In part 3 of this series we explored the burden of healthcare expenses and health financing models. In this part 4 of our series on India healthcare impact investing, we explore the current status and the novel business solutions within the field of maternal and neonatal care.
Much work to be done for mothers and infants in India
While most hospital visits and procedures are feared and avoided at all costs, childbirth has the unique potential of being an anticipated and joyous event in one’s life. For many low-income Indians, however, this positive potential is negated by uncertainty and inadequate health resources. The 2013 State of World’s Mothers report found that India has the highest incidence of maternal deaths and 29% of global newborn deaths. The report showed that 56,000 Indian mothers die annually while over 300,000 babies passing within the first day of life in India each year.
For better or for worse, many of these newborn deaths are caused by preventable factors, such as inadequate hygiene and high infection rates. Up to 40% of maternal deaths are directly or indirectly attributed to detectable and preventable cases of anemia. While these statistics have inspired many government initiatives and entrepreneurs, like Biosense, to heed the call, much work remains left to be done.
Leveraging the $2 billion birth care market to provide for low-income families
Unsurprisingly, these issues disproportionally affect low-income families. “If all newborns in India experienced the same survival rates as newborns from the richest Indian families, nearly 360,000 more babies would survive each year,” said the 2013 report. Indeed, large investments have been infused into the serving the health needs of urban mothers. The $2 billion birth care market India is being recognized by investors like Sequoia and Matrix partners, who recently funded the Cloudnine birthing boutique with Rs 100 crore ($16 million).
Because childbirth is a (medical) event among both high and low-income families, there is an interesting potential for cross-subsidization in order to reach various socio-economic strata of mothers. For example, Fernandez Hospitals, which is widely perceived as an excellent and expensive hospital, have incorporated a flexible model that allows them to provide treatment to economically weaker patients (currently make up around 10% of their patients). Fernandez Hospitals offers various tiers of services to families according to their ability to pay.
Enterprise solutions reaching BoP mothers
While these are cost-effective solutions for middle-income women, product-based efforts may be more viable for BoP mothers. Despite government initiatives to increase deliveries in professional centers, it has been suggested that the cost of transportation may be a significant deterrent for mothers to take advantage of these schemes. According to Unicef, only 53% of Indian mothers have their deliveries assisted by a skilled birth attendant. Companies like Ayzh, produce a $2 home birth kit that include sterile tools to prevent infection at the time of birth and reduce maternal and infant mortality. They operate using a B2B business model that sells primarily to medical institutions and non-profit organizations.
Bringing rural mothers to urban areas for antenatal and delivery services is complicated, but it may be the case that by providing rural options and bringing skilled health workers to women at low-costs, it is possible to move away from unsupervised home births to safer options. The acclaimed social enterprise, Drishtee, uses a franchise model to increase outreach. The company identifies and trains rural women franchisees to function as rural maternal health ambassadors including: leading community meetings, registering and maintaining records of pregnant women in the region, educating women about pregnancy and the options available to them, holding weekly clinics, tracking drop-out cases, visiting women prior to due date to lock-in delivery plans, and returning for post natal check-up. Drishtee finances the initial set-up costs of a Drishtee Health Kiosk (DHK), which is repaid in installments over time. Each kiosk is linked to a qualified Auxiliary Nurse Midwife (ANM) that is available through scheduled appointments and a gynecologist holds a maternal health camp once a month at each kiosk. Each DHK contains a digital thermometer, blood pressure monitor, digital blood glucose monitor, weighing scales, pregnancy test strips, etc. The women are charged a small fee for registration for these services and the revenue is shared between the DHK, ANM, and gynecologist. This motivates the enrollment of high numbers of women into the program, increasing impact.
Private mHealth companies, such as Dimagi, have been able to supplement government initiatives regarding maternal health. For example, the National Rural Health Mission in India has incorporated their mobile apps to standardize care administered by Accredited Social Health Activists (ASHAs). The platform is video-based to address literacy issues among the ASHAs as well as the users.
With private mHealth companies like Dimagi developing video based technology used for health education it is possible to standardize quality of care provided by rural staff. Additionally, medical devices are getting cheaper and more efficient everyday. Signostics is a handheld, portable ultrasound machine that is available at a fraction of the cost of these machines in hospital. These advances incorporated into a model like Drishtee’s Health Kiosk may allow for significant rural penetrance and facilitate the growth of mobile health clinics that can cater to rural India.
Clearly, there exist many dedicated entrepreneurs who hope to bring health and happiness to BoP mothers and their families. Unitus Ventures is calling to healthcare startups that hope to impact and scale within the field of maternal and infant medicine.