It's Not Business As Usual - Unitus Seed Fund by Rajiv K

IT’S NOT BUSINESS AS USUAL

STARTUPS IN HEALTHCARE, EDUCATION AND LIVELIHOODS

TABLE OF CONTENTS I. For Profit, For Good II. Education i. Early Education to Get a Head Start ii. Integrating From Within the Education System: Science iii. Aggregating After School Tuition Services iv. Noticing Discrepancies in Higher Education

III. Livelihood Enhancement i. The World of Cooperatives ii. Transforming to Evolved Craft iii. Using Technology to Aggregate and Connect iv. Making Transportation Easy v. The Social Need for Logistics vi. Empowering With Technology and Financial Services

IV. Healthcare i. From Doctor to Entrepreneur ii. Giving Customers a Reason to Pay iii. Affordable Medical Devices and Tele-Medicine iv. Reaching the Eyes of the Masses v. Creating Accessibility Through Design and Innovation

V.Cracking the Low-Income Market ÂŠ 2015 Capria Ventures LLC

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For Profit, For Good It's simple: customers will spend money on things that add value to their lives. At the base of the pyramid, where wallets are limited and there is no money to waste, it can be difficult to figure out what exactly it is that adds value. According to international consulting firm McKinsey, 1 billion Indians live in households that make less than 17,000 INR ($275) a month. With the increasing formalization and overall GDP growth of India's economy, tapping into the buying power of the economically disadvantaged is more important than ever. For businesses that want to work with customers at the base of the pyramid, this creates an interesting conundrum. If the assumption is that most of these buyers are uninformed and underserved, do entrepreneurs have a responsibility to sell products and services that will improve lives? Those that have answered this question affirmatively have helped create a new breed of businesses: impact businesses. In this book, I've decided to explore three types of impact businesses that Unitus Seed Fund has worked with over the past few years. The first group enhances the current state of education in India either by working with or outside of the academic system. The second involves livelihood enhancement and allows economically disadvantaged individuals to apply their skills in a relevant context. The third provides access to low-cost, quality healthcare services and products. In order to establish their presence across India's vast, diverse and largely unorganized landscape, these businesses have had to combine affordability with quality, provide access to customers that live their lives in a diverse number of ways and scale rapidly without using much money.

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Although many of these businesses are young and work with customers outside of the socio-economic strata of most readers, we are confident that their efforts will be immensely significant in a few years. The insights in this book are supported by hours of interviews, research and feedback collected from India's growing community of impact entrepreneurs, investors and thought leaders. Whether they are attracted by the immense market potential at the base of the pyramid or motivated by a desire to serve those with very little by building affordable and scalable products and services, we've seen that impact entrepreneurs face a series of challenges that are unique to the customer base that they work with. The mission of this book is to shed light on a complicated ecosystem and help in the creation of a framework that will empower the poorest individuals in the world. Meghna Rao

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EDUCATION “Education is the most powerful weapon that you can use to change the world.” --Nelson Mandela The sheer scale and potential of the Indian education system raises several questions for the impact entrepreneur that wants to start an educational business: Why is the current method of education broken? How can an entrepreneur work within and around the system in order to improve the state of education in India? In recent years, the Indian government has passed two important programs: the Sarva Shiksha Abhiyan or “Education for All” movement and the Right to Education act. Both of these programs attempt to establish free education for children between the ages of 6 and 14. Unfortunately, the reach and results of these programs have been disappointing. Despite the fact that government schools remain the single largest provider of education in the country, most are run-down, lack relevant curriculums and have poor teacher attendance. An alarming number of parents – over 50% in some states – have turned to private schools as an answer and, despite attempts to lower costs, national ASER (Annual Status of Education Report) studies have shown that the rate of reading proficiency in rural areas continues to decrease. According to Surga Thilakan, CEO of iSTAR, the only way to solve a problem as large as India's broken education system is to begin at its roots. iSTAR is a low-cost skilling service that works directly with colleges in order to provide business and commerce students with viable job outcomes after graduation. “I was working with a 2

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microfinancing organization for a bit and providing loans to economically disadvantaged individuals,” she reminisces. “This was too far along in the cycle. Not everyone wanted to be an entrepreneur. We need to attack the issues that are happening much earlier in the process with our education system.”

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Early Education to Get a Head Start Hippocampus Learning Centers Founder: Umesh Malhotra Headquarters: Bangalore The concept of pre-kindergarten schooling is foreign for most children in India. “The real issue here is that the void begins even before elementary education,” explains Hippocampus Learning Centre CEO Umesh Malhotra. “There are no resources to ease children into India's school system. Especially in rural areas, parents can't read and their environment is stifling.” For Umesh, this realization came to him as a result of a conversation with his precocious four-year-old son. The year was 1996 and Umesh was set to leave a glamorous job amidst San Francisco's bustling start up scene in order to return to India. With his entrepreneurial experience, India's rapidly growing economy was a hotbed of opportunities. The situation did not fare as well for his son, however. He would be forced to part with a local library overlooking a lake and, unlike San Francisco's free public library system, India did not have many resources for younger children. For Umesh's son and others like him, the library represented a world of learning and self-education. He refused to leave the country. “My son's stubbornness really opened my eyes to how lucky he had been growing up. In order to convince him to come with us, my wife promised immediately that we would open a similar library in India.

Hippocampus students with founder Umesh Malhotra 5

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Within the next few years, Umesh and his wife had established a chain of non-profit rural libraries. The libraries used a color-coded system in order to establish different levels of reading comprehension and were stocked with hundreds of volumes, including some of the couples’ favourite books. This was an entirely new concept in India. One day, while conducting one of his regular visits to a rural village, Umesh was shunted out of his comfort zone with another conversation. “I was sitting and having a coffee with a woman named Sharanamma in one of the villages that we were working with. She said to me, ‘Libraries are great, but in more developed villages they have this schooling system that includes very young children. Why can’t we have a similar kindergarten and nursery school system in ours?’ She went on to talk about the problems her children faced in the local schooling system. They weren’t learning English, could barely do basic math, the private schools were expensive and inefficient. It was shocking to me because this was 2009, and we were in a very conservative village. I mean, we were chatting over tea and I was complimenting this lovely goat that she had tied up, and all of a sudden she was shaking me out of my comfortable life and demanding more. I had to listen.” And listen he did. “We decided to establish pre-kindergarten and kindergarten schools across rural India. I want these children to have the same excellent education that my son did. And to be able to ask the same important questions.” “The most important thing that I wanted to prove was that you don't need to spend a lot of money to provide quality education,” explains Umesh Malhotra. “That was my biggest problem with the government's approach to the system. They would blame their shortcomings on a lack of resources. That should never be the case.”

