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Piramal e-Swasthya: Attempting Big Changes for Small Places in India and Beyond

Anand Piramal and his team sought to "democratize healthcare" in India through the development of a new service delivery model. If Henry Ford could build and deliver cars to everyone in the United States, Piramal thought, then why can't India deliver healthcare to the 70% of its citizens who lack access to it? They began pilots in 2008 but soon ran into unexpected difficulties. After a second round of pilots in early 2010, they had to decide whether to proceed and if so how.

AJaya Kumar Sahu 0021/49

Table of Contents:
1.Problem Essay 1.a Problem definition 1.b Diagnosis 1.c 2. Recommendation 3. Action Plan 3.a Goal 3.b Action Steps 4. Conclusion

1. A: Problem Definition: The Piramal e-Swasthya revenue has gone down as they are not getting enough patients per village to make the service Sustainable, Profitable and Scalable. 1. B: Diagnosis:
The current model employs educated females known as Piramal Swasthya Sahayikas (PSS) to carry out the daily operations and also to attract the local customer (patients) in their village. Earlier the model was predicted sustainable if each PSS could serve seven patients per day. But as the demand decreased it was then reduced to 3 patients per day. But even this target was not achieved as each PSS on an average

received less than one patient per day. By 2010 they had lost 26 villages out of original 40 villages
and were able to add only 60 more villages. Although the initial survey done by Anand Piramal and his team suggested that good number people/villages showed openness to service (receive care over the phone) the model was not generating enough revenue at a cost of $500,000 per year. 1. C: Proof:

There were many reasons for the above mentioned outcomes. I. The patients were referred to other hospitals like public health care and private clinic in case of illness was more serious. Piramal e-Swasthya would refer one tenth of the patients to other providers which annoyed some of the patients. The negative word of mouth publicity by patients and government providers stopped others from visiting Piramal. And the public health practitioners would delay the service and make them wait longer if they were referred to by the Piramal e-Swasthya. II. The satisfaction level among the customers was decreasing as the patients were not getting immediate results as compared to the service of quacks who offered steroids

which provided immediate results, though compromising on long term. The quacks were opinion leaders and had political influence. The patients were happy to see immediate benefits. The quacks also threatened the villagers to not visit the Piramal e-Swasthya. Besides this, the quacks also offered flexibility in payments. Patients could pay later and even barter for the service. III. The PSS were young women with low status and were part of a conservative society and many limitations were imposed on them. Hence they proved inefficient as they interacted only with small community and demand for the PeS services decreased. The PSS were lacking in the right motivation for this job because many of them became PSS just to increase their social status. 2. Decision Analysis: