NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

As 20 community health workers file into a small room of a near-dilapidated school at Rangashaipet village near Hanamkonda, Andhra Pradesh, to interact with the Vaatsalya hospital team, one thing becomes clear: Changing the health care scenario in India will require a lot of organizations working together.

With a population of 1.2 billion (2011 census), more than 72 percent of whom are deemed rural, and with the biggest health care facilities in the country clustered in a few metropolitan areas, there has been a huge gap in health care accessibility and affordability for a whopping 840 million people in India.

The obvious challenges include: few doctors and fewer specialists in geographically distant and sparsely populated towns; lack of basic medical infrastructure and technology to deliver high-quality health service; few opportunities for growth to attract doctors and other paramedical staff; and lack of affordability for families with an approximate income of $250 a month, or less than $100 a month for 30 percent of residents.

The challenges continue. Previously unexplored geographies? Check. Battle for human resources? Check. Inability to get highly efficient, even moderately expensive systems and processes on board? Check. Out-of-pocket customers with a high tendency to go to less expensive quacks? Check. Negligible awareness of preventive health care? Check.

So, is it even possible to carve out a financially viable and socially relevant model of health services in the rural, semi-rural and semi-urban patches across all of India? In the past few years the entry of small and large, single- and multi-speciality enterprises in the picture has helped answer this question: Yes.

At Vaatsalya Healthcare (where, full disclosure, I manage corporate communications) – one of the top 10 most innovative companies in India according to Fast Company – it has been eye-opening to see the changes brought about by various enterprises. What are these companies doing differently so that they come out as game-changers, even with all the checkmarks in the wrong places?

Hospitals in small towns are trying to reach customers in their homes, before they come to the hospital. At Vaatsalya, for example, nearly 300 camps have been organized in 20 different tier II and tier III cities and surrounding villages in the past few years, trying to create awareness about health and diagnosis.

Interestingly, larger hospitals that are entering this market segment are following suit. Apollo hospitals in Hanamkonda recently partnered with Vaatsalya for a large-scale oncology awareness drive and check-up camp. Though Vaatsalya works only in primary and secondary care delivery (and not oncology), the key driving factor is to generate as much visibility for all health care facilities as possible.

Building on this, the way forward for health care players in these places is partnerships, few of which are seen in large cities, where most facilities are independent.

Vaatsalya primarily caters to general surgeries in its Physician, Pediatrics, Gynecology and General Surgery (PPGS) model. In Hubli, however, a partnership with Nova Speciality Surgery is eliminating the need for patients to travel all the way to Bangalore for special surgeries related to urology, orthopedics and obesity. A similar partnership was formed with Vasan Eyecare. Thus, enterprises are joining hands as they develop a network in rural and semi-rural India. They are complementing each other, adding to the services being offered by one, generating capacity for the other.

Besides private sector relationships, health care enterprises are joining the existing public and government actors in the scenario. For instance, enrollment for Rashtriya Swasthya Bima Yojana (RSBY), or government-run health insurance, is helping hospitals serve customers at the bottom of the pyramid – those who cannot pay out of their pockets for their medical treatment.

Insurance and empanelments result in 20 to 30 percent of cashless treatments at hospitals in these places. Whether it is seeking the aid of community health workers (Accredited Social Health Activists, or ASHA’s) in spreading the word about treatment available nearby, or tapping into local networks such as local radio and television shows, deep-rooted marketing is helping enlarge the footprint of health care.

Another important solution provided by innovators is a corporate ladder for doctors. Doctors are effectively stepping into management of hospitals and clinics – becoming senior managers and medical directors – extending their exposure and scope in the organization and incentivizing their services.

Indigenous and international product innovators and labs are actively eyeing this development, which might well become an opportunity for them. In some cases, the very problem faced by enterprises becomes an opportunity with a homegrown solution. Building a pipeline for internal talent is one example.

Whether service or product based, companies are innovating and customizing at every step, tailoring to the place they’re in which they’re operating, patiently carving a niche in customers’ hearts. Above all, they are nurturing a strong belief in their product and/or service every day by monitoring the most intimate details of customer satisfaction.

Sakshi Mittal is works on special initiatives and corporate communications at Vaatsalya Healthcare and is a project manager at the National Association of Social Enterprises, a nonprofit collaboration of India’s leading social enterprises.