1. Forthefirsttimein India, global harmaceutical
a
p
company entbeyond
w
the
traditional
medical
representative byaddressing
route
theunmet
health
needs f
o
rural ndia,
I
thereby
dramatically
improving
access
tomedicine atthesame
while
timeprovidingpportunities expand
o
to
business an innovative
in
andsocially
responsible Novartis
way.
isthefirstpharmaceutical
multinational asocial
touse
business
model
toreach
India'suralmarkets.
r
Forsome
800million
men, omen
w
andchildren
inmore
than600,000
villages
across
India,he ideaof accessible,
t
affordable
andhigh-quality
medicines
is
oftenasremote
astheirruralhomes.
Institutional
healthcare ruralIndiais
in
limited
tothegovernment
structure.
Private
healthcare
servicesreindividuala
driven
andunstructured.
Thegovernment health
offers
services
freeofcostbut
over 0percentrural eople forhealth
7
p
pay
services.
Novartis
commissioned tounderstand
MART
theheath
needs,
behaviour
andattitude
towards edicine
m
inrural reas.
a
MART thattheawareness
found
ofhealth
issues aspoor,
w
andpeople ccessed
a
health
services trying
after
various ome
h
remedies.
Thedelay
intreatment
andtheensuing mergency
e
wereconsidered
natural.
Ailments
related
tonutrition,
allergies
andinfections
werenotdifferentiated,eading
l
tothepatient
notapproaching
therelevant
health
service rovider.
p
Thisleads
toasignificant
waste money ndnorelief romailments. of
of
a
f
Many
these
peopletayed
s
undiagnosed
because
theyeither idnotunderstand
d
their
symptoms,
orthedoctors eretoofar away, theywereafraid thecosts
w
or
of
involved
orofsocial
prejudice.
Womenndchildren ere
a
w particularly
vulnerable.

2. Tuberculosis wasidentifiedsa keyailmentn ruralareas
(TB)
a
i
andthiscase
focuses nTBtreatment.
o
Problems
Themainproblem healthareforruralpeople asrelated
in
c
w
tothe4As,which
isdiscussed
below.
.
Affordability
- Perceived
orexperienced
costoftreatment
forTB,if thepatient
hastobe
taken a nearby
to
townfortreatment
(treatment
period
isfromsixto nine
months)
isestimated
tobemore INR
than 10,000 ingovernment
health
centres,
againstNR15,000through
I
private
treatment. government
In
centres,
patients togotoprivateiagnostics
had
d
centresnd medicines.
a buy
- Forsimple
infections skinallergies,
or
thecostof private
treatment
was
between 250-1,000.
INR
.
Availability
- Access health
to
services ndmedicines
a
hasbeenthe major
problem.
Qualifiedoctors,
d
private government, licensedrugstores
or
or
d
arenot
available
invillages.
Therefore,
thereisthecostoftravelling
totheblock
town, here
w
thePHC
(public ealth
h
centre) private
ora
doctorslocated.
i
.
Awareness
- Patientshavepoordiscerning
capabilities nd cannotidentifythe
a
appropriate
doctorortheirailment.
f

3. - They
have
noidea
ifthemedicines
prescribed
bythedoctor rethesame
a
asthose
given
bythechemist.
- Patients ave
h noideaif the"medicines"
arepreventive,
curative r for
o
maintenance.
.
Acceptance
- Patients theirownperceptions ailments. those
have
about
Only
ailments
thataffectheirworkproductivity
t
areattended
to.
- Treatment
ofchildren ets
g priority ver hatofadults.
o t
Hence,
Novartis theneed reliable
felt
for
health
services ndmedicines a
a
at
reasonable
cost.
.
MART'sStrategic Suggestions
Tocreate
awareness
among
thelocal opulation,
p
establish
anetworkf"foot
o
soldiers"
recruited
fromvillages
toworkas"health
educators". would
They
support
patients
forallhealth
services
andfollow
uptocomplete
thetreatment rocess.
p
Toimprove
theavailability health
of
service,
qualified
doctors
needto be
identified fromamedical
either
institution
orindividual
practitioners
intowns
withpopulations
greater
than50,000(blockowns
t
orbelow).
