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Forthefirsttimein India, global harmaceutical
company entbeyond
representative byaddressing
Tuberculosis wasidentifiedsa keyailmentn ruralareas
focuses nTBtreatment.

Themainproblem ...
- They
bythedoctor rethesame
- Patients ave
h noideaif...
Thissocial usinesspproach
Table1 Communication



Communication theailmentsndtheirsymptoms


Sinceits business
modelis not basedon puredonations, rogya
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Arogya parivar


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Arogya parivar

  1. 1. Forthefirsttimein India, global harmaceutical a p company entbeyond w the traditional medical representative byaddressing route theunmet health needs f o rural ndia, I thereby dramatically improving access tomedicine atthesame while timeprovidingpportunities expand o to business an innovative in andsocially responsible Novartis way. isthefirstpharmaceutical multinational asocial touse business model toreach India'suralmarkets. r Forsome 800million men, omen w andchildren inmore than600,000 villages across India,he ideaof accessible, t affordable andhigh-quality medicines is oftenasremote astheirruralhomes. Institutional healthcare ruralIndiais in limited tothegovernment structure. Private healthcare servicesreindividuala driven andunstructured. Thegovernment health offers services freeofcostbut over 0percentrural eople forhealth 7 p pay services. Novartis commissioned tounderstand MART theheath needs, behaviour andattitude towards edicine m inrural reas. a MART thattheawareness found ofhealth issues aspoor, w andpeople ccessed a health services trying after various ome h remedies. Thedelay intreatment andtheensuing mergency e wereconsidered natural. Ailments related tonutrition, allergies andinfections werenotdifferentiated,eading l tothepatient notapproaching therelevant health service rovider. p Thisleads toasignificant waste money ndnorelief romailments. of of a f Many these peopletayed s undiagnosed because theyeither idnotunderstand d their symptoms, orthedoctors eretoofar away, theywereafraid thecosts w or of involved orofsocial prejudice. Womenndchildren ere a w particularly vulnerable.
  2. 2. Tuberculosis wasidentifiedsa keyailmentn ruralareas (TB) a i andthiscase focuses nTBtreatment. o Problems Themainproblem healthareforruralpeople asrelated in c w tothe4As,which isdiscussed below. . Affordability - Perceived orexperienced costoftreatment forTB,if thepatient hastobe taken a nearby to townfortreatment (treatment period isfromsixto nine months) isestimated tobemore INR than 10,000 ingovernment health centres, againstNR15,000through I private treatment. government In centres, patients togotoprivateiagnostics had d centresnd medicines. a buy - Forsimple infections skinallergies, or thecostof private treatment was between 250-1,000. INR . Availability - Access health to services ndmedicines a hasbeenthe major problem. Qualifiedoctors, d private government, licensedrugstores or or d arenot available invillages. Therefore, thereisthecostoftravelling totheblock town, here w thePHC (public ealth h centre) private ora doctorslocated. i . Awareness - Patientshavepoordiscerning capabilities nd cannotidentifythe a appropriate doctorortheirailment. f
  3. 3. - They have noidea ifthemedicines prescribed bythedoctor rethesame a asthose given bythechemist. - Patients ave h noideaif the"medicines" arepreventive, curative r for o maintenance. . Acceptance - Patients theirownperceptions ailments. those have about Only ailments thataffectheirworkproductivity t areattended to. - Treatment ofchildren ets g priority ver hatofadults. o t Hence, Novartis theneed reliable felt for health services ndmedicines a a at reasonable cost. . MART'sStrategic Suggestions Tocreate awareness among thelocal opulation, p establish anetworkf"foot o soldiers" recruited fromvillages toworkas"health educators". would They support patients forallhealth services andfollow uptocomplete thetreatment rocess. p Toimprove theavailability health of service, qualified doctors needto be identified fromamedical either institution orindividual practitioners intowns withpopulations greater than50,000(blockowns t orbelow). Tomake health services affordable. Patients wereoften mis-informed about thetotaltreatment costandbelieved to bemuch it higherhantheactual t cost,becausef whichtheyavoidedeeking o s treatment. Thiswrong perception ascorrected, w afterwhich patientsealized r thatthetreatment was affordable. Tomake health service cceptable, a theprogramme identifiedritical ealth c h issueselated r toinfection, nutritionnd a allergies. Arogyarogramme The p addressed these identified issues, delivering results ndthereby uilding good a b trustwithin thecommunity. . . . The Solution To