Accessing the Market by Marketing Accessibility

Management guru CK Prahlad articulated his belief in the creation of new market systems by the private sector whereby they gain higher coverage in the "Bottom of the Pyramid" ('BOP'). People in the BOP have been defined as the 4 billion lives, surviving on less than USD 2 per day. These low-income consumers are seen as a large opportunity for providers of products and services, if they are able to innovate on their business models.

I have spent about 2 years now, closely observing the low-income segment. And frankly, I absolutely abhor and detest usage of the term BOP -- find it very demeaning and sermonising -- maybe I am slightly leaning towards the left, of late :-) Nevertheless, if one were to map CK Prahlad's "12 principles of innovation for BOP markets" to the work we do, the following interesting observations can be made --

1. Price vs Performance equation: CK Prahlad says that just because the poor cannot afford high-prices does not mean that they do not deserve high-quality products. Very true! People understand and demand better services -- they know an MBBS doctor is better qualified than the local village-quack -- they know MDs are specialists -- they demand medicines in strip-packing (though need not be justified). Cost is the barrier, not the aspiration or awareness levels. Infact, sometimes the poor may require better-quality products -- the barrier for investing in a new-product is higher for them and hence, they require a better incentive


2. Use advanced technology with existing infrastructure: CK Prahlad believes that new technologies should be used to overcome barriers in accessibility and operational costs. Most micro-finance institutions have begun experimenting with biometric ATMs, smart cards, point-of-sale devices, etc. However, we believe the consumer is not yet ready to pay for this additional burden -- especially in an insurance-linked service. Because everything adds up to the premium and thereby, making the product less attractive price-wise. Any such investment should currently be financed by the service-provider or an external agency, like the public institutions.


3. Economies of scale: This is a motherhood statement for all kinds of businesses (not just a BOP model) -- CK Prahlad believes that volume is the mantra for return of investment for a BOP business. Can't be truer -- 'cost-of-operations per life' becomes so prohibitively expensive when consumers are spread across a large geography and 'available skilled manpower for selling' is so prohibitively low, that steady-state economics must assume a high number. We have seen that trends in consumer behaviour (number of claims, disease incidence rates, demographic profile of consumers, etc) become meaningless below a critical mass -- which we are yet to achieve even after a year! :-)


4. Be eco-friendly: CK Prahlad believes that products used for BOP market may need to realign their resource composition. All innovations must minimize packaging and consider the impact of the product on the environment. We have not seen any direct implication of this point as yet and hence, have not been required to innovate thus. However, we do appreciate the fact that both climate and environment change can have an impact on the health and health-seeking behaviour of the low-income segment.


5. Customise the functionalities: CK Prahlad believes that products for the BOP market should not be just scaled-down or less-expensive versions of the traditional products. Again, very true. Every day brings in new learning -- our first attempt has been to redesign the organisation structure of the operations team -- both those who sell and those who service the consumers.


6. Process innovation: CK Prahlad believes that products should take into account the specific needs of the BOP market and hence, adapt their processes accordingly. This is core to our belief also. Some we have tried to address -- like closely supporting the patients during admission and discharge at a hospital. Some we still have not -- a lot of the unaddressed needs of our consumers still revolve around transportation costs, opportunity cost of lost-wages and reimbursement of mother-child care (pre-natal, delivery and post-natal care).


7. De-skilling work: CK Prahlad believes that products should be simplified so that they can be serviced by less expensive workers -- this would reduce the cost of operations substantially. Herein, our opinion has been swinging like a pendulum. We started off with the premise that a high number of low-skilled workers (and hence, low-cost) are preferable. Over time, we realised that their motivation levels are not enough to meet our targets and we switched to a low number of high-skilled workers. The problem with the latter model was the 'lack of reach' -- such a lean force was not able to cater to a large geography. Currently, we have settled on a 2-tiered hybrid model of low-skilled and high-skilled personnel.


8. Invest in educating your consumer: CK Prahlad believes that time, money and energy spent in creating awareness amongst consumers, is a worthwhile investment. The methods for reaching out to such an audience has to be innovative also. For us it has been a much-desired but little-achieved goal. As the complexity of the product goes up, the investment on education grows exponentially and the retention-rate (ie recollection about product features amongst consumers) drops inversely


9. Design for hostile conditions: CK Prahlad believes that products should take into account the limitations of available infrastructure in a BOP market. While our experience has been limited on this front, we have come across some interesting products of late. Prominent amongst them being -- a small refrigerator working on a 4-hour battery backup (because of power-cuts in villages), an 'unbreakable' re-chargeable torch and a zero-smoke stove operating on bio-pellets.


