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Building a Healthy Rural India
- 2. “To Err is Human – To Delay is Deadly” In Jhunjhunu and Sikar districts of Rajasthan between November 2010 and March 2012 90 percent of deaths occurred due to delay in transit time 809 deaths out of 1065 maternal deaths reported in Madhya Pradesh between April 2011 and January 2012 happened on the way to a health centre In Karnataka 69 health facilities reported that 20 percent of women die during transit Since September 15, 2008 till April 20,2010 an ambulance service in Tamil Nadu has saved the lives of 4,11,288 persons. Out of these 1,26,492 were accident and trauma cases 1,10,480 were pregnancy cases 21,782 were cardiac cases 15,660 were poison cases 21,185 were critical cases 6,930 Tribal beneficiaries Maternal Mortality Ratio Infant Mortality Ratio Source: 12th 5 year plan Source: The Hindu – April 2012 Source: www.tnhsp.org
- 3. Aarogya – Value Proposition Lesser dependence on farm income Increase in procurement prices Increased government spending Improved access to finance Policy measures such as MNREGA AAROGYA Mobile consultation with doctors Other initiatives (Blood donation camps, etc.) SMS based information services 24x7 Ambulance service Medicine supply Rural healthcare related problems in India: Increasing demand for healthcare facilities Huge demand-supply gap Rise of chronic and lifestyle-related diseases
- 4. Aarogya: Business Framework Creating Healthy workforce for a Prosperous India Create, Shape and Develop Markets Create new consumer categories, develop new sources of data, customize and innovate products, and create new channels to reach new customers and carve new markets Co-Create value through innovative use of technology Focus on utilizing technological platforms and solutions to co-create value with local resources Be a part of local fabric Build networks through local participation Mission Framework Drivers 25% 34% 35% 6% Preference for Medical Consultations Doctors Health Centres 7% 24% 32% 21% 16% Frequency of medical check-ups Every week Once in a month Once in 3 months 24% 59% 17% Time required to reach city hospitals <30 mins 30-90 mins >90 mins 31% 52% 17% Satisfaction with healthcare facilities Yes No Indifferent Consumer Pain Points: Survey Results
- 5. Rural healthcare – Opportunity Assessment Increasing demand for healthcare services in rural India opens up new avenues Growing mobile base in rural India can be explored as a medium to provide mobile-based healthcare services Next wave of growth for pharmaceuticals is expected to come from rural and tier-2 markets
- 6. • Aarogya Call centre workforce : At Jaipur, 2 executives; 10 medical suppliers • Major cities and towns are the hubs for hospitals (Jaipur, Ajmer, Kishangarh, Dudu, Bagru) • Hubs supply medicines & ambulance facility • No. of hospital partners : City : 10, Town : 2-3 • No. of ambulances : City : 30, Town : 10 • Medicine supply on daily basis. Each med. Supplier to cover nearly 15 kms. • Radius served : City 30km, Town 10km • Public Private Partnership with Government Pilot project – at Rajasthan Major City Towns Resource Plan Total Population served is nearly 15 lakhs Maternal Mortality Ratio Source: CensusIndia
- 7. Aarogya – Mobile Consultation with Doctors Rural wireless scenario Subscriber base : 323.27 m Subscription growth rate : 1.96% (greater than Urban rate of 0.30%) Rural wireless teledensity : 38.33% Source : Telecom Subscription Data as on 31st March 2012, TRAI for Q4’11 Consultation charges will be deducted via mobile wallet service Fixed charge for 5 minutes (Rs30 for the doctor, Rs20 as commission) + Rs5 per minute basis henceforth Aarogya helpline called Case forwarded to hospital concerned Case 1 : Generic ailment found Case 2 : Physical checkup required Medicine prescribed (Option to buy from Aarogya suggested) Appointment for the check up given (Option to avail ambulance service from Aarogya suggested) Caller location traced; call transferred to nearest hospital • Doctors to population ratio is 6 times lower in rural areas than in urban areas • Beds to population ratio is lower by 15 times • 31% of them travel more than 30km to seek healthcare Source : International Journal of Scientific and Research Publications, Volume 2, Issue 5, May 2012 Key problems addressed
