E Healthpoint’s learning partnership with P&G

Amid the commotion of the Washington [mHealth Summit](http://www.mhealthsummit.org/) this week we managed to catch Dr. Al Hammond, cofounder and CEO of [Healthpoint Services Global](http://healthmarketinnovations.org/program/e-health-point), to learn about an innovative partnership between his company and “a small company from Cincinnati called Procter & Gamble,” as David Aylward, Director of the mHealth Alliance, joked during his opening remarks, announcing Hammond’s news. Dr. Hammond is also a member of Ashoka's [Leadership Group](http://www.ashoka.org/node/4774). Here is an excerpt of our conversation.

**Rose: You deliver services in rural areas via two-way video—doctors in cities, patients in villages. How does this work?**

We started Healthpoint to address a fundamental problem which is access. To seek care, rural people have to deal with informal providers—quacks—or with government doctors that show up one afternoon per week. Or they get on a bus to go to a city, which takes a whole day. They lose income and pay bus fees. The cost of access is more expensive than health care itself, so people put it off, they defer. That is the situation of roughly 3 billion people.

I have been studying the health market in rural India for a long time. The only way to scale is to be successful commercially. We are spending $40,000 per village to build a facility.

This model is still fairly new, and it came out of understanding the access problem, and the technical revolution under way at point of care diagnostics. If you can put modern diagnostics at patients’ point of care they might get the right drug. Currently they have to guess. For example, if you you have a fever, you’ll be given a malaria pill. Amit Jain, our Indian partner, helped us realized that offering safe water is an excellent social marketing device. If you have an unmentionable disease and you don’t want people asking why you’re going to the health clinic every week, water provides a social cover – you can tell your family you are going to pick up the water. It brings daily traffic to the clinic.

**What services do you offer?**

We offer primary care with an increasing focus on chronic conditions, supported by electronic medical records and a pharmacy.

The largest reason for indebtedness is hospitalization – if you can prevent this by catching high blood pressure or diabetes early you can prevent the devastating impact on families. Village health workers with a mobile phone and diagnostics can catch these things – our health workers visit every customer every two months regardless of reported health problem.

Everyone has assumed you have to provide free care to poor people. When you do that they get lousy care. They would much rather pay for good care as long as it’s within their means. We charge less than a dollar for a doctor consultation. That’s affordable. We also offer safe water for nickel a day. Yet we can actually be a sustainable company at these prices.

**What are the limitations of telemedicine?**

Our patients actually prefer it to having a doctor present -- particularly women. They are used to dealing with male quacks. One, it’s a little safer if the doctor is not in the room. Two, the doctor cannot gossip about patients because they are not local. That turns out to be the killer value for Indian villagers. Doctors have found they can do quite a lot via telemedicine. They can order really good tests to know whether the condition is malaria or not. So far, our doctors have diagnosed epilepsy and brain tumors over the telemedicine system. There are some things where you need a physical exam, such as gynecology, and for that patients are referred to a specialists.

I think telemedicine is the future of rural health care even in the US. There are not enough doctors to see patients in the rural areas. In developing world there will never be enough doctors in rural areas. The only hope for quality health care is telemedicine with no other solution.

**Are there stories that stick out in your mind about the care Healthpoint centers have provided?**

A farmer in one of our villages was having pains in his shoulder and neck. The government primary care center sent him home with aspirin. The pain got worse, and he couldn’t work. His wife convinced him to go to one of our clinics. Our doctors discovered he had a history of seizures, and they sent him to a diagnostic center in the city where the epilepsy diagnosis was confirmed. Now we sell him medicines every week and he is fine.

**What is your company’s proposition to Proctor & Gamble?**

This is a learning partnership. We are learning from P&G how to do some parts of our business better. They are learning from us how to provide services to poor rural people. They are historically more of a product company. We think working together we can scale this to more countries rapidly. We will build out an ecosystem for scale. We are also partnering with the mHealth Alliance for this reason.