For years, Jagdeep Gambhir’s neighbours wondered why an alumnus of one of India’s leading business schools (ISB) and former Goldman Sachs analyst left a respectable job in New Delhi to return to Udaipur and tinker in a tiny office with a few people.
For the co-founder and CEO of Karma Primary Healthcare Services Private Ltd, the neighbours’ scepticism encapsulates the experience of starting up in a smaller city, away from the hype and noise, but focussed on the challenge.
Gambhir’s startup sets up clinics across villages in North India, where a doctor shortage and consultations from fake doctors are all too common. Karma sets up a physical clinic where a nurse facilitates a video call with doctors all over the country. It currently has 25 clinics spread across Rajasthan, Haryana and Madhya Pradesh, and serves 100-150 patients a day.
And for his model, his hometown of Udaipur seems an apt base, if a challenging one. “Our cost base is lower in a small city; rent and talent is cheaper. For example, even during the pandemic, we weren’t forced to shut down our physical office, like firms in big cities. Having a low cost base is crucial. For our model, the revenue is there, the scale is what we have to find,” Gambhir says.
Today, 34-year-old Gambhir seems more settled and in sync with his company and its 80-odd employees, but starting up in Udaipur was not easy.
Technology talent to build software capability was not available, and an ecosystem- to raise money, hire people and network is absent.
“People don’t understand the startup culture so well here. In the early days, at 6pm, someone would say, ‘Okay let’s pick this up tomorrow’. And I would say, ‘No, let's finish it today!’ And with that passion and interest, people would wonder if I’m on steroids,” Gambhir recalls.
Even today, more so after the coronavirus pandemic hit, Karma’s employees are outside Udaipur. While outreach workers are in the villages they need to target, he found tech talent in Delhi, and doctors all over, from Hisar (Haryana) to Bengaluru.
“Access to talent does become a problem, so you have to look a little outside. But being in a small city gives us a lower cost base and lower rentals, which is crucial,” he said.
Speaking to Gambhir, the focus on impact comes through. Words like impact, mission-driven and community pepper the conversation. In villages, income levels are low, so the average patient is rarely forking out more than a hundred rupees. But Karma is funded by impact investing firm Ankur Capital and angel fund 1Crowd — return-seeking investors.
Gambhir says the revenue is there, not only from core consultations, but from selling medicines — either each Karma clinic has its own pharmacy or it ties up with a nearby one — and by selling related services. For example, Karma now offers eye and ear care too, in addition to health insurance, for which it has tied up with Aditya Birla.
Balancing business and growth along with the impact and mission of primary care — the company’s ‘karma’, if you will — is a challenge. The six-year-old startup had a revenue of Rs 2.9 crore for FY20, and Gambhir says this gives Karma some legitimacy and scale, ahead of another fundraise it is eyeing in the next six months.
Eyeing steady growth
“We are not going to burst out with rapid growth, but I think steady growth is good enough to give our investors at least a 3-4x exit. I believe that if you solve a real problem for the customer, there is money to be made. So we have a clear business,” he says.
Gambhir compares Karma to Rahul Dravid, renowned Indian cricketer and a beacon of stability, rather than Virender Sehwag, a swashbuckling, fast-scoring but often unreliable batsman,
Like many startups, the pandemic also made Karma grow up overnight and evolve every aspect of its business. While earlier a nurse would assist the patient to do a video call on a large screen TV in the clinic, this has given way to a fully contactless updated tele-consultation software, which Karma built a few days into the lockdown. The service, combined with its COVID-19 response, has catered to over one lakh people.
Gambhir also got a vote of confidence from late President Pranab Mukherjee, in what he says is one of Karma’s biggest moments so far. When the President was looking for ways to improve rural India via his foundation, healthcare was touted as a key issue, and Karma was touted as a solution. The President’s office got in touch with Gambhir and told Karma to open more centres in Haryana with the President’s support. Karma is currently listed as an official partner of the Pranab Mukherjee Foundation.
“In Udaipur, there isn’t even a startup ecosystem. That lack of an ecosystem makes it tough at times. But validation from the President gave us a lot of credibility. Our mission is clear. It is hard, but that’s why I like it,” Gambhir says.Follow the entire Small-Town Startups series here.