Mumbai : Edenred, the inventor of meal vouchers and the international leader and India’s foremost in work-life benefits, rewards and loyalty solutions along with Great Place To Work® Institute celebrated the achievements of India’s

Intel Technology India Private Limited topped this list with exceptional rewards and recognition practices in their organization, with Ujjivan Financial Services Private Limited and NTPC Limited who are ranked as second and third company respectively. American Express India Private Limited, Music Broadcast Private Limited- Radio City 91.1.FM, InterGlobe Enterprises Limited, AAPC India Hotel Management Private Limited, Philips Electronics India Limited, Intuit India, NIIT Limited, PayPal India, United Colors of Benetton India, Eli Lilly & Company India Private Limited, Forbes Marshall Private Limited and Mahindra Intertrade Limited were also recognized as India’s Best Companies for Rewards and Recognition 2013.

The 1st edition of this study was conceptualized and established in 2012. TPG Software, Intuit Technologies and American Express were felicitated as the top 3 winners last year.

Commenting on the occasion, Mr. Sandeep Banerjee, Managing Director and CEO, Edenred India said, “The evolving dimensions of the work environment have triggered the Indian organizations to relook at their rewards and recognition programs in a strategic and structured fashion. Companies are differentiating in their offerings with elements that contribute to the overall employee experience, personal growth and development within the organization. The outcome of our study will help organizations benchmark their rewards and recognition initiatives with some of the best in the country. The top 15 winners have set the stage for the new era of rewards and recognition which are in line with the needs and aspirations of the Indian workforce. As we forge ahead in the 2nd edition of ‘India’s Best Companies for Rewards and Recognition’, our endeavor is to take this association to the next level in the years to come.”
Mr. Prasenjit Bhattacharya, CEO, Great Place to Work® Institute, India said, “The best workplaces in India have demonstrated a significant shift in mind set when it comes to rewards and recognition. Not only are they talking about total rewards encompassing aspects of financial, intellectual, physical, social and psychic rewards, they have recognised that talented employees are worth far more than an average employee. There is growing realisation that winning in the talent market is as important as winning in the market for customers. We are grateful to Edenred who has partnered us in bringing this pioneering Study to you all. The top 15 companies featured in this Study demonstrates that rewards and recognition can go far beyond conventional definitions and be a key driver of emotional engagement with the employee”

Participating companies went through a rigorous assessment that includes administering the Great Place to Work® Trust Index© employee survey and completing an audit of the company’s culture through a detailed questionnaire on their rewards and recognition practices. The 2nd edition of India’s Best Companies for Rewards and Recognition saw participation from more than 100 companies. More than 25,000 employees across 15 sectors like IT/ ITES, media, agriculture, biotechnology, healthcare, hospitality, infrastructure, etc. were assessed to honor the exemplary rewards and recognition practices of the Indian companies.
A research report on the insights and findings of the study highlighting some of the best practices in rewards and recognition was unveiled at the event by Guest of Honor for the evening, Mr. Harsh Mariwala, Mr. Sandeep Banerjee and Mr. Prasenjit Bhattacharya.

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Ujjivan’s CFO, Ms.Sudha Suresh was honoured with the Winning Edge in Risk Management award instituted by The CFO Institute and CFO India Magazine. She is in the list of the CFO100 Roll of Honour.

The CFO100 is an annual benchmark for rising stars among India’s CFOs. It is an annual initiative to recognise India’s finance leader’s extraordinary contributions to the corporate world. CFO India magazine identifies and brings together 100 CFOs, who are clearly a cut above the others, to honour their achievements in areas including cost management, raising capital, green initiatives, risk management, governance and strategy.

The awards jury consists of celebrated industry leaders and well-established CFOs of India’s largest organisations and conglomerates.

See the entire list of winners here

Post-October 2010, the microfinance sector faced its biggest crisis since inception. The banks and Financial Institutions had curtailed their lending to MFIs. During these critical months when many MFIs were facing severe liquidity issues, Ujjivan managed to keep afloat, sourcing funds through non-convertible debentures (NCDs) and loan securitizations. We were one of the first MFIs to receive funding when few banks opened up to selective MFIs.

Ujjivan successfully raised equity capital of Rs.1280 million – one of the highest in the sector during the crisis period. This also included the entry of two new global investors. In 2012-13, Ujjivan raised equity of an additional Rs.472.8 million, one of the highest in this fiscal.