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Working In Rural Areas Rural markets are notoriously conservative. Despite the bad reputations of government schools, they continue to dictate the culture and attitude towards education across rural India. The most important challenge that Umesh faced was finding a way for Hippocampus Learning Centres to integrate within the existing framework of a rural village. “It's a well-known fact that trust dictates the customer flow in rural areas,” he explains. “We had to penetrate the community in order to establish that.” After entering a village, the Hippocampus team interviews local young women to hire as teachers. After several rounds of interviews, only 15% of job applicants are chosen to work at the schools. Each teacher is then connected with an individual from the management team. “This helps establish a system of credentials and increases the sense of intimacy we have in our team,” Umesh Malhotra explains. “When I’d walk into a center, people would see me and say ‘hey, you’re the one who interviewed me, right?” A Curriculum-Led Environment Since most of Hippocampus' centres are not easily accessible from the Bangalore based entrepreneurs' residence, Umesh has had to establish certain tangibles that allow him to remotely manage the work culture of the centres. “If there is a student that is consistently getting bad grades, we don't blame anyone. We look at the curriculum and ask what our mistakes are. Where are we missing the connection? How can we reach this student better?” While the curriculum-led education minimizes the need for teacher supervision, they are still asked for monthly and annual feedback. Teachers are also left with the responsibility of enhancing parts of the curriculum with their own understanding of the environment that they work in. When asked to explain to students the meaning of the word “large”, for example, teachers are directed to find the largest building in the village. “The Empire 2

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State Building isn't relatable,” explains Nirmala Thyagarajan, Director of Programs at Hippocampus Learning Centres. “On the other hand, the community center or the temple is.” The curriculum also works across local languages. “We currently work in areas where Kannada is the predominant language. Sometimes, when people meet, they ask if you've eaten instead of asking “how are you?” We ask our teachers to be sensitive to nuances like that.” Beyond academia, there are several factors that allow Hippocampus centres to be a hub of progressive and intuitive learning. Each centre is decorated with bright colours and is designed to stand out. While corporal punishment is still common in India, Umesh explains that it is strictly prohibited in his centres. “There was an incident where a child was hit by a teacher,” he reminisces. “The parents called our helpline and complained. Within 3 hours, our team was there and the teacher was fired on the spot. We had to close our center for a few weeks, but it was worth it.” The Next Step While Hippocampus' low-cost setup costs and teacher acquisition model are strong enough to scale quickly, Nirmala explains that the most important factor is aligning with local norms. “India is extremely diverse. There are a million different factors that change in rural areas. If you want to successfully scale across all of them, your curriculum needs to be sensitive enough to emanate from each rural area. North India is completely different from Karnataka. Some places are closer to cities than others.” Because of this, the Hippocampus team believes that its approach to human led learning is something that won't become outdated. “It's hard to even establish a basic understanding of what a rural area needs. You need to hire intelligent teachers that can deliver that.” 8

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For many parents, the low standards of a government education seem even worse when juxtaposed with an early education at a Hippocampus center. In order to maintain continuity between the two, Nirmala explains that it is important to understand the next steps that a child will take after finishing a kindergarten education. “The key word is enhance, not replace,” she explains. “We can teach our students cursive at 4 but if that's not what they're learning in a local school, it will be unnecessary. It's important to look at current curriculums and expose the best angles of what they have to offer.”

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Integrating from Within the Education System: Science Curiositi Founders: Manoj Thandassery, Vinod Abraham Headquarters: Bangalore Other entrepreneurs feel that problems are best solved within the existing framework of the Indian schooling system. “People have spent years establishing schools across India,” explains Curiositi CEO Vinod Abraham. “There's no need to reinvent the wheel.” For Vinod and his co-founder Manoj Thandassery, one of the biggest problems within the current framework of schools was the academic approach to science. Despite the fact that many Indian students graduate with degrees in science and engineering, the country continues to meet criticism on the lack of support it shows for innovative thinking. Support for science research in India continues to take up less than 1% of the national GDP. After years of rote learning, memorization and antiquated methods of teaching, most students who choose to pursue a career in science are taught to reverse engineer instead of developing new products. In order to invigorate young students with a passion for science, the two co-founders decided to create kits that would work alongside school curriculums. Once a month, the team at Curiositi sifts through textbooks and academic syllabuses to find relevant material that will inform their kits. The lack of innovation in classrooms, they explain, often leads to an impractical understanding of science. “Science comes from the world around us,” explains Vinod. “We like the structure of classrooms but wanted to remind the world where the origins of science were from.”

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Students using a Curiositi kit

For Pavan Shinde, one of four co-founders of LabInApp, the wonder and curiosity of science fit perfectly with the world of 3D technology. “When a teacher explains a concept like throwing a ball on the moon, it's boring to sit down and work it out on paper,” explains Pavan. “The wonder and curiosity behind science just disappear.” Unlike Curiositi, LabInApp chooses to work with older students who study advanced scientific theories. The cost of laboratories that will allow students to enact these theories in the physical world is often too expensive for schools. Most science laboratories also require staff that understand a diverse set of safety regulations while handling physical materials. Instead, Pavan and his co-founders developed LabInApp. LabInApp enhances science curriculums with access to a 3D virtual laboratory. “We've put it in a gaming format so that students can get the most learning out of our application.” Developing a Product that Works With Diverse Curriculums Several iterations went into the development of Curiositi's kits. Despite the team's research, their first few kits were riddled with issues. “Many of our first kits were too complex to work alongside a curriculum,” Vinod explains. “We had an idea in our head that didn't translate into reality the way we thought it would. That's when we realised that our ultimate will always be the pursuit of the most intuitive kit possible.” In order to reach this point, students, teachers and principals were asked to fill out feedback 2

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forms that rated the kits on scales like difficulty, compatibility and engagement. The kits are in constant improvement and 50% are adjusted each semester. These changes are sometimes as simple as replacing one colour with another and, at other times, as complex as entirely restructuring the way in which the kit interacts with the curriculum. “We once had someone tell us that a certain part of our kit took too long to cut out,” Vinod reminisces. “We don't want that. We need our kits to fit in to a school schedule. We changed that to something that could be punched out instead.” Whenever there is a mishap, the Curiositi team offers immediate support. “We had an incident out in a school that was 50 kilometres away from our office. A piece was missing and it was hindering the class progress. We treated it like a fire and sent one of our employees out there on his bike.”

STARTUPS IN HEALTHCARE, EDUCATION AND LIVELIHOOD STARTUPS IN HEALTHCARE, EDUCATION AND LIVELIHOODS

LabInApp Founders: Pavan Shinde, Girish Shirigannavar, Pramod Ramdurg, Vinayak Hulabutti Headquarters: Hubli Pavan Shinde explains that the LabInApp team sees themselves as a resource that has an organic place in any science classroom. “We get our curriculums from the Internet and go with the assumption that there are certain experiments that are carried in science classes all over India. Whenever a teacher wants to show a specific experiment, she looks into our program and finds it. We're not doing anything other than letting her students visualise science differently.” By finding the common link between a diverse range of science classes, the LabInApp team is instead able to focus on their technology. “We don't need to go through a bunch of iterations,” explains Pawan, “For us, the most important thing is establishing powerful technology.” Convincing a Community of Stakeholders It can be difficult to justify the addition of the cost of a kit because of the community of stakeholders that exist within an educational ecosystem. “You have to please students, teachers, parents, principals, management,” explains Vinod. “There are a variety of financial and psychological stakeholders at play when you're selling to a school.” Since Curiositi works largely with schools with low budgets, the team had to find a way to allow for the existence of both affordability and universal value. They began by establishing a price point that would fit the budget of the poorest schools that would sign up with Curiositi. “Technology is great. It really is,” he explains. “But when a school can't even afford basic textbooks, you have to start in a non-disruptive way. You have to start by working in the same pace that they're working with. We're not here to outstrip anyone. Everyone in India is working really hard to improve the education system. We want to contribute to 2

