1. Role of Technology and Innovation in Rural
Healthcare in India
5
Anshul Pachouri
Senior Researcher
Institute for Competitiveness, India
E-Mail: anshul.pachouri@competitiveness.in

2. Rural India: A Snapshot
s
Definition of Rural India
The most standard and widely accepted definition is given by
Census of India in 2001 which define an area as rural area if it
fulfills the following conditions;
(1)Population density of less than 400 sq km
(2) Atleast 75% of the male population engaged in agriculture
(3) No presence of Municipal Corporation or Board.
Quick Facts
Rural India – 70 % of the total Indian population
Total Rural Population :- 833 Million Individuals
Contribution to the National Savings – 33 %
Contribution to Total Consumption – 57%
Source: Data Extracted from Key Indicators of Household Consumer Expenditure in
India 2009-10, Ministry of Statistics, Government of India
Contribution to Total GDP – 45%
(Source: IBEF, NCAER and Census of India)
• The monthly household per capita consumer expenditure (MPCE) in
rural areas has increased by more than thrice from 1993-2010.
• Rural areas are going high on spending.
• But in the actual terms, they are spending half in comparison to
their urban counterparts.

3. Rural Healthcare : Opportunities
• India BoP healthcare market is estimated to be 26.5 billion
2005 International dollars at purchasing power parity dollars.
In 2008
• The average rural population meant to be served by each health
sub-center and primary health center is more than 6000 and
36000 respectively.
• It is estimated that nearly 1.75 millions of beds will be required to
achieve the status of 2 beds per 1000 people, 700,000 doctors to
reach one doctor per 1000 population by 2025. (PWC)
•The total capital investment to reach the above targets is
estimated to be US $ 80 billion approx.
• 8% of the total expenditure of rural people on health.

4. Rural Healthcare: Challenges
Rural People Challenges
Organizational Challenges

5. Emerging Business Models
Changing Times in Rural Healthcare
With the advent of time, there has been significant change in
the business models practiced in
rural healthcare and each type of healthcare is served by a
particular type of business – model
and format.
Traditional brick and mortar model can’t serve the healthcare
needs of rural people.
There is a need of sustainable and scalable business models
which can cater to this potential customer base.
Healthcare Information Management Systems:
Telemedicine and BPO Model:
A new model which is emerging today is delivering healthcare with
the help of information technology tools.
Companies have discovered a notion to provide doctor’s advice on
phone by using latest tele and video conferencing technologies.
This model also uses the ICT technologies to guide its users
about various good health practices.
It teaches its subscribers about the different steps they should take
which depend on the type of disease or health problem they
encounter.

6. Case 1.1: Apollo Tele-Medicine
Apollo Telemedicine is largest and oldest telemedicine network
in India founded by Apollo Hospitals in 1999.
Apollo Hospitals has two concurrent businesses in rural
healthcare and telemedicine, one is under the banner of Apollo
Telemedicine Network Foundation and other is Apollo Reach
Hospitals.
The company was started way back in 1983 by visionary doctor Dr.
Prathap Reddy when private healthcare was not so popular in India.
Challenges
•Changing the mindset of the people towards telemedicine.
•Winning the trust of the patients of rural areas.
•Standardize the protocol of interaction between doctors and telemedicine center.
Healthcare Delivery Model
The patients were advised from doctors from the distance
varying from 200 to 2800 Kms.
The technology had enabled the telemedicine centers to scan and
mail the X-Ray’s and other medical
Apollo Telemedicine Networking Foundation
First project of Telemedicine was implemented in the village of
Aragonda in state of Andhra Pradesh by building 50 beds
hospital connected to Apollo multi-specialty hospital of Chennai.
Video conferencing tools supplied by the Indian Space Research
Organization (ISRO) were used to make tele-medicine possible to
reach the villages of India.
One tele-consultation with the super specialized doctor is done at
price of US $ 11.2-16.7 and 50 US $ if overseas consultation is
being done.
The details of the patients were transferred to be multi-specialty
hospital by using desktop software.