Ujjivan’s portfolio quality held up well in the context of the crisis. We continued to lend to existing customers in affected areas who demonstrated strong credit discipline. Our credit risk was contained through several credit initiatives: introduction of revised group lending – removal of financial guarantee in the higher cycles, implementation of branch-wise credit policies based on occupation, income levels & history of credit behaviour, mandatory credit bureau checks on all our loans etc.

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Glocal Healthcare, a private company that is pioneering the use of technology to make healthcare more affordable and accessible, has developed a software that allows doctors to diagnose common diseases quicker and prescribe medicines with greater ease.

Dr Sabahat Azim, founder and CEO of Glocal, told Business Line the software – called LitmusDx – helps a physician diagnose and treat routine diseases with their associated symptoms. “Our goal was to offer the latest evidence-based medicine to doctors in a relevant, easy-to-use and digestible form,” he explained.

There are some clinical decision support systems, but these are fragmented and available only for management of advanced treatment pathways. Dr Azim said that LitmusDx, however, is a cloud-based end-to-end solution that can be used in any setting “for error-free healthcare”.

Glocal’s focus was on common diseases that practicing physicians in this country encounter every day. “This need has emerged from our personal experience in secondary healthcare delivery,” Glocal CEO said.

A physician today works in a universe characterised by over 3,000 symptoms (represented by 6,000 synonyms and acronyms), 2,000 risk factors, 10,000 diseases, 300 tests and investigations (with 6,000 possible outcomes), 5,000 branded drugs, and 20,000 prescription-related risk factors.

Statistics further suggest that there are over 22 million research papers available in the field of medicine and biology and journals in these fields recorded a 200 per cent growth in less than two decades.

“Our software helps a doctor to find his or her way out of this maze of information”, Soura Bhattacharyya, (Technology Head for Glocal) said, ahead of the soft launch of the product.

LitmusDx, according to him, will factor in test and investigation results before medicine selection. “It also will help the doctor to identify drug-related risks and choose the right combination of medications,” he said.

Glocal has initiated the process of patent registration in India and abroad. “We plan to market the product ourselves. We will shortly begin marketing it to hospitals and doctors”, he said.

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Around 18 months ago, when a new milk collection center opened in her village, Kattegollanahalli in the Tumkur district of Karnataka, 60-year-old Siddamma was surprised. Her village is a small one with less than 50 homes. Of these, around 35 households, including hers, mostly have just a cow or two. All of them sold their milk to the state milk cooperative which has been operating in that region for many years. Siddamma saw no reason to shift to the new center opened by MokshaYug Access (MYA), a Bangalore-based private company. But a few months later, the MYA milk collection center head, 35-year-old Anusuyafrom the same village, convinced Siddamma that the firm could give her a better deal.

Today, Siddamma is glad that she changed her mind. While MYA doesn’t pay her more for every liter of milk, her yield per cow has increased. “My cow now produces four liters of milk per day, as compared to two liters earlier,” she says. Like Siddamma, 11 other families in the village have shifted to MYA and have seen their income per cow go up. “It is tough to convince families to move to MYA because of their long association with the state cooperative, but I am confident that over time, when they see the benefits that their neighbors are enjoying with MYA, they will be more open to this option,” notes Anusuya. Her own two cows, she adds, have also increased their yield and now bring in more money. Anusuya and her assistant, 30-year-old Shashikala, collect milk twice a day at fixed times. At the time of collection, they test the milk quality with a lactometer and show it to the farmers. Every MYA household has a card in which the amount of milk sold and the lactometer readings are noted daily. Payments are made every two weeks.

Anusuya and Shashikala also sell cattle feed specially formulated by MYA, coordinate between the MYA veterinary doctor and the farmers, help MYA to organize camps to educate the farmers about good dairy practices, and other such tasks. “I was part of a self-help-group in the village. When MYA approached us, I agreed to run the collection center because it gives me extra income and a better status within my community. I can also help my neighbors to learn better dairy practices and improve their income levels,” says Anusuya.

Some results are already evident. According to a study conducted a few months ago by Upaya Social Ventures, a U.S.-based nonprofit organization, households that supply to MYA reported monthly incomes that are on average 24% higher than their counterparts, the quality of the milk produced in these homes is several points higher in terms of fat and protein content, and because of transparent and timely payments, nearly half of all producers in the MYA supply chain now depend on dairy as their primary source of income (rather than agriculture, which is monsoon dependent), compared to just a quarter of households before MYA started operations in these villages. Sachi Shenoy, founder and executive director of Upaya, adds: “We also observed that those households that have joined MYA have increased their consumption of milk at home by an additional 5.5 liters per month. This indicates that they are secure in their income from MYA.”