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the community effort.” Next, they ensured that each of the kits were designed to fit into the existing framework of the classroom. “It's important for our designers to visit our schools,” explains Vinod. “When you're explaining things like gender sensitivity, language barriers, colour themes - you just can't be detached from who you're designing for.” Supporting Teachers On the other hand, the decision that the LabInApp team made to work with schools with slightly larger budgets allowed them to establish higher price points. The toughest challenge that they have faced is proving to teachers that they are not trying to replace physical laboratories. “There's this fear that technology is here to replace the role of teachers,” explains Pavan. “We want them to understand that we are here to enhance their jobs and create new types of interaction.” In order to introduce classrooms to the concept of LabInApp, the team makes sure to explain the importance of interactive technology to their stakeholders. “Animation means that you passively watch something on a television,” says Pavan. “Interactive technology introduces a whole world where you break physical boundaries and explore the possibilities of the future.” According to Vinod and Manoj's long term vision, Curiositi's kits have a natural place in the current and future states of an academic education. “We've definitely had a little bit of difficulty convincing people to purchase the kits,” he explains. “I remember that there was a principal at a school who was easily 80 years old. The entire time that we were pitching to him, he was unappreciative and we thought we'd lost the deal. At the end of our conversation, I described Curiositi's grander vision to him: putting intuitive learning back into the lives of our students. We immediately saw him relax and we got the deal.” 14

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As Curiositi scales further, Vinod explains that it will be necessary to tap into the increasingly organised logistics market. “We're at this point in time where the quality of our logistics planning will really help dictate our future,” he says. “We believe that our model helps foster the type of creative self-learning that India's students need. Once we see that our model is successful, we plan to expand into other areas of education. Math, English, history... I believe that India is at a point where all of this is actually possible.” And, with Pawan Shinde, Girish Shirigannavar, Pramod Ramdurg and Vinayak Hulabutti planning to use LabInApp to enhance the limitations of physical laboratory work, the curiosity gained from an excellent early education in science can be used by older students to explore the 3D world of scientific possibilities.

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Aggregating After School Tuition Services CueLearn Founders: Manan Khurma, Jagjit Khurma Headquarters: New Delhi Small businesses, independent tutors and private schools have targeted the void caused by the failure of India's education system for years by providing after-school tutoring services. According to the Associated Chambers of Commerce of India (ASSOCHAM), the private after school training industry was valued at $24 billion in 2014. Within this bracket, the K-8 segment was valued at $10 million. The growth rate was over 35% and there were between 20-50 million learners estimated in the segment. These statistics were very important to Manan Khurma, CEO of CueLearn. As someone who enjoyed teaching mathematics out of the confines of academia, Manan realised that a good program could aggregate the vast number of learners and teachers under a uniform brand. Digging deeper into the Delhi/NCR region revealed shocking results: Although over 75% of parents were enrolling their children in tuition services, many of them were unhappy with the type of education they were getting. Manan and his father, Jagjit Khurma, decided that it was important to find a scalable solution to these problems.

A CueLearn tuitions class 16

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Tapping Into an Existing Tuitions Market “Distribution has always been the biggest challenge in any education project,” explains Manan. “That's where our idea started out.” After graduating from college, Manan launched a startup that provided training to students that wished to take the JEE (Joint Entrance Examinations) in India. His father had been a professor for thirty years. Together, the two had experience teaching over 50,000 students. “I've always loved math,” Manan explains. “My initial motive was to start early and find a way to disrupt the primary school education model by teaching students from K-8 how to love it too.” CueLearn provides affordable after school tuition services to young students. Since physical educational resources were often expensive and the online market was cluttered with competition, the two decided to translate their curriculum to work on both tablets and paper. “We have two streams of education,” explains Manan. “There should be no reason that the medium limits the type of information you receive.” In order to cut costs even further, Manan and his father decided to tap into the vast market of unemployed women. “We empower local women to be teachers. They hold classes out of their homes. This allows us to spend less on infrastructure and, even more importantly, creates a level of trust between the community and our business.” Furthermore, most of these women have not worked as teachers before. “Our curriculum is created in a way that anyone with a complete high school education can deliver it without difficulty. It's more affordable for us to engage someone with lower qualifications and, by investing two hours a day of their time in us, they end up making more money than they would otherwise.” Developing an Intuitive Framework The years of experience that Manan and his father had in education helped establish the basics of CueLearn's framework. 2

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“One thing that I've learned from my experience is that there can't be abrupt leaps in your curriculum,” Manan explains. “Your content has to be well organised and challenges have to be achievable.” The first program that CueLearn presented was “CueMath”. For over 16 months, the team worked on development until they reached an iteration that they were happy with. After each iteration, the team distributed small learning modules to students. Based on the feedback that they received, the curriculum and technology would go through a series of updates. “The biggest mistake that we made was not establishing learning outcomes,” Manan explains. “We had an open ended curriculum with no tangible, measured results for what we wanted from the students.” The final CueMath program presents a series of approaches to mathematics depending on the skill level and age of a student. Parents can access grades online and the team at CueLearn uses this data to inform their own curriculum revisions. Instead of focusing on customer acquisition, CueLearn makes their product appealing to teachers. With CueLearn's model, teachers act as micro franchises with the responsibility of acquiring their own customers and maintaining the standards of their classes. “Once we have teachers signed on, it's their responsibility to convince customers. The more customers they have, the better for them. While the CueLearn brand speaks loudly enough about the quality of our services, the added endorsement of a local woman strengthens our brand.”

STARTUPS IN HEALTHCARE, EDUCATION AND LIVELIHOODS

Noticing Discrepancies in Higher Education iSTAR Founders: Surga Thilakan, Sreeraman Vaidyanathan Headquarters: Bangalore While 80% of India's youth are considered literate, young job seekers still make up 49% of the country’s unemployed population. After years of being trapped in an unsatisfactory education system, students that graduate from non-elite universities find that they do not possess the skills that employers are looking for. According to a recent study conducted by NASSCOM, less than 15% of graduates are ready for the job market. 75% of engineering graduates, 85% of finance graduates and more than 90% of other graduates are not considered employable. Despite the emergence of government initiatives, large-scale corporate services and informal tutoring classes, the problem has not been solved. iSTAR Skill Development Services trains students to be employable in banking, IT, ITeS and other service industries during the course of their college education. “I saw both sides of an unequal college education system,” explains Surga Thilakan, co-founder of iSTAR. “The discrepancies between the two helped me understand the immense amount of privilege I had and what I could provide to those who didn't have any.” Surga was born and raised in Mumbai and completed her undergraduate career in a college that was similar to the ones that iSTAR, a low cost skilling service, works with. “I had gone through a traditional education here in an institution that is very similar to the ones that we train for now,” she explains. “The problem there was that the pedagogic approach, the peer group, the infrastructure availability, the quality of faculty, I mean, really everything was significantly below par. Most of my learning was very self-directed.” Unlike her peers, Surga managed to excel and, 19

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after working for a few years, returned to one of India's top universities to complete a degree in management. “Things were different in graduate school,” she explains. “I realised that a good education could give you a framework for life. It should give you that.” After completing graduate school and shuffling through a few jobs, including a promising position at Goldman Sachs, Surga decided to quit her corporate career in order to understand how she could fix the problems that she'd seen. During this time, she reconnected with an old classmate from IIM Ahmedabad, Sreeram Vaidhyanathan. Together, they came up with the initial model for iSTAR. When they analysed the market, they observed that the period of time between graduation and getting a job was definitive. Many students, burdened by debt and the responsibility of providing financial support for their families, would get tired of searching for a career that fit their skill sets. Instead, they would settle for unsatisfying lower-skill employment. iSTAR’s first decision was to approach the universities that churned out these frustrated graduates directly. “When we went to these colleges and met the principals, we didn’t even need to complete our pitch,” Surga explains. “They knew what was missing.” Creating an Applicable Curriculum After years of being trapped in an unsatisfactory education system, many college students have lost faith. “I think most students in India have given up on the education system,” Surga explains. “They go in there with the objective of gaining certification, so they need to write an exam, get a certificate, and that’s the extent of their interest in college. The rest of it is enforced through attendance, and withholding of hall tickets, but they’re really hostages in the classroom, I mean, they don’t want to be there.” In order to combat this, iSTAR classes are interactive and empower students with a better understanding of the world 20

