AFFORDABLEDIAGNOSTICSFORINDIANBASE OFTHE PYRAMIDMARKETSA PILOT PROJECT TO CONNECTFINNISH AND INDIAN DIAGNOSTICSINDUSTRIESA...
ACKNOWLEDGEMENTT   his report has been prepared    with the ardent support andcontributions of many persons. The          ...
EXECUTIVESUMMARYA    ffordable diagnostics for     Indian Base-of-the-Pyramid(BOP) markets is a key pilot under           ...
TABLEOF CONTENTSi. Acknowledgementii. Executive Summary                                               5. Strategic Managem...
LIST OFACRONYMSAIIMS		              All India Institute of Medical ScienceBoP		                Base of the PyramidBHC		   ...
LIST OFFIGURESFigure 1.1	    Income segments of BOP market worldwide (Hammond, Kramer, Katz, 	                            ...
1
INTRODUCTIONT   o provide solid ground on    the project, this chapterbegins with briefly introducing                     ...
1.2 Research Aim                             1.3 Limitations of Research period of research part: Stake-                  ...
differs by nations and regions          gregate value of Indian BOP               (WBG, 2007), the BOP market for(London, ...
novation ecosystem in various                                                                                     countrie...
Figure 1.4                                                                                                 Figure 1.5   Fi...
2
OBSERVATIONSINFINLANDI   nnovation Ecosystem in our    work refers to a network ofinterconnected actors working           ...
1                                                                       2                                 3 4             ...
companies internationalise and        2.2 Finnish Diagnostics                 almost every interviewed com-connect to righ...
3
OBSERVATIONSIN INDIAO    n a quick note, the multi-     tude of actors and the levelof complexity of the Indian eco-      ...
company as it enjoys 70% market              rectorate General of Health Ser-                                  Figure 3.1 ...
search (ICMR) as they fund re-       the state of Gujarat, and Save           more successful and creative insearch on aff...
4
FIELDEXPERIENCE:EXPLORINGHEALTH CAREIN RURAL INDIAT   his section describes our    observations on the IndianBase of the P...
Block Health Centre                          and medical treatment and basic         Figure 4.1                           ...
other government medical facili-     emergency. Apart from nurses,            year calls for diagnostics thatties, devices...
4.3 Observations on people                   a person from a lower caste has       types of tests and diagnosis couldand m...
the village level. One practical                                                                   doctors in theexample o...
5
INFOGRAM:STRATEGICMANAGEMENTTOOLA    fter the analysis employing     the Actor Map had been per-formed, we realized it was...
egorized into three colour-coded               However, due to the very            the field trip to India. Some aresegmen...
AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS   //23
6
CONCLUSIONSANDFUTURERESEARCHT   his chapter gives a conclud-    ing review of the study madein this paper. A concise descr...
6.1 Suggestions for Future                     In conclusion, we have pre-Research                                    sent...
AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS   //27
REFERENCESAdner, R. (2006) ‘Match Your                 Dai, Weihui, Chen, Mingqi, & Ye,   Fukuda, K. & Watanabe, C.(2007)I...
Available at http://crds.jst.go.jp/   at the bottom of the pyramid,            Ward, T. & Shackleford, R. (2003)output/pdf...
APPENDICES                                                                        APPENDIX Avii   AFFORDABLE DIAGNOSTICS F...
APPENDIX A             AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS   //viI
APPENDIX Bvii   AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS
APPENDIX B             AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS   //vii
Final Report_
Final Report_
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Final Report_

  1. 1. AFFORDABLEDIAGNOSTICSFORINDIANBASE OFTHE PYRAMIDMARKETSA PILOT PROJECT TO CONNECTFINNISH AND INDIAN DIAGNOSTICSINDUSTRIESAdalgisa Santos Supervised by:Chi Zhang Teija Lehtonen MSc. (Econ.)Giulia Centonze Dr. Mikko Koria DSc (Econ.) MBA (DesMgt.)Ramsankar MuraleedharanTuuli Hakkarainen R INDUSTRY PROJECT 2010/11
  2. 2. ACKNOWLEDGEMENTT his report has been prepared with the ardent support andcontributions of many persons. The Further, the team also wishes to thank everyone who has been in- terviewed during the project; theproject work was supported by Auli representatives from diagnosticsPere, Chief Technology Advisor, companies, Indian specialists andTekes and supervised by Dr. Mikko contact persons from the non-Koria and head of BoP service governmental organizations. project, Teija Lehtonen. The coreteam is composed of AdalgisaSantos, Chi Zhang, Ramsankar Mu-raleedharan, Giulia Centoze andTuuli Hakkarainen. Valuable con-tribution and comments were alsoreceived from Dr. Minna Halme andPaula Linna. Our gratitude alsoextends to the Department of Bio-technology, India for their supportand help during our field trip.  AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS //i
  3. 3. EXECUTIVESUMMARYA ffordable diagnostics for Indian Base-of-the-Pyramid(BOP) markets is a key pilot under project Affordable diagnostics for Indian BOP markets. Beginning with a background introduction, holders and their interactions in and across Finland and India. Lastly the Infogram, the endthe larger Sustainable Innovations the key concepts of BOP in the outcome of the project is present-at the BOP service project at Aalto Indian context, the diagnostics ed. It is a tool for companies to askUniversity. The project was funded industry, and Indian and Finnish the right questions concerningby Tekes, the Finnish Funding innovation ecosystems are ex- their suitability for the BoPAgency for Technology and Innova- plained. This theoretical section markets (for the visualisations oftion and set on the assumption is then followed by the main find- Actors Map and Infogram, see thethat Finnish medical diagnostics ings on the Finnish innovation appendices). It is supported by acompanies desire to expand their ecosystem focusing on the actors hints section which provides keenmarkets while India shelters a huge in both the Finnish and Indian di- insight into the Indian BoP sce-BOP market that needs innovative agnostics industry. The connec- nario based on background re-and affordable diagnostic tech- tions within and across Finland and search and observations from thenologies. The objectives were to India are also discussed.  field trip. The Infogram is expect-visualise the complexity of both Afterward, the report will bring ed to help companies test theirinnovation ecosystems and provide forth observations and case exam- products and assess the expecta-helpful information and tools that ples of the BOP market in the Indian tions on the Indian BoP. enable organizations analyse dif- rural areas where the team con-ferent aspects of creating new ducted fieldwork. Based on thebusiness at the Indian BOP.  findings, the Actor Map, one of the This report discusses the key major deliverables of the project,findings and outcomes of the is used to visualize the key stake- AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS //ii