10. User-friendly interfaces: CK Prahlad believes that products should be easy enough for the poor households to understand and use. Our own endeavour has been to 'smoothen out' the complexities of our services to the maximum extent possible -- so that anybody can understand. Even at the backend, we data-monkeys are always in debate whether to 'gather more & more information' or 'to keep the formats stupidly simplistic'


11. Distribution: CK Prahlad believes that using existing arrangements (by tying up with other players who already have a financial linkage with the low-income segment) may be an effective model for distribution. We are still in two minds about this point. We started off with a similar premise which has given reasonable dividends. There is a significant learning curve in getting to know your partners well and then, working within the skills available with them. Our perpetual (and as yet, unanswered) query is -- can we do better on our own?


12. Challenge the conventional wisdom: CK Prahlad believes that enterprises have to think differently -- about customers’ needs, product design, delivery systems and even business models. That has been our constant goal -- that we understand the low-income segment better, design a product which best suits their needs, make it appealing enough for them to embrace and hopefully, in the process evolve a good business model for ourselves also!

There would continue to be debates on how best to 'farm' the untapped low-income segment. And of course, whether they should be 'exploited' at all by the 'capitalistic multinationals' :-) CK Prahlad's principles were not entirely new -- there have been numerous attempts to reach out to the low-income segment from the early 90's itself. But what his literature has managed to do definitely, is to expand people's thinking beyond providing social protection to the poor -- now the low-income segment is seen as a profitable market by the commercial players also.

Herein lies the hope of universal access to all 'non luxury' products. Amen!

PS: I will personally strangle the next person who mentions the phrase 'bottom of the pyramid' before me!

An Apple or an Antibiotic a Day?

We have 4 doctors in our team. Maybe add another 0.75% (because he believes he is as good as the rest, even though he is not a qualified physician) and a 25% also (because he is a PhD drop-out). That makes it 5!

Every day that I spend with our doctors, my respect for the health-services industry diminishes by a few notches. Nothing to do with them -- they are perfectly honourable, genuine people. And I am sure that there are thousands of such doctors around. My respect diminishes because I get more insider scoop on how most physicians operate in India. And the more I learn, the more are such practices apparent to me, on a daily basis.

Here are some interesting facts --

• Doctors try to cover all possibilities -- they believe in "shotgun therapy". Medications given to you would most probably cover all the possible diseases which show similar symptoms. Its common for a patient to be treated for both malaria and typhoid at the same time. Hence, exercise the right to know what your prescription contains


• Doctors over-prescribe because they are intimidated by patients who "demand" drugs. More so in rural areas where its common for every doctor-visit to include an injection (probably water) and / or a IV-drip (probably just glucose).


• The doctor's main source of information about new drugs in the market is not an authorised publication, but instead the medical representatives of the drug companies -- who obviously supply biased information!


• The more drugs doctors write, the more they earn. Yes -- doctors receive commissions and gifts from the local pharmacy as well as from the marketing representatives of drug companies. Not to mention that twice-a-year 'conference' in Singapore or the 'educational tour' to Bali


• Doctors have a concept of "prescription fillers" -- ie medications unrelated to the symptom are prescribed along with the essential medicines. Lets see the top-5 drugs sold in India -- vitamins, digestives, cough syrups, antibiotics and injections. Smell anything fishy?


• It is the standard practice (both in rural and urban India) amongst pathologists, X-ray centers, sonography labs, etc to pay 30-40% commission to the doctor who prescribes such tests to the patient. Guess there is money to be made in referrals too!


• Doctors believe (or want you to believe) that generic-drugs are of inferior quality compared to branded-drugs! All drugs are known by 2 names - the molecule name (eg 'paracetamol') and the brand name (eg 'Crocin', 'Anacin', 'Panadol'). After the expiry of the original manufacturer's patent, others have a right to manufacture the same drug as generics. As long as the molecule composition is the same and appropriate quality standards are met, the effect on patients has to be also the same.