Building Income Certainty

For Harsh Moily, founder and CEO of MYA, the increase in consumption of milk by rural households in the company’s network is an important social metric. “This has a direct bearing on their health,” he notes, adding, “The minute you increase income in rural India, other benefits will fall into place — doctors, teachers, health care.” Describing MYA as a rural supply chain solutions company, Moily says the firm is a “commercial enterprise with a social conscience. We are in the business of building income certainty for rural producers by participating across every component of the rural supply chain.”

Set up in 2006, MYA experimented with different business models before settling on its current form three years ago. The business started as a microfinance company and then added an infrastructure arm under which it sought to set up primary health care centers and dairy farming units to provide services, as well as entrepreneurial opportunities, to the rural poor. While the microfinance business continues as a separate firm, Moily thought MYA could add more value to the rural economy as a supply chain solutions provider focusing on dairy. Prior to setting up MYA, 40-year-old Moily, who belongs to a political family, had worked for more than 14 years in private equity, telecommunications and agri-businesses in India, the U.S. and the U.K.

Explaining the thought behind the company’s rather esoteric name, Moily says: “‘Moksha’ means liberation in Sanskrit and ‘Yug’ means world. I’ve always believed that the fundamental reason why the poor remain poor is because they lack access to income-generating opportunities. So as melodramatic as it may sound, I named [MokshaYug Access] because we wanted give the rural poor ‘access to a liberated world’.

MYA currently has around 1,200 milk collection centers across 23 rural clusters spread over 1,100 villages in five districts in Karnataka. The company procures more than 100,000 liters of milk every day from over 15,000 dairy farmers. According to Viswanath Hegde, MYA’s chief operating officer for upstream business, in a bid to boost women’s empowerment, most of the milk collection centers are run by females from within the villages.

Recently, MYA took a big leap forward. The company launched its own dairy brand starting with liquid milk, under the name Milk Route. Prior to entering the retail segment, MYA was operating only in the business-to-business (B2B) space supplying milk to other dairy firms.

Moily points out that the average net margin in dairy B2B for liquid milk is 3%; in the retail sector it ranges from 4% to 20%, depending on the product variant. For example, the net margin in the short shelf life pasteurized milk is 4%, but for the longer shelf life ultra-high temperature (UHT) milk, it is 8% to 20%. According to Arun Subbiah, MYA’s chief operating officer, currently around 10% of the milk procured by the firm is used for its own brand. Subbiah expects this figure to increase to 100% by the end of this year. In due course, MYA also plans to begin offering higher margin milk-based products like butter, cheese and clarified butter under the Milk Route brand.

MYA’s entrance into the retail business benefits the farmers in two ways, Moily notes. “One, since there are no intermediaries, the farmers receive a higher share of the end consumer price. Two, the higher profit margins from retail milk will be diverted back into R&D and other value-added services to the farmers. This will help them in the long run in the form of increase in yield and quality improvement, and also lower value loss of the milk in the supply chain.”

Improving Yield and Quality

Improving the yield and quality of the milk per cattle is central to MYA’s business model. Take yield, for instance. India is the world’s largest producer of milk — according to the government department of animal husbandry, dairying and fisheries, in 2011-2012 India produced 127 million metric tons of milk and accounted for about 17% of global milk production. But the productivity of Indian cattle is extremely low. Kiran Konher, founder of Dairy Assist, a Pune-based dairy consultancy, points out that while the yield per cattle per day is around 40 liters in the U.S., Canada and Israel, in India it is only two to three liters. There are various reasons for this: Dairy farmers are not able to feed the cattle adequately throughout the year, the quality of cattle is not very high, artificial insemination services are not easily available, there is more focus on treatment of cattle diseases than on prevention, and dairy farmers in the country do not follow adequate hygienic practices while milking.

At MYA, the mantra is same farmer, same cattle, more milk and better milk. The company wants to show its farmers a roadmap to increase the daily yield per cattle to 15 liters over the next three years. On the quality front, MYA’s aim is to increase the fat and protein content in the milk and to reduce the bacterial load.

One key plank of MYA’s strategy is deep farmer engagement. MYA team members interact regularly with the dairy farmers in their networks to both educate them about best practices in dairy farming and animal husbandry, as well as to gain a greater understanding of their needs and problems. “The capacity of cattle to produce milk depends on its feeding, its breeding, its health and so on,” says Konher, who has been a consultant to MYA since its inception. “Everyone in the dairy industry knows this. What makes MYA different is its focused approach, appropriate implementation and a strong R&D orientation.”