- 8. Aarogya – Medicine Supply (Rural + Urban) Dearth of medicines in rural India Rural market account for 17% of total pharmaceutical sales in India, current valuation : $2B in 2010 PwC estimates : CAGR of 15-20% over 10 years, expected valuation : $12B Source : India Pharma Inc: Capitalizing on India’s potential, PwC 2010 Medicines prescribed by doctors in Aarogya network Customer willing to buy medicines from Aarogya Case 1 : One time medicine supply Case 2 : Medicines for chronic diseases (supplied regularly) Case 3 : Common medicine supply (without prescription need) • 66% population do not have access to critical medical facilities • 7 out of 10 medicines in rural areas are substandard or counterfeit products • Villagers end up spending 1.5 times more compared to urban counterparts for same illness Source : International Journal of Scientific and Research Publications, Volume 2, Issue 5, May 2012 Key problems addressed Medicine delivery charges will be deducted via mobile wallet service (already implemented by telecom providers) ( fixed charge of 25 rupees) Actual medicine charges to be levied upon as cash on delivery
- 9. Aarogya – 24x7 Ambulance service Medical emergencies in rural India NSSO data indicates that critical incidence rate of accidents/ injuries/ poisoning is 662 per one lakh population in rural areas More than 25% emergencies are pregnancy related Source : Indian Emergency Journal, Vol. 7, Issue 1, March 2012 Ambulance charges will be levied only after onset of the treatment at the hospital (fixed charge of 50 rupees) Appointment for the check up in Aarogya network given (Option to avail ambulance service from Aarogya suggested) Customer willing to avail Aarogya’s ambulance service Ambulance service to be provided within 1 hour Ambulance service sought in case of critical / medical emergencies • Approximately 700 million population reside in 636K villages. Commutation to nearby towns is still an issue. • 20-24% of the world's maternal deaths are reported in India. Delay in reaching an appropriate health care facility due to lack of affordable and accessible emergency transport is a major reason for this. Source : 1) International Journal of Scientific and Research Publications, Volume 2, Issue 5, May 2012 2) BMC proceedings, 2012 Key problems addressed Ambulances will be provided by our hospital partners
- 10. Aarogya – SMS based Information Service SMS based service prospects 250K quarterly subscriptions by 100K farmers across 10K villages in 23 months of operation by Reuters Market Light SMS service ($1m revenue as in 2010) Source : Masters of rural markets: The Hallmarks of High Performance, Accenture 2010 Key problems addressed Subscription charges will be deducted via mobile wallet service (already implemented by telecom providers) (fixed charge of 10 rupees/ month) ( auto renewal) SMS subscription start/stop request received from customer Customer’s mobile number status updated into SMSC database of Aarogya Case 1 : SMS service started Case 2 : SMS service stopped SMS to be sent on maternity, child health, hygiene, sanitation, vetnary tips, seasonal diseases precautions, government directives on health & information on camps/ workshops in nearby areas • 10% of all deaths in India is directly related to poor sanitation and hygiene • Maternal Mortality Ratio (MMR) in India is 254 per 100K live births according to Sample Registration System (SRS) Report for 2004-06 Source : 1) Rural sanitation and hygiene strategy (2012-22), Nirmal Bharat, Ministry of Rural Development, Govt.of India, July’11 2) Report on maternal health in India, UNICEF