  4. 4. TABLEOF CONTENTSi. Acknowledgementii. Executive Summary 5. Strategic Management Tool:iv. Table of Acronyms Infogramv. Table of Figures // 5.1 What is the Infogram 211. Introduction // 5.2 The Application 21// 1.1 Background 1 // 5.3 The Information 22// 1.2 Research Aim 2 6. Conclusions and Future Research// 1.3 Limitation of Research 2 // 6.1 The Results 25// 1.4 Research Method 2 // 6.2 Suggestions for Future Research 26// 1.5 Related Concepts 2 vi. References2. Observations in Finland// 2.1 The Actors Map: Finland 7 vii. Appendices// 2.2 Finnish Diagnostic Companies 93. Observations in India// 3.1 The Actors Map: India 114. Field Experience: Exploringhealth care in Rural India//4.1 Rural Areas at a Glance 15//4.2 Observations on the Environment 17//4.3 Observations on people and 18mind sets AFFORDABLE DIAGNOSTICS FOR INDIAN BASE IF THE PYRAMID MARKETS //iii
  5. 5. LIST OFACRONYMSAIIMS All India Institute of Medical ScienceBoP Base of the PyramidBHC Block health centreCHC Community health centreCDSCO Central Drugs Standard Control OrganizationDBT Department of BiotechnologyDGHS Directorate General of Health ServicesDCGI Drug Controller General of IndiaGVL Global Venture LabFDA Indian Food and Drug AdministratorICGEB International Centre for Genetic Engineering and BiotechnologyICMR Indian Council for Medical ResearchIIM Indian Institute of ManagementIIT Indian Institute of TechnologyIISC Indian Institute of ScienceNGO Non-governmental organizationPPP Public-Private-PartnershipPHC Primary health centreSitra The Finnish National Fund for Research and DevelopmentSHC Sub-health centreTekes The Finnish Funding Agency for Technology and InnovationTEM The Finnish Ministry of Employment and EconomyVTT The Technical Research Centre of FinlandWHO World Health Organizationiv AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS
  6. 6. LIST OFFIGURESFigure 1.1 Income segments of BOP market worldwide (Hammond, Kramer, Katz, 4 Tran, & Walker, 2007) //3Figure 1.2 Structure of an Innovation Ecosystem Aimed at Solving Problems //4Figure 1.3 Innovation Ecosystem in the United States //4 Figure 1.4 Finnish innovation ecosystem //5Figure 1.5 Indian innovation ecosystem //5Figure 2.1 Street views of New Delhi, Spring 2011 //8Figure 3.1 A Busy day in AIIMS, New Delhi //12Figure 4.1 Community Health Centre and Rural Health Centre //16Figure 4.2 Interviewing people in the Rural Village //17Figure 4.3 Invisible Barriers: Border between castes is respected //18Figure 4.4 Information Booklet for Mothers //19 AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS //v
  7. 7. 1
  8. 8. INTRODUCTIONT o provide solid ground on the project, this chapterbegins with briefly introducing new business (Prahalad, 2009; Rangan, 2007). Finland is a technology and in- research on both Finland’s and India’s innovation ecosystem, then through visits to variousthe background of this project. novation driven nation, and it’s representatives of the actorsThe research aim, limitation and investment in the same has been within the system, we understoodresearch methods used in the ranked among the top three in their operational models and thestudy are also described and the the world for quite a while (OECD associations operating betweenthird stage elaborates on the as- Science, 2008). Hence, we take the actors. Subsequently, wesociated concepts including Base the model of the Finnish inno- also went deep into the Indianof the Pyramid (BOP) and diag- vation ecosystem as a starting BOP community. We conductednostics industry. Finally, Finnish point for preparing the Indian interviews inside the villages inand Indian innovation ecosys- market entry. For the BOP market Gujarat area, trying to make cleartem models based on a literature in particular, a well-founded the needs of ordinary people atreview are presented.  platform is a key prerequisite the BOP and their awareness and for business operations. In this attitudes towards medical care study, we intended to combine service, diagnostics in particular.1.1 Background innovation ecosystem concept This study is based on learning with the actual situation of BOP and understanding innovation A wide range of literature to help Finnish companies and ecosystems and industrial net-reveals the importance of large relevant organisations explore works, combined with a bundle ofpopulation, but low-cost markets a proven business development practical experience for the firstwhich provide potential op- methodology. Keeping in mind hand material which we calledportunities and challenges for this purpose, we first conducted fact-finding process.  AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS //1
  9. 9. 1.2 Research Aim 1.3 Limitations of Research period of research part: Stake- holder analysis, Actor-Resource- Affordable diagnostics for All of the information and con- Activity analysis, and Actor Map.Indian BoP markets is one of the clusions are based on the field work Based on the understanding ofpilot projects under the larger Sus- made by the Aalto University team. the complexity of the wholetainable and User-Driven Innova- The discussion on the rural areas network, we further developedtions at BoP Markets service of India is mainly based on one canvas framework tool which isproject at Aalto University. The region in India and there could based on the widely used strategicproject is funded by Tekes and un- exist variations across the country, management tool, Osterwalder’sdertaken by four master´s level so the conclusion from this study Canvas. When the canvas tool isstudents of International Design may not apply to other parts of used together with the Actor Map,Business Management (IDBM) of India. Also, due to the limited time they are intended to facilitate theAalto University. Its aim is to help frame of 16 working days in India, understanding of the project ob-Finnish diagnostic companies to it was possible to cover only a small servation. The result is also ex-operate in a sustainable way in the part of research topic. The report pected to make contribution to theIndian market, and also assist in aims to bring up relevant issues for Indian market entry for the Finnishdelivering affordable and innova- further research and does not guar- companies.tive technologies there. Thus, both antee comprehensive informationcountries will benefit from this regarding the Indian BOP market.collaboration. Moreover, there exists dynamics 1.5 Related Concepts This study has taken Finnish in the emerging economy such ascompanies’ interests to enter the India, therefore the information 1.5.1 Indian Bop MarketIndian low-cost market as an provided here could become out-example and analyses, observes, dated if no follow-up research is The Base of the Pyramid (BoP)and elaborates on the recognition conducted.  