Devanath Tirupati, professor of production and operations management at the Indian Institute of Management in Bangalore, notes that MYA’s sharp focus on “the first mile” of production could yield strong returns. According to Tirupati, the Gujarat Co-operative Milk Marketing Federation — better known as Amul Dairy — introduced similar practices decades ago, but under a cooperative model. “The cooperative model has come under strain over the years with the market opening up and private players entering the space,” Tirupati adds. “MYA’s is a market-driven model. If it succeeds, it could well be a role model more suited for today’s environment.”

MYA also follows the “golden hour principle,” which entails collecting and chilling milk within the first hour of milking. In the traditional dairy model, players set up large bulk milk chilling plants of 30,000 liters to 50,000 liters capacity. These bulk milk chillers service a wide area. This means that the milk has to travel a significant distance from the collection point and is not always chilled within the golden hour. In order to stay within that time period, MYA has opted to set up 5,000 liters capacity milk chillers within a maximum of an hour’s distance from its collection centers. For optimum utilization, the location of these chillers — of which there are 23 at present — is determined based on various parameters, including the density of dairy farmers in the area, the amount of milk that can be procured daily, and the road and power infrastructure. “Our next step is to see if we can use R&D to chill the milk at the collection center itself at minimum additional cost,” Moily says.

Currently, MYA has outsourced the processing and packaging of its milk because these activities require heavy capital expenditures — for example, it costs around Rs. 3 crore to Rs. 5 crore (US$550,000 to US$900,000) to set up a 100,000 liter processing unit. The current volume of milk procured by MYA does not justify such spending. “As with our chilling units, we are looking to set up micro processing units cost effectively. A lot of our R&D is focused on this,” notes Subbiah. He points out that MYA also has a strong R&D focus at the farm level for various aspects like setting up a better storage system for fodder and capturing data on each herd regarding its lineage, health and daily yield. “We are looking at a number of low-cost innovations to increase efficiencies and productivity across our supply chain.”

The Power of Technology

Mark Straub, co-founder of the Khosla Impact Fund, which has invested in MYA, cites the company’s strong focus on technology as a key strength. “MYA is using science and technology to make small dairy farming more productive and to improve income certainty for small dairy farmers. Many of the other organizations in this space depend on subsidies, and subsidies don’t scale. Eventually, the money runs out,” says Straub.

The Khosla Impact Fund, which was set up in 2011 with venture capitalist Vinod Khosla’s personal funds, supports entrepreneurs who develop market-based solutions — products and services — for the poor. “MYA is a good fit for us because it is building capacity in rural India, both in terms of nuts and bolts infrastructure and also in terms of best practices in dairy farming and animal husbandry,” notes Straub. “As investors, we are very pleased with MYA’s progress. It has had tremendous success in scaling up in the past three years.”

In August of last year, MYA entered a new vertical: fruits and vegetables. With 80% of dairy farmers also growing fruits and vegetables, it was a logical move, says Moily. “It ensures better income certainty for the farmer and better loyalty for us.” MYA sells the fruits and vegetables to institutional buyers. The company is also experimenting with the retail format in this segment and has set up one pilot store in Bangalore branded as The Good Chain. Moily notes that the store is modeled on U.S.-based chain Whole Foods.

For the year ended March 2012, MYA’s revenue was Rs. 100 crore (US$18 million). Over the next three years, Moily wants to reach out to 100,000 farmers and is targeting revenues of over Rs. 500 crore (US$91 million). Of this, milk and milk products are expected to account for 80% and fruits and vegetables will bring in the rest. Moily predicts that it will take another year for the company to be profitable at the operating level.

A New Set of Challenges

Meanwhile, with its foray into retail, MYA now has to compete with the country’s two leading milk cooperatives – Amul Diary and Karnataka Milk Federation — in addition to domestic private players like Heritage and Britannia and also multinationals like Nestle.

Currently, MYA has eight distributors in Bangalore and a retail network of around 400 outlets in the city, primarily mom-and-pop stores. It is also reaching out to consumers through independent milk vendors who supply to large apartment complexes. Moily wants to wait before approaching the modern retail format. “We want to build our brand so that we have better bargaining power with them,” he notes. Moily is also looking to gradually launch the Milk Route brand in other cities in Karnataka followed by other states across the country.

