Healthcare As A Social Business

Swiss pharmaceutical company Novartis continues to promote Arogya Parivar, a rural Indian healthcare business, which launched in 2007. Having been rolled out across ten states in India, Arogya Parivar leverages Novartis’ medical know-how and resources to channel important healthcare information, medicines, and services to rural communities across India. Services include health camps, free check-ups, and educational and awareness campaigns. To date, the organization has reached 50 million rural Indians, and has a target of covering 350 million people over the next ten years. This story originally appeared in our March 10, 2011 e-magazine. Click here to subscribe.

Novartis has employed a social business model to tackle the behemoth that is rural healthcare in India.

No one needs to be told that India is a huge country with consequently huge challenges. Of its 1.2 billion person population, more than 700 million people live in the country’s 640,000 villages. Half of national income is generated in rural India. At least 50% of the rural population lives on US$2-3 (INR90-135) per day. Many of these people are field laborers with a nominal daily wage. Falling ill, therefore, can have devastating effects on household income and on one’s ability to escape poverty.

Health education and healthcare are hard to come by in rural India. People have limited access to information about preventative and curative measures, as well as to professional medical treatment. Because there is this pervasive ignorance, India’s rural poor will suffer illness to keep working instead of seeking treatment. Evidently, there is a clear and present healthcare need to be met.

Arogya Parivar
Enter on scene Novartis, the Swiss pharmaceutical company dedicated to creating, developing and marketing innovative products to prevent and cure diseases. At present, Novartis is a global brand and operates in 140 countries around the world – including India. Who better, then, to address the gaping hole of accessible rural healthcare in India?

Dr. C.K. Prahalad’s ground- breaking book The Fortune at the Bottom of the Pyramid: Eradicating Poverty Through Profits inspired Novartis India Limited to start Arogya Parivar (AP), a rural healthcare business targeting the bottom of the pyramid (BoP). It was officially launched in July 2007. Today, AP is present in 180 districts in 10 states across India, including Andhra Pradesh, Bihar, Chhattisgarh, Gujarat, Karnataka, Maharashtra, Rajasthan, Tamil Nadu, Uttar Pradesh and Uttarakhand. It covers an estimated 50 million people in rural India with the eventual goal of reaching 350 million people in the next decade.

A Social Business Model
Novartis is the first pharmaceutical multinational to use a social business model to reach India’s rural markets. The company already has the medical know-how and resources to meet the needs of the BoP. However, it needed to approach the rural healthcare challenge by merging the lessons of government agencies and NGOs operating in the same space with thepractices of fast moving consumer goods companies for optimum efficacy.

The guiding principles of AP are utilizing local knowledge, harnessing entrepreneurial creativity and employing a bottom-up dynamic. AP is based on four pillars to ensure long-run impact and the availability of comprehensive rural healthcare. The pillars are: awareness, acceptability, availability and adaptability. It is because of AP’s four pillars that a variety of different illnesses can be addressed and Novartis is able to dispense medications to treat tuberculosis, diabetes, intestinal worms, cough, cold, allergies, respiratory infections, and gynecological and skin infections, among others.

The first pillar of awareness confronts the fundamental function of healthcare: people must be educated about the importance of good health. AP recognized that educators need to come from local communities so that information could be effectively communicated to people. Acceptability is the next step whereby people’s perceptions of healthcare being expensive and inaccessible need to be addressed. Novartis has decided to package medication in smaller units at affordable prices, thus changing rural perceptions. It is important to note that Novartis is not selling products at a lower price to the rural market versus the urban market; the same price per unit is maintained, but rural packages are smaller and therefore less expensive. Once acceptance is in place, the third pillar of availability is critical. A big part of AP’s ability to deliver healthcare is strong linkages with doctors: it goes beyond traditional “big pharma” practices to ensure “last mile availability.” Lastly, adaptability helps to support the AP framework. India has as many as 2,000 different dialects, so to successfully communicate with rural peoples, packaging and training tools must be adapted to each region in which they are distributed.

“You need to be sensitive to local culture and social structure,” says Ranjit Shahani, Vice Chairman and Managing Director at Novartis India Limited.

Impact
“AP conducts 500 health camps across different villages across the country on a monthly basis,” says Shahani. “These health camps are conducted in villages where access to healthcare is very poor. In these camps, free check-ups are done for the patients to make the healthcare affordable to the local population. However, our experience has shown that in rural India, more than affordability, it is a low healthcare awareness and lack of infrastructure that are the main hurdles.”

Internally, Novartis is tracking the impact of their social business. They have identified key performance indicators to follow – such as number of people covered in a health education and awareness program, number of health camps conducted, number of new patients diagnosed and number of doctor referral cards distributed. The current reach of the project to those 50 million people, or 250 rural cells where a cell is an area of 25-30 km² including 80-100 villages each, is indicative of AP’s success to date.

Shahani goes on to say: “It is not the Novartis brand, but the brand Novartis Arogya Parivar, which is being established. We chose the name ‘Arogya Parivar’ [Happy Family] so that even a regular villager could relate to it. This is also an environment largely untouched by any of the usual communications media so that often the only way of getting your message across to people is through face-to-face communication. And if you want to talk to people in rural India, it is a huge mistake to think that English will do the job given the number of regional languages and dialects. Hence, it is very important to include the local faces in the program.”

The Future
AP is cognizant of the importance of working with NGOs, especially in awareness programs via community-level meetings and the health camps. In 2011, AP plans to form a consortium of at least 20 NGOs in India to provide targeted intervention in the causes of diabetes, tuberculosis, diarrhea and clean water.

There are also plans to replicate and adapt the AP model in other countries throughout Africa and Asia over the next few years. “Based on the experience in India, a number of similar initiatives focused on patient access are being launched in different developing countries. One has been recently launched in China,” says Shahani.

Photo Credit: Flickr user United Nations Development Programmehttp://beyondprofit.com/healthcare-as-a-social-business/