refers to the largest, but low-in-of the entire industry network come socio-economic group. Thealong with some first-hand infor- population of this group is stillmation of the Indian low-cost 1.4 Research Method growing rapidly (London & Hart,market. It is intended to help 2004). According to the reportFinnish companies and organiza- This project was started with from World Bank Group (2007), thetions to get some insights when Objective-Attributes criteria anal- BOP market constitutes four billionbuilding up the initial stages of ysis, conducted by means of Logical people whose annual incomes arethis strategy. Framework and Context Map. below $3000 (measured in 2002 This study mainly utilizes Actor Within this sub-section, we also international dollars and equiva-Map as the visualizing tool to map utilised problem tree analysis for lent to €2090 as of July 2011). Theout both Finnish and Indian inno- better understanding of the core annual income contributed by BOPvation ecosystem in Diagnostic problems and their relationships. market is around 5 trillion dollarsfield. Also, based on the under- As the preliminary objective of the globally. The income segmenta-standing of connections between project is to build a network map tions are shown in Fig 1.1. innovation ecosystem and Indian which can visualize the collabora- However, even though there issociety, a strategic tool, Infogram tion between the two countries, it significant business potential inwas made to provide perspective is important to understand the this BOP market, the transnation-on the process of setting up the stakeholders, their roles and the al business strategies cannot bebusiness strategy to BOP market connections among them in the directly used for this low-incomein Indian context.  network. For these purposes, we market. BOP market differs from utilized three methods to develop the other markets and the charac- the project during the second teristics of the BOP market itself2 AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS
  10. 10. differs by nations and regions gregate value of Indian BOP (WBG, 2007), the BOP market for(London, 2007; UNDP, 2008). For market, this provides huge poten- pharmaceuticals in Asia is $30.8example, the daily income of Brazil tial for companies and organiza- bn (€21.45 bn), out of which $26.6BOP is $3.35 (€2.33) while in China tions that possess advanced tech- bn (€18.53 bn) is from India. Inthe number is $2.11 (€ 1.47) nologies that can better serve the addition, the BOP market accounts(Hammond, Kramer, Katz, Tran, & needs of local customers. There- for 85% of the national expendi-Walker, 2007). fore, it is an important first step to ture in health care; however the The daily income of Indian BOP carefully observe the local market spending in health care from BOPmarket as given by the report is and to identify business opportu- market is only 2.9% sector wise.$1.56, and the BOP accounts for nities. Based on the observations This gap to some extent indicates95% of the Indian population. Al- and findings, relevant business the business potential of providingthough the individual’s purchasing models and products are to be de- high-quality and affordable diag-power in Indian BOP market is veloped for the market entry. nostics in India. weak, yet the aggregate purchas- Diagnostics cover a range ofing power implies significant busi- 1.5.2 Diagnostics Industry advanced technologies: optics,ness opportunities. The annual microelectronics, industr ialexpenditure of the Indian BOP The diagnostic industry consists Design, nanotechnology, bimo-market is more than 1.2 trillion of companies and organizations lecular recognition, materialsdollars, representing 85% of the that offer analytic or diagnostic science, mathematics, micro ma- services, i.e., to apply chining and printing. Finland in imaging and laboratory this area has its competitive ad- capabilities to deter- vantage. In Finland, there are 30 mine the cause of an companies with approximately illness. Diagnostics 2000 personnel in the diagnostics plays an important role industry (Jouko, 2010). The annual in health care sector. It net sales are about €350 million. detects symptoms of The personnel and the investment heath risks and disease in R&D will increase by 8% and 12% at an early stage, by 2014 respectively. It is, there- Figure 1.1 thereby decreasing the fore, expected that the combina- medical costs and improving peo- tion of Finnish know-how in diag- Income segments of BOP market worldwide (Ham- ple’s health. Along with the pro- nostics and massive Indian market mond, Kramer, Katz, Tran, & gress of the economic situation in would create a double-win situa- Walker, 2007)) India, the spending in health care tion. has been increasing. The Indian diagnostic and pathological labs 1.5.3 Innovation Ecosystemnational expenditure. Please refer test services market was valued atto page 128 of (WBG, 2007) for Rs. 66.87 bn (€1.05 bn) in 2008, Ecosystem is an environmentmore details of these statistics. and is expected to reach Rs. 159.89 where there exist certain relation- The Indian BOP market is mostly bn (€2.51 bn) by 2013, reflecting ship and interaction between in-rural, and it is a poorly served, in- a growth rate of 18.9% during dividual, the living organisms andefficient and noncompetitive 2009-2013 (Cygnus, 2009). nonliving components (Dai, Chen,market. According to (WBG, 2007), Although the continuous moder- & Ye, 2007). Innovation is definedmany people in the BOP have to nisation and improvement in living as a new idea, a certain practice,pay higher prices for the same or standards, the BOP market still or object that is created through aeven lower-quality goods and ser- play an important role in the Indian process that various factors suchvices. Considering the size the ag- health care sector. According to as talent knowledge, funds, AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS //3
  11. 11. novation ecosystem in various countries, it turns out that there are mainly three key factors, i.e., Figure 1.2 Structure of an Innovation Ecosystem Aimed at Solving Problems.(Japan Science, 2011) public community, industry com- munity, and research community. Public community refers to the government and administrative agencies who take the role of le- gitimacy. They support the crea-systems, and markets are related ganizations interact to produce tion of scientific knowledge andto one another in a complex manner and use the innovations (Japan goods and services, and also(Japan Science, 2011). An innova- Science, 2011). Due to the cul- develop new policies to promotetion system is a “set of institutions tural and economical diversity of cooperation between the innova-whose interactions determine in- various countries, it is not feasible tion organizations (Japan Science,novation performance” (Kim & to find a universal model, even 2011). Industry community standsNelson, 2000). National innovation among developed countries. For for enterprises in various indus-systems have been identified as example, innovation ecosystem in tries producing goods and ser-the primary engine for innovative Japan aimed at solving problems vices. Research community referscapacity and fast growth (Kim & (As shown in Fig. 1.1), while in- to universities and research insti-Nelson, 2000; Freeman & Soete, novation ecosystem in the United tutes generating scientific knowl-1997). Such systems are becoming States aimed at sustaining indus- edge (Japan Science, 2011). Eachincreasingly open to innovation trial ecology (As shown in Fig. 1.2). actor plays a role in developing andsystems of other countries, as their Based on the observation of in- adopting innovation, and the in-efficacy increasingly depends not teractions amongonly on local institutions, but also them are also impor-on global connectedness. To main- tant.tain the continuous creation of Nowadays, innova-innovation, we need to organize a tion ecosystem atwell-defined environment sur- national and regionalrounding innovation. Within the level is needed tosystem, each member’s knowledge bring innovations toof the innovation is dependent on commercial reality.and subject to the “cycles of inter- And many countriespretation” happening in the larger have realized thatcommunity (Swanson & Ramiller,1997). Figure 1.3 Inside the innovation ecosys- Innovation Ecosystemtem, networks of innovations and in the United Statescommunities of people and or- (Judy, 2009)4 AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS
  12. 12. Figure 1.4 Figure 1.5 Finnish Innovation Ecosystem Indian Innovation Ecosystempromoting national innovation and universities. The three parties form curately describe the operation ofentrepreneurship to maintain the close relationships and interac- the innovation ecosystem there.economic growth is a common chal- tions through formal or informal Based on our previous analyses andlenge for both social and econom- cooperation. Policy makers provide the field trip in India, it is not easyic perspectives (Charles, 2005). The for the company funding, policy to implement a sustainable innova-benefits of this ecosystem include assistance, research centres, aca- tion ecosystem. In order to achievedecrease the risk of innovation, demia and so on. Companies accept such a long-term system, it isdecrease the cost of sustaining in- the assistance from the policy simply not the close cooperationnovation, increase learning cycles makers, and at the same time, carry among the important actors. Moreand diversity of innovation (Jeff, out various short-term or/and important factors. e.g. culture,2008). Realising the needs and the long-term projects with research leadership, funding, policy, educa-benefits of innovation ecosystem institutions. tion should be carefully consideredwe were led us to first examine both and planned. The realisation ofFinnish and Indian national innova- Indian Innovation Ecosystem innovation process is not a quicktion ecosystem model. fix, it requires a long-term gradual According to CII (2010), due to process. First of all, it should startFinnish Innovation Ecosystem the challenges in the fields of edu- from the culture, education and so cation, infrastructure, water, that people can realize the impor- According to Ilkka (2010), the energy and so on, it is difficult to tance of innovation. This topic isFinnish innovation ecosystem is identify such an innovation eco- beyond the scope of this study, socomposed of three components: system in India. We have made our we will not expand our discussionpolicy maker, company and aca- assumption of the model based on on that here.demia. Policy makers include the our preliminary research as showngovernment and relevant decision in Fig 1.3.makers. Companies refer to those However, after the informationcompanies and organizations that from the field trip and interviewsare operating for profits from the conducted in India, it is found thatindustry point of view. Academia our previous assumption of Indianincludes the research institutes and innovation ecosystem does not ac- AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS //5
  13. 13. 2
  14. 14. OBSERVATIONSINFINLANDI nnovation Ecosystem in our work refers to a network ofinterconnected actors working Finnish innovation ecosystem. Such relevant actors for diagnos- tics industry are discussed in the Tekes is one of the founders of an important player FinNode, which is the access node to hookaround a core platform of tech- following section and visualized up with partners in Finland. It is anology and business. Accord- in the Actor Map on the following community of Finnish public anding to our findings, the Finnish page.  nonprofit organizations, made toinnovation ecosystem is well- enhance international R&D coop-structured where the main eration and business (FinNode.actors—policy makers, compa- 2.1 The Actors Map: Finland com). Along with Tekes, thenies and academia—have their founders are Academy of Finland,well-defined roles. In a relatively The Actors Map is given as Finpro, the Finnish National Fundsmall country like Finland, coor- Appendix A. for Research and Developmentdinating the roles and common (Sitra) and the Technical Researchobjectives is possible and it is Concerning the connection- Centre of Finland (VTT). FinNodegainful for every actor to cooper- enablers between Finland and is steered by The Finnish Minis-ate towards a common goal, such India, we observed that The try of Employment and Economyas aiding to understand a starkly Finnish Funding Agency for Tech- (TEM). India became the fifth op-contrasting country such as India nology and Innovation (Tekes) erating country of FinNode in thein terms of doing business there. has a critical role in connecting beginning of year 2011, whichWe assume that it is important the private sector, academia and shows a growing interest towardsto understand the key players in research organizations; India has India as an important market po-medical diagnostics sector and been one of the focus countries tential for Finnish companies.the rest of the ecosystem and the of Tekes for some years already. FinNode is helping Finnish AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS //7
  15. 15. 1 2 3 4 Figure 2.1 Street views of New Delhi, Spring 2011. Photos by: Tuuli Hakkarainen (1,2,3) Adalgisa Santos (4)8 AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS
  16. 16. companies internationalise and 2.2 Finnish Diagnostics almost every interviewed com-connect to right partners in Companies panies mentioned cultural dif-India. As part of this project, we ferences as one of the challengesinterviewed Finnish diagnostics In order to understand the or concerns. These challengescompanies. Based on these, one Finnish diagnostics industry five included differences in the waycan observe that, while there companies were interviewed. The of communicating and the issuesare many relevant issues that aim was to get a general picture in creating mutual trust when es-the companies are well aware on the possibilities for them to tablishing a partnership far away.of, deeper understanding on the venture into the Indian market There was also discussion on theIndian markets is something or learn about their experiences, limited resources that small andmost of the mention to be still if they already were operating medium-sized companies have.lacking. As such, the fact that in India. The companies have It was several times mentionedFinNode included India as their high-end products with premium that large companies are able tooperating countries is significant quality, conferring them high po- expand to India because they arein improving the flow of informa- tential but operating in India is able to take bigger risks.tion within parties that are inter- complex, and has unique factors One can observe the impor-ested in India.  