But investments on the front end — especially in branding and marketing — will require deep pockets. So far, Moily has raised Rs. 45 crore (US$8 million) by way of equity and debt. Apart from Moily, who holds the majority stake in the company, other investors include Khosla Impact Fund, Unitus Equity Fund and Unitus Impact. Moily is looking to raise around Rs. 80 crore to Rs. 100 crore by the end of the year. But there is another challenge for MYA: That of mindset. “The DNA of MYA is the first-mile focus. If I spend more than 10% of my time on sales and marketing, I feel it’s a waste of my time,” Moily says. At present though, he is not looking to hire anyone senior for this role and will be handling it himself “with the help of advisors.”

Could this be a roadblock for MYA? Straub does not think so. While he concedes that there is a need to strengthen the company’s management capabilities in marketing and branding, Straub says that what is more important at present is to deliver a quality product to the consumers. “MYA has always demonstrated a thoughtful approach to expansion as [opposed to] a careless one,” he notes. “We think that if it can achieve an early adopter consumer base in Bangalore, then there is good evidence for justifying an increase in marketing spending.” Upaya’s Shenoy suggests that the market is ripe for a product like Milk Route. “For the new-age consumer there is something very appealing about knowing that you are getting fresh milk and also benefitting the farmer in the process.”

IIMB’s Tirupati also believes that MYA can afford to build the front end gradually. “If you can assure a good quality product, then half the battle is won. The back end is where MYA can differentiate itself, because not too many people are focusing there.”

According to Tirupati, it is critical that MYA does not take its eye off R&D. “Farmer engagement works well up to a point; but once the market develops, the farmer can give his milk to anyone else. This is what is happening with Amul. In order to maintain its edge, it is important for MYA to continue to invest in R&D to improve the yield and quality of milk, and all aspects of the supply chain.”

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Harimati Das, 60, a destitute widow with no children, lives in Panchtupi, a remote village in  Murshidabad district of West Bengal. When she was suffering from piles and fistula, kindly neighbours took her for treatment to the Khargram block, some 10 km away. They had heard that a spanking new hospital, clean as a whistle, had sprung up there. They praised this hospital for its caring staff and good food.

People were aware that it was a private hospital, but money was not an issue for the impoverished Harimati. After all, she owned the magic card – a piece of green plastic containing her biometric data – that the government had given her under the RashtriyaSwasthyaBimaYojana (RSBY), which is a health insurance scheme launched in 2008 for Indians living below the poverty line (BPL).

Opened in June 2012, the Khargram hospital is one of five that Glocal Healthcare Systems Pvt. Ltd. (GHSPL), a social enterprise based in Kolkata, has set up in a short span of 20 months. The company was launched in late 2010. Encouraged by RSBY, which gives a family up to Rs30,000 a year for healthcare, Glocal has created a sustainable business model for inexpensive hospitals that have the potential to bridge the huge gaps in India’s health delivery system.

The government has failed to provide adequate healthcare infrastructure in rural areas. Most private sector hospitals on the other hand prefer to chase profits. They offer super specialty facilities and charge high fees.

Under RSBY 30 million cards have been issued and some 150 million people are covered by the scheme. Hospitals have been empanelled and insurance companies have been selected. The costs of procedures have been fixed. The scheme is computerised and cashless with money transferred directly to the hospital. But the problem remains that hospitals which people can go to in rural areas don’t exist.

Glocal is the first chain of hospitals that has chosen to swim against the tide. It has shown that it is possible to serve RSBY cardholders and yet be profitable.  In Glocal’s hospitals, care is being provided at a cost which is 40 to 50 per cent less than industry standards. A caesarean section is performed for Rs7,000  compared to Rs15,000 in other hospitals, an appendectomy for Rs12,000 instead of Rs20,000. Despite being so much cheaper, Glocal hospitals are breaking even in six to eight months compared to the industry standard of two years.

Glocal is all poised to expand exponentially. After setting up five hospitals in poor areas, it plans to construct another 50 hospitals with 5,000 beds in the next 18 to 20 months. Glocal aims to become India’s largest hospital chain by 2015 outrunning current private sector healthcare leaders, Fortis and Apollo, which cater to the rich in urban areas.

“All healthcare indicators for India are poorer than each and every South Asian country. But we are right at the top globally when it comes to the number of CT Scans and MRI machines per capita. This just shows how private sector healthcare in India is more focused on a patient’s wealth rather than health,” remarks DrSabahatAzim, Chief Executive Officer (CEO) of Glocal Hospitals at his modern minimalistic office in Kolkata’s Rajarhat New Town.

