When his father was suffering from stress and heart diseases, Sujay Santra, an employee at Oracle in Bangalore, admitted him to a hospital in that city. A cardiac surgeon prescribed various medicines and asked him to return for a check-up after six months. Santra's father returned to his house in Kharagpur.
What the Bangalore-based doctor later told Santra shocked him - a local doctor who was attending to his father had prescribed wrong medicines, when changing the dosage of the original prescription would have been enough.
"This event had a huge impact on me. It propelled the concept of iKure," says Santra, adding the rural population has been a victim of inadequate health facilities and quality medical assistance is a luxury many can't afford. The demand-supply gap in the Indian healthcare sector is no secret. And, the government's efforts to address this haven't borne fruit so far.
BETTING ON RURAL HEALTH CARE
iKure runs rural health care centres in West Bengal. It also makes software that records patient data, footfalls, the treatment prescribed and the medicine inventory
The software records patient data like blood pressure, blood sugar and electrocardiogram (ECG), and sends these by wireless to a specialist at a city hospital
The cloud-based platform is available on subscription, starting Rs 2,000 a month. This is capable of running even at low bandwidth speeds of 10 kbps
iKure's centres offer an alternative to govt-run primary health centres and are linked to tertiary hospitals in smaller towns
iKure runs rural health care centres in West Bengal. It also makes software that records patient data, footfalls, the treatment prescribed and the medicine inventory. iKure founder Santra admits he has always been inclined towards technology - from his first job at the National Remote Sensing Agency to working with IBM and Oracle in Bangalore.
According to the founder of a rural healthcare
provider, telemedicine isn't suited for rural areas; also, it is capital-intensive and needs high-bandwidth lines. Doctors have to be available on a real-time basis. "So, remote answering seemed the best answer," says Santra, who came up with the concept of STEP - the Science and Technology Entrepreneur Programme - at the Indian Institute of Technology (IIT)-Kharagpur. The programme helps record patient data such as those relating to blood pressure, blood sugar and electrocardiogram, and sends these by wireless to a specialist at a city hospital.
iKure's proprietary software, WHIMS (wireless health incident monitoring system), is registered with IIT-Kharagpur and is due for a patent soon. Santra says a major benefit of WHIMS is its low resource needs. "Our entire enterprise resource planning works at 10-kbps speeds," he says. WHIMS, a cloud-based platform, is available on a subscription model at prices starting Rs 2,000 a month.
WHIMS' trial run was held at Jubilant Kalpataru Hospital at Madhyamgram, North 24 Parganas. Initially, Santra sold the software to hospitals and worked with the corporate social responsibility (CSR) arms of multinational companies to augment their healthcare initiatives. The iKure model was tried at Salboni in West Midnapore district, as part of JSW Steel's CSR. "But this wasn't enough to create an impact, as each deal took time to materialise," Santra says.
This brought about the concept of iKure rural health centres.
Rural health centres
iKure launched its first centre after running several pilots, through 30 months. "These are an alternative to government-run primary health centres," Santra says. There are 922 primary health centres in West Bengal. But "doctors are not available most of the time. It was just not enough", he adds.
The first of iKure's 14 rural health centres was launched in Keshiary, West Midnapore district; another was set up in Surul village near Bolpur. While the first was in association with the Rotary Club of Calcutta Metro South, for the latter, it tied up with a non-government organisation (NGO), Surul Foundation, operating out of its premises.
The fees charged by iKure centres typically vary from Rs 10 for blood pressure monitoring or injections to Rs 60 for an ECG test and Rs 100 for major dressings. For general consultations, one has to pay Rs 80 a visit; this includes medicines for five-seven days. "This helps in early detection, which saves treatment costs and lives," Santra says.
For most in rural areas, this is an affordable and accessible option and ensures they don't lose a day's wages and save on travel costs. Each centre has a lady attendant, a doctor, a pharmacist and a coordinator.
iKure's model is linked to tertiary hospitals operating in smaller towns. It has tied up with Mission Hospital in Durgapur, around 35 km from Surul, as well as Sanjiban Hospital in Howrah's Fuleshwar town for its Keshiary centre. "Associations with NGOs are important. NGOs have a certain brand equity and it helps to get along with them," Santra says. Surul Foundation, for instance, has been working on issues such as sanitation, women's empowerment and education for about 10 years. Cases requiring further intervention are referred to Nanavati Hospital, Mumbai.
