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Forthefirsttimein India,aglobalpharmaceuticalcompanywentbeyondthetraditionalmedicalrepresentativeroutebyaddressingtheunmethealthneedsofruralIndia,therebydramaticallyimprovingaccesstomedicinewhileatthesametimeprovidingopportunitiesto expandbusinessinan innovativeandsociallyresponsibleway.NovartisisthefirstpharmaceuticalmultinationaltouseasocialbusinessmodeltoreachIndia'sruralmarkets.
Forsome800millionmen,womenandchildreninmorethan600,000villagesacrossIndia,theideaofaccessible,affordableandhigh-qualitymedicinesisoftenasremoteastheirruralhomes.Institutionalhealthcarein ruralIndiaislimitedtothegovernmentstructure.Privatehealthcareservicesareindividual-drivenandunstructured.Thegovernmentoffershealthservicesfreeofcostbutover70percentruralpeoplepayforhealthservices.
NovartiscommissionedMARTtounderstandtheheathneeds,behaviourandat-titudetowardsmedicineinruralareas.MARTfoundthattheawarenessofhealth
issueswaspoor,andpeopleaccessedhealthservicesaftertryingvarioushomeremedies.Thedelayintreatmentandtheensuingemergencywereconsiderednatural.Ailmentsrelatedtonutrition,allergiesandinfectionswerenotdifferenti-ated,leadingtothepatientnotapproachingtherelevanthealthserviceprovider.Thisleadstoasignificantwasteofmoneyandnorelieffromailments.Manyofthesepeoplestayedundiagnosedbecausetheyeitherdidnotunderstandtheirsymptoms,orthedoctorsweretoofaraway,or theywereafraidof thecostsinvolvedorofsocialprejudice.Womenandchildrenwereparticularlyvulnerable.
Tuberculosis(TB)wasidentifiedasa keyailmentin ruralareasandthiscasefocusesonTBtreatment.
Problems
Themainprobleminhealthcareforruralpeoplewasrelatedtothe4As,whichisdiscussedbelow..Affordability
- PerceivedorexperiencedcostoftreatmentforTB,if thepatienthastobetakentoanearbytownfortreatment(treatmentperiodisfromsixtoninemonths)isestimatedtobemorethanINR10,000 ingovernmenthealthcentres,againstINR15,000throughprivatetreatment.In governmentcentres,patientshadtogotoprivatediagnosticscentresandbuymedicines.
- Forsimpleinfectionsorskinallergies,thecostofprivatetreatmentwasbetweenINR250-1,000..Availability
- Accessto healthservicesandmedicineshasbeenthemajorproblem.Qualifieddoctors,privateorgovernment,or licenseddrugstoresarenotavailableinvillages.Therefore,thereisthecostoftravellingtotheblocktown,wherethePHC(publichealthcentre)oraprivatedoctorislocated..Awareness
- Patientshavepoordiscerningcapabilitiesand cannotidentifytheappropriatedoctorfortheirailment.
- Theyhavenoideaifthemedicinesprescribedbythedoctorarethesameasthosegivenbythechemist.
- Patientshavenoideaif the"medicines"arepreventive,curativeor formaintenance..Acceptance
- Patientshavetheirownperceptionsaboutailments.Onlythoseailmentsthataffecttheirworkproductivityareattendedto.
- Treatmentofchildrengetspriorityoverthatofadults.
Hence,Novartisfelt theneedfor reliablehealthservicesandmedicinesatareasonablecost.
MART'sStrategic Suggestions.Tocreateawarenessamongthelocalpopulation,establishanetworkof"footsoldiers"recruitedfromvillagestoworkas"healtheducators".Theywouldsupportpatientsforallhealthservicesandfollowuptocompletethetreat-mentprocess..Toimprovetheavailabilityof healthservice,qualifieddoctorsneedto beidentifiedeitherfromamedicalinstitutionorindividualpractitionersintownswithpopulationsgreaterthan50,000(blocktownsorbelow)..Tomakehealthservicesaffordable.Patientswereoftenmis-informedabout
thetotaltreatmentcostandbelievedit to bemuchhigherthantheactualcost,becauseof whichtheyavoidedseekingtreatment.Thiswrongper-ceptionwascorrected,afterwhichpatientsrealizedthatthetreatmentwasaffordable..Tomakehealthserviceacceptable,theprogrammeidentifiedcriticalhealthissuesrelatedtoinfection,nutritionandallergies.TheArogyaprogrammead-dressedtheseidentifiedissues,deliveringgoodresultsandtherebybuildingtrustwithinthecommunity.
The Solution
Toaddressthe healthissuesin ruralIndia,Novartisdesignedan arogya(meaninggoodhealth)programme,thewinnerofthebestlong-termruralmar-ketinginitiative(RMAI2008 SilverAward,WOW 2008 SilverAwardandGoldenPeacockAwards2008),whichofferedpharmaceuticalsolutionsandalsoin-tegratedtheneedtonetworkwithlocaldoctors,educatepotentialcustomers(patients),andlinkpatientstospecializeddoctors.TheNovartisteamaddressedthechallengesbyusinganinnovativedirectapproachtomakevillagersawareof prevalentdiseasesandencouragethemto seektreatment.Bylate2006,theArogyaParivarinitiativewaslaunchedwiththehelpof MARTasa pilotprogrammeinUttarPradeshandMaharashtra.
