Note to readers: What are the next Zomatos and Flipkarts of India? What if they are growing in the hinterland, out of earshot and away from eyeballs? India does have such startups but they struggle for attention or are not thrilled with the limelight. Small-Town Startups is a series of articles that shines a light on enterprises focussed on customers based in India’s tier-2 cities, townships and other non-metro centres.
When India reported its first cases of the coronavirus, the biggest worry was thousands of villages and towns that are home to the majority of its 1.3 billion people but have little or no medical support.
The viral outbreak that has overrun even the best healthcare systems in the world has, so far, been kinder to India’s rural areas but the fact remains that healthcare in these parts is woefully inadequate. Quacks fill in for doctors and their concoctions are the best medicines people can hope for.
Patna-based health-tech startup Medishala Healthcare Pvt Ltd wants to change that, replacing the quacks with doctors, with some help from technology.
"Back in college, we would get calls from our parents to book doctor appointments. There were times when we had to skip classes, spend time travelling to the doctor's clinic just to get an appointment," Medishala director and co-founder Rituraj Swamy told Moneycontrol over the phone from Patna.
Launched in February 2019 by Swamy and friends Suman Sourav, Prince Kumar and Mohammad Amanullah, all alumni of Birla Institute of Technology, Mesra, Medishala connects patients in Bihar’s remote areas to doctors based in the state capital Patna.
It has tied up with local pharmacists in several villages. People can come to the nearest medical store to get a doctor’s appointment on Medishala's app, which is operated by the chemist.
While companies like Practo and JustDial were gaining traction in cities in other parts of the country, they were not very active in the eastern region and rural areas were just out of question.
Heavily funded ventures such as 1MG and Practo have managed to address the issues of doctor appointments and teleconsultation in the cities, they haven't been able to make inroads in rural parts. This is the population that still lacks high-speed internet and regular electricity supply.
"We thought about the time, resources and money a villager would spend on making an appointment in case of a disease and thought the gap needed to be filled," the24-year-old Swamy said.
The four started working on the idea while in college. It didn’t take them long to launch Medishala, as they had the resources and the technical know-how.
Except Amanullah, who is from the information technology stream, the other three trained as civil engineers.
Launching the company was the easy part, convincing the doctors wasn’t. They were not keen on switching to technology. Their experience with the startups had not been great and for them, teleconsulting was an extra piece of work.
"We had a tough time convincing them that given our local background, we were better equipped to understand the requirements of localities and could help them manage their time more efficiently instead of overlaps between offline and online patients," said Swamy who like other three co-founders hails from Patna.
The company's USP was that unlike most apps, it didn’t need patients to own or use a smartphone. All a patient had to do was to walk to the local chemist to book an appointment.
"It's true that today even people in villages have smartphones but while they are comfortable using Facebook and YouTube, there still is a trust deficit when it comes to using a doctor appointment app," he said.
They might be wary of technology but they trust pharmacists, which is true for all villages and small towns. In the absence of a doctor, it is the local chemist that people visit in times of illness.
"They trust their local pharmacists and can rely on them to give them proper guidance. And that is what we are betting on. It is an online to offline strategy," Swamy said.
Depending on the seriousness of the situation, the doctor can call a patient for a diagnosis to the city or prescribes medicines during a virtual consultation if the illness is not serious. The consultation fee varies from Rs 99 to Rs 500, depending on the doctor.
The company has a bank around 315 doctors, including general physicians, dentists, oncologists, neurologists and surgeons, on board.
"Rural India doesn't have enough senior doctors or specialists. For every complaint, they end up visiting a general physician. They only travel to the big city when the situation worsens. We are trying to address this pain point," Swamy said.
According to the 2018-19 Economic Survey, 60 percent of primary health centres, the basic unit of the public health system in India, have only one doctor. The situation is grave in states like Bihar, UP and Rajasthan with the number further falling to 70 percent.
India's spending on healthcare is among the lowest in the world. At a time when the US spends 16.9 percent and Japan around 10.9 percent, India just spends 3.6 percent of the GDP. According to a 2019 study, India has a shortage of over 600,000 doctors and 2 million nurses.
The vital cog
Pharmacists help patients make the right appointments and it is the doctor who decides if a visit to the city is called for. It not only saves time and money but also ensures timely treatment of an illness that can worsen.
The company has tied up with 40 pharmacists in districts such as Punpun, Samastipur, and Bhatiyarpur. They are paid Rs 10 per appointment.
It earns money from doctors by offering them a platform to publish their articles and blogs for an annual fee ranging from Rs 6,000 to Rs 12,000.
The company, which has Trivago-fame Abhinav Kumar an adviser, is looking to raise Rs 2-3 crore from early-stage investors and plans to use the money for developing an artificial intelligence-powered voice assistant for doctors to help them write a prescription and manage medical records electronically, which will save them a lot of time. Funds will also be used for marketing and expanding the app.Follow the entire Small-Town Startups series here.