present in the area. In addition to screening, field teams also offer medicine for de-worming, calcium deficiency, frolic supplements as well as multivitamins. At mobile clinics, BDS doctors are hired as skilled workforce in rural area is a huge challenge. The doctors have been given the mandate to do initial screening based on strict protocol and feed patient details in to a mobile app, and create an online as well as a hardcopy health card for the patients. Based on appointment given to them, patients can visit the back office and meet the doctor or receive referrals for meeting specialists. The customers have several subscription options, which range from Rs 150 for children and Rs600 for adults. With multiple services for their customers, Sevamob is also slowly widening its catchment area. Saxena refers to his branches in Bangalore, National Capital Region and Luknow. Most of the areas don't have a good hospital within 10 kilometre radius and the nearest hospital is at least 25 minute drive away from their location. By now the story of Sevamob has been well told, and Sevamob has won several accolades. The website of Sevamob has a list of all the honors and awards won during the last three years and a brief biography that identifies it as a platform which uses cloud, big data and mobile technology. Ayesha Chaudhury Windmill Health Ayesha Chaudhury’s rise from a Biotechnology student in Banaras Hindu University to a Stanford India BioDesign fellow can only be described as meteoric. She received her Doctoral degree in biomedical engineering from IIT Mumbai in 2010 and authored several articles in international journals. It was during this time that she developed an interest in entrepreneurship. “I wanted to be close to science and create an impact for the society. The one year fellowship with Stanford was an eye opener. Spending time in hospitals made me realize that the ground realties are very different from what is being projected and perceived. These experiences during my fellowship made me empathize with people and think towards creating a solution for their problems,” says Chaudhury. In 2011, she started Windmill Health Technologies along with her classmate Dr Avijit Bansal. It was their first innovation, NeoBreathe that won them grants from various agencies. So, how would she describe NeoBreathe? “NeoBreathe is the first innovative product from Windmill. It helps with reducing infant death. It enables paediatricians and hospital care specialists to prevent death of infants who have breathing issues. We have 800,000 infant deaths every year. And the primary reason has been resuscitation. Windmill has developed a simple to use infant resuscitator that helps infants resuscitate effectively,” explains Chaudhury. “The idea was generated as part of the structured process of the fellowship which includes three major steps-identify, invent and implement. We spent a lot of time in hospitals across India covering both primary and secondary healthcare and came up with a 500-600 observations. And as a team we had to look for solutions to address these observations. We also had collaborated with doctors to understand to identify the compelling problems, which can have an impact on the society with a simple solution. We zeroed in on the problem of “resuscitation” and finding a solution for the same,” recollects Chaudhury. “Initially there were four members working on the theme, later Avijit Bansal and I decided to continue on this and take this to market,” adds Chaudhury. At this point she also lets us in about the launch plans of her product. “The team has started working on the project two years ago, with a tag line innovating healthcare for everyone. Our product is still in the development stage. It will take another 6 months to get the final product out. And we are 1.5 yrs away from taking it to market. Our focus is towards Tier 2 and Tier 3 cities where there is a dearth of healthcare professionals providing resuscitation interventions,” explains Chaudhury. Would she call user friendly nature of her product its USP? She thinks for a minute and replies. “NeoBreathe enables new born infants to take their first breath. Our product doesn’t require extensive training. Hence it enables even the lesser trained front line health care professionals to act immediately and prevent infant deaths. For this particular problem the entire world is currently focusing on training professionals to perform a procedure. Our differentiator is design innovation rather than training.” Of course, the team has a strong marketing plan in place. “Initially our in-house sales and marketing team would be focused on point selling to specific institutions in the cities we target. We then plan to move to larger institutions in Tier 1 cities. We have had several meeting with government agencies and the response has been positive. Our product is low maintenance one and hence it has generated a lot of interest in the sector,” adds Chaudhury. The team is hoping that they should be able to scale and penetrate in all tier 2 and tier3 and tier 4 towns. “Once we have achieved the scale required we would move to the next project in terms of providing social impact,” adds Chaudhury. The company is also planning to roll out two versions of the product, one for the rural sector and the other with more advanced technology for the private sector. On pricing, she says that the device could cost between Rs5000 to Rs10, 000. “It’s too early to talk about it. But it would be in this range,” adds Chaudhury. Be it in Mumbai, Chennai or Hyderabad, several entrepreneurs often find it hard to raise funds. How did Windmill tackle this problem? “Funding was not difficult. But it was a little time consuming. It required a lot of paper-work and has huge turnaround time. We have grants from Bill and Melinda Gates Foundation which is $100,000 and also from institutions in Canada, adds Chaudhury. Besides stating that it is