ArogyaParivarfollowsadecentralizedmodelwherethefieldforceisinautono-mouscells(250cellsin2011),eachcoveringa radiusofapproximately35kmor 20 miles.Eachcellismanagedbya supervisor,assistedbya fewhealtheducatorswhocollaboratewithlocalhealthprofessionals,pharmacychainsandNGOstoaddressthewhole"patientflow",includingeducation,diagnosis,treat-ment,delivery,andavailabilityandaccessibilityofmedicines.
Akeydifferentiatorisofferingpatientsintegratedsolutionstohealthproblemsratherthanmainlysellingproductstohealthprofessionals.Productsselectedfortheinitiativearesimpletouseandpackagesarereducedinsizetokeepout-of-pocketcostslow.Theinitiativeaimstobuilda sustainable,profitablebusinessthatimprovesaccessto healthcareamongtheunderservedmillionsin ruralIndiabycreatingawareness,enhancinglocalavailability,anddesigningappeal-
1'"ir
ingandaffordablehealthsolutions.Thissocialbusinessapproachrepresentsamixofcorporatecitizenshipandcreativeentrepreneurship.
AnArogyabrandwascreatedfor theuniquehealthservicesofferedbythecompany.Theumbrellabrandhelpedto overcomebrand-relatedissuesandbecameeasyrecallfor the illiterateandsemi-literatevillagers.TheArogyaParivarbrandissupportedbyconsistentgraphicsofleaflets,banners,educationprogrammes,uniformsfor healtheducatorsanddecorationsfor bicycles.Allcollateralisdesignedkeepinginmindthenatureoftheaudience,particularlyintermsof literacyandcomprehensionlevels.Effortismadeto focusonspecificdisease/sonrespectiveWorldDiseaseDaysthroughactivedoctorparticipation.
Tocreateawarenessamongthelocalpopulation,Novartisestablishedanetwork'of "HealthEducators'(HE)recruitedfromvillagestoprovidepatientswithsup-portandfollowuptocompletethetreatmentprocess.TheHEwasprovidedwithbrandedT-shirts,capsandbags.Novartisusedbrandedaudiovisualvans,com-munitymeetingsandadvisoryleafletstocommunicatethebenefitstotheruralmasses.The"HE"movesfromvillagetovillageona permanentjoumeyplan(PJP).Theyconductgroupmeetings,identifypatientsindifferenthouseholds,educatethefamilyandconvincethemof the needfor treatment.Theyalsoensurethatpatientshavetheirsupportwhentheydecidetovisitthedoctor.It isalsoimportantthatthemedicineisconsumedasprescribed.One-on-onecom-municationisnecessarytoconvincethepatientandtheirfamily.Aninformedpatientismorepositivelyorientedtowardscompletingthetreatment(thereisatendencytodiscontinuetreatmentassoonasthepatientfeelssomerelieO.TheHEservestwoblocksand30activepatientsandispaidINR1,500permonth(commissionof10percentfromsaleofmedicines),andnewproductsarebeingaddedbyNovartistosupplementincome.TheNovartisexpenseoncommunica-tionandpromotioniscompensatedthroughthemarginfromincreasedsalesoftheirmedicine.
Theinitiativeis structuredasa "socialbusiness'andisa perfectopportunityto expandthereachofhealthcareto thosepeoplewhofalloutof thecurrentsystemsimplybecausetheydonotliveinurbanorsemi-urbanIndia.
ArogyaParivarbuildsona "bottom-of-the-pyramid"businessapproachmeanttosellproductsandservicesto low-incomepopulationsinemergingcountries.
ArogyaParivaristargetedatallagegroups,especiallywomenandchildren.Thetargetwasselectedonthebasisof publisheddataandmarketresearch.Thispopulationwaseffectivelydisfranchisedfromtherighttoqualityhealth.
ArogyaParivarusesa uniquebusinessmodel,combiningtechniquesusedbypharmaceuticalandconsumergoodscompanies.Its fundamentalinnovationrestsonapplyingamarketingmixbasedonthe4As-awareness,acceptability,affordabilityandavailability-adaptedto low-incomemarkets.
ThecommunicationtoolsusedfortheArogyaParivararedetailedinTable1.Thecommunicationstrategyincluded:
- One-on-oneinteractionatthecommunitylevel(SHGs)- Brandedvanusingaudiovisualsonthevarioushealthissuesandtheneed
toseektreatment- BrandedT-shirts,caps,brandedbicycles,handbills,flip charts,patient
cards.
Impact
Thecurrentreachoftheprojecttothose50millionpeople,or250ruralcells,wherea cellisanareaof 25-30sq.km,including80-100villageseach,isindicativeofthemodel'ssuccesstodate.
