Improving motorcycle based healthcare in India: the conclusion

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The view from a rooftop tibetan restaurant on our last night McLeod Ganj: Hanuman Ka Tibba looms over the foothills, as one of the smaller mountains in the range, it rises to a ‘mere’ 18,500 feet (5,639 m).

We made it through 3 all-too-short weeks in India.  At the end of week 2, we left Bihar and returned to Delhi.  Upon analyzing our data, we found that the Last-Mile-Outrider (LMO) motorcycle program was at a tipping point – it had been able to slowly grow in a highly competitive landscape (pharmaceutical delivery by WHP directly competes with large established incumbent pharmaceutical corporations), and needed to take decisive action in order to grow and reach a minimum self-sustaining size and achieve profitable economies of scale.

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A typical Delhi street scene: The safari comes to us / Aloo Tikki, fried potato pancake with veggies and spices / traffic melees are quintessentially Indian.

Although our team generated a set of actionable recommendations for the LMO program, a part of us wanted to ‘lose’ some paper work, or perhaps a computer would crash.  This would buy us at least another week in India, a place that had begun to feel like home.  We schemed while consuming possibly unsafe amounts of Indian street food, but alas, no paper work was lost and our cloud storage actually worked for once.  Sealing our own fate, we presented our findings to the leadership at WHP.  A summary of the recommendations:

Optimize motorcycle routes by:

  • Gradually raise sales goal in order to achieve self-sustainability- Improve sales conversion rate by:* Changing the sales model from “visit & sell” to “call & deliver”

    in order to reduce non-value generating follow-up visits

    * Adapting frequency of visits based on economic order quantity

    * Reviewing outlets based on sell-trough and success of 4 verticals

    * Test more entrepreneurial approach in 1 district: let LMOs manage all

    day-to-day operations

Implement a structured hiring and training program that:

  • Incorporated structured interviews and short exams
  • Involves high-performing LMO riders in coaching and mentorship
  • Implements a mechanism for anonymous upwards feedback
Aphay Kumar, one of our favorite LMO's showing off his ride.  Note the SkyMed (WHP's brand) bag on the back!

Abhay Kumar, one of our favorite LMO’s showing off his ride.  SkyMeds (WHP’s brand) are strapped on the back!

We have high hopes for not only the LMO program, but WHP’s vision as a whole.  Their rapid prototyping approach to implementing self-sustaining, market based public health, has left a strong and positive impression on a rag-tag group of two consultants and a former military officer.  We look forward to internalizing the lessons from our project and spreading the word on WHP and the ability for small organizations to make big impacts in the world of development.

And of course, we managed to sneak in some weekend adventures.  The first weekend our team pilgrimaged to Dharamshala and McLeod Ganj, in the state of Himachal, in the foothills of the fabled Himalayas.  Dharamshala is the home of the Tibetan exile government and our experience was as if we spent a weekend in Tibet itself.

[Clockwise] Prayer wheels / monks need to stay out of the sun too / bustling downtown at sunset / the team hanging out at a snowmelt river

[Clockwise] Prayer wheels / monks need to stay out of the sun too / bustling downtown at sunset / the team hanging out at a snowmelt river 

On the second weekend, we made a pit stop at the town of Bodh Gaya, in southern Bihar, where we visited the very location that Siddhartha Gautama, otherwise known as Buddha, attained enlightenment over 2500 years ago.  Finally, we finished our sight-seeing with the obligatory Taj Mahal visit.

A monk from Myanmar gave us a monastery tour / leaves from the legendary Bodhi tree (Ficus Religiosa) / Tammy and Wolfgang ponder enlightenment in the rain

A monk from Myanmar gave us a monastery tour / leaves from the legendary Bodhi tree (Ficus Religiosa) / Tammy and Wolfgang ponder enlightenment in the rain

Parting shot

The guestbook at the Tibetan Exile Museum: FREE TIBET

Healthcare for India’s rural populations: Delivering medical services on motorcycle to the last-mile in the State of Bihar

The Bihar countryside

The Bihar countryside

Team WHP is in India working with WORLD HEALTH PARTNERS  to evaluate the sustainability of motorcycle courier-based pharmaceutical delivery and medical sample pick up for patients that lack access to centralized and sophisticated healthcare.