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that they live in. “The world isn't in a textbook. We had an accounting class and talked about that huge deal that happened between Facebook and WhatsApp. That's interesting because they understand the term “mergers” and see it happening in real life. They also notice the changes in WhatsApp. It's important to teach real life skills.” Maintaining Affordability iSTAR maintains its low costs by taking advantage of the scale that universities can provide. “After signing up a class, we become a mandatory part of the curriculum,” explains Surga. “We get access to thousands of students and a great infrastructural setup.” Although hiring excellent trainers is important, Surga explains that a high level of qualification is not always necessary to deliver iSTAR's content. “We were hiring very qualified people for a while. This was getting really expensive and our curriculum allows delivery from someone without much experience. We decided to do a trade-off and focus on upskilling our own trainers.” The Future of Education in India Set to become the world's youngest economy by 2020, India is faced with the responsibility of providing its newest citizens with the resources to live a happy life. While the entrepreneurs that are choosing to solve the country's largest problem are faced with difficult challenges, their failures and successes are creating a framework for the citizens of India to better understand and solve the shortcomings of the education system. “I just want to prove one thing,” explains Umesh Malhotra. “A good education does not need to be expensive. It can be something that everyone can have.”

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LIVELIHOOD ENHANCEMENT When a skilled worker cannot survive off of the money he makes, he is forced to look for alternate sources of income. Unfortunately, higher education means that one has to spend precious time and money. A lack of opportunities for labour has created a pattern that leaves people without relevant skills with limited wallets and limited life choices. Although technology has replaced the need for human labour in many areas of production, it has also created the potential for new markets between skilled workers and global customers. “There are a few things that a skilled worker needs to be successful,” explains Kunal Sachdev, founder of Caravan Craft. “Relevance is one of the most important ones.”

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The World of Cooperatives GoCoop Founder: Siva Devireddy Headquarters: Bangalore Many artisans across India exist in organisations that are owned and run jointly by their members. Known as cooperatives, this business model came into popularity in the early 1900s as a method for farmers to pool resources, pay off debts and market agricultural produce. Support for the communal enterprises rose, and today, India is estimated to have over 6 lakh (600,000) cooperatives. For years, cooperatives acted as the direct point of purchase for apparel, artisanal crafts and other basic necessities. With the advent of machinery, large scale distribution and e-commerce companies, however, millions of craft workers are finding that they are no longer needed to produce their crafts. According to some estimates, the global handicraft market is valued at $400 billion. India's 7 million artisans contribute to less than 5% of this number. For years, the Indian government has unsuccessfully tried to combat this growing disconnect by funnelling money into artisanal clusters. Despite their efforts, artisans continue to occupy the most economically disadvantaged brackets in Indian society. Although Siva Devireddy was born and raised in Chennai, India, he spent most of his adolescence moving through the country. “My father had a job that caused us to relocate a lot and I changed schools pretty often,” he reminisces. “I used to spend a lot of time out in my grandparents' village in Andhra Pradesh and that's where I really fell in love with the rural life.” After graduating from college, Siva became the director of the innovation centre at Accenture. “I was always looking out for the latest trends in technology and conceptualising how to create business plans around them that would be attractive to our customers,” he 2

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explains. “At some point, I realised that there was a whole world out there that could use the benefits that all of this breakthrough technology was providing. I wanted to do something more important.” While visiting Bengaluru, Siva met Dr. Siddhanthi, the director of the Regional Institute of Cooperative Management. “I met Dr. Siddhanthi when I enrolled in the RICM for a two year program,” says Siva. “Rural India is so complex. Dr. Siddhanthi has really helped guide us through a lot of difficult problems. I think anyone that's starting a venture in an informal market needs a mentor. You need someone who gets it.”

Women working in a cooperative

Studying at the RICM exposed Siva to many of the discrepancies that existed between the public's understanding of cooperatives and the actuality of the situation. For one, he explains, despite having growing up on milk from AMUL, one of the largest cooperatives in the world, the methodology of its production, manufacturing and distribution were not well known. “It was fascinating to see how cooperatives exist in so many parts of our daily lives in India and yet, none of us had any idea about how they worked. I wonder how things would have been different if I had grown up with an understanding of their business structure.” His market research led him to an important conclusion. The two biggest issues that plagued the artisanal sector were the lack of a 24

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market connection and a low level of operational management. â&#x20AC;&#x153;Between a cooperative and its final consumer, there are tons of middle men and prices are increased at least 300-500%. By the end of the journey, artisanal products are expensive and don't bring much value to the producer. There is no transparency in pricing. I decided to use my experience in cloud computing and bring it to the world of cooperative computing.â&#x20AC;? In order to combat these issues, Siva established GoCoop. A cooperative that signs up with GoCoop is offered a host of services including a listing on their online directory, a customised eCommerce website and an end-to-end website management service. GoCoop uses both online and offline marketing to connect artisans with consumers.

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Transforming to Evolved Craft Caravan Craft Founder: Kunal Sachdev Headquarters: Bangalore While GoCoop connects business to business buyers with conventional craftwork suppliers, Kunal Sachdev, CEO of Caravan Craft, explains that there is an entirely untapped part of the market that is looking for upskilled goods. “These artisans are talented enough to provide to a very premium market,” explains Kunal Sachdev. “While I was working as CEO of HiDesign, I had the opportunity to visit a few of these clusters. The scene was completely different from what I had pictured in my mind. These were not unskilled labourers. They were highly talented artisanal workers that were producing beautiful goods.” The sight of unused talent was enough to convince Kunal to leave his job at HiDesign - a global retailer with an annual turnover of more than 125 crore ($20 million) - and attempt to create a market context for artisans. “I had to ask myself: How can I provide these artisans with the global relevance that they deserve?” In the next few months, Kunal created a detailed plan that would require him to conceptualise global products, connect with artisanal clusters and provide them with the skills that they would need to create these goods. For Kunal, the biggest boost of confidence arrived in the form of the support of the government. “I decided to approach NSDC (National Skill Development Corporation) with my idea. The CEO's first reaction was 'listen, we can't fund you because you're not a pure skilling initiative'. He sat with us for ten minutes and I asked 'how much money has the government spent on this sector? Has it improved the life of the artisan in any way?' He listened to that and gave it a few hours of thought, and called me back. That call from him was so great to 26

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hear. Everyone realises how necessary change is for these artisans.”