Plans are afoot to expand out of Bengal. Santra says this is a good career option for "40,000 doctors graduating every year in India. Of these, 20 per cent get access to specialist courses such as MD or MS. The remaining 32,000 become general practitioners or resident medical officers in hospitals. They're required to spend 40 hours a week at the hospital and many do not have their own chambers."
The scalability of this model, apart from the fact that it was affordable for most, helped Santra find a set of investors.
In an email response to Business Standard, Victoria Fram of US-based investor Village Capital said one of the major reasons the company invested in Santra's project was it helped address major social and challenges. "We are excited at the peers' selection of iKure, which has already demonstrated significant traction in addressing the pressing need for quality, affordable rural health care by enabling access for about 200,000 customers. As they continue to leverage their technology and focus on expansion of rural health centres, we expect significant social returns from this investment, with the prospect of also achieving solid financial returns," she said.
CIIE (IIM-Ahmedabad's Centre for Innovation Incubation & Entrepreneurship)'s Akash Bansal, an investor in iKure, says, "iKure's dedication to expanding rural health care access is extremely commendable. We are looking forward to seeing how their innovative delivery model can scale rapidly to enable last-mile reach to quality, yet cost-effective medical care by leveraging technology. CIIE and Village Capital's investment in iKure was a result of it being selected by peer social enterprises as one of the two winners of the Tech4Impact programme, an acceleration programme for some of India's top early-stage social start-ups We expect iKure to deliver strong returns on our investment."
Webel, the nodal agency of the West Bengal government for developing information technology, electronics and information technology-enabled services in the state, provided the first round of external funding - Rs 75 lakh through a seed fund in 2010. In 2011, MSME provided a grant of Rs 6 lakh for technology innovation. A grant of Rs 10 lakh from the National Bank for Agriculture and Rural Development followed.
The venture received angel funding of Rs 20 lakh in two tranches from two angel investors, with the Intellecap Impact Investment Network (i3N) - Jayesh Parekh, co-founder of Sony Entertainment Television, and Nandan Maluste, president, CSO Partners. "We are also in talks with two major investors. That should be closed soon," Santra says, choosing to keep the names under wraps. He, however, indicated while one investor was from Japan, the other was a domestic investor.
But securing funds wasn't easy, Santra says. "In India, it is difficult to get investors for start-ups. One has to be patient and confident about the project."
At the operational level, the rural health centres have recorded break-even, says Santra. iKure isn't far away from profits, too. In 2012-13, revenues stood at Rs 30 lakh; the company is targeting revenue of Rs 80 lakh this financial year and Rs 30 crore by FY17. Profits would primarily be driven by the rural health centres, sales of its WHIMS software to hospitals and CSR projects, for which companies bear the cost. Currently, software sales and rural health centres contribute about 40 per cent each to revenues.
"We are selling software to many in countries such as Brazil and Kenya. Corporate accounts will grow with time," Santra says. Each iKure centre can cater to a population of 100,000," he adds.
iKure is already working with the Association of Community Ophthalmologists of India, mandated by the World health Organization to screen and prevent eye diseases and develop an ophthalmology module. "We've been able to crack the code, in terms of technological feasibility and business model," says Santra.
A huge shortage of doctors in rural areas severely affects the availability of basic health care. The use of technology can bridge the shortage of skilled manpower and the addition of vocational workforce such as nurses and physicians' assistants, as in western countries, is the need of the hour.
The National Skill Development Council is making major progress in this direction and simple technology such that used by iKure, developed by IIT-Kharagpur, as well as its monitoring system, is definitely a step in the right direction. Using a cloud-based platform to reduce infrastructure cost is also a step forward. Scaling up becomes easier on a cloud environment. The success of such projects depends on the acceptance of technology among users, both the paramedical workforce and patients. Its long-term viability would depend on the scale the company can achieve, as well as the appropriate human resources it can attract. The addition of nurses to its network would be highly beneficial to the company. Additional services such as vaccination and chronic disease management will make these clinics more relevant. Due to the lack of access to health care in rural areas, there is great potential for companies concentrating on primary health care. The right mix of technology and service would be the winning formula.
A Raghuvanshi is vice-chairman, managing director and group chief executive, Narayana Hrudayalaya