Sriram Gutta

Piramal eSwasthya (Part 2): Building Acceptance for Mobile Health

Editor’s Note: This is the second of two posts on Piramal eSwasthya as part of NextBillion’s Advancing Healthcare With the BoP series. Part one of the interview with Kavikrut, who currently heads the Piramal eSwasthya, may be found here.

Sriram Gutta, NextBillion: How has the model evolved over the last three years?

Kavikrut, eSwasthya: Based on our learnings from the field and client feedback, the model has mainly evolved along the following three areas:

  • (Clinical Decision Support System) CDSS – Over the years, we have added more ailments to the system. We had started with 40 and now the CDSS can diagnose over 70 ailments. Even the workflows of the existing aliments have been modified based on learnings. We are now looking to deploy a mobile application based system where the PSS (Piramal Swasthya Sahayika (PSS) – A village-based health worker) will enter all data on her phone with many basic CDSS questions moving onto the application. This will make the process faster and hence increasing the system’s capacity and accuracy.
  • Client acceptability/marketing – This is a radical service and takes a longer time for client acceptance. Even with the penetration of mobile and internet, the affluent class is still a little skeptical about e-commerce and mobile banking. Thus, we are not surprised by the skepticism about our model where they don’t see the doctor and thus can’t attach tangibility to the treatment. We have continuously reinvented marketing techniques and customer involvement for the BOP through drug reminder SMSes, follow-up calls, PR articles that encourage embracing telemedicine among others
  • Health worker – (The) Health worker is one of the most critical parts of our system. It takes a long time to recruit and train the right one. Trying to change their behavior takes a lot of time, resources and money. Over a period of time, we have identified certain traits that are required to be a good PSS. Some of those (include the) need for an additional income, entrepreneurial ability to understand commissions and franchisee model, etc. We started with a fixed salary for the health worker and realized that there wasn’t any motivation for her to source more patients and service them well. We then moved to a part fixed and part variable pay which later gave way to a complete variable franchisee type system. Now the health workers need to bring an upfront starting investment and franchisee fee paying for training, medical equipment and a security deposit against drugs

NextBillion: Seems like hiring women workers could be a bottleneck when you are looking to scale. What are some of the innovations that you are looking at?

Kavikrut: We are currently working with the government of Rajasthan to hire ASHA workers as our health workers. There are a total of 267,000 such workers in India – one for every 1,000 population. She has a kit of over-the-counter drugs, conducts health related surveys and supports most government initiatives such as polio camps. The Rajasthan government has shown interest in the model and we have now launched a PPP pilot with the Churu collectorate as part of which we are launching 100+ villages in one block of the district. This is a win-win solution for all. The government can provide primary care consultation now within the village, we get access to trained health workers who already have an established “health service provider” relationship with the village, and the ASHA worker can increase her income by working with us. It is still preliminary to talk about the results of this model but if successful, it holds immense promise for scaling the model very quickly.

NextBillion: Have you also partnered with private players?

Kavikrut: Yes, we have partnered with several players to offer better and high quality products/service to our clients. Some of our partners include:

  • Tata Consultancy Services – TCS have played a big role in designing the CDSS. All the rules and platform have been provided by them
  • Vision Spring – They have enabled us to add primary eye care also to our service offering by giving access to low cost reading glasses through the health workers. This is an additional source of income for the health workers and provides quality eye care to our clients
  • Medentech and aquatabs – We have worked with these organization that manufacture water purification tablets that help reduce water contamination at the household level

NextBillion: Do you have any interesting insights from patient behavior for the readers?

Kavikrut: Yes, many of them. One of them presents a big challenge for us – most patients hesitate from buying the entire prescription. For instance, if a patient comes with cough and also has high temperature, we prescribe both a cough syrup and paracetamol. The patient typically buys only the cough syrup as syrup is the more obvious need to them. Similarly, for skin ailments a patient may ignore the prescribed antibiotic and instead only buy the ointment tube that is also part of the prescription. We are working on ways to change this behavior. Some of the health workers who have a reputation manage to convince patients about the need of buying and consuming all the drugs in the prescription.

NextBillion: Is it required for an entrepreneur to have healthcare experience to be in this space? Why or why not?

Kavikrut: Not necessarily. I entered this space without any background in healthcare and don’t think it was a big barrier. It is good to have the background but not a deal breaker. It is more important to understand the business and the mindset of people at the bottom of the pyramid when working to deliver essential services such as health, education etc. What we are working on is a healthcare delivery model and not just a health product or service per se. It is as much about the supply chain or marketing as much it is about the clinical treatment side of health

NextBillion: How would you describe your progress so far?

Kavikrut: Over the last three years we have achieved a few milestones that we believe are important indicators of our experience as well as our passion to find solutions healthcare problems. We have treated over 40,000 patients through several pilots including a more traditional telemedicine model in Tamil Nadu that deployed videoconferencing and Medical Data Acquisition Units. In Rajasthan, we have worked in more than 200 villages in three different districts (Jhunjhunu, Nagaur, Churu) and in the process have trained over 200 health workers. Our pilots, challenges and learnings were recently published as a Case Study by the Harvard Business School. Through social experiments and meticulously designed operational processes, eSwasthya has also innovated on several fronts in the context of delivering services and goods to rural consumers. In 2009, the organization was awarded the ISO 9001:2008 Certification for its Quality Management Systems across all villages, rural offices and the Mumbai centre.

NextBillion: What would you like the headline of eSwasthya’s website to be in 2020?

Kavikrut: The world’s most radical yet simplest healthcare delivery model for the BoP. Largest number of patients treated through remote diagnosis. Piramal eSwasthya becomes synonymous with the word “telemedicine”.

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