- 11. Financials: Steady Growth in Profits for the Next 5 Years Year 1 Year 2 Year 3 Year 4 Year 5 Optimistic Revenue Rs. 1,776,000 Rs. 5,328,000 Rs. 7,992,000 Rs. 11,988,000 Rs. 17,982,000 Expense Rs. 1,795,400 Rs. 2,401,800 Rs. 2,852,200 Rs. 3,308,600 Rs. 3,785,000 Profit Rs. -19,400 Rs. 2,926,200 Rs. 5,139,800 Rs. 8,679,400 Rs. 14,197,000 Most Likely Revenue Rs. 1,776,000 Rs. 3,596,400 Rs. 4,855,140 Rs. 6,554,439 Rs. 8,848,493 Expense Rs. 1,795,400 Rs. 2,295,800 Rs. 2,712,200 Rs. 3,128,600 Rs. 3,545,000 Profit Rs. -19,400 Rs. 1,300,600 Rs. 2,142,940 Rs. 3,425,839 Rs. 5,303,493 Pessimistic Revenue Rs. 1,776,000 Rs. 2,450,880 Rs. 2,818,512 Rs. 3,241,289 Rs. 3,727,482 Expense Rs. 1,795,400 Rs. 2,032,600 Rs. 2,229,800 Rs. 2,430,800 Rs. 2,628,000 Profit Rs. -19,400 Rs. 418,280 Rs. 588,712 Rs. 810,489 Rs. 1,099,482 Rs. -2,000,000 Rs. 0 Rs. 2,000,000 Rs. 4,000,000 Rs. 6,000,000 Rs. 8,000,000 Rs. 10,000,000 Rs. 12,000,000 Rs. 14,000,000 Rs. 16,000,000 Year 1 Year 2 Year 3 Year 4 Year 5 Profit forecast for next 5 years Optimistic Most Likely Pessimistic Assumptions Optimistic • 50% CAGR in coverage population per year • 100% Increase in ratio of number of cases to total population covered Most Likely • 35% CAGR in coverage population per year • 50% Increase in ratio of number of cases to total population covered Pessimistic • 15% CAGR in coverage population per year • 20% Increase in ratio of number of cases to total population covered
- 12. Appendix
- 13. Future Plans & Challenges • Adoption of service by medical consultants • Getting required time slots from physicians’ schedule • Creating awareness about healthcare among rural population • Convincing orthodox rural population for adopting mobile healthcare facilities, when every now and then they are cheated by fraudsters • Teaching target population to use mobile wallets • Establish check-up centers in villages, which be equipped with a internet enabled computer with webcam, and will have an attendant who will be able to measure pulse rate, blood pressure, etc. and tell the same to the doctor at the other end. • Expanding medicine supply services in cities • Providing machines to chemists which will enable them to take floated orders on first come first serve basis Future Plans Challenges
- 14. Financial Analysis: Income Statement for 1st Year Population Expected Life Deprecia tion 1500000 Electricbikes 250000 5 50000 Commission 50 Computer 20000 5 4000 Cases perMonth 150 0.01% Land line phones 2000 5 400 Total 1 7500 Furnitures 5000 5 1000 55400 Commission 25 Cases permonth 2500 0.17% Call Centre Executive 30000 Total 2 62500 Medicine Supplier 25000 (10*2500) Marketing 45000 CSR Initiatives 25000 Charges 10 Others (utilities, rent) 20000 Customers permonth 7500 0.50% Total 145000 Total 3 75000 Revenues 1776000 Commission 20 Costs 1795400 Customers permonth 150 0.01% Profit -19400 Total 4 3000 SMS Based Information Service Mobile Consultation One time Expense Income Statement Financials - Revenues Ambulance Service Medicines Financials - Monthly Expenses
- 15. References International Journal of Scientific and Research Publications, Volume 2, Issue 5, May 2012 Telecom Subscription Data as on 31st March 2012, TRAI for Q4’11 India Pharma Inc.: Capitalizing on India’s potential, PwC 2010 Indian Emergency Journal, Vol. 7, Issue 1, March 2012 BMC proceedings, 2012 Masters of rural markets: The Hallmarks of High Performance, Accenture 2010 Report on maternal health in India, UNICEF Rural sanitation and hygiene strategy (2012-22), Nirmal Bharat, Ministry of Rural Development, Govt. of India, July’11 Corporate websites for CSR activity details