addresshe healthissuesin ruralIndia,Novartis esigned arogya t d an (meaning health) good programme, thewinner fthebestlong-term maro rural ketinginitiative(RMAI 008 SilverAward, OW 2008 SilverAwardandGolden 2 W Peacock Awards 008), hich 2 w offered pharmaceutical solutionsndalsoina tegrated theneed network ithlocaldoctors, to w educate otential p customers (patients), andlinkpatients tospecialized doctors. TheNovartis addressed team thechallenges byusing aninnovative approach make direct to villagersware a of prevalent diseasesndencourage a themto seektreatment. Bylate2006, theArogya Parivarnitiative aslaunched iththe helpof MART a pilot i w w as programme inUttar radesh P andMaharashtra. Arogya arivar P follows decentralized where a model thefieldforceisinautonomous (250cellsin2011), ach cells e covering radius a ofapproximately km 35 or 20 miles. ach E cellis managedya supervisor, b assisted ya fewhealth b educators whocollaborate withlocal ealth h professionals, pharmacy chains nd a NGOs toaddress thewhole "patient flow",ncludingducation, i e diagnosis, treatment, elivery, d andavailability andaccessibilitymedicines. of A keydifferentiatoroffering is patients integrated solutions health to problems ratherhanmainlyelling t s products tohealth professionals. Products selected for theinitiativeresimple a touseandpackages arereduced insize tokeep out-ofpocket costs Theinitiative ims builda sustainable, low. a to profitableusiness 1 b thatimproves access healthcare to among theunderserved millions rural '" in India bycreatingwareness, a enhancing availability, local anddesigning appeal- ir
  4. 4. ingandaffordable health solutions. Thissocial usinesspproach b a represents a mixofcorporate citizenship andcreativentrepreneurship. e AnArogya brand wascreated the unique for healthservices ffered o bythe company. Theumbrella randhelped overcomerand-related b to b issues and became easyrecallfor the illiterate andsemi-literateillagers. v TheArogya Parivar brand issupported byconsistent graphicsfleaflets, o banners, education programmes, uniformsor health f educatorsnddecorations bicycles. a for All collateral isdesigned keeping inmind thenature oftheaudience, particularly in terms literacy ndcomprehension Effortsmade focus of a levels. i to onspecific disease/s onrespective Disease through ctive World Days a doctor articipation. p Tocreate awareness among thelocal opulation, p Novartis established anetwork' of "Health ducators' recruited E (HE) fromvillageso provide atients ithsupt p w portandfollow uptocomplete thetreatment process. TheHE wasprovided with branded T-shirts, andbags. ovartis brandedudiovisual comcaps N used a vans, munity meetings andadvisory leaflets communicate to thebenefits totherural masses. The"HE"movesromvillage village f to ona permanent joumey plan (PJP). conduct They group meetings, identify patientsn different i households, educate thefamilyandconvince themof the needfor treatment. also They ensure thatpatientsave h theirsupport when theydecide tovisitthedoctor. Itis alsoimportant thatthemedicine isconsumed asprescribed. One-on-one communication necessary convince is to thepatient ndtheirfamily. a Aninformed patient more is positively oriented towardsompleting c thetreatment (there isa tendency todiscontinue treatment assoon asthepatient some feels relieO. The HE serves twoblocksnd a 30activeatients ispaid 1,500 p and INR permonth (commission of10percentfromsale ofmedicines), andnew products arebeing added byNovartis tosupplement income. TheNovartis expense oncommunicationandpromotion iscompensated through themargin fromincreased of sales theirmedicine. Theinitiative structured "social usiness' is asa b andis a perfect opportunity to expand thereach healthcare those of to people whofalloutof thecurrent system simply because theydonotliveinurban orsemi-urban India. Arogya Parivar builds ona "bottom-of-the-pyramid" business approach meant tosellproductsndservices low-income a to populations inemerging countries. Arogya arivar P istargetedtallagegroups, a especially women ndchildren. a The target asselected nthebasis publishedataandmarketesearch. w o of d r This population waseffectively disfranchised fromtherighttoquality ealth. h Arogya Parivar a unique uses business odel, m combining techniques by used pharmaceutical andconsumer goods companies. fundamental Its innovation rests onapplyingmarketing a mixbased onthe4As-awareness, acceptability, affordability andavailability-adaptedlow-income to markets. The communication used tools fortheArogya arivar P aredetailed inTable .The 1 communication strategy included: - One-on-one interaction atthecommunity (SHGs) level - Branded vanusing audiovisuals onthevarious ealth h issues ndtheneed a toseek treatment - Branded -shirts, T caps,branded bicycles, handbills, charts, atient flip p cards. Impact Thecurrenteach r oftheproject tothose million 50 people, 250ruralcells, or where cellis anareaof 25-30,including 0-100villages ach,s a 8 e i indicative ofthemodel'success s todate.