India: a land of contrast.  In New Delhi, where our team has spent the first week, boasts some of the highest concentrations of wealth and power in India, but also an expansive population of poor and marginalized citizens.  Healthcare in India takes a similar tack, with top medical care available to those who can afford it, leaving the majority of the country with highly variable access to basic healthcare services.

We started our project in the New Delhi headquarters of WHP, one of the world’s most lauded and agile healthcare NGOs.  Backed by the Gates Foundation, WHP applies innovative market-based solutions to improve the quality of healthcare for India’s rural poor, including running Telemedicine centers and an developing an in-house generic brand of pharmaceuticals.   Specifically, we’ve arrived to investigate the operations of WHP’s Last-Mile-Outrider (LMO) Program, that delivers pharmaceuticals and provides sample pick up for distant patient care regions.

The team spent the first week in the office, trying to beat the record temperatures (114 degrees!), preparing for our immersion in the state of Bihar, one of the most underdeveloped and poor regions in India – in week 2, we dove right into ethnographic interviews, data collection, and the lives of Bihari’s.

Where the cool kids hang out

Where the cool kids hang out in Bihar

Bihar was a world apart from Delhi – the oppressive humidity (highlighted by pre-monsoon rains), the striking beauty of a far-inland tropical plain, the stark austerity of the average villager, and the random fact that the best lychee fruits in all of India come from Bihar, all created an experience unlike any other.  As we drove around Bihar to conduct our research, we saw firsthand the potential difficulties in delivering basic healthcare services (or any services) to some of the most remote regions in the country – how might we optimize and improve WHP’s current delivery and courier operations?  Our minds were racing.

How can we teach someone anything about optimization when they take it to the next level? #nextlevelbatchprocess

How can we teach someone anything about optimization when they take it to the next level? Eat your heart out Terry Taylor
#nextlevelbatchprocess

Within the first day, we saw the varied and complex landscape of healthcare services, to include the surprising proliferation of village scale pharmacies, a wide-ranging offering of medical “professionals,” and the significant opportunities for innovative solutions to make an impact in the effectiveness of LMO motorcycle couriers.

TOP & BOTTOM: The team bears the Bihar heat & humidity (barely)

TOP & BOTTOM: The team bears the Bihar heat & humidity (barely)

TOP: Getting into the details BOTTOM: Last-Mile Healthcare is a family affair: Father and son help a patient connect to a remote Doctor on ReMeDi Telemedicine software

TOP: Getting into the details
BOTTOM: Last-Mile Healthcare is a family affair: Father and son help a patient connect to a remote Doctor on ReMeDi Telemedicine software

As the week progressed, we began to discover the challenges in implementing a self-sustaining motorcycle delivery operation.  The endeavor faced obstacles such as a lack of economies of scale, inefficient order quantities (of drugs to pharmacies and doctors), and typical personnel issues that plague projects in the developing world.  Despite the daunting issues, team WHP gathered a host of data and reluctantly returned to Delhi, where we found the 110 degree temperatures to be “a dry heat” and the lack of cows, trash, dogs, and gangs of curious villager to reflect an absence of charm.

Bringing our 1st world problems to Bihar: "We'd like to pick our own fresh Lychee"

Bringing our 1st world problems to Bihar: “We’d like to pick our own fresh Lychee”

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Nikita & Jon fit in with the locals

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Everywhere we went, crowds of curious onlookers surrounded us. We were the “Bieber” to their “Fever”

Now back in the Delhi office, proudly wearing the badge of having experienced the “real India,” and armed with battle-hardened digestive systems, we began the task of analyzing and generating a cohesive recommendation for WHP in order to take decisive action on their LMO program.  Stay tuned.

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The villagers promptly recommended: “Leave the jumping to Jeremy Lin and stick to your MBA.”
Either career path seems dubious at this point