Tomake
health
services
affordable.
Patients
wereoften
mis-informed
about
thetotaltreatment
costandbelieved to bemuch
it
higherhantheactual
t
cost,becausef whichtheyavoidedeeking
o
s
treatment.
Thiswrong
perception ascorrected,
w
afterwhich
patientsealized
r
thatthetreatment
was
affordable.
Tomake
health
service cceptable,
a
theprogramme
identifiedritical ealth
c
h
issueselated
r
toinfection,
nutritionnd
a allergies. Arogyarogramme
The
p
addressed
these
identified
issues,
delivering results ndthereby uilding
good
a
b
trustwithin
thecommunity.
.
.
.
The Solution
To addresshe healthissuesin ruralIndia,Novartis esigned arogya
t
d
an
(meaning health)
good
programme,
thewinner fthebestlong-term maro
rural
ketinginitiative(RMAI 008 SilverAward, OW 2008 SilverAwardandGolden
2
W
Peacock
Awards 008), hich
2
w
offered
pharmaceutical
solutionsndalsoina
tegrated
theneed network ithlocaldoctors,
to
w
educate otential
p
customers
(patients),
andlinkpatients
tospecialized
doctors.
TheNovartis addressed
team
thechallenges
byusing
aninnovative approach make
direct
to
villagersware
a
of prevalent
diseasesndencourage
a
themto seektreatment.
Bylate2006,
theArogya
Parivarnitiative aslaunched iththe helpof MART a pilot
i
w
w
as
programme
inUttar radesh
P
andMaharashtra.
Arogya arivar
P
follows decentralized where
a
model
thefieldforceisinautonomous (250cellsin2011), ach
cells
e covering radius
a
ofapproximately km
35
or 20 miles. ach
E cellis managedya supervisor,
b
assisted ya fewhealth
b
educators
whocollaborate
withlocal ealth
h
professionals,
pharmacy
chains nd
a
NGOs
toaddress
thewhole
"patient
flow",ncludingducation,
i
e
diagnosis,
treatment, elivery,
d
andavailability
andaccessibilitymedicines.
of
A keydifferentiatoroffering
is
patients
integrated
solutions health
to
problems
ratherhanmainlyelling
t
s
products
tohealth
professionals.
Products
selected
for
theinitiativeresimple
a
touseandpackages
arereduced
insize
tokeep
out-ofpocket
costs Theinitiative ims builda sustainable,
low.
a to
profitableusiness 1
b
thatimproves
access healthcare
to
among
theunderserved
millions rural '"
in
India
bycreatingwareness,
a
enhancing availability,
local
anddesigning
appeal- ir

4. ingandaffordable
health
solutions.
Thissocial usinesspproach
b
a
represents
a
mixofcorporate
citizenship
andcreativentrepreneurship.
e
AnArogya
brand
wascreated the unique
for
healthservices ffered
o
bythe
company.
Theumbrella randhelped overcomerand-related
b
to
b
issues
and
became
easyrecallfor the illiterate
andsemi-literateillagers.
v
TheArogya
Parivar
brand
issupported
byconsistent
graphicsfleaflets,
o
banners,
education
programmes,
uniformsor health
f
educatorsnddecorations bicycles.
a
for
All
collateral
isdesigned
keeping
inmind
thenature
oftheaudience,
particularly
in
terms literacy ndcomprehension Effortsmade focus
of
a
levels.
i
to
onspecific
disease/s
onrespective Disease through ctive
World
Days
a
doctor articipation.
p
Tocreate
awareness
among
thelocal opulation,
p
Novartis
established
anetwork'
of "Health ducators' recruited
E
(HE)
fromvillageso provide atients ithsupt
p
w
portandfollow
uptocomplete
thetreatment
process.
TheHE
wasprovided
with
branded
T-shirts, andbags. ovartis brandedudiovisual comcaps
N
used
a
vans,
munity
meetings
andadvisory
leaflets communicate
to
thebenefits
totherural
masses.
