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Vision India 2020: Doctor On Wire

Posted on Sunday, Aug 10th 2008

In Doctor At Hand, we addressed the opportunity of building a network of pharmacies to address the common illnesses that a few hundred million people face in rural India.

While common illnesses could be tackled without trained doctors, there was, of course, a tremendous need for the remote geographies to be able to access doctors capable of diagnosing and treating more complex ailments.

Doctor on Wire was our tele-medicine venture to make doctors accessible to the vast majority of the rural Indian population.

The concept was based on building local diagnostic clinics in villages that could run a battery of tests based on symptoms. Similar to Doctor At Hand, we made available a medical knowledge base accessible from mobile phones that could guide a clinic nurse through what tests were needed on a case-by-case basis.

The diagnostic clinics were Doctor on Wire franchises equipped with medical equipment ranging from basic blood pressure monitors to X-ray and ultrasound machines, ophthalmoscopes, and so on.

We used a similar strategy as Doctor At Hand to finance the venture. Our main investor was GE Capital. GE, as you know, is one of the world’s largest makers of medical diagnostic equipment.

We also used the micro-franchise formula to build a chain of entrepreneurs who owned and ran the clinics. The sum of money and the financing requirements were significantly higher in the case of the clinics than the pharmacies. Therefore, we chose to do one clinic for every ten villages. And of course, the World Bank Guarantee (WBG) came in handy with this greater financing need.

Training was provided to the franchise owners and their staff on how to operate the equipment and what to measure.

Every clinic was linked via high-bandwidth connectivity to a regional hub where a team of doctors were stationed. This team of doctors owned and operated their own franchises, for which we also arranged financing through the banks we partnered with. Each hub supported ten clinics and one hundred villages. We started operating with twenty doctors per hub, with different specializations, and from each hub, supporting a territory of 100,000 people. Over time, we were able to scale the number of doctors per hub, such that the ratio of doctors to patients improved.

Five years into the project, our coverage was shadowing Doctor At Hand, and we distributed medication through their pharmacies. Our doctors also held local ‘chambers’ at Doctor At Hand facilities on a monthly basis.

Surgery, however, had to be done at the hubs. It was something that we started layering on after five years, as a new offering. For the first five years, we partnered with the closest hospital to a hub that had the facilities. This was not easy to scale, and very often we were faced with inadequate facilities.

Eventually, in 2015, we launched regional nursing homes attached to our hubs where doctors could avail of full operating facilities.

Cancer treatment was another sub-segment in the realm of major illnesses that required specialized expertise and treatment centers. We could only start tackling this area around 2017 due to the serious lack of trained talent that we needed to scale such an effort.

Two key questions emerge out of this massive infrastructure building that we undertook: (a) where did we get the doctors, and (b) how did the rural Indian population afford medical services that Doctor On Wire or Doctor At Hand made available?

The doctors came from a medical education franchise à la MIT India that was also created around 2008, which I will talk about in a later column.

The affordability question was also addressed via an innovative medical insurance company that was founded in 2009, and that worked closely with the Indian government. I will talk about that too, in a subsequent column.

So you see, a full-fledged healthcare ecosystem was being built by these four ventures: Doctor At Hand, Doctor On Wire, Doctor For Sure (Medical Insurance) and Harvard Medical School, India (Medical Education).

They all came together by 2020, such that, it was possible to provide comprehensive healthcare to rural India on a dramatically larger scale than ever before.

Note: Vision India 2020 was subsequently published as a book. You can order it from AmazonKindleAmazon.in, etc.

A call to Indian entrepreneurs everywhere, Vision India 2020 challenges and inspires readers to build the future now. In this “futuristic retrospective,” author Sramana Mitra shows how over the next decade, start-up companies in India could be turned into billion-dollar enterprises. Vision India 2020, which encompasses a wide range of sectors from technology to infrastructure, healthcare to education, environmental issues to entertainment, proves how even the most sizeable problems can be solved by exercising bold, ambitious measures. Renowned in the business world, author Sramana Mitra conceived Vision India 2020 from her years of experience as a Silicon Valley strategy consultant and entrepreneur. Well aware of the challenges facing today’s aspiring entrepreneurs, Mitra provides strategies, business models, references, and comparables as a guide to help entrepreneurs manifest their own world-changing ideas. 