A woman from Umden, Assam weaving a silk sari

The first question that Kunal asked himself was an important one: who was his consumer? “It was clear that we were targeting a global, culturally conscious consumer, so we decided to have our first run with some products in a duty free airport store. This was a hit.” According to market research, there was an increasing trend towards cultural and social awareness amongst young, career oriented women. “We decided to take this forward into a real store and build our products around the sensibilities of the modern 25-30 year old. We wanted our products to be modern, attractive and useful.” His experience in global markets indicated a few product trends. “We figured out that people buy products for three main reasons: functionality, aesthetics and story. The crafts in this country have a brilliant story, but they need a lot of improvement on the other two fronts.” Once Kunal identified a product with applicable functionality - a USB drive, for example the Caravan Craft team would work on enhancing its aesthetics and identifying a storyline that would engage customers. “We've hired designers from all over the world to figure out how to add an element of craft to the aesthetics of each of our products. For the USB drive, we wanted to add Bidri inlay, which is this beautiful type of metal handicraft. The story behind these crafts are 2

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apparent. They're real and we're just letting craft workers speak to the global market.” Upskilling and Developing Ownership for Artisans As Kunal expands his reach, the artisans that work within the clusters are left with modern skills. “We have this bluetooth speaker with Bidri inlay," Kunal says. "We trained clusters for a few months in order to be able to take their own Bidri talent and apply it to modern technology. Many of them start their own projects after working with us. Others stick around and train more people. I'm not afraid to say that we see ourselves as a small pebble in a pond. More than anything, we want to be the harbingers of change. If the Caravan brand can demonstrate that artisans can make desirable merchandise, we think people will take a leaf out of our books." Unlike many other informal sectors, Kunal explains that the artisan understands his value in the marketplace and is ready to change his methods in order to realise his full potential. “You see, the artisan’s commercial acumen is very sharp. He realises what he needs to do in order to survive. If there is a commercial proposition that comes his way, something that doesn’t dilute his craft in any way, but adds value to his livelihood, he’ll embrace it.” For Siva, on the other hand, the biggest impact that GoCoop has on the lives of artisans lies in providing them with a chance at establishing new channels for themselves by using the Internet. “The entire concept of a cooperative is deeply rooted in the democratic belief that every individual should have power over their own lives. An online marketplace liberates workers from having to work with middle men and allows them to reach millions of new customers online.” Despite global competition from online vendors, GoCoop's products attract a unique customer base. “We're not really competing with online marketplaces that sell apparel or other fashion goods,” explains Siva. “We want this to 28

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be a supplier led marketplace, and, since the price of the product is lowest when they are selling directly to a customer, we think this positions us really well. Every piece is unique and handmade. Nothing is the same.â&#x20AC;?

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Using Technology to Aggregate and Connect Jiffstore (Acquired by PepperTap in Dec 2015) Founders: Shameel Abdulla, Aswin Ramachandran, Sandeep Sreenath, Satish Basavaraj Headquarters: Bangalore Four close friends meet to watch a cricket match and decide to order food from a local, family-owned grocery (known as kirana in India) store. Five hours and 15 phone calls later, the order arrives in shambles. The situation is a familiar one that has been addressed with a simple solution: large, franchised stores and grocery delivery services have approached desperate customers with promises of increased efficiency and quality. Unfortunately, this solution has lowered sales for kirana store owners and put many at the risk of losing their only sources of income. For the four friends and co-founders of JiffStore, the potential for change was immense. Shameel Abdulla, Aswin Ram, Satish Basavaraj and Sandeep Srinath had spent months discussing the best way with which to tap into the next technology trend. “We had at least 6 different ideas running,” Shameel explains. “We created a few parameters and measured them against the market. What was the potential for our idea? How complicated was it? Is it ahead of its time? Is it easy to make revenue? 92% of India's retail market is informal. This is a humongous economic opportunity.” According to Shameel Abdulla, customers at the base of the pyramid are no stranger to the opportunities that low cost smartphones, mobile application technology and affordable data have created. With historical relevance, customer relationships and hyper-local operations on their sides, the only thing that they lacked was an entrance into the world of online commerce.

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Shameel Abdulla, Aswin Ramachandran, Sandeep Sreenath and Satish Basavaraj

Unfortunately, as Shameel soon found out, the implementation of “technology” was not a blanket solution to their problems. In order to create a service that successfully fostered communication between kirana store owners and India’s growing urban population, the four co-founders of JiffStore spent months understanding their customer base. Thanks to the diligent efforts of other successful grocery delivery service, the team realised that there were a few tried and tested ways with which to reach mainstream urban customers. Keeping aspects like simple design and powerful e-commerce abilities in mind, they set their eyes on tackling the massively diverse population of kirana store owners and employees. Unlike the mainstream urban customers that would be using the app, kirana store employees ran the spectrum of everything from technology savvy to completely illiterate. This was a new challenge for Shameel Abdulla. “As a software developer, I’m used to developing an application and putting it out,” he explains. “Regular technology parameters are: how powerful is this application? How many devices can this be used on? With JiffStore, I had to actually follow user demand. If a customer wanted a simplistic SMS based application, I’d have to comply.”

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Hiring a Mentor Because JiffStore was the team's first attempt at providing a service to a group of low-income customers with limited technology experience, they decided that it was important to find a mentor. They created a comprehensive list of the skills they possessed and those that could be improved with the help of an experienced individual. This included someone with the experience to answer their questions about application development with a design-centric focus and skills that would help address the various ambiguities that came with running a startup. In order for the mentor to be able to deliver effectively on these skills, the first criterion that Shameel and his team agreed on was someone who was located close enough to attend meetings. “I think we really wanted someone experienced that would make up for what we were missing out on. We wanted someone in Bengaluru, someone that we could visit in person and someone that was willing to talk for two to three hours, or even two to three weeks.” Within the framework of these needs, JiffStore created a map of possible resources and, by the time the company was launched, the four co-founders had figured out a useful group of mentors. “Not to pick favourites, but one of our most important mentors stays 7 kilometres away from my office. He has a lot of experience working with the base of the pyramid and is running an NGO hospital in Bengaluru. Another one of our mentors used to work with a local multinational company as a director and quit to start his own business. He also gave great advice on how teams and organisations should operate and how they should structure themselves in the future.”

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Impact for Kirana Owners JiffStore revitalises the livelihoods of kirana store owners and helps them level the playing field with their technologicallyadvanced competition. “For the first time in thirty years, we can use analytics to see what our local customers want,” explains Manjunath. Manjunath and his family have owned Sri Manjunatha Stores in Ulsoor, Bengaluru for over 30 years. Although his parents are illiterate, he is no stranger to the Internet. After working for 8 years with AOL, Manjunath launched a website content development business. He explains that his subscription with Jiffstore has helped combat the surge of on-demand grocery delivery services. “We are learning to use analytics to prevent overstocking and fill our store with products that people here would want to see.” Another store owner, Sunil, explains that Jiffstore has reintroduced many old customers that he thought he had lost to online delivery services. “I don’t blame them because they left,” Sunil explains. “We weren’t providing what they needed. Jiffstore helps me cater to their demands in an efficient way.”

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Making Transportation Easy mGaadi Founders: Vishy Kuruganti, Solomon Prakash Headquarters: Bangalore The advent of technology has also ushered in a new era of efficiency for transportation. With the exception of railroads and public buses, transportation in India has been largely informal. This has led to a largely unorganised industry of taxi, auto rickshaw and truck drivers and perpetuated issues like unstable incomes, a lack of safety regulations and unpredictable standards of quality. For Solomon Prakash, co-founder of mGaadi, the formalisation of transportation in India could only take place if it worked within the existing framework of the country. “You can't solve chaos by replacing it with something new,” Solomon explains. “You have to analyse the situation and find a way to give it some sort of direction.” Solomon's hometown of Bengaluru, India has transformed from a small, residential town into one of India’s largest metropolitan cities. Unfortunately, its rapid pace of development has outstripped that of its transportation system and it is notoriously difficult to get around the city. In particular, Solomon explains that he observed a growing resentment between Bengaluru’s auto rickshaw drivers and their customers. Many of his female co-workers would recount horror stories of their rides back to their respective homes. Auto rickshaw drivers were wary of long distance trips and unfamiliar locations. They would often refuse rides, charge more than the cost of the meter and, in rarer cases, harass their passengers. “It was really eye opening to hear some of these stories,” Solomon reminisces. “It just reminded me of how many stories I’ve heard like this, and how many years of inefficiency both auto rickshaw drivers and their passengers have had to face. 34

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There was no transparency in communication between the two groups.”

