Al Hammond

Notes from the Field, Part 4: A Hybrid Approach to Building a Company

Editor’s note: Al Hammond, entrepreneur in residence at Ashoka, writes a series of reports documenting his experiences and the learning involved in started a “base of the pyramid” (BoP) healthcare venture to serve developing countries. This is his third report in the “Notes From the Field” series. You can read the first three parts here, here and here.

Building a new venture from scratch often takes a lot of time. Operating in a rural area with imperfect infrastructure only makes it harder. But we were able to leverage the existing field force of our Indian partner to begin construction of our healthpoint units almost immediately after incorporation. Getting pharmacy licenses could have posed a big barrier–anyone who knows India will tell you that government approvals can take months-but we got our licenses approved in a week, thanks to our partner’s strong relationship with the Punjab Government.

We could be efficient in our pre-launch marketing campaign, because it was based on the prior experience and on-the-ground knowledge of our local partner. And the bottom line is that we initiated a pretty complex business and started seeing patients just 3 months after we began activities in India -a huge saving in time and money. Those are just a few of the benefits of our hybrid model in which our NGO partner, the Naandi Foundation, helped get us off to a running start and whose brand equity has given us a huge initial credibility with our customers (Naandi’s logo is on our units, along with the logo of the Punjab government and that of the company, Healthpoint Services India Pvt. Ltd. See above.)

At the same time, the company hired lawyers and negotiated with several suppliers of telemedical software and with a couple of Indian diagnostic companies to pick our key technology suppliers. As a result, we offer more than 60 different diagnostic tests from day one.

We hired staff in Hyderabad, and promptly moved a lot of them to Punjab to help with the launch. We set up banking services (not as simple as it sounds-the number of pieces of paper that have to be signed, authenticated, and countersigned for banking in India is fairly amazing, and it still took us 6 weeks to get internet access to the account, because that’s a whole different application process) and mastered the art of wiring money to India via Mauritius (don’t ask). Also, the school programs we ran as part of our marketing efforts were a huge hit-the kids got telemedicine and its potential right away, and went home to tell their parents all about it. At the launch, we also distributed baseball caps with our ehp logo (for E Health Point, our Indian trade name) to kids, who proudly wore them everywhere.

Not everything went smoothly. It’s a startup, after all, and our model requires four different, fairly complex services, from telemedicine to advanced diagnostics to pharmacy to water treatment. Our broadband connections worked sometimes and sometimes not, until we got our suppliers focused. Software tools went on the fritz, and our IT team stayed up all night getting them ready to operate in the morning. The electrical grid was so undependable we broke down and installed generators (we are now moving to solar/battery power supplies). We narrowly averted one serious disaster, when a cast iron connector snapped and wireless tower under construction at one unit collapsed, so that the tower worker had to jump 30 feet to the ground, fortunately without injury.

To ward off any sense of bad luck that could have kept patients away, the local holy man was engaged to conduct a Hindu healing/blessing service at the site (whatever it takes!). But finding and training clinical assistants from the villages served by our units and getting doctors to staff our urban telemedical unit went reasonably well. The biggest challenge for the clinical assistants was not the diagnostic training -they all now take blood or measure vital signs like pros- it was learning how to use a computer, which none of them had seen before.

In short, it was a fairly typical business startup, compressed in time, but successful because, I think, the overall model and advance planning were mostly right, and the skill and dedication of the India team-and the Naandi staff-were superb.