This originally appeared in Dowser.org
Photo Courtesy of E-Health Point
Al Hammond and Amit Jain of E-Health Point found a hook to get rural Indians to come to their clinics: provide clean water. Cheap clean water brings the foot traffic that lets their modern medical facilities flourish. Because there are no local doctors, the clinics use wireless broadband and two-way video with remote medical professionals. Last year their model caught the attention of Proctor and Gamble, whose investment in the company will allow them to scale up across India. Below Hammond describes the pull of the bright shiny medical office, the natural collusion of clean water, healthcare and technology and how he provides affordable medical care while growing his for-profit social enterprise.
Dowser: How has the general reception been to your highly technical medical facilities in rural India?
Hammond: Rural individuals have access to television – that makes them realize that they are falling behind their Western counterparts. So, when they see a clean, well-functioning facility, they equate it with something urban. And that makes them feel proud that they have such a good quality place in their own community. Plus, it’s not charity; they’re a consumer, they’re a paying customer. So, it makes them have a great sense of pride. And that’s not unique to India. That sentiment is across the developing world. In fact, if they don’t like our service, they don’t have to come.
What technologies are key for Health Point in Punjab?
I often say that this would not have been possible five years ago. There were four key technologies that were not available before.
1. Rural broadband
2. Good telemedical software
3. Modern point-of-care diagnostics mobile diagnostics
4. Cheap water treatment
Would it be classified as a social enterprise or non-profit?
We’re a for-profit social enterprise. We’re going to spend $50,000 per village. And we’re going to spend probably $30 million of investment capital per country. And raising grants on that magnitude is not sustainable. Doing 100 units is not enough. We have to get enough units out there on a large scale so that capital markets and the global health market start viewing this as an alternative method to solving these problems.
Are you finding that even though you’re charging less than a dollar (30/40 Rs.) per medical test or consultation, you’re able to raise enough funds?
Yes. We’re in the positive. There are three strata in rural Punjab to consider and we cater to the middle.
Top: 5% are wealthy: landowners, drive nice cars, can afford health services.
Middle: 60-65% are successful farmers, merchants, etc.: can afford these kind of prices. They would typically have an income of $2 per day per family member. That’s our core market.
Bottom: 30% are landless immigrants and migrants. They typically cannot afford it. It’s hard to get those families to become water users or healthcare users. If it’s not free, they tend not to get it. The way to get those people is through public-private partnerships by offering subsidies. So, if we can get them access to clean water through such means then we can address childhood diarrhea, etc., which is so closely linked to water.
Why did you start in Punjab?
Southern Punjab is very poor. Also, it was easier if we started in a place where we had support and could set it up. Then we can show it as an example to the government. We had an introduction to the ex-finance minister, which helped us get local support. Now, we’re at a stage where we’re wanted in the state and we can think about expanding to other parts of North India and then extend towards the South.
The key is that you have to engage government to do this, even if you’re financially independent.
Doctors provide the tele-medical consultation, who are these doctors and how far away are they?
The doctors are coming from Bhatinda (a nearby city in Punjab) who are local and know the local language. We can of course get doctors from Delhi, Mohali, etc. And as we expand to the South or other regions, we’d get doctors from corresponding areas to ensure that they can speak the local languages.
Are they paid?
It’s not sustainable if they’re not. We pay our doctors about 30,000 Rs. per month. We pay our village health workers. We pay our unit staff that we hire and train from the village. We cover those costs with patient fees.
That’s what’s amazing – that we can do a reasonably good service, in an area where there wasn’t any, and make enough to cover our costs. That’s what’s revolutionary – that it’s sustainable.
Does the clean water help people get to know about the clinic and come use its services?
Yes, and in the future, we’re going to open the water first and then open the health services. Then the health care would be profitable sooner. Water provides traffic. Water helps avoid disease. Water tends to wipe out the diarrheal diseases, etc. They’re both aspects of health. The water is the easiest to get up and going. The health takes a bit longer to make it profitable.
Will you provide immunizations down the road?
Yes. We could do it as part of the government program and then charge for some additional ones. Later, we can provide insurance as well.
Could you tell me more about the Proctor and Gamble partnership?
P&G is looking to get into the services sector and especially the BOP [Base of the Pyramid]. So, they’re able to learn through our model. And they’ll be able to help scale it. Fundamentally, they’re an investor that’s interested in learning about the market and we’re helping them do so.
Do you find that there is any hesitancy when it comes to Western medicine? Do they prefer ayurvedic or homeopathy?
Some of our patients do feel that ayurvedic is better. But the vast majority of rural individuals are looking for solutions using traditional medicine. They take pride in seeing our facilities where everyone is dressed in a uniform, we have a stainless steel water purification machine, we have an on-site licensed pharmacy, and we have licensed doctors. They’re happy to see such services available in a rural setting.