difficult to estimate market size in India, she also confides that it’s also tough to estimate the demand. “The other challenge is to find a team which is aligned. Finding people who are willing to work for cause and not money is difficult,” concludes Chaudhury. PR Ganapathy, COO, Villgro Villgro Innovations Foundation is one of the oldest social enterprise incubators in the country, supporting innovators and entrepreneurs during their early stage of development. Since 2001, Villgro has incubated 71 such enterprises, generated around 3803 jobs and secured Rs 200 million in funding. It has provided Seed funding and has assigned experience advisors to guide rural healthcare start-ups like Windmill Health in its customer development, helping to create its business model and expand sales, marketing and distribution. PR Ganapathy, Chief Operating Officer of Villgro, is an experienced business executive with global leadership experience. In addition to mentoring rural social enterprises in the Villgro portfolio, he also volunteers a portion of his time to help Teach for India Chennai. From an entrepreneur to COO of an incubator, it’s been a many-splendored journey for Ganapathy. However, he admits that he is still fascinated by the sector. He concedes that it is relatively easy to build a product in the IT space and take it to market. “All it takes is a good idea to be supported by a capable talent. One person can sit in his / her dorm and create IT products and take it to market through the internet. There is very less capital that is required to build a product and marketing and testing is easy because of internet. The time taken from ideation stage to going to market to getting it commercialized is very less, in comparison for the med-tech space there is whole lot of research required. This in itself takes time. After research you need to develop a product. The product needs to go through rigorous certification process. And then you take it to market for testing. Then you change the product basis the feedback and then commercialize. The whole process takes a very long time. As the product you develop in med-tech directly impacts lives, the process involved to getting it to market is very stringent. Hence it is understandable that young people who want to make quick returns will always turn to IT. Med-tech space is not for the faint hearted. It is for those who are entirely committed to making a change and impacting society. And this does take time,” says Ganapathy. He is also not averse to the idea of foreign investment in the social sector. “There has been a lot of money that has been raised through investors from foreign investors. We are seeing initial signs of this investment increasing in India. For example the Indian Angel Network has created an initiative to identify investors in the domestic sector to fund social enterprises. The reluctance in domestic sector is because of the time it takes for them to see valuable return and also time it takes to scale,” explains Ganapathy. Being part of one of the few social incubators that has been flourishing despite the odds, he enlists the criteria for funding a rural start up. “We look for 3 broad criteria. First is the team, how competent is the team and talent. Secondly we check the technology differentiation and idea and the last one is the target / market segment and competitiveness of the product or idea. On all of these 3 areas we do a thorough due diligence post which we fund the start-ups,” says Ganapathy. He is also all praise for Gen-X entrepreneurs “There are many exciting ones. In our own portfolio we have Bio-sense, Windmill Health and One-breath. We have 3 bio-tech engineers in our GIR program who are working to create low-cost glucose monitoring. Outside of our portfolio, in the health care delivery side we have been very impressed with SugaVazhvu. We have two entrepreneurs who we are interacting with who are working on foetus monitoring. We are quite happy with the level of activity and interest the youngsters are showing,” adds Ganapathy. He also adds that though they have a cap on funding, the enterprise hasn’t reached a situation where they haven’t been able to fund a good idea. “This year around 50-60 enterprises will work through our various programs and get support from us. Last year, we funded 29 enterprises,” adds Ganapathy. Talking about impact investment in India, he points out that there are 23 impact investors in India. “There is a lot of funding but there is a dearth of ideas. My message to entrepreneurs would be to work on a good idea and there is no short of funding that is available. There would be a lot of global MNC’s that would be interested in acquiring these small companies once they have a proven and scalable model. Therefore it’s an opportunity that exists and it’s a real possibility. I am seeing a trend where experienced healthcare executives are getting into this. The CEO of One-breath used to run BPL Healthcare. There are people who have worked for companies like GE Healthcare and Philips Healthcare for over 15-20 years getting into med-tech industry to create a social impact. This is a great trend which significantly increases good execution,” says Ganapathy. But what does he think is the reason for the increase in the number of the new tribe of entrepreneurs? “It’s a combination of all these things. One, more and more people want to create a meaning / purpose for their lives. Two, people are getting the confidence from their well-built careers & experience and hence are not averse to taking risks. If they fail they can always fall back on their sustainable careers. There is a lot of opportunity for funding and also high returns which acts as an additional motivation. When they get into med-tech they get a sense of satisfaction of touching many lives because what they create impacts lives directly. This is not the case if you are on a traditional work path,” concludes Ganapathy.