Vishy Kuruganti and Solomon Prakash

Years of complaints had only produced failed government and corporate attempts at solving the issue. Unlike his predecessors, Solomon had the power of timing on his side. “I’d seen this problem for a while. The one major difference in the late 2000s that didn’t exist 10 or 20 years ago was the existence of smartphones.” After meeting his co-founder, Vishy Kuruganti, Solomon decided that they needed to develop an application that would aggregate auto rickshaws and connect them to potential customers. Vishy’s experience in GPS mapping brought another level of organisation to the chaotic rickshaw sector. “I want travelling to be easy, but within the city’s existing terms, including its auto drivers,” explains Solomon. “I want to use the massive amount of skilled labour that we have in this city to build a better community.”

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The Social Need for Logistics Blowhorn Founders: Mithun Srivatsa, Nikhil Sivaprasad Headquarters: Bangalore While one end of the transportation spectrum involves shifting people, the other end involves the movement of goods. With the advent of on-demand goods delivery companies - the goods being anything from groceries to laundry - the logistics of transportation is an important aspect of delivering quality. For Mithun Srivatsa, co-founder of Blowhorn, the only way to overcome these issues was to face the challenge headfirst. “In more developed places, you can drop technology into these organised, green pastures and issues are solved. It's not the same in India,” explains Mithun. “Planning logistics in India revolves around behaviour and creating efficiency in a chaotic environment.” Mithun's experience in overseas markets dictated his understanding of the empowerment that well planned logistics brought with it. After time spent in the United States, Brazil and London, he explains that the differences between organised and unorganised markets begin to stand out. “I've always been a startup guy so I've observed these trends. You realise how much easier it is to introduce interesting startups when the logistics are easy. For us, solving that really difficult problem would liberate India's economy and make everything move that much smoother. It would actually be the precursor to a very rapid pace of development.”

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Customers in front of a Blowhorn mini-truck

Although several other companies are attempting to organise the logistics of moving, Mithun explains that the Blowhorn team has one key advantage. “We actually talk to our drivers,” he says. “We're not just coming into this ecosystem with very advanced technology.” The driver application works under the assumption that its user will be illiterate. “You have to start with the lowest common denominator when you're working with these things. We explain GPS on a step-by-step basis and break things down to their simplest levels.” In terms of the successful aggregation of the moving market, the Blowhorn team is of the opinion that organising logistics in India is more of a social problem than anything else.

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Empowering With Technology and Financial Services Milaap Founders: Sourabh Sharma, Anoj Viswanathan, Mayukh Choudhury Headquarters: Bangalore A little money in your pocket can take you a long way. "The basic concept of microfinance and loans with low interest rates always intrigued me," Anoj Viswanathan, co-founder of Milaap explains. "With a little bit of money, people were empowered to take big decisions on their lives, and, in turn, these decisions would produce something that would get them out of their cycles" For Milaap co-founder Anoj Viswanathan, social impact was always a primary goal. “It was during a summer break in college that I began looking for something that I could do with the skills that I had. At that time, the concept of microfinance as a means for social impact was huge. ” While reading the Times of India, Anoj came across an opportunity to work with a large microfinance organisation “I was working with things like solar lamps and cook stoves on EMI (equal monthly instalment) models, and this was all very interesting. Soon, however, I came to realise that this wasn't really helping break cycles of poverty. Unless there are jobs and assets available at the grassroots level, having enough money to buy a buffalo or set up a small shop isn't really going to solve your problems.” After meeting his two co-founders, Sourabh Sharma and Mayukh Choudhury, Anoj's realisation was solidified. “Together, we thought to ourselves: there are so many people that want to help out. What if we built a platform that enabled this?” With Milaap, a crowd-loaning platform, borrowers can raise capital for low interest rates from lenders who are not expecting high returns. On the other end, smaller microfinance institutions and other 38

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non-profit organisations that are not heavily funded are able to gain visibility on the online platform. The Milaap platform focuses on lending to seven different sectors: education and training, water, energy, sanitation, small business, sustainable farming and healthcare. “The only way to access people was to treat it like it was a technology play,” explains Anoj. “The sheer scale that we wanted to achieve would not be possible in any other way.”

A customer at Milaap used her loan to construct a new toilet

Anoj toyed with the idea of leaving college early in order to pursue his passion. “Once I had this idea, I felt like I should just quit university,” he reminisces. “I didn't, but after going back and attempting to complete it while running this startup, I realised how important focus was to an idea as big as Milaap. We were having discussions over email and phone calls but in order to see traction and pull other people into it, we had to jump in headfirst.” Although Anoj was nominated for Forbes' prestigious “30 Under 30” award, he explains that his lack of experience acted as a slight hindrance towards developing the final concept behind Milaap. “When you start out, you look at things purely from what you want to do from a product perspective. It's all 'this is what we want to build', and 'this is how we want to go about building things'. You don’t have the maturity or the experience to think 2

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about building an organisation.” Fortunately, as Anoj explains, his two co-founders helped him achieve a steady balance. “It really is important to have co-founders in situations like these.” Tiny Capital Makes Big Improvements A particularly moving story that Anoj remembers happened in a small slum outside of Bengaluru. “An entrepreneur that was making office handicraft equipment was at the brink of bankruptcy because she did not have access to capital. She would hire orphans and destitute women to keep wage costs down. Despite all of this, she had a definite plan that could fix things. It would require 3 lakh rupees (~$5000) and it would go straight into sales and marketing. Today, after nearly 15 months, she's employed 60 people with 20 of them working full time. She's doing a manual production of 3 million rupees (~$50,000). This is huge.” Anoj is confident that this would not have been able to occur on any other platform. “The reason that we were able to help her is because we raised capital from socially conscious individuals. Even if she had not succeeded, I’m sure that 95 percent of lenders would say that’s fine, she made the effort. This is why low-cost and risk tolerant capital is the way to really liberate these individuals.” Entrepreneurs are Powering Future Livelihoods By tapping into the vast amount of human capital that India has to offer, entrepreneurs can revitalise the livelihoods of millions of individuals as well as earn money from organising its vast informality. “I believe that if you can crack the logistics market in India, you can crack it anywhere,” explains Mithun Srivatsa, co-founder Blowhorn. “The challenges that you overcome here make your business model airtight.”

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HEALTHCARE While India is renowned for its highly trained doctors and state of the art facilities, access is often limited to the wealthy. The majority of money spent in the INR 60 lakh crore ($100 billion) healthcare industry happens in large metros and is concentrated amongst the top 10-15% of the population. This inequality has its real effects amongst the urban and rural poor: Statistics show that the economically disadvantaged suffer the most from poor quality healthcare, Along with the exorbitant prices of most non urban clinics, the loss in daily wages that comes from a visit to a clinic makes the situation worse. The increasing demand for better healthcare services creates a huge opportunity for entrepreneurs that choose to tackle the challenge of bridging the country's broken healthcare continuum. The most important thing, however, is to prove to a customer that the addition of healthcare services will ultimately improve the overall quality of his or her life.