7. Case 1.1: Apollo Telemedicine
ISRO
State
Governments
Offering Primary and
Secondary Healthcare
services
Tele-Medicine
Affordable & Quality
health-care services in
Tier-2 cities and rural
areas
Managing customer
data online
Rich Patients
Medical
Equipment
Suppliers
Doctors
Para-Medical staff
Video-conferencing
through tele-medicine
centers
Diagnostic Setup
Medicines
Infrastructure (Hospital, Equipment, Staff)
Resources (Doctors, Paramedical staff)
Training, ICT Setup, Software
Poor Patients
(Subsidized)
Fees for specialist tele consultation
Fees for Primary and Secondary
Healthcare Services
Medicines

8. Case 1.1: Apollo Tele-Medicine
Results
Today, ATNF has more than 150 tertiary hospitals which are connected to 35 specialty
hospitals across the globe.
Today, Apollo had done 69000 tele-consultations done by more than 100 teleconsultation centers setup across the globe.
The Aragonda hospital has done more than 2000 consultations had been provided in the
last
10 years from direct video interaction with specialist doctors.

9. Case 1.2: Apollo Reach Hospitals
Apollo Reach Hospitals
In 2008, Apollo started its initiative Apollo reach hospitals to deliver low cost quality healthcare in Tier-2
cities, sub-urban and rural areas.
Apollo reach hospitals also extend the telemedicine network of the group which helped the people of the
villages to get the best advice at their reach.
Challenges
The Apollo reach hospitals faced the critical challenge of availability of the doctors as people don’t want
to work in smaller cities.
Innovation in Business Model
The Apollo reach hospitals targets both rich and poor patients in equable manner.
The revenue comes from the high income people and affordable healthcare was provided to the low
income people on the other side.
The health insurance covers RSBY hospital expenses up to Rs. 30,000 ($667) for a family of five people.
The transportation costs were also covered up to a maximum of Rs. 1000 ($23) including Rs. 100
($2.23) per visit to the hospital or doctor.
Apollo had also signed a loan of 50 million dollars from International Finance Corporation to open up
more reach hospitals and telemedicine center in 2010.

10. Case 1.1: Apollo Tele-Medicine
ISRO
Diagnostic Tests
State Governments
Tele-Medicine
Consultation
Medical Equipments
Suppliers
Affordable & Quality
health-care services in
Tier-2 cities and
rural areas
Primary & Secondary
Healthcare
Poor Patients
(Subsidized)
Insurance Offer
(RSBY)
Rich Patients
Primary and
Secondary Healthcare
Doctors
Face2Face Consultation
Para-Medical staff
Video-Conferencing
Diagnostic Setup
Infrastructure (Hospital Setup, Equipment etc)
Resources (Doctors, Paramedical staff)
Training, ICT Setup, Software
Primary and Secondary Healthcare
Money from Insurance
Medicines

11. Case 1.2: Apollo Reach
Results
The inclusive business model of Apollo Hospitals had helped to reach sustainable
revenues
ranging from Rs 6000 ($132) to Rs. 7000 ($154) per bed.
It is estimated that more than 1, 00,000 patients who earn less than 2$ per day had been
served from Apollo reach hospitals.
The group aims to open 15 more hospitals and serve more than 400,000 patients by 2015.
The group also aims at opening 1000 telemedicine centers by the end of 2012.

12. Case 2: E-Health point Services
E-Health Point services is owned by HealthPoint Services India (HIS)
started its operations in 2009 in partnership in Ashoka Foundation and
Naandi Foundation in the state of Punjab.
Three projects were started simultaneously at different places by
providing the services of tele-medicine, diagnostic services, pharmacy
and clean drinking water supply to around 10000 people.
In 2011, E-Health Points (EPHs) are operational with more than 80
EPH centers spreading over seven districts of Punjab.
Innovation in Business Model
The services were offered with a nominal fees of less than 1$ mostly to
make it affordable for rural households.
The subscription was given at a very nominal fees of 1.5$ per month and
gives 20 liters of clean drinking water daily which has helped in decreasing
the water-borne diseases in rural areas.
The medicines were given to patients by licensed pharmacy available at EPH
and are sold at a discount of up to 50% on the listed prices and directly
procured from channel partners of the companies to get the cost advantage.
Healthcare Delivery Model
Tele-medicine consultation was done by HIS urban health center
where doctors give their advice
and diagnose by videoconferencing tools.
Doctors were recruitment from local areas so that there are no
linguistic disadvantages and they are especially trained to for
providing tele-consultations.
EPH also has the facility of performing near 70 tests and
equipped with devices like digital stethoscope, blood pressure
monitoring machine and ECG.
The average cost of each medical test was just $1.