The"HE"movesromvillage village
f
to
ona permanent
joumey
plan
(PJP). conduct
They
group
meetings,
identify
patientsn different
i
households,
educate
thefamilyandconvince
themof the needfor treatment. also
They
ensure
thatpatientsave
h theirsupport
when
theydecide
tovisitthedoctor.
Itis
alsoimportant
thatthemedicine
isconsumed
asprescribed.
One-on-one
communication necessary convince
is
to
thepatient ndtheirfamily.
a
Aninformed
patient more
is
positively
oriented
towardsompleting
c
thetreatment
(there
isa
tendency
todiscontinue
treatment
assoon
asthepatient some
feels
relieO.
The
HE
serves
twoblocksnd
a 30activeatients ispaid 1,500
p
and
INR
permonth
(commission
of10percentfromsale
ofmedicines),
andnew
products
arebeing
added
byNovartis
tosupplement
income.
TheNovartis
expense
oncommunicationandpromotion
iscompensated
through
themargin
fromincreased of
sales
theirmedicine.
Theinitiative structured "social usiness'
is
asa
b
andis a perfect
opportunity
to expand
thereach healthcare those
of
to
people
whofalloutof thecurrent
system
simply
because
theydonotliveinurban
orsemi-urban
India.
Arogya
Parivar
builds
ona "bottom-of-the-pyramid"
business
approach
meant
tosellproductsndservices low-income
a
to
populations
inemerging
countries.
Arogya arivar
P
istargetedtallagegroups,
a
especially
women ndchildren.
a
The
target asselected nthebasis publishedataandmarketesearch.
w
o
of
d
r
This
population
waseffectively
disfranchised
fromtherighttoquality ealth.
h
Arogya
Parivar a unique
uses
business odel,
m
combining
techniques by
used
pharmaceutical
andconsumer
goods
companies. fundamental
Its
innovation
rests
onapplyingmarketing
a
mixbased
onthe4As-awareness,
acceptability,
affordability
andavailability-adaptedlow-income
to
markets.
The
communication used
tools
fortheArogya arivar
P
aredetailed
inTable .The
1
communication
strategy
included:
- One-on-one
interaction
atthecommunity (SHGs)
level
- Branded
vanusing
audiovisuals
onthevarious ealth
h
issues ndtheneed
a
toseek
treatment
- Branded -shirts,
T
caps,branded
bicycles,
handbills, charts, atient
flip
p
cards.
Impact
Thecurrenteach
r
oftheproject
tothose million
50
people, 250ruralcells,
or
where cellis anareaof 25-30 sq.km,including 0-100villages ach,s
a
8
e
i
indicative
ofthemodel'success
s
todate.

5. Table1 Communication
Tools
Communication
Tools
Leaflets
Communication theailmentsndtheirsymptoms
about
a
Flip
charts
Tocommunicate
themethods
ofidentifying
symptoms
forailments,
causes failmentsndnecessary
o
a
treatment
procedures
T-shirtsandcaps
Toidentify
the"health
educators"
withtheArogya
Programme
Use
communication
tocreate highdecibel
a
Branded
vans
by"health
educators". recallorthe
Brand
f
Branded
bicycles Used
audience
exposed
tothehighdecibel
brand
promotion
Patient
cards
Foridentifiedatients
p
tocarryasreference
tothe
concerned
doctor
People
acrossfive stateshaveaccessto qualityhealthcare
with thousands
of
doctorsand hundreds pharmaciesbeingservicedby ArogyaParivar. ne
of
O
hundredandthirty-eightdistrictsin UP,Maharastra, P,Biharand Rajasthan
M
arecovered
underthe initiative, nd12,000patients
a
havebeentreatedsofar in
1,000villages. urrently,
C
morethan20 healthprogrammes
arerunning,covering tuberculosis,
respiratory
infections, kinandgynaecological
s
infections, iad
betes, icro-nutrients
m
duringpregnancy ndduringchildhood,ntestinal orms,
a
i
w
acidreflux, oughandcold,aswellasallergies.
c
Arogya
Parivar asbuilta healthynetwork doctors,paramedics ndpharmah
of
a
cists,whosharea similarmissionandsupportthe initiative.It hasalsoestablishedstrongalliances
with pharmacy
andhospital hainsthat serveas a good
c
complement Novartis.
to
Thecompetitive
advantage ArogyaParivaris that it makeseveryactorwin.
of
Patients
areeducated
andavoidhealthcomplications.
