Rural Service Delivery: Business Acumen Trumps All Else?

Any project which uses the informal private sector and entrepreneurship as the basis to deliver services in underserved areas involves risk. The common temptation is to minimize the risk by starting small, but the development sector is strewn with small projects which produced great results but could neither be replicated nor matched with similar results when scaled up. Getting a donor who will support risk on scale is the first hurdle. Fortunately, we found one.

Our project, World Health Partners, combines technology with village entrepreneurs acting as facilitators to connect rural communities with formally qualified urban doctors. Establishing these rural centers called for investment, availability of space as well as more than functional literacy. To allow the project to go to scale, these entrepreneurs also needed to take on an important administrative role so that a group of neighboring rural health practitioners can be managed efficiently and a supply chain for medicines and products can flow cost-effectively. The understandable first step in identifying these entrepreneurs was to get the best educated in the village with investment capability. It was surprising to find so many well educated women sitting idle in villages. They were often from the higher socio economic class for whom the requisite investment was not an issue.

The best human resource of the village, using simple and intuitive technologies tailored to deal with weak infrastructure, delivering commonly-needed health care—the combination should work, right? It didn't. Despite everything going in their favor, these village entrepreneurs lacked business skills and fervor for making that extra buck. They waited in their centers for the community to arrive rather than go and seek out clients who were often unsure of what was being offered. The client load was often a trickle and interest was waning quickly.

So the project quickly went back to its drawing board. After many field visits, we went back to families which were already in the health care business in place of the ‘best from the village’. Women members drawn from the families of makeshift pharmacies, rural health practitioners or informal paramedics became the resource pool despite their educational qualifications often being far below par. They underwent training, mainly on computer skills, and exhibited innate business and social skills which produced quick response from the community and proved to be effective managers. The project implementation team was then able to focus on expansion instead of micro-management, and the project took off after that.

In less than 18 months, the project established a health service delivery network that covers 1,300 rural villages of Uttar Pradesh through a network of 1,300 informal rural practitioners, 120 telemedicine centers, 9 diagnostic centers and 16 franchisee clinics. The project’s central medical facility now conducts 80-160 tele-consultations per day, with a higher volume of visits projected in the coming monsoon months. Sure, we took a risk, and even though the project has and continues to undergo numerous obstacles and constant tweaks, flexibility and quick response to make course corrections allowed the project to build a sound foundation for program management and a scalable field infrastructure.