"A doctor at the beginning of his career starts with 20 drugs for 1 disease, and the one at the end of his career has 1 drug for 20 diseases"
-- Sir William Osler

So where do we go from here? As consumers, the following list may be a good starting point -

• Have basic knowledge of medicines and how they work


• Know which drugs are hazardous, banned or need to be avoided. Be careful of Schedule-X drugs -- look for a red-colored "Rx" against the molecule-name


• Ask your doctor for more information about the drugs in the prescription


• Avoid tonics, vitamins, health restoratives, etc if you can and instead, rely on a healthy diet


• Ask your doctor to prescribe generic drugs -- you will save a lot of money!


• Report unethical practices to the local consumer forums

The worst form of violence

Sunday is the holiest time of the week -- especially early afternoons. Its when your senses are numbed by the week's exhaustion and all you want to do is retire to a lazy siesta. Hardly the time to be rudely jolted awake. And that was precisely what happened -- on my last precious Sunday afternoon.

I always believed that my work takes me closer to the rural folk. And hence, the underlying assumption that I understand and appreciate poverty better now than I used to before. Yet, this Sunday, the very foundation of it endured a Richter-8.0 earthquake -- I was so wrong!

We reached this small town in north-eastern Maharashtra before day-break -- a place infamous for farmer suicides. The entire set-up was organised on a Sunday -- partly, because of our travel plans and partly, because Sunday seemed the most convenient for the rest. The agenda -- to interview and identify female health-workers from the community -- people who could perform rudimentary diagnosis, dispense basic drugs, provide referrals to secondary / tertiary facilities (if required) and promote preventive care at the village-level itself. Our experience over the past year has shown that the 'ideal candidate' is a married woman of 30-40 years of age, preferably with elderly kids and having significant 'social standing' (for the want of a better word) in the community.

It was supposed to be a long day -- interviewing more than 60 candidates and then, selecting 25-30 of them. Customary exchange of niceties about the weather (read - lack of rain) with the field-team, a quick drill on the selection criteria, and pronto -- we are ready to roll! Hours passed by. And the interview process became more routine with every passing minute. The field-team had done a good job because the candidates broadly fit into the profile we required.

Until...

A girl of about 13-14 years of age walked into the room -- with matted hair and a terrified look on her face. I looked at Tabassum next to me with a question-mark writ all over my face. "Why is she here?", I whispered. She replied, "Its a long story! Will update you later". My knowledge of Marathi is very functional and the dialect spoken in that part of the state, almost alien to me. Hence, I could stitch together only bits of the girl's story -- "parents own a 3-acre plot" .... "soya-bean cultivation" ... "help my parents on the field" ... "have 2 siblings but they're too young to work" ... "left school after 7th".

I asked her sternly, "Do you know why you are here?". "No, I dont!", she replied, as she curled her toes and retreated to the farthest corner of her chair. She went on, "I was told that I can earn Rs 300-400 a month from this job and that money means a lot to us. We are very poor people. Doesn't matter what kind of work it is, I have-to have-to to get it". For a brief moment, I was speechless. I turned an accusative look at my colleague and questioned again,"Why is this girl here? She does not fit our profile at all." It turned out that during a previous field-visit, the villagers pressurised the team to take the girl's candidature. Her family was indeed extremely impoverished and any cash would have been a great relief to them. "So I relented," said Tabassum,"No harm in interviewing and then rejecting her later on".

Soon after that, we let her go. She almost sprinted out -- now that her agony was over -- so mightily relieved that she forgot a thank-you.

We didn't end up spending the night in the place. Instead, we took a 7-hour bus ride to a larger town, a few hundred kilometres away. The noise of the rickety bus and bumpy roads kept me awake. As the bus tore into the darkness the incident replayed on my mind, many times over --

• Isn't that the money that I spend on a beer over the weekend?
• Or ... on a single phone-call to an overseas friend, discussing random gossip?
• Or ... that movie ticket to a multiplex cinema?
• Or ... that silly t-shirt I won't wear more than 5 times in my entire life?
• Or ... that single dish in a fancy restaurant, which would be left half-untouched?

Yes -- quite the cliched 'guilt conscience' that we privileged folk go through, isn't it? Maybe. Yes, maybe.