This segment is a part in the series : Vision India 2020

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One of the big needs in India is a social networking site for patients and doctors so that patients can get educated about medicine and what really ails them.

The real problem in India is that doctors fleece patients;
also, they dont educate patients; finally, if you go to a doctor, there will be more questions on your financial status rather than on your illness.

It is high time this scam is busted, and it can be best done by a social networking site that communicates about
illnesses and among patients and doctors.

But with most of the US based VCS funding more labour arbitrage and concept arbitrage ventures in India, the situation doesnt look very bright to say the least.

regards,
Samir

Samir Kelekar Sunday, August 10, 2008 at 11:51 AM PT

Interesting road map to the future. Have you considered whether one would need several parallel ‘systems’ — for Muslim, Hindu, Buddhist, Dalit, Tribals or others who might face problems of acceptance and service availability based on religion or caste status? Similar issues exist (though often denied) in the American and Canadian health systems based on financial status, Aboriginal status, educational status, etc., so it’s not a problem unique the the Indian healthcare domain.

Bob Kirk Sunday, August 10, 2008 at 3:03 PM PT

Sramana,
the article was indeed interesting , but somehow far-fetched.In a country where pottable water and grains are hard to come by,you are proposing usage of mobile phones,advanced medical equipment and high-bandwidth connectivity.While it may be possible in small towns to some extent,carrying this to villages,in states like interior Bihar seems an impossibility.How would you counter hurdles like no accessibility via road,illiteracy,linguistic barriers,caste barriers?Please comment.

Manjeet Monday, August 11, 2008 at 12:00 AM PT

Bob, as long as the Pharmacy franchises are willing to support all the said communities, I don’t see why there needs to be separate parallel systems.

There is, of course, a stratification due to financial wherewithal, which would mean that people who can afford it, would access higher orders of medical care, and would be able to potentially travel to other places for that.

This particular franchise is focused on serving the people who would want local care.

Manjeet,

Mobile phone penetration in India is already extremely high. You will see, in the next decade, these phones are going to become the terminals for administering many services, including banking, for instance.

As for addressing barriers that you are bringing up – that’s what entrepreneurs do. Remove obstacles. If an entire village has only illiterate people, then the pharmacists would need to be brought in from a nearby village.

And the short answer to your question also is that you need to stage the process, and pick villages that have at least 35 literate people, and are accessible by roads, have carrier penetration, etc.

As time goes by, roads, telecom service, literacy levels – all would increase. With that, the coverage of the project would also spread further.

Sramana Mitra Monday, August 11, 2008 at 8:56 AM PT

OK, your replies make sense. 🙂

Bob Kirk Monday, August 11, 2008 at 2:50 PM PT

Sramana,call me the eternal pessimist,but I would definitely like to see this happen to believe it.It has a possibility of working in small towns where networks like Reliance and Tata have already penetrated deep.However,an extremely strong franchisee system with strong rules AND goverment aid(to cut the red tape) will be required to make this program work or else the pervasive corruption in our beaurocratic system will ground the program as soon as it takes off.We’ve seen it happen to the Rs 2/kg rice program and scores of others too. Still , the idea seems interesting. 🙂

Manjeet Tuesday, August 12, 2008 at 12:32 AM PT

Sramana, a very interesting concept but a little far fetched. Currently in India there is no concept of standardisation – be it diagnostics or therapeutics. The first hurdle is to get the standardisation…even now the most expensive antibiotics are used willy nilly for no real reason by trained doctors and promoted by the pharmaceutical companies making resistant bugs a big problem in India. This is just one of a million examples. Sorry for being a pessimist but the infrastructural change needed will be difficult to achive by 2020 but definitely a very nvel concept.

Srabani Tuesday, September 23, 2008 at 1:08 PM PT

Vision is always somewhat far-fetched, Srabani.

Sramana Mitra Tuesday, September 23, 2008 at 2:30 PM PT

[…] Our two partners in the project were, of course, Doctor At Hand and Doctor On Wire. […]

Vision India 2020: Harvard Medical School, India | The Pharma Times Saturday, August 19, 2017 at 2:39 AM PT