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Story Publication logo November 2, 2015

Technology Alone Is Not the Answer in Healthcare


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A weak public health system has given rise to market-based approaches in India. A new breed of young...


"A technology only solution isn't going to get us anywhere," says Shelly Saxena.

He's referring to the growing number of social enterprises and development initiatives that use mobile phones and telemedicine to deliver healthcare in India.

"Whether you're poor, middle class, or wealthy, you want to see a doctor, and you would prefer to see that doctor in person," he says.

That's why Saxena developed Sevamob, a hybrid solution to solve India's healthcare woes– a mobile clinic that arrives on wheels, stays camped out for the duration of the checkups, provides the patient with test results and even basic treatments, and then leaves.

Saxena who worked at IBM and is well-versed in technology became passionate about healthcare when his mother who lives in Lucknow, India was misdiagnosed and her treatment, subsequently, was delayed. The fact that she couldn't get timely, and accurate care, frustrated him.

Saxena, who has been living in the US since 1998, had been traveling back and forth between India and Atlanta. He was quite familiar with the challenges in getting decent healthcare outside of India's major cities: lack of doctor and tech-savvy clinics who valued data, and inadequate medical equipment. But how to solve this? Telemedicine alone, SMS campaigns and mobile health wasn't going to cut it.

Saxena says he could have just set up a tech-based health enterprise. "But who would I sell the technology to?"

Instead, he realized he had to be the service-provider. In 2012, Sevamob started its mobile van services. Rather than purchasing the vans and decking them out, he rented the vehicles by a local agency or even Uber, and then filled them with diagnostic equipment. But sending them to individual residences became costly.

"People are willing to pay 60 to 100 Rs. for a consultation. But is that cost-effective?" he asks.

Turns out, it isn't. That's largely why it's so hard for any development agency, NGO, or social enterprise to deliver healthcare to communities outside urban areas. The transaction costs are too high, Saxena says.

Sevamob pivoted from offering consultations to individuals to groups. Now, they sell their services to private corporations, social enterprises, and development agencies — anyone who can band together a group of about 60 people or more and pay a service fee.

The services they offer are exhaustive: dental care and treatment, eye exams, and an endless list of tests — dengue, malaria, hemoglobin, diabetes, urine analysis, and more. The vans come with doctors, accredited professionals to carry out tests, and aides.

Currently, the service is available in 7 states in India and recently, Sevamob expanded to South Africa and Lesotho. Saxena says that as the company grows it's keen to work with local partners to help keep its costs low. For instance, in Africa, they're doing a 50-50 joint venture with their local purveyor, meaning Saxena doesn't have to invest in costly local infrastructure.

It's part of Saxena's broader vision to keep the company growing while keeping his costs low. So far, Sevamob has raised $650,000 of capital through two rounds of funding — a small sum. That's significantly lower than other health and tech startups in India who are getting $1 million or more under their belt to begin with.

Saxena isn't tempted though.

"There's a bubble right now in India," he says. "One that will likely bust in the near future and the valuations of these companies are too high."

Instead of being stressed by a high valuation, Saxena says he wants to take in the capital piecemeal. "Take it when you need it is my approach."

Plus, he's been able to take a few shortcuts. For instance, he himself contributed to the technology needed for Sevamob. And as he grows the enterprise, he's looking to test markets before setting up offices and infrastructure in the various many locales.

Currently, Sevamob has 15 units in the works. Most are profitable, he says.

Ironically, the hardest area for him has been Uttar Pradesh, his hometown, where it's been difficult to find clients who are willing to pay a fee for the health camp. But Uttar Pradesh has been tough state even for large international agencies like the UN to deploy health campaigns. Low incomes, a history of poor health and sanitation, and a densely packed population have led to sluggish development.

Saxena is not deterred though. He says he will continue to work in the area and has had luck recently with pilot camps in two new cities in the state.

Two years ago, Sevamob also introduced a marketplace for healthcare — an online portal where patients can shop for doctors and specialists. That's where Saxena plans on dabbling more heavily in telemedicine. It's another layer to the Sevamob model, he says. If a specialist is far away from a patient who needs further consultation, he can log into the site, pick a doctor, and pay the fee for an online "visit."

For patients who don't have access to the Internet, Sevamob comes with a 24/7 hotline, a call center where staff can direct patients to a pharmacy, doctor, or specialist.

Ultimately, though Saxena argues that healthcare in India cannot be digitized completely. Reaching its massive population isn't an easy task. Yet, "we can't just assume that by sending an SMS, the person will read it, follow through, and actually take care of their health."

The answer is much more complex: it's layers of services that complement one another and a business model that caters to crowds, not individuals, he says.



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