I don't understand poverty. I would never be able to understand it. Because my exposure to it has been so very limited -- a few glamourised movies, socialist literature written by Western idealists, fleeting glances at pop-cultured TV news and leftistly-militant (or should it be militantly-leftist?) activism of some luminaries.

I am humbled by my total ignorance. I am too intellectually-challenged to be questioning the reason for its existence. Or the socio-economic and socio-political implications of poverty. Right now I am just curious -- because how little it impacts my daily life!!

"Poverty is the worst form of violence" - Mahatma Gandhi

Singh is not King!

The following is an extract from my blog in a social-networking website, written a few months ago. It does not reflect the official beliefs and opinions of Swasth India, as an organisation.
-------------------------------------------------------------------------------------------------------------------------------------

I work in the services industry. I have always worked in the services industry. From a 'cost plus' model in my previous organisation, I have moved to a 'high volume, low margin' game. From being a 'technical advisor' , I have migrated to being a 'service integrator' . My customers no longer belong to corporatedom -- they belong to the 'Bottom of the Pyramid' (as CK Prahlad would call them).

The last month-odd has been madness at work -- sales pressures, demanding customers and a lethargic sales-force. But its been a very enlightening experience. I have tried to pen-down my Top-10 learnings about my Customer. And having said that, I am aware that I still probably know next-to-nothing about him either. Most probably, all of this is common knowledge. And in all probability, this stuff is taught in great detail in marketing courses of B-Schools. And certainly, my colleagues in the field would know infinitely more than me. Still, lemme make a sincere attempt to articulate my own experiential learnings:

1. Customer is the King: This is self-explanatory -- I will let it be! :-) Our customer demands the best-in-class service, he wants to be pampered, he demands to chew-off your head for lunch, he demands that you serve him coffee dressed up as an Elvis in a pink leotard. Do that. Swallow your pride. Entertain him!!!
2. Customer knows whats best for him: Ladies, do you like to be told that green makes you look FAT? Or guys, that your favourite T-shirt from college is only fit for a mop now? Of course NOT!!! We know what works best for us and please f**k-off, if you think you know better how we should conduct ourselves. Then ... errr ... why do we make the mistake of assuming our customers HAS-TO like our product -- the 'greatest invention since bubblegum' , on which we had spent precious 3 months designing using complex algorithms and in-depth research? The customer just wants a Moped for commuting to the nearest metro-station and be at ease till he returns from work -- he doesn't want a Mercedes-SLK Convertible parked at the station, which would keep half of his mind occupied for the entire day at work!!
3. Tiny drops make the ocean: All the little cost-elements used-up in servicing your customers might seem insignificant; but they all add up to monstrous proportions. These can be -- that fancier prospectus for your consumer, that extra 0.5% incentive to your sales force or that poster negotiated at the last moment with the printer. The '80 : 20' rule does not seem to apply here. Instead it should probably be the '80 : 80' rule -- 80% of your Opex would be made up of 80% of those tiny, tiny items. When you skim over that Excel sheet, these bloody gremlins would be happily sitting in a tiny crevice -- undetected and undeterred.
4. Seeing is believing, touching is knowing: Yes, everybody wants to touch and feel the product. No fancy stories or promises would make them budge an inch. They would only be convinced once they know it works! And in the service industry, the problem compounds manifold because there is nothing to physically 'touch and feel' . Hence, the only remedy is to induce trials. Get the first bunch of customers (somehow and anyhow), make them use the service (somehow and anyhow) and then, expect the rest to follow when the first bunch spreads the word around (a good one, hopefully!).
5. 3-point Contact Rule: Lemme rephrase it as "Atleast the 3-point Contact Rule". Your Excel sheets should provision for costs relating to atleast 3 visits to the prospective consumer. The first would be 'Meet, Greet and Explain' contact. The second would be 'Follow-up, Clarify-Doubts, and Convince' contact. And the last one is the real b**ch - 'Seal the Deal' contact. If the third contact is not fruitful, go back to Contact-2 and repeat until either you or the prospective customer throws up his hand :-)
6. A Lower price is More valued: Yes, we have heard this so many times before. B*lls to 'value-added services' and 'better customer care' . Please refer to Point-[2] -- your customer knows what works for him. And at the 'bottom of the pyramid' (God! I hate this phrase), people want the maximum bang-for-the-buck. So go back to that drawing board, strip apart all the frills and start with the bare-minimum -- you have a better chance at making it to the finish line. But then again, it only increases that probability by a few basis-points :-)
7. Give him options: Ever wondered why does your credit-card company has those variations - Silver, Gold, Platinum (I suppose, there's nobody with an Amex-Black here :-)) ? Because people need to know the range of choices available to them. Never mind if you know that Option-B is redundant; because 90% of consumers are sure to gravitate towards Option-A anyway. Unless you show your prospective customers Option-B, they will keep waiting for it to come up. And this they know will happen ultimately. Hence, sooner the better -- you dont have the time, but the customers have an infinite supply of it.
8. Gharki murgi, daal baraabar: I dunno of an English equivalent of this beautiful Hindi-phrase :-) If your sales force is drawn from amongst your target consumers, then convincing becomes a tougher task. There is this school of thought which believes that a sales force recruited from the common-mass, gives greater credibility to the product -- after all, the sales person cannot disappear with the money. But I believe this applies only to a physical product -- for a service, (especially a new, untested one) customers demand best-in-class knowledge and experience -- which can 'never' (sic) come from "somebody, who till the other day was one amongst them".
9. Work on your precis-writing skills: Keep the fancy 4x4 matrices, the IF-THEN-ELSE clauses and the Waterfall graphs only for your drawing board. When it comes to spreading the message for your service offering (and the price-points), a KISS works best -- I meant 'Keep It Simple & Stupid' -- err, maybe you can even try an actual kiss. You never know, it may just work -- or you might end up getting lynched!! :-)
10. What's in a name? Everything!: Be very careful of what you name your product as. Brush-up your knowledge of the local language. Calling something a 'Fund' instantly means you are from a scamster agency out to dupe the poor people of their hard-earned money. Calling something a 'Trust' means people expect you to be charitable!! Anything that remotely refers to 'protection' or 'safety' is unacceptable -- after all, talking of ominous happenings is bad-luck for most people :-)
    