to be taken into consideration. tance of networking with rel- In Finland, universities are Broadly conceived, the com- evant actors in Finland in orderworking closely with companies panies were on different levels to achieve a common goal of un-and research centres. University in their expansion to India; some derstanding the Indian marketsof Turku could be stated to have had already established partner- and thus enable company successthe leading position in the re- ships and certain others were in Indian operations. As we havesearch in diagnostics in Finland. thinking about the expansion learned during the project, noThe connection is beneficial to all possibilities. They often men- one can survive alone in Indiaparties as companies are inter- tioned operations in China and and we emphasize the impor-ested in the newest technology it appears to be a more familiar tance of support networks, suchand University of Turku is devel- market, but owing to the huge as FinNode.oping new technology together potential, companies may wantwith the best know-how on diag- to consider India as well. It wasnostics in Finland. as well widely known that the Another interesting actor to markets of China and India differmention is Global Venture Lab highly, yet there was lack of in-(GVL) which is an entrepreneurial formation on the Indian marketsand university-based business and challenges in practice. Also,creation platform. Their Indian the fact that there is huge poten-health kiosk program is further tial for diagnostics companies indiscussed in the Indian part. India was discussed with everyGVL is an interesting issue in the company.Indian context, as it was founded Many of the Finnish companiesby three professors: one from stated that they aim to keep man-University of Jyväskylä, another ufacturing or other key functionsfrom University of California and in Finland and primarily lookthe third from Indian Institute of for distributors in India. SomeTechnology (IIT).  also expressed interest in col- laborating with manufacturers in India, typically if there would be someone to finance it. Also, AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS //9
  17. 17. 3
  18. 18. OBSERVATIONSIN INDIAO n a quick note, the multi- tude of actors and the levelof complexity of the Indian eco- 400 Indians, which interest- ingly enough, is many times the number of primary schools and 3.1 The Actors Map: India The Actors Map is given assystem seem to be the main dif- primary health centres in India. Appendix A.ferences compared to the Finnish (Source: The Indian Express,innovation ecosystem. It is quite www.indianexpress.com) In the policy makers in Thecharacteristic of such huge and As part of the project the team Actors Map of India the most rel-emerging countries to have a travelled to India for 16 working evant to diagnostics industry arelarge number of actors; like, or- days to learn and understand the Ministry of Health and Familyganizations (both profit and how the health care system works Welfare as well as Ministry ofnonprofit making ones), policy in the rural areas in the state of Science and Technology, undermakers, research centres, and ac- Gujarat. The field trip was an es- which the Department of Bio-ademia, all of which are relevant sential part of the project, since technology (DBT) functions. DBTto the diagnostics industry. In the official viewpoint (such as has connections with Tekes, andthe case if India, the presence of from the health officials) and the as revealed during our fieldwork,non-governmental organizations actual situation (for example, ex- they are at the crux of collabo-(NGOs) is more significant than plained by rural health workers) ration in diagnostics betweenin Finland. According to a recent seems to differ and therefore it is Finland and India. DBT is also thestudy commissioned by the gov- essential to go to the grass-root actor connecting policy makersernment, the number was esti- level and observe how the system to diagnostics laboratories andmated at 3.3 million, accounting works.  companies in India.for all such entities until 2009. J.Mitra is chosen here as anThat is one NGO for less than example of an Indian diagnostics AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS //11
  19. 19. company as it enjoys 70% market rectorate General of Health Ser- Figure 3.1 A Busy day in AIIMS, New Delhishare in low cost in-vitro diagnos- vices (DGHS) play an importanttics in India and, it focuses on af- role and it administers Indian Photo by:fordable diagnostics for the BOP. Food and Drug Administrator Tuuli HakkarainenWe also found out in the course (FDA) and Central Drugs Standardof the interview that they have Control Organization (CDSCO),established collaboration with which leads Drug Controller their comments, the collabora-the Finnish diagnostics company General of India (DCGI). These tion could be more intensive andMedix Biochemica. The managing actors are relevant to all diagnos- might be something to developdirector of J. Mitra mentioned, tics companies working in India in the future. One may state thatthat the main benefit from the (both Indian and foreign) as the this linkage would be beneficialpartnerships with Finnish compa- regulators. for fostering innovation withinnies for the Indian companies is In between governmental a country by joining company re-the latest technology. and research organization is In- sources and university research J.Mitra is merely one example ternational Centre for Genetic to benefit all. This collabora-of an Indian diagnostics company Engineering and Biotechnology tion could be one of the buildingand others that were mentioned (ICGEB) which has a collabora- bricks towards a more coherentduring the interview were com- tion with Tekes. ICGEB also has innovation ecosystem.panies such as SpanDiagnostics, collaborations directly with diag- Another future possibil-The Tulip Group India, Abbott nostics companies in India. ity could also be collaborationDiagnostics, Bayer and Beckman Nevertheless, the collabora- between universities in FinlandCoulter India Pvt. tion between the industry and and in India. Some institutes From the manufacturers´ the academia does not appear like the Indian Institute of Man-side there is Orchid Biomedical to be very strong in India. From agement, IIM conducts researchSystems and to illustrate con- our interviews with professors at on the Base-of-the-Pyramidnections to the policy makers. Dr. Indian Institute of Management markets. Other relevant insti-Toprany Laboratory, serves as an (IIM) and the ICGEB, the link tutes to diagnostics are Indianexample of a private laboratory. seems not to be strong at least Institute of Science (IISC) andFrom the policy makers´ side, Di- in the diagnostics field. Based on Indian Council for Medical Re-12 AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS