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From Doctor to Entrepreneur Smile Merchants Founders: Dr. Rushi Trivedi, Chandrashekhar Pandey Headquarters: Mumbai With the increase in support for healthcare businesses, many doctors are turning to entrepreneurship. For Dr. Rushi Trivedi, CEO of Smile Merchants, this was a new concept. When he was 12 years old, his family decided that he would grow up to become a dentist. He would then get married, have children and settle into a stable, mature lifestyle. Soon, however, Rushi realised that there was a gaping hole in this plan: outside of large cities, India’s landscape was devoid of dental clinics. The market opportunity for dental care in India was immense and could yield the dual impact of improving the quality of millions of lives while accessing a vast market of untapped customers. Who would be the super entrepreneur to tackle this issue? “The answer had to come from me,” Rushi explains. “The only problem was that… I’m a doctor. I didn’t even know what funding was. When I told them I was starting a line of dental clinics rather than simply practicing on my own, my parents thought that I had gone crazy.” Despite Rushi's initial hesitation, the market need for scalable dental solutions was too strong to ignore. Along with two classmates, Rushi decided to start Smile Merchants, a chain of branded, low-cost dental clinics across India. On the other hand, Dr. Anand Lakshman, CEO of AddressHealth, applied to medical school with the sole intention of finding a scalable healthcare solution for the masses. During a ritual freshmen hazing tradition, a young Dr. Lakshman was asked to explain his reasoning behind attending medical school. “This senior of mine came up to me and asked me whether I was there for the money, or for the option of a stable job,” he reminisces. “I 42

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A patient in a Smile Merchants clinic

told him that I was there to solve bigger problems. I wanted to provide a large scale solution to the healthcare problems of the world and I felt that an education in medicine was perfect for that. It teaches you that the world works logically and that there are certain symptoms and signs that can lead you to a rational decision.â&#x20AC;?

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Giving Customers a Reason to Pay AddressHealth Founders: Dr. Anand Lakshman, Dr. Anoop Radhakrishnan Headquarters: Bangalore After researching India’s rural population for several years, Dr. Anand Lakshman realised that a large portion of medical issues came from unchecked and unmanaged childhood incidents. Children play an important role in the lives of Indian families and, with his expertise in paediatrics, Dr. Lakshman was the perfect person to address the unmet market need with a scalable solution. He initially approached his customer base through a series of educational programs. These programs intended to teach children and their parents how to prevent or manage chronic diseases like asthma, type 1 diabetes, epilepsy and atopic dermatitis. “We were everywhere,” Dr. Lakshman reminisces. “At times, we felt a bit like pharmaceutical representatives. My cofounder Anoop and I visited 150 paediatricians trying to change their prescription practices. We got into education in schools, ran a program called ‘Asthma Absent’ that reached 50,000 children and certified 50 schools as absent from asthma.”

Students at an AddressHealth lesson 44

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As Dr. Lakshman soon found out, changing behaviour with the promise of a long term outcome was difficult. “People were looking for a solution. They were used to doctors providing instant answers and drugs. Our program would end and parents would come to us and say ‘That’s great, doctor, but where is your clinic?’ Some people would even go so far as to question if we were even doctors.” Without a clinic, Dr. Lakshman realised that the impact of Address Health would be transient and occasional. The few people that would be convinced of the importance of preventative paediatric care would not have the support of a clinic, and the residual feelings of the necessity of change would eventually wear off. “We wanted to show people that we believed in this idea enough to put our own hard earned money and work into it.” After observing the data that they had collected from their programs, Dr. Lakshman and his co-founder, Dr. Anoop Radhakrishnan, realised that conventional paediatricians did not address most of the problems that children faced. “Dental? Nothing. Nutrition, eye care? Nothing. We needed to have one-stop-shop community clinics. Our goals were big and we wanted to address everything.” Soon, AddressHealth pivoted to establish their low cost clinics all across India. Lowering Costs and Getting Customers to Return Once Dr. Trivedi realised that his medical background provided him with the perfect framework to analyse India's dental landscape, he worked with his team to understand the reason that dental care remained unpopular amongst the rural and urban poor. The primary reason that they came up with was the disconnect between the budgets of the economically disadvantaged and the pricing of most dental clinics. ”Urban dental clinics have flashy décor and expensive instruments,” he explains. “This feels intimidating,drives up costs and makes dentistry a luxury service.” A cost analysis of conventional dental clinics helped the team figure out how to save costs. For one, Dr. 2

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Trivedi focused on the typically expensive infrastructure that housed a clinic. Instead of wasting money on establishing new facilities, the team took a decision to renovate old, dilapidated buildings. This hasn't always been the easiest task: Rushi recounts a particularly unfortunate incident when a clinic collapsed on itself. “We learned our lesson from that,” he explains. “The basis behind saving money can be straightforward but doing it right takes diligence and close management. Now, we make sure that our cost-saving techniques have several checkups behind them.” The second thing that the Smile Merchants team observed was the lack of immediate incentivization that plagued the world of preventive healthcare. “You don't get your teeth checked up once and see a quick reaction,” Rushi explains. “This isn't uncommon in the real world. To combat this, we decided to use an old business tactic and implement a warranty.” Patients that visit a Smile Merchants clinic are offered a warranty with the guarantee that a treatment will be successful in the long run. “If you feel that we've failed, we'll do whatever it takes to fix it,” says Rushi. “This ensures quality on both ends of the service: Our dentists provide the best service possible to avoid repeating it, and customers will return because they are confident that their money is going to get lasting results.” And, for the few immediate concerns that do plague dental patients, the dentists that work at Smile Merchants provide quick, accessible and affordable care. “Our plan is that our clinics will have a spoke and hub model,” explains Rushi. “The spokes are located in tier 3 cities and are good for patients that don't have the time to travel for a checkup. If there is a need, we refer them to our hubs.” Affordable Medical Devices and Tele-Medicine As the Smile Merchants team researched new methods that would help them run their clinics for less, they realised another 46

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important aspect driving the pricing of dental clinics. “There is just so much unnecessary equipment in some of these clinics,” explains Rushi. “As a doctor, you realise the basic necessities behind a procedure. You don't need so much of the extra equipment.” Furthermore, the Smile Merchants team discovered that there was a whole world of innovation in the realm of low-cost medical devices. By tapping into this world, the clinics can exist on minimal costs. While conventional medical devices are often expensive, resource inefficient and require a relatively high level of education for proper usage, the advent of innovations like cloud technology and micro-devices had attracted the attention of entrepreneurs looking to provide services to consumers at the base of the economic pyramid. For some medical fields, this made a world of difference. In emergencies, accessibility to healthcare becomes more important than ever. With chronic diseases like hypertension and diabetes on the rise, cardiac ailments have become increasingly more common. Problems with the heart require immediate care. For the founders of iMMi Life, however, India's 5000 cardiologists for its' patient base of 64 million cardiac patients were more than sufficient to solve the problem. iMMi Life is a platform that connects patients visiting general practitioners with 5 different cardiologists. Based on the opinion of the five, the general practitioner and patient decide on a solution. IMMi Life co-founder explains that the precious time and money saved by their network can be invested elsewhere. “This allows doctors to address a greater number of patients in a shorter period of time,” he says.

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Reaching the Eyes of the Masses Welcare Founder: Dr. Tamilarasan Senthil Headquarters: Chennai Innovation in healthcare has also had a significant effect on establishing awareness of preventive care. For Dr. Tamilarasan Senthil, CEO of Welcare, low-cost medical technology was the only way to overcome the limitations of human capital that plagued ophthalmology in India. According to a survey conducted in 2010 by the International Council of Ophthalmology, there are 9 ophthalmologists for every 1,000,000 individuals. With a growing population of 1.25 billion people, this leaves 11,000 ophthalmologists to serve the entire country of India. By the time Dr. Senthil had completed several years of ophthalmology school, field work and research, he had realised a few things about these statistics. For one, he realised that it was not easy to convince customers with limited resources and education to invest in preventive eye care services. Research led Dr. Senthil to yet another conclusion. Although there had been massive innovations in decreasing the costs of conventional ophthalmology technology, innovators had difficulty reaching the customers that really needed it. Among these, Dr. Senthil found a low-cost, efficient ophthalmology device known as the Forus 3Nethra. Produced by a company that addresses health issues with low-cost, innovative telemedicine products, the 3Nethra was easy to use, portable and affordable. Furthermore, it had the ability to connect rural clinics with urban doctors over the mobile internet. Dr. Senthil decided to establish Welcare in order to utilise the potential of the new generation of telemedicine devices and take advantage of the awareness that India’s most popular disease had garnered. “At least 60 million people have diabetes in India,” he explains. “1 in 4 of these patients struggle with some sort of eye problem or, in the worst case, diabetic retinopathy [a preventable 48

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condition causing blindness]. We reached out to diabetes clinics — thankfully there is a decent amount of awareness about diabetes — and decided to install devices there. This then allowed us to connect them back to our doctors for diagnosis.”