And yes, its a never-ending learning process. Maybe in a week's time, I would strike-off half of the items in the above list. Or add, 15 more to them. Or, maybe I would be dressed up as a Pink Elvis, serving filter-kaafee. But I know where my cheque comes from -- from my dearest Customer. And he demands the Best, the Cheapest and the Simplest!! He is the KING!!

Doctor Testimonials for Arogya Nidhi

Testimonials provided by some of the empaneled doctors from the hospitals and diagnostic labs in the Arogya Nidhi scheme.

Promotional Film on Arogya Nidhi

A short-film used during the promotional campaign used for the Pilot Launch in Latur, Maharashtra (March 2009). The film itself is broken up into 2 parts - (i) the former, showcasing some of the problems faced by the target consumers and (ii) the latter, demonstrating how some of these problems can be mitigated by subscribing to the Arogya Nidhi scheme

Training of 1st batch of CHWs

On October 13th, 2008 technical training was started for 30 female Community Health Workers (CHWs) from Latur and Solapur districts. Called 'Arogya Sakhi's, they would provide doorstep healthcare services (both curative and preventive) such as - basic consultations, first aid and emergency care, informed referrals and maternal and child care. The Arogya Sakhi is trained on the proper usage of the Diagnostic Kit and the Drugs Kit provided to her.

The Arogya Sakhis would be deployed by the NGO Swayam Shikshan Prayog for providing outpatient services in Pilot villages in these 2 districts. The 10-day training is being conducted by Dr Shashikant Ahankari and his team from HALO Foundation at their training premises in Anadur, Turjapur. Fortnightly refresher courses would be conducted over a period of 3 months, thereafter.

The main benefits of the Arogya Sakhis are -

• Significant reduction in outpatient expenses for the community - easy access at the village itself and minimal fees compared to an MBBS / BAMS doctor
  
• Ease in promotion of any additional health products - Arogya Sakhi enjoys the trust of the community
  
• Reduction in the cost of distribution of health products - no additional sales force required

The training covers multiple aspects - roles & responsibilities of a CHW, awareness about human anatomy & physiology, maternal & child healthcare, introduction to diseases, diagnostic flowcharts for detection & treatment of common illnesses, detection (and subsequent referral) of major illnesses, usage of instruments in the Diagnostic Kit and usage of OTC drugs and consumables in the Drugs Kit