In India, approximately 80 million people live in urban areas on incomes that are below the poverty line and in Mumbai, 54% live in urban slums with inadequate access to clean water, sanitation and health facilities. They say, sickness is a great equalizer; it hits the poor and the rich uniformly, but the poor are disproportionately affected by health inequities. According to WHO estimates in 2010, approximately 71% of all spending in health care was private, but about 86% of this spending was out of pocket, which risks pushing the poor further into poverty.

In the midst of these trends, many non and for-profit healthcare organizations are testing new models to meet the health needs of its large and diverse population. One such is, Swasth India; a brainchild of IIT Bombay alumni which was started with the motive of providing affordable healthcare to working poor.

Swasth India are “Service Integrators”, as they call themselves, who work with different service providers across the health value chain of doctors, labs, pharmacies, hospitals, nursing homes, drug companies, insurance companies and bring them on a common platform to deliver quality services to low income households.

Since its launch in 2008, Swasth has 100,000 patient visits till date with cumulative direct savings of more than USD 1 million to patients.

Key Program components

Innovative operational processes

Swasth’s services are delivered through a network of self-sustaining health centres located in slums that provides one-stop solution for 5D services (doctor, diagnostics, drugs, daycare and dental). The service is currently achieved through their 15 health centres at 50% of the market rate with 90% user satisfaction.
The prescription drugs are sourced directly from top pharma manufacturers; thereby completely removing the supply chain; enabling them to avail medicines at lower cost.

The right partnership

Partnership is a widely used strategy by inclusive businesses. Swasth is in tie-up with well-known hospitals across Mumbai, where patient requiring secondary/tertiary care (radiology tests, inpatient treatment, specialist consultation) are referred and treatment is provided at discounted rates. Swasth also plans to partner with VisionSpring, a pioneer in low cost eye health checkups across India, to conduct vision screening and sell low-cost eyeglasses at their centres.

Using ICT and leveraging loyalty

Through the Integrated Health IT system of Swasth, each family enrolling with Swasth gets a unique identity card which helps Swasth track patient and his family data in electronic health records and relay the information to specialist medical professionals in their empanelled hospitals.

These incentives encourage them to access the services.

Customizing the model for the Working Poor in Urban India

Most informal medical facilities are open during morning hours making it inconvenient for the working poor to avail treatment. Swasth leveraged this opportunity by providing consultation during both morning and evening hours. As per Swasth, approximately 70% of the patients avail evening consultation.

Empowering Women to become Change-makers

Two thirds of Swasth’s staff are women; who are recruited from the community which is being served. In addition to the monetary benefits, Swasth supports formal education of these women and also trains them in English speaking, use of computers, undertaking diagnostic tests etc.

Fostering Behaviour Change through Community Outreach / School Health Programmes

Swasth also runs a Community Outreach Program that is staffed entirely by women belonging to communities served by them. Swasth’s data reveals that these women, trained as health workers spread knowledge about good health practices and each women worker is capable of impacting approximately 10,000 other women in their village.

Business Lessons for us

Don’t start from scratch. Leverage existing capabilities

Swasth India has partnered actively with community-based organizations (e.g. NGOs, micro finance institutions, co-operatives, and employers) that have the access and trust of the community at the grassroots level. This helped them to leverage work done by these organizations and overcome challenges related to distribution, access in remote areas, technical assistance, workforce etc.

Understanding customer pain points through tools like behaviour science and ethnography

It is important to understand decision-making patterns in BoP markets. Swasth found that setting up the health clinics inside slums prevented families from the neighbouring slums to visit the centre due to territorial and cultural divisions, and it was not sustainable to cater to only limited families of one particular slum. Thus taking into consideration people’s needs and preference, the clinics were shifted to public places like market areas.

Building a relationship of trust with consumers

For low-income communities, a cheap product or service may not be enough of an incentive to make a purchase. It is imperative that they feel they are getting the best quality for their money. By enabling consultation from highly qualified doctors, sale of pre-packed medicines from pharmaceuticals at discounted rates, use of state of the art devices and diagnostics, Swasth ensures that no compromise in quality is made.

Driving profits by volume

Quoting Dr. C.K. Prahalad, father of the term bottom of the pyramid, “BoP is not a market that allows for the traditional pursuit of margins; instead, profits are driven by volume". In a typical business model offering service to BoP segment, margins are likely to be low; however, if the model has potential to scale, it is likely to attract investments to spread its wings of social development to other parts of the country.

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