  20. 20. search (ICMR) as they fund re- the state of Gujarat, and Save more successful and creative insearch on affordable diagnos- the Children as an example of an its operations directly with thetics. They coordinate projects for international NGO with notable Indian BOP markets. In a discus-World Health Organization (WHO) influence. sion with the Aegle representa-in India, which is one example of Concerning other organiza- tives, we were informed thatthe collaboration between a re- tions that are operating direct- they are considering expandingsearch institute and NGOs. ly with the BOP, an excellent their business and according to Other player in the health example would be Aegle Angels our field trip, there is demandcare system of India is AIIMS Foundation. They have health for innovative businesses aroundwhich stands for All India Insti- kiosks called Aegle Angels Kiosks, health care to cover for gaps intute of Medical Science, which is which are stores equipped with the typically government-fundeda leading medical college and a vital measuring equipment. The health care system in the remotelarge hospital in New Delhi. The strength of the kiosks is that they rural areas.patients at AIIMS come from can be located close to the com-all around India as the hospital munity in remote areas (www.provides affordable health care aegle.org). They are centrallywhich is free of cost for the pa- connected with hospitals. Wetients who are classified as un- wish to emphasize their work, asderprivileged by the government. it is a good example of a business In the non-governmental or- model in the sector of affordableganization (NGO) area, we took diagnostics for the Indian BOP.the example of Deepak Founda- After an academic year´s researchtion, a local NGO, which is doing we haven’t been able to identifysignificant work in rural areas in another entity which has been AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS //13
  21. 21. 4
  22. 22. FIELDEXPERIENCE:EXPLORINGHEALTH CAREIN RURAL INDIAT his section describes our observations on the IndianBase of the Pyramid (BOP) based are divided into districts. Each district is further divided into sub-districts, which are known huge volume, reaching the BOP market is challenging. There are diverse needs and possibilitieson our field work, which included differently in different parts in for new businesses; however, thetrips to rural regions near Va- the country. Villages in rural access to the people seems to bedodara and Ahmedabad, in the areas are, along with towns in one the key challenges. state of Gujarat. Our experience urban areas, the lowest primaryon the rural areas, villages, and administrative units of adminis-health centres will be noted in tration (Census India). Therefore, 4.1 Health care system inthis section, along with exam- the many levels of administration Gujaratining the BOP and the mentality and divisions affect the organiza-towards health care. In the rural tion of health care system in the The complexity of the healthareas we visited health centres of country. care system in India is visualisedall levels (see their description According to Census India in the Actors Map. In the ruralin more detail in Indian actors´ there are total 638, 365 villages areas in Gujarat, the health caresection and in the The Actors (Census Data 2011). As large as is organized on the state, region-Map). 70 percent of the population live al and community level. The roles in these villages, and they are of each centres are discussed inRural Areas at a Glance of different population density the following. The examples and depending on factors such as emphasis is on our field trip to India is formed of 28 states geography of the area as well Gujarat and villages which are re-and 7 union territories. These as availability of land and water ferred to are located in the state.states and the union territories (Census India). Owing to such AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS //15
  23. 23. Block Health Centre and medical treatment and basic Figure 4.1 diagnosis are provided hence- Left: Community Health Centre Above: Sub Health Centre Block health centres are the forth. Whatever advanced diag-administrative offices, which nosis they may require,patients Photos by:operate in the same building to- are charged Rs.20. The centre we Ramsankar Muraleedharangether with a local health centre. visited was a Public Private Part-Health centres report to the nership (PPP) between Deepakblock office, except for the sub- Foundation and the Government private clinics. But, neonatologyhealth centre, which operates di- of Gujarat and is an Integrat- diagnostics are yet to be avail-rectly under a primary health care ed Child Development Scheme able.centre. (ICDS) facility. The main activities are focused Primary Health CentreCommunity Health Centre on the mother and child (which seemed to be the case in all Serving a population of nearly The community health centre health facilities visited), and 30000, PHCs are arguably ill-is a major health facility in the there is a gynaecologist working equipped when it comes to equip-region, which provides services on spot, available 24 hours a ment and whatever might befor a very nominal fee, this is to day. All basic diagnosis for this available seems not to be usedsay almost free of charge. Pa- purpose like haemoglobin/HIV frequently. There is a generaltients are requested to take tests can be done in-house but physician available and the placean OPD (out patient diagnosis) more advanced tests need to also serves as a storage facilityticket for which Rs.5 is charged be referred to district hospital/ for vaccines. Like CHCs and all16 AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS
  24. 24. other government medical facili- emergency. Apart from nurses, year calls for diagnostics thatties, devices and medicines are they are also counsellors who are robust and can handle hotprovided by the state with an provide advice on HIV, family weather and humidity.annual budget allocation of Rs. planning and related issues. Equally, the overall hygiene100000 (€1592) which might be ASHAs also contribute greatly and sanitation levels are low.hardly adequate. to this purpose. They are women Access to clean water is another from the community and play a problem and future efforts onSub Health Centre key role and social mobilization water purification were stated by and awareness regarding health the health officials as important. Hardly a health centre, SHCsresemble more a kiosk withinthe village where a public healthnurse resides and provides basicmedical advice and treatment.They cater to about 5000 peopleand also act as a local centre fordispensing the polio vaccines.For instance, the vaccines aretaken to the houses by the nursesalong with an ASHA worker onthe second and third days of thevaccination. The nurses are alsoclose with the community and and safety. Figure 4.2 : Interviewing peoplethe ASHAs are from the local in the Rural Village The environment of remotevillage which facilitates access rural areas is challenging in terms Photo by:to people´s homes. Treatment is of adequate and sophisticated Adalgisa Santosdone in SHC only when the doctor health care. Drought is not un-is visiting, the rest of the time common, especially in Northernhardly any equipment based diag- and North West of India, which From interviews with health of-nosis is performed and no devices poses challenges with health and ficials, we learned that there isare available. food in the areas. In contrast, power supply in the rural villag- during monsoons, heavy down- es. But, based on our experience pour constrains the already de- and discussion with the people4.2 Observations on the ficient infrastructure with roads working at rural areas, powerenvironment are flooding and muddy. Rural cuts are not uncommon, which health workers mentioned this as is an important issue to take into On the whole, public services a key problem as ambulances are consideration when planningprovided under this system are not always able to reach villages. health care. For example, as onebasically free of cost and cover Besides, vector-borne diseases, cannot rely on the distributiontherapeutic and preventive especially malaria, is a problem of electricity, health care equip-health care. Vaccination kits and during this time. The health of- ment is best when portable andsuch are provided from the PHCs ficials mentioned prevention and work with a back-up battery forwhich the female health workers cure of malaria and early-stage instance. Also, as rural healthdeliver to the village people with diagnosis of tuberculosis as some workers frequently make housethe help of ASHA workers. They of the major areas of health care calls, anything easily portable isvisit each house in the village that needs improvement. Harsh a working solution.for this purpose or in case of any climate prevailing for most of the AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS //17
  25. 25. 4.3 Observations on people a person from a lower caste has types of tests and diagnosis couldand mind sets towards touched a device, a person from be performed during the samehealth care the upper caste may well refuse visit. Health workers told us that to touch it. people try to avoid hospital visits In the villages, the caste According to several interviews and “faith in destiny” affectssystem cannot be neglected and and observations, one can argue their attitude towards diseases.it seems to affect the every- that health does not seem to be Rural health workers (usuallyday life. In one village which we a priority in India. For example, one to two women) have solvedvisited there were four different even entertainment goes before the problem of people avoidingareas for people from different health care. Education for boys the health centres by walking tocastes. First we met people from is another issue which families the villages to see the people inthe lowest hierarchy and we were may invest in before health care their homes. For example, nursestold that their income level is low for the whole family. Like, when and ASHA workers keep recordas they do not own land and are we visited the poorest part of one on pregnant women and go formainly working on fields. And, on village, the father of the family regular visits to the women´stop of that, there is no work all told us that he paid for his son to homes. The rural workers are wel-year round and they are forced to go for a computer class. The lack comed to the houses as mutualmigrate sometimes even tens of of money might not always be trust has been built. As ASHAskilometres in order to find work. the reason for neglecting health are people from the village them-An ensuing problem is that chil- issues. Still, as awareness on the selves, they are well trusteddren remain absent from school. health care rises, this could then among the village inhabitants. A concrete example of the caste lead to more understanding of The government distributessystem inside the village was that the importance of both preven- pregnancy kits free of charge. Thepeople do not cross the invisible tive and curative health care in health workers told us that they Figure 4.3: Invisible Barriers: Border between castes is respected. Photo by: Chi Zhang aim to promote the kits and en- courage in their usage. However, the usage rate is relatively low. We were told that one of the reasons for this is that as price is the sign of quality in India, free products are not trusted. There-barriers. Even children who were people´s minds. fore, even a nominal charge mayfirst following us stopped and Currently, diseases are cured be beneficial in health care.stayed in their own part of the as they occur, and even in a case Child nutrition is another issuevillage. In health care and diag- of sickness, regular check-ups are that all the rural health workersnostics the strict caste rule poses not typically followed. This could emphasized and health care forchallenges. For instance, sharing be taken into consideration when mother and child appeared toa device or other items would designing diagnostics services be underlined both from the of-not be practical across castes. If in a sense, that more different ficial point of view as well as at18 AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS
  26. 26. the village level. One practical doctors in theexample of such initiatives in the rural areas wasrural areas was an informative mentioned fre-booklet given to the mothers. quently by healthForm the booklet they can follow workers of differ-if their child´s growth is healthy. ent levels. In oneMany (according to our research, rural area wherethe average of 50%) of the women we visited, thereat the BOP are illiterate thus was a new, onlythere are informative pictures in couple of yearsthe booklets as well. Using pic- Figure 4.4: Information old primary health centre built bytures for communication seems Booklet for Mothers the government which now wasto be a relevant issue in every Photo by: empty due to the lack of employ-product aimed at the BOP and is Adalgisa Santos ees. The fact that the daily life inadvised for diagnostics products a health centre is mainly run byand services as well. Spoken com- nurses and other health workersmunication can be considered ef- doctors the same amount of with basic health education, putsfective too. salary, so doctors tend to prefer emphasis on the fact that diag- Concerning challenges, as we working in cities. Moreover, if is nostics in the health centres needdiscussed with the rural health there is the opportunity to work to be simple and easy to use.workers and DBT, there is a chal- for a private hospital, it is oftenlenge in attracting doctors to the first choice because of higherwork in the remote rural areas. salary. The problem of not havingThe government pays all public adequate amount of qualified AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS //19
  27. 27. 5