13. Case 2: E-Health point Services
Ashoka
Foundation
Naandi
Foundation
Pharmacy
Tele-Medicine
Consultation
Providing Clean Water
Affordable & Quality
health-care services in
rural areas
Primary Healthcare
Poor Patients
Clean Water
Rich Patients
Government
of Punjab
Doctors
Video-conferencing
Setup
Center Staff
Infrastructure (Tele-medicine center, Equipment etc)
Resources (Doctors, Staff)
Training, ICT Setup, Software
Video-Conferencing
EPH Centers
Tele-medicine Fees, Medicine revenues and Clean
water subscription

14. Case 2: E-Health point Services
Results
EHP has done about 29000 tele consultations, 15000 diagnoses and 35000 prescriptions
have been given since its inception to September, 2011. T
he impact and wider reach of EHP at bottom of the pyramid can be understood by the
way that it has around 3,50,000 daily users of clean water in rural areas.

15. Case 3: Piramal E-Swasthya
Piramal E-Swasthya was started in 2008 as a social healthcare
initiative of well established pharmaceutical company Piramal Healthcare in
collaboration with Dean Nitin Nohria of Harvard Business School.
Innovation in the Business Model
E-Swasthya doesn’t charge any consultation fee from the patients, they just
charge the expense of the medicines.
The medicines were made available to the health workers for selling to the
patients to generate instant revenues.
The marketing was done in a very effective manner to engage the rural
people and BoP households through regular messages, drug
remainders and publication of articles on telemedicine.
Challenges
The patients are not ready to buy all medicines as prescribed or just
don’t complete the full course of medicine.
Recruit the motivated health workers which can take the model to the next
level.
To address this challenge, E-Swasthya has launched pilot project with
Government of Rajasthan to recruit ASHA (Female Government Health
workers).
Healthcare Delivery Model

16. Case 3: Piramal E-Swasthya
Government of
Rajasthan
Tata Consultancy
Services
Vision Spring
Pharmacy
Tele-Medicine
Affordable & Quality
health-care services
in rural areas
Primary Healthcare
Poor Patients
Health worker
Rich Patients
Selling Water
purification tablets
and
reading glasses
Aquatabs
Doctors
Health workers
Call center
Clinical Support
Systems
Infrastructure (Call center)
Resources (Doctors, Call center Staff, Health
worker)
Training, ICT Setup, Clinical Support System
Video-Conferencing
Health worker
Medicine revenues

17. Case 3: Piramal E-Swasthya
Results
E-Swasthya has treated 40,000 patients through several pilot projects which were deployed .
E-Swasthya gets on an average 1.2 patients per health worker per day in 50 operational villages.
To cover all the costs including the operational, technological and personnel and make the model
financial sustainable in the long run, it is required to achieve 1.7 patients per health worker per
day on an average for 1000 villages. The figure is quite achievable as already many villages have
witnessed more than 3 patients per health worker per day.

18. Conclusion
Tele-medicine has emerged as a sustainable business which can cater the healthcare needs of the rural people
and bottom of pyramid.
Tele-medicine is extremely helpful in primary and secondary healthcare, however more advancements are
required to replicate the model for tertiary healthcare in rural areas.
The use of information & communication has removed the distribution and geographical challenges in
delivering the primary and secondary healthcare in rural areas.
ICT has significantly reduced both the infrastructure and operating cost for delivering the quality healthcare
services to rural areas.
Tele-medicine has been used as market development tool by the companies to create a new market for getting
an expert doctor advice without meeting him in personal.
The emerging business models looks very promising but it’s very early to comment on their long term
scalability and sustainability. The next 2-3 years will actually show clearer picture of the future of tele-medicine in
India.
The treatment of the poor segment at cheap and affordable price is a huge social capital created by these business
models.
By giving treatment to the poor segment and people in rural areas, these business models are contributing in the
inclusive growth of India full filling the dream of “healthcare to all”.

19. Recommendations
Government hospitals should be converted into public private partnership models to make them more profitable and effective in delivering the
healthcare.
Companies need to make tele-medicine as their core activity rather than a side activity. They need to offer full basket of healthcare services
in order to make their business models more sustainable and scalable.
There is also a need of more advanced healthcare information management system like Nokia health tools. Healthcare information systems can
play a crucial role in preventive healthcare and creating the awareness about healthcare with the increasing penetration of mobile phones in rural
India.
The government need to give adequate subsidies and tax benefits to the companies operating in rural healthcare to make their business
models more scalable which can enhance the reach of tele medicine to different parts of the country.
It is very important that bigger companies should enter the market the tele-medicine and rural healthcare industry to develop the market and
make it more scalable and sustainable.