Table1 CommunicationTools
Tools
Leaflets
Flipcharts
T-shirtsandcaps
Brandedvans
Brandedbicycles
Patientcards
Communication
Communicationabouttheailmentsandtheirsymptoms
Tocommunicatethemethodsofidentifyingsymptomsforailments,causesofailmentsandnecessarytreatmentprocedures
Toidentifythe"healtheducators"withtheArogyaProgramme
Usecommunicationtocreateahighdecibel
Usedby"healtheducators".Brandrecallfortheaudienceexposedtothehighdecibelbrandpromotion
Foridentifiedpatientstocarryasreferencetotheconcerneddoctor
Peopleacrossfivestateshaveaccessto qualityhealthcarewith thousandsofdoctorsand hundredsof pharmaciesbeingservicedby ArogyaParivar.One
hundredandthirty-eightdistrictsin UP,Maharastra,MP,BiharandRajasthanarecoveredunderthe initiative,and12,000patientshavebeentreatedsofar in
1,000villages.Currently,morethan20 healthprogrammesarerunning,cover-
ingtuberculosis,respiratoryinfections,skinandgynaecologicalinfections,dia-betes,micro-nutrientsduringpregnancyandduringchildhood,intestinalworms,
acidreflux,coughandcold,aswellasallergies.
ArogyaParivarhasbuilta healthynetworkofdoctors,paramedicsandpharma-cists,whosharea similarmissionandsupportthe initiative.It hasalsoestab-
lishedstrongallianceswith pharmacyandhospitalchainsthatserveas a goodcomplementto Novartis.
Thecompetitiveadvantageof ArogyaParivaris that it makeseveryactorwin.Patientsareeducatedandavoidhealthcomplications.Healthprofessionalssee
morepeoplethantheymightotherwise,andarealsotrained.Healtheducatorswhoworkforthecompanyarelocallybased,receiveextensivetraining,andgainadditionalstatuswithintheir communities.As for Novartis,theyare improving
healthcareandchangingthelivesof peoplein need.
A holisticmodel,ArogyaParivarhasensuredthatareasthatwerehithertorela-
tivelyuntouchedby traditionalmedicalrepresentativesare now on the road
map.Theinitiativehassucceededinbringingin additionalrevenue,thusaddingto thebottomlineof thecompany.
I FIG.1 I The Arogya Model
SocialImpact +
Philanthropy Social business
Bottom-lineGrowth
-I-
PR/Damagecontrol
II
II
J~
Performance-drivenCSR
---.----
Sinceits businessmodelis notbasedon puredonations,ArogyaParivarisaneconomicallysustainable"socialbusiness",scalableto morepeopleinIndiaandabroadthataimsto:.Provide health education (hygiene,nutrition, disease awareness)and
improvethequalityof lifefor localpopulations.Improvepublichealthwithouttheneedfor costlygovernmentinterventionorlimited-durationNGOprojects.Createa revenuestreamfor localpersonsassociatedwithArogyaParivar.Increasefootfallat localhealthprovidersandbusinesspartners(encouragingtheirsupportto ruralmarkets).GenerateincomeforNovartisandbuildbrandequitywithanupwardlymobilepopulation.HighlightedbyNovartisin internalandexternalcommunication(inthesamemanneras CSR).FulfilformerPresidentAbdulKalam'svisionof PURA,that is,providingurbanremediesto ruralIndia
Learning.Thepoorarewillingtopayforqualityandeffectivetreatment..Earlier,malepatientswerereluctantto consultANMs(females);however,theArogyaHEismaleandabletogainacceptance,convincepatientsandsupportthem..ChemistsbeganstockingNovartisproductsoncedoctorsbeganprescribingthem..Doctorsaremotivatedduetotheincreaseinincome,andarethereforewill-ingtoparticipateintheprogramme.
. Doctorsareprofessionallysatisfiedthatpatientsnowcompletetreatmentandgetcured.
The Way Forward
TheArogyaprogrammeiscognizantof theimportanceofworkingwithNGOs,especiallyinawarenessprogrammesviacomrnunity-Ievelmeetingsandhealthcamps.In2011,theArogyaprogrammeplannedto forma consortiumof atleast20NGOsinIndiatoprovidetargetedinterventioninthecausesofdiabetes,tuberculosis,diarrhoeaandalsofortheprovisionofcleanwater.
Planshavebeenmadeto replicateandadaptthemodelin othercountriesthroughoutAfricaandAsiaoverthenextfewyears.
Motherandchildnutrition,skinallergyanddiabetesarebeingaddedto thelist
of treatments.Novartisalsoplansto addalliedproductslikesanitarynapkins,waterpurificationproductsandcleandeliverykits to supplementthe incomeoftheHE.Theaccompanyingvideoexplainshowthisprojecthasbeeninitiatedand
implementedin UttarPradesh.
Discussion Questions
1. Whatproblemsof the ruralcommunitywereaddressedthroughthismodel?2. Ust thekeyreasonsfor thesustainabilityof thismodel.
3. Doyouthinkthismodelcanbereplicatedinothercountries?Ifyes,howandin whichcountries?