Healthprofessionalsee
s
morepeople
thantheymightotherwise, ndarealsotrained.Healtheducators
a
whoworkforthecompany
arelocallybased, eceive
r
extensive
training,andgain
additional tatuswithintheir communities. for Novartis,heyare improving
s
As
t
healthcare ndchanging livesof peoplein need.
a
the
A holisticmodel, rogya
A
Parivar
hasensured
that areasthat werehithertorelativelyuntouched traditionalmedicalrepresentativesre now on the road
by
a
map.Theinitiative
hassucceeded bringingin additional evenue,
in
r
thusadding
to the bottomlineof the company.
I FIG. 1 I
The Arogya Model
SocialImpact +
Philanthropy
Social business
Bottom-line
Growth
-I-
PR/Damage
control
Performance-driven
CSR
I
I
I
I
---.----
J
~

6. Sinceits business
modelis not basedon puredonations, rogya
A
Parivarsan
i
economicallyustainable
s
"socialbusiness",
scalable morepeople
to
inIndia
and
abroadthat aimsto:
.
Provide health education (hygiene,nutrition, disease awareness) nd
a
improvethe qualityof life for localpopulations
.
.
.
.
.
.
Improve
publichealthwithoutthe needfor costlygovernment
intervention
or
limited-duration
NGO
projects
Createa revenue
streamfor localpersonsassociated
withArogya
Parivar
Increase
footfallat localhealthproviders
andbusiness
partners
(encouraging
theirsupportto ruralmarkets)
Generate
income
forNovartis
andbuildbrandequitywithanupwardly obile
m
population
Highlighted
byNovartis internalandexternalcommunication
in
(inthesame
manneras CSR)
FulfilformerPresident
AbdulKalam's
visionof PURA, is,providing
that
urban
remedies ruralIndia
to
.
.
Learning
Thepoor rewilling
a
topayforquality
andeffective
treatment.
Earlier,
malepatients erereluctant consult
w
to
ANMs
(females);
however,
theArogya
HEis maleandableto gainacceptance,
convinceatientsnd
p
a
support
them.
Chemists
began
stocking ovartis
N
productsnce
o doctors egan
b
prescribing
them.
Doctors
aremotivated
duetotheincrease
inincome,
andaretherefore
willingtoparticipate
intheprogramme.
Doctors reprofessionally
a
satisfied
thatpatients
nowcomplete
treatment
andgetcured.
.
.
.
The Way Forward
TheArogya rogramme
p
iscognizant theimportance working ithNGOs,
of
of
w
especially
inawareness
programmes
viacomrnunity-Ievel
meetings
andhealth
camps.n 2011,theArogya
I
programme
plannedo forma consortium at
t
of
least 0NGOs
2
inIndia
toprovide
targeted
intervention
inthecausesfdiabetes,
o
tuberculosis,
diarrhoea
andalsofortheprovisionfclean
o
water.
Plans
havebeenmade replicate
to
andadaptthe modeln othercountries
i
throughout and
Africa Asiaover henextfewyears.
t
Motherandchildnutrition,skinallergyanddiabetesare beingaddedto the list
of treatments. ovartis
N
alsoplansto add alliedproductslike sanitarynapkins,
waterpurification
productsandcleandeliverykits to supplementhe incomeof
t
the HE. heaccompanyingideoexplains
T
v
howthisprojecthasbeeninitiated
and
implemented UttarPradesh.
in
Discussion Questions
1. Whatproblems the ruralcommunity
of
wereaddressed
throughthis model?
2. Ust the keyreasons the sustainability this model.
for
of
3. Doyouthinkthis modelcanbereplicatedin othercountries? yes,howand
If
in whichcountries?