  5. 5. Table1 Communication Tools Communication Tools Leaflets Communication theailmentsndtheirsymptoms about a Flip charts Tocommunicate themethods ofidentifying symptoms forailments, causes failmentsndnecessary o a treatment procedures T-shirtsandcaps Toidentify the"health educators" withtheArogya Programme Use communication tocreate highdecibel a Branded vans by"health educators". recallorthe Brand f Branded bicycles Used audience exposed tothehighdecibel brand promotion Patient cards Foridentifiedatients p tocarryasreference tothe concerned doctor People acrossfive stateshaveaccessto qualityhealthcare with thousands of doctorsand hundreds pharmaciesbeingservicedby ArogyaParivar. ne of O hundredandthirty-eightdistrictsin UP,Maharastra, P,Biharand Rajasthan M arecovered underthe initiative, nd12,000patients a havebeentreatedsofar in 1,000villages. urrently, C morethan20 healthprogrammes arerunning,covering tuberculosis, respiratory infections, kinandgynaecological s infections, iad betes, icro-nutrients m duringpregnancy ndduringchildhood,ntestinal orms, a i w acidreflux, oughandcold,aswellasallergies. c Arogya Parivar asbuilta healthynetwork doctors,paramedics ndpharmah of a cists,whosharea similarmissionandsupportthe initiative.It hasalsoestablishedstrongalliances with pharmacy andhospital hainsthat serveas a good c complement Novartis. to Thecompetitive advantage ArogyaParivaris that it makeseveryactorwin. of Patients areeducated andavoidhealthcomplications. Healthprofessionalsee s morepeople thantheymightotherwise, ndarealsotrained.Healtheducators a whoworkforthecompany arelocallybased, eceive r extensive training,andgain additional tatuswithintheir communities. for Novartis,heyare improving s As t healthcare ndchanging livesof peoplein need. a the A holisticmodel, rogya A Parivar hasensured that areasthat werehithertorelativelyuntouched traditionalmedicalrepresentativesre now on the road by a map.Theinitiative hassucceeded bringingin additional evenue, in r thusadding to the bottomlineof the company. I FIG. 1 I The Arogya Model SocialImpact + Philanthropy Social business Bottom-line Growth -I- PR/Damage control Performance-driven CSR I I I I ---.---- J ~
  6. 6. Sinceits business modelis not basedon puredonations, rogya A Parivarsan i economicallyustainable s "socialbusiness", scalable morepeople to inIndia and abroadthat aimsto: . Provide health education (hygiene,nutrition, disease awareness) nd a improvethe qualityof life for localpopulations . . . . . . Improve publichealthwithoutthe needfor costlygovernment intervention or limited-duration NGO projects Createa revenue streamfor localpersonsassociated withArogya Parivar Increase footfallat localhealthproviders andbusiness partners (encouraging theirsupportto ruralmarkets) Generate income forNovartis andbuildbrandequitywithanupwardly obile m population Highlighted byNovartis internalandexternalcommunication in (inthesame manneras CSR) FulfilformerPresident AbdulKalam's visionof PURA, is,providing that urban remedies ruralIndia to . . Learning Thepoor rewilling a topayforquality andeffective treatment. Earlier, malepatients erereluctant consult w to ANMs (females); however, theArogya HEis maleandableto gainacceptance, convinceatientsnd p a support them. Chemists began stocking ovartis N productsnce o doctors egan b prescribing them. Doctors aremotivated duetotheincrease inincome, andaretherefore willingtoparticipate intheprogramme. Doctors reprofessionally a satisfied thatpatients nowcomplete treatment andgetcured. . . . The Way Forward TheArogya rogramme p iscognizant theimportance working ithNGOs, of of w especially inawareness programmes viacomrnunity-Ievel meetings andhealth camps.n 2011,theArogya I programme plannedo forma consortium at t of least 0NGOs 2 inIndia toprovide targeted intervention inthecausesfdiabetes, o tuberculosis, diarrhoea andalsofortheprovisionfclean o water. Plans havebeenmade replicate to andadaptthe modeln othercountries i throughout and Africa Asiaover henextfewyears. t Motherandchildnutrition,skinallergyanddiabetesare beingaddedto the list of treatments. ovartis N alsoplansto add alliedproductslike sanitarynapkins, waterpurification productsandcleandeliverykits to supplementhe incomeof t the HE. heaccompanyingideoexplains T v howthisprojecthasbeeninitiated and implemented UttarPradesh. in Discussion Questions 1. Whatproblems the ruralcommunity of wereaddressed throughthis model? 2. Ust the keyreasons the sustainability this model. for of 3. Doyouthinkthis modelcanbereplicatedin othercountries? yes,howand If in whichcountries?