  28. 28. INFOGRAM:STRATEGICMANAGEMENTTOOLA fter the analysis employing the Actor Map had been per-formed, we realized it was neces- 5.1 What is the Infogram? The Infogram (given as Appen- sideration of business at the base of the pyramid. sary to use a business approach dix B) is a tool for organizationsfor analysing the outputs. As it which are planning to do business 5.2 Application in thistakes significant effort to develop at the Indian BOP. It helps gain an projectthe business model, and with the overview of different aspects thattime constraints, we developed need to be taken into account There are two parts of the In-the strategic management tool, before making a move and even fogram; the first being an info-Infogram, based on the Osterwal- acts as a filter to check if they graphic questionnaire, which isder Business Model Canvas. are actually ready for the market. referred to as the ‘infogram’, as This chapter presents Infogram Alex Ostwerwalder’s well rec- shown in Figure 8, and a hintsas a strategic management tool ognized Business Model Canvas section which provides keyfor analysing the market entry (Osterwalder, 2010) is used as the insight into multiple facets of theto Indian BOP market. The first framework and the nine ‘building Indian BOP as shown in Figure 9.part briefly introduces the Info- blocks’ also make an appearance The Infogram poses the user(s)gram tool. Next, the application here. The factors, namely; key with a series of carefully chosenof the Infogram in this project is partners, key resources, key ac- questions, which span the ninedescribed. The last part of this tivities, cost, value proposition, business building blocks, and canchapter explains how to utilize revenue streams, customer rela- serve as a reflection on why andthis tool, and the information re- tionship, channels and customer how an organization is intendingtrieved from the Infogram. segments cover basic business to do business at the BoP. operations, and is a holistic con- The questions are further cat- AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS //21
  29. 29. egorized into three colour-coded However, due to the very the field trip to India. Some aresegments of green, blue and red, complex nature of BOP markets in cultural insights, others factualemerging from the line of the India which demanded such a tool data, yet all from the socio-eco-same colour. Green stands for as the Infogram, it is not feasible nomic fabric woven around the‘safe-zone’, organisational level to classify questions black and Indian BOP market. These couldquestions like ‘can you scale your white. There are always overlap- be hard to find elsewhere, in anyproduction up?’ which the user ping and intersections and the theoretical references or busi-is expected to be able to answer. most determinative questions, ness literature for that matter. AsBlue is for ‘hazy-zone’ questions like ‘is your offering affordable?’ such, using this part in conjunc-which do not come directly under may fall under these.  tion with the infogram will provethe organization’s scope, but to be a strong tool in assessingsomething they might have an the suitability of your offering oridea about, or has been consid- 5.3 The Information organization with respect to theering. Examples would be ques- BOP and as a guide for contem-tions like ‘what problems can A glance at this first part might plating any future explorationsyou solve?’ and ‘have you con- leave the user(s) with an im- into the same. One can even chartsidered partnerships?’. The red pression of how complex things their progress by marking theor ‘ambiguous-zone’ questions can be at the Indian base of the white spots provided on the lineare the most difficult to answer pyramid, and it’s to assist the an- for each question.and could be even beyond com- swering of these that the ‘hints’prehension at the present. An section exists. These, again, spanexcellent example would be ‘how all the ‘business building blocks’to reach the BoP?’—so simple, yet and are based on real-life obser-so startlingly difficult. vations that the team had during22 AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS
  30. 30. AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS //23
  31. 31. 6
  32. 32. CONCLUSIONSANDFUTURERESEARCHT his chapter gives a conclud- ing review of the study madein this paper. A concise descrip- From the Finnish side, col- laboration with relevant players seems be helpful for everyone in- there appears to be a technology gap, which has been indicated by Indian companies and whichtion of what has been achieved is terested in expanding their oper- Finnish companies could tap into.given and finally the implications ations in India. Therefore the role There seems to be a constantand recommendations for future of FinNode seems to be of high need for new technology.research are briefly discussed.  importance since one could argue Although there are many chal- that no small to medium organi- lenges in India, the huge poten- sation can survive in India alone. tial attracts new business also in6.1 The Results The ecosystem in India is a health care. The health kiosk idea complex issue and this project is a concrete example that doing With its rapidly growing popu- aims to give insight on the key business at the Base-of-the-Pyr-lation, India serves huge poten- actors and issues concerning the amid is possible and the govern-tial for new business around the key actors and their relations. ment is not the only possible waydiagnostics industry. The poten- Also, the cultural issues and to the health care system in ruraltial is possible to reach, with one other important factors in the areas in India. The Infogram toolof the key elements being under- operating environment around aims to help companies test theirstanding of the environment and health care are in the focus of the potential for the BOP markets andthe key actors in India. The Actors project at hand. To overcome the provide useful hints about India.Map visualizes the complexity complexity, collaborating withand relations between key actors Indian organizations and com-in the diagnostics field. panies seem to be a good way to access the markets. All in all, AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS //25
  33. 33. 6.1 Suggestions for Future In conclusion, we have pre-Research sented a real Actor Map providing links to health care actors in both As the topic of our research is India and Finland, and based onwide, there are many interesting understanding of the complexitypoints for future research under of the innovation ecosystem, athe topic. strategic tool is made that is suit- able for building up first step into • In the interviews with the Indian BOP market. The resultsFinnish companies, there were achieved so far are satisfactory.suggestions and questions on The feasibility and applicabilityconcrete issues that could be an- of this tool will motivate furtherswered in detail if work continues improvement and research.around the India project: • Are there start-up compa-nies in India that could lead tofuture collaboration with Finnishdiagnostics companies? Whatkind of business models would bepossible? • How does the health careand diagnostics in the urban poorareas work? Does it differ fromthat of rural India?26 AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS
  34. 34. AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS //27
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  37. 37. APPENDICES APPENDIX Avii AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS
  38. 38. APPENDIX A AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS //viI
  39. 39. APPENDIX Bvii AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS
  40. 40. APPENDIX B AFFORDABLE DIAGNOSTICS FOR INDIAN BASE OF THE PYRAMID MARKETS //vii

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