An eye test at a Welcare clinic

Medical devices are not always easy to sell. Despite the obvious advantages that the Forus 3Nethra brought to the world of eye care, it was important for diabetologists to believe that the device and Welcare's ensuing ophthalmological services were worth the cost. For Dr. Senthil, the most obvious method with which to prove the importance of the Forus 3Nethra was to convince his own close knit network of doctors. He decided to install the first device in a friend’s clinic. Within weeks, the positive response had reached the ears of other diabetologists and, soon, Welcare's services were being requested regularly. “We don’t have a regular marketing team,” he explains. “It’s all about word of mouth for us.” Accessing New Customer Bases: Rural and Urban Factors like limited Internet penetration and a lack of pre-existing customer channels make it really important for impact businesses to use pre-established networks. “We wouldn't have been able to reach out to half of these clinics without my network,” explains 2

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Dr. Senthil. “There are places where advertisement and the door to door salesman model just doesn't work.” In order to sell UE Life Science’s breast cancer detection devices, founder and CEO Mihir Shah first reached out to the midwives, social workers and rural doctors that already had access to a large part of the economically disadvantaged customer base. In fact, as Mihir explained, the slow process of creating awareness and then distributing their products would have limited its reach. Creating Accessibility Through Design and Innovation For UE Life Sciences, the most important aspect of their devices was how easy they were to use. “A typical breast cancer detection device is a mammogram,” Mihir Shah explains. “Let's say we worked on making an affordable one - which in itself is improbable at this point in time - how many people would know how to use it? Who would read the results? Instead, we decided to create easy to use, non-invasive devices.” For example, Mihir explains, the iBE, a non-invasive handheld scanner, is now prototyping to be read on any smartphone. The small device is made up of directional arrows and an intuitive design that allows for simple image interpretation. In order to bypass the fact that there are few trained radiologists, the device is designed with a person with minimal education in mind. Despite this, UE Life Sciences maintains a rigorous set of standards when distributing their devices. “Typically, workers come from NGOs and clinics. We like to make sure our device is in the right hands and is representing us well. We administer a written exam and test for basic communication skills.” Initial testing shows that the iBE will be 80-90% as accurate as a mammogram, and the company expects this number to only increase. The high sensitivity of the device is attributed to its use of UELS' patented sensor technology. “We consider this a 50

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pre-screening device,” Mihir explains. “A vast majority of breast cancer deaths can be stopped if they're detected in their early stages. They can also help people save money on later stage surgeries. Our focus is on areas where basic mammograms are not even available.” Delivering Quality with Human Capital While telemedicine solutions promise a certain level of quality, there remain several things that cannot be delivered digitally. Employees who work in Smile Merchants clinics are required to follow certain researched best practices. Without a proper understanding of the outcomes that these best practices produce, daily practices like the proper disposal of used needles and washing hands after seeing a patient can seem mundane and become entrenched in routine. To combat this, dentists that work with Smile Merchants are asked to envision themselves in the dental chair. “Good habits can make services easier and more efficient,” explains Rushi. “This is an ideology that we try to instil in our employees.” “The unconventional nature of working for an impact business can make it difficult to find quality employees who would otherwise work stable jobs. Dr. Lakshman explains that slight trade-offs helps AddressHealth meet its budgets. “We've decided to cut down our dependence on doctors,” he says. “We use video technology and hire more nurses.” And, in order to lower costs and retain the quality of an employee with a doctoral education, AddressHealth hires dentists to act as salespeople. “We started out by observing that dentists were generally in demand in the evenings and were free during the day. In order for us to establish programs in schools serving low and mid-income groups, we send our dentists to talk to principals and management. Regardless of what sort of a doctor is, they listen, and we spend less because we're not taking him away from too much.” 2

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Adding Affordability to Quality In order to ensure quality and alignment to their mission, the dentists who work for Smile Merchants are recruited directly from college campuses. “We go into these campuses and hire the best ten,” Rushi explains. For Smile Merchants to scale successfully and rapidly, he explains that it is necessary to find doctors who have a bigger picture in mind. “My favourite interview question to ask is ‘What is the goal of your life? What’s your vision?’ If someone says that they want to work their whole life as a dentist in a local clinic, I feel sceptical about them. I want to hear that you want to start your own clinic, and maybe have five chairs in it. I need to hear something that shows that you want to do more than what's expected of you with your skills.”

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Paving the Path for Healthcare in the Future With barely 1% of its GDP allocated to its healthcare sector and less than 0.7 doctors nurses available for every 1000 people, India is in danger of leaving many economically disadvantaged individuals behind. Although the advent of technology has brought with it a sudden boom in healthcare entrepreneurship, it is not enough. In order to salvage itself, the industry needs to foster an ecosystem of entrepreneurs that are passionate about developing and delivering low-cost healthcare alternatives to India's poor. Fortunately, doctors like Dr. Anand Lakshman are paving the way for impact healthcare entrepreneurship. “Even more important than knowledge is taking a risk,” he says. “Sometimes, you're looking at a patient and, even though none of the symptoms make sense, you get a feeling that you just have to go for it.”

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Cracking the Low-Income Market Despite India's rapid pace of growth, five out of every six citizens continue to live on less than $2 (~INR 130)/day. Those of us who work in the world of impact do not claim to have the next big answer to the world's problems. We know that doesn't work. What we do know, however, is that the world doesn't work nearly as well as it should. We hope that using the scalable and motivational powers of business to focus on the real problems that affect over two-thirds of the world will to help make things a little bit better.

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ACKNOWLEDGMENTS It is difficult to be an entrepreneur, and nearly impossible when one is forced to do it alone. Unitus Seed Fund is always finding new ways to support impact businesses in India. None of this would be possible without the dynamic team that they have managed to build. The eternally young trio of partners, Will Poole, Dave Richards and Srikrishna Ramamoorthy, are living proof that idealism is alive and kicking. Those in Bengaluru, India, the Silicon Valley of Asia, are my second family. Thanks to Radha Kizhanattam for welcoming me with open arms and a smile when I first arrived in India, Sunitha Viswanathan for always having a joke on the tip of her tongue, Srikrishna Ramamoorthy for his silent but effective (and, sometimes, even a little scary) ways of managing the team, Shalini Pal for her exuberant personality and love for buying others milkshakes, Sandhya Thukaram for her giving personality, dependability and impeccable sense of style, Angad Rikhy for the way he throws himself into his work, Kailash Nath for his quick mind, eagerness and wealth of knowledge about... everything, Sneha Rajan for always being the smartest but quietest person in the room and Ramana Gogula for somehow maintaining his musical side throughout all of these years. Special thanks to Will Poole for putting up with me, and myself for putting up with him.

STARTUPS IN HEALTHCARE, EDUCATION AND LIVELIHOODS STARTUPS IN HEALTHCARE, EDUCATION AND LIVELIHOOD