Health Care Education In India – A Sustainable Business Model

In this blog, we would like to focus on two specific goals from the existing larger framework of the U.N. Sustainability Goals, and examine them with respect the healthcare education industry in India.

 

Reduce the global maternal mortality ratio.

End preventable deaths of newborns and children under 5 years of age.

 

 

Ensure equal access for all women and men to affordable and quality technical, vocational and tertiary education, including university

Substantially increase the number of youth and adults who have relevant skills.

 

 

The problem

The current Indian healthcare education industry has been struggling to address the above sustainability goals and a large amount of investments in both the public sector and the private sectors is needed to improve conditions.

In the public healthcare sector, there is a chronic shortage of skilled frontline health workers who form the backbone of public health systems in middle and low-income countries. India’s healthcare system has consistently underperformed relative to other developing countries based on fundamental Human Health indices.

The inequitable distribution of resources among various states and urban-rural settings severely restricts access to health care for low-income patients. Issues such as non-availability of trainers, contractual nature of jobs, workforce management issues and rural postings have prevented the government from building a robust training infrastructure and ensuring qualification of workers. Currently, healthcare workers such as doctors, nurses, paramedics are dependent on physical in-person training, which are costly and difficult to scale. Consequently, this has adverse effects on the availability of healthcare and the quality of services available to the public as seen below. All these factors have a direct impact on worsening the health indicators such as infant mortality rate, mother mortality rate etc.

 

Many organizations are trying to address the issue through their own means, but no solution has proven to be consistent or sustainable so far. NGOs have launched projects, including mNewbornCare and mSakhi, to address this critical gap. These mobile-phone based multimedia applications target frontline workers of accredited social health activists (ASHAs). However, the depth of educational content is severely limited by budgetary concerns. Worse still, NGO-sponsored projects often do not have the “stickiness” factor to extend the length of their lifetime usefulness; once the funding ends, so do the short- to long-term projects.

Private healthcare education sector solutions from firms including Elsevier and Pearson have innovated through the inclusion of digital educational modules in their health education courses targeted for undergraduate and graduate programs. Their solutions do not cater to the developing countries in pricing or delivery methods. As a result, they largely ignore the “bottom-of-the-pyramid” customers: the undertrained nurses and community health workers at the underfunded and understaffed hospitals.

Business Model Innovation

The Idea: The critical issues faced by the healthcare education industry can be resolved by utilizing web and mobile-based platforms with health education content that is specifically designed to train healthcare workers such as nurses, paramedics, and community health workers. By leveraging low-cost, scalable tech solutions, complex medical topics can be taught to bottom-of-the-pyramid health employees using pictorial videos in regional languages. The medical content must be developed and curated by a team of medical experts supported by illustrators who make the concepts graphic and easy to understand, even for those with low literacy levels.

The key features of such a solution will include:

• High quality and standardized content catering to the education standards of the health workers
• Certification provided to validate their knowledge and to provide with opportunities in the job market
• Regionalized language content catering to the different states
• An adaptive style of assessment to measure the skill level improvements to further learn from the patterns
• Offline mode/low bandwidth telecom networks used to provide/refresh training content
• Ability to monitor training of health professionals by superiors from a central location
• Mobile games that reinforce educational content in an engaging manner

The Business Model: Though the idea seems sound, choosing the right partners and business model is key to the success of the innovation. In order to disseminate this technology, we will partner with the government institutions and large public hospitals. The content should be developed with these organizations to safeguard against any risk of non-compliance. The developed courses could then be piloted in the same institution with a subsidized monetization scheme. Once we develop the basic courses, we move on to distribution and sales mode, where we can sell to hospitals – public and private. Based on the nature of the courses and customizations required to the course, we can differentially charge the institutions on a case by case basis. Even in the premium tier of pricing, we believe that the price of the trainings would be much lower than that of an in-person training, and the learning itself would be more effective.

 

Sustainability goals

By focusing on healthcare in a developing country, if calculated on a per-dollar-invested basis, we can maximize our impact on achieving the sustainability goals proposed. The improved education of nurses and community health workers—many of whom are midwives—directly “reduces the global maternal mortality ratio” and “works toward ending preventable deaths of newborns and children under 5 years of age.”

Additionally, by targeting a profession heavily dominated by women, we are actively “working to ensure equal access for all women and men to affordable and quality technical, vocational and tertiary education, including university.”

Last but not least, a business model delivering localized medical training, if executed effectively, will “substantially increase the number of youth and adults who have relevant skills.” The following is an example of a logic model that elucidates how this innovation can prove its contribution to the U.N. Sustainability Goals described above.

 

How does financial growth and social/environmental impact form a feedback loop (i.e. the faster the growth, the larger the impact and vice-versa)?

 

From a business economics perspective, the more we expand, the more economies of scale we can leverage. Also, because this is a low tech and low cost model, the business will benefit with growth in volume, which will provide working capital to invest in newer courses. This will further improve the quality of education (and service) in healthcare education.

It is clear that the more healthcare professionals we reach, the more will be the benefits to society. The social impact and social sustainability goals form a positive feedback loop with financial growth within this business model.

The following social impacts directly accompany financial growth:

• Nurses and community health workers (end users) benefit from improved access to timely medical professional education and hence better job opportunities
• Mothers, infants, and patients (benefactors) enjoy a higher quality of life.

Why this innovation could be game changing (demand and/or supply point of view)?

This business model innovation links existing technology, existing content and domain knowledge, with a bottom-of-the-pyramid customer base. By only focusing on the most relevant yet still cutting-edge and up-to-date medical education content and delivering it via a low-cost technology, this innovative business model is capable of realizing profitable unit economics for such a target customer group.

In the public sector, especially, given the budgets that government hospitals have to run with, a reduction in training costs will go a long way and free up capital for investment in other priorities. The improved quality of education will also significantly improve the institution’s ability to serve more people in an effective manner, reducing the burden on the limited abilities of human resources.

What are potential costs and risks of this innovation?

The costs of creating such a business model is a potential long ramp-up period during the initial content creation process. Credible and useful educational content must be developed to attract the first customer trials. This process is unavoidable and may be costly, but can be optimized by leveraging potential customers as content development partners. Fruitful business development and content development partners can produce the necessary first iteration of a “sellable” product.

Additionally, even if there is an intellectual property protection through filing for patents, the actual regulation of the same can prove to be very challenging in India. Thus, if  a bigger player enters with a lot of working capital, the barriers to entry are relatively low. By pursuing a focused strategy of curating a low-cost product for a largely ignored market, however, it is possible to gain a first-mover advantage in developing countries against the conventional competitors who command a much higher profit margin.

 Is anyone in the world implementing this?

Bodhi Health Education was founded in 2014 to provides high-quality education to a health care professional in India. Its long-term target is to increase the quality of health care services, in rural areas and hospitals all over India.  Bodhi’s mission is to address the acute shortage of quality healthcare in India and beyond using innovative low-cost technology solutions.

Based on interviews with the founder, Bodhi firmly believes that critical health indicators in developing countries such as maternal and infant mortality rates can be improved significantly with better skills and knowledge among health professionals. The immediate output of Bodhi’s activities is an increase skill levels for healthcare workers that eventually translate into lower infection rates, more reliable hospital referrals and faster diagnosis of treatable diseases that require medical specialists.

Thank you for reading!

– Soumya Raja, Edgar Xie, Benedict Koehncke, Abhinav Sharma