Photo: iStockphoto
Photo: iStockphoto

We need innovation and entrepreneurship beyond e-commerce

If sectors like healthcare are ripe for entrepreneurial disruption, then why is the reality different?

Recently, India became the third largest start-up location globally. We are also the fastest growing location for start-ups in the world. That’s great news. As a first generation entrepreneur co-founding a tech start-up 35 years back, I can only react to this achievement with great joy. But, it also makes me wonder if it is too one-sided—with a few sectors crowding out others.

India is a land of contradictions. Start-ups are no exception. Sectors like e-commerce or mobile payments are attracting strong interest among entrepreneurs and investors. On the other hand, sectors like healthcare, clean-tech and education have lagged. India roughly spends under 2% of gross domestic product on public health, under three on clean-tech and under four on education. In all these sectors, accessibility, affordability and effectiveness are huge problems. Let me illustrate with healthcare. Non-communicable diseases (like diabetes, stroke, cancer and respiratory ailments) account for more than 60% of deaths. Our physician-to-population ratio is a mere 1 per 1,000 and for hospital beds it is 0.7 per 1,000. The problems are worse—the difference between rural and urban India for the same metric is lower by a factor of 10. Moving to education, in 2014, a UN report stated that India has over a million unschooled children in the age group of 6-11 and around six million children from rural India are out of school. Lastly, we are all aware that the air quality index touched the 500-mark in Delhi very recently and India is the third most polluted country in the world. As per one estimate, rising pollution levels has reduced average life expectancy by 3.2 years. Clearly, increasing our spend in these areas is neither feasible nor adequate. It is only through technology innovations we can improve outcomes.

Often I am asked, “Are these sectors not different?" In many conversations, I also hear words like “social" or “impact" to refer to these sectors. A few years ago, the same labels were applied to any business focused beyond urban population. Today, the same segments are the fastest growing for consumer tech firms. The challenge is the market, it is about finding the right product-market-fit and building the right business model to support it. And I believe tech start-ups can solve many of the problems in these sectors.

There are a number of business models that can be relevant. Take the example of hospital searches for surgeries. Lakhs of people from villages come to the cities in search of hospitals for surgeries. Today, to find the right hospital, they have to negotiate multiple layers of touts and agents. They end up spending their hard earned money on things unrelated to treatment. The hospitals get only a small share of what they end up paying. Is this not a great opportunity? Can we not have a local language enabled recommendation engine that ranks hospitals and helps people find directly the hospital that suits their needs best? Will this not save time and costs for the patient and improve profits for hospitals? Similarly, we can use mobile technologies to allow better post-operative care of patients outside of hospitals. This will reduce the burden on hospitals and increase their throughput. We live in a country where 900 million people have access to mobile phones and small traders run their businesses on WhatsApp. Technology adoption should be the entrepreneur’s last concern. If we look close enough, we can come up with many more tough, big and good problems to solve.

If sectors like healthcare are ripe for entrepreneurial disruption, then why is the reality different? The reasons are many. One, areas like healthcare require one to know the problem and the context deep enough. And, they are not as intuitive as a consumer tech business. We need to step out of our cities to where most of India lives to understand the problems. Second, many solutions that are readily available reside within research labs. We need to excite more inventors and scientists to get their research out of the labs to solve real problems. Third, many tech entrepreneurs who have built technologies are not aware that their solutions can solve the problems in areas like healthcare. We need to focus the attention of our entrepreneurs to take up these challenges.

Mere understanding of the problem does not change anything. It is, at best, a start. At Axilor, we are looking at different ways to increase the number of experiments. Some are in search of solutions, finding the right talent working on tough problems to join our EIR (Entrepreneur-In-Residence) programmes. Some others are in search of problems—like our effort at running competitions on big problems to attract inventors with innovative ways for solving large health problems. Some are in search of bridges to connect problems to solutions—like our effort at connecting scientists with business.

In a world full of choices, resources are not scarce. Attention is. Our job is to shine a light on the right problems. I am certain our entrepreneurs will take up the challenge.

S.D. Shibulal is co-founder of Infosys and Axilor Ventures, a platform to increase the odds of success for early-stage entrepreneurs. This column is part of an anniversary series from Axilor founders sharing their reflections.

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