The youngest son of a civil servant in Uttar Pradesh (UP), Azim was persuaded to become a doctor by his parents. Keen to work for the country, he joined the IAS and ultimately became Secretary to the Chief Minister of Tripura.

But he found his role as a bureaucrat limiting. So he quit his secure, prestigious government job and joined the SREI Group in Kolkata which had undertaken the task of building rural IT infrastructure in India under the Union government’s National e-Governance Plan (NEGP).

In 2007 Azim helped launch Sahaj e-Village, which envisaged creating Common Service Centres (CSCs) in six states, offering B2B, B2C, G2C and e-Learning services. While setting up 18,000 such centres, he identified a major rural lacuna – the absence of affordable and quality healthcare.

In 2010, Azim and some of his colleagues quit SREI  to bridge this gap.  Azim floated Glocal with an initial capital of `1 crore pooled from his own savings and from his Sahaj colleagues, Major (retd) AshutoshShrivastava, GautamChowdhuryand  PareshSinghal. The company brought on board as chairman M. Damodaran, former chairman of UTI and SEBI, well-known as a champion of corporate governance. He is also a founder investor.

Impressed by Glocal’s innovative business and healthcare delivery plan, Sequoia Capital, financier of search giant Google Inc., and Elevar Equity co-invested $3 million (Rs15 crore) as equity in January, 2011, even before the company set up its first hospital. United Bank of India (UBI) chipped in with debt funds of Rs18 crore and in March, 2011, Glocal dug the foundation of its first hospital at Sonamukhi in Bankura district of West Bengal.

“Our first hospital had 30 beds,” recalls Major AshutoshShrivastava, Glocal’s chief operating officer. Sonamukhi is a sub-divisional town and the hospital’s catchment covers 40,000 urban and 100,000 rural people. It became fully operational with all licences and permits in just five months. In July 2011, the hospital admitted its first patient.

Glocal’s second hospital with 30 beds was built in Dubrajpur, Birbhum, another sub-divisional town with a population of 50,000 urban and 300,000 rural people. It became operational in December 2011.

The third one, also with 30 beds, is at Khargram in Murshidabad district. Khargram’s population comprises 400,000 rural people. The hospital began functioning in June 2012.

The fourth hospital with 70 beds is at Bolpur, another sub-divisional town in Birbhum district. It caters to 60,000 urban and 300,000 rural people. It became operational in July 2012.

The fifth hospital with 100 beds is at Bahrampur, headquarters of Murshidabad district. This hospital attracts an urban population of 100,000 people. It began providing services in November 2012.

“The first four hospitals were our laboratories. We learnt and standardized our model. Now all our hospitals have been upgraded to 100 beds or are adding beds. Our future hospitals will have 100 beds,” Azim says. The time taken to construct and make each hospital operational has been fixed at six to eight months. This helps to cut costs, he explains.

Meanwhile, land acquisition for two more hospitals – at Jeypore in Orissa and Raipur in Chhattisgarh – have been finalized and construction will start this month. Land acquisition for four more sites in Lucknow and RaiBareilli districts of UP and Siwan district in Bihar is expected to be completed shortly.

Over the next 12 months, four hospitals will start construction each month so that by August 2014, Glocal will have another 50 functional hospitals with 5,000 beds.
“By 2015 we should equal or cross Apollo Hospitals, which has 49 hospitals and 7,946 beds,” says Azim.

Speed and volume: Ranjit K. Maity is Glocal’s Senior Governance Advisor. A former Special Secretary to the West Bengal government, Maity ensures that compliance and licensing issues are dealt with quickly and hospitals are constructed as per deadline.

“In West Bengal as many as 30 licences, permits, NOCs or empanelment processes are required to set up a hospital,” says Maity.  Glocal thoroughly studied all licensing norms and incorporated them into the design of its hospitals. This has helped the company to get clearances within six to eight months.

“Our credibility and connections in the state government have helped us   get clearances in record time without paying any bribes. But in other states we are forming limited liability partnerships so that our partners can take care of clearances within our construction time of eight months,” Maity said. “The regulatory framework is a lot simpler in other states so our hospitals should get the clearances even faster.”

Apart from the speed of construction, what is more unbelievable is the fact that financially all five hospitals have broken even. “The Khargram hospital which is in the poorest area and became operational only in June 2012, has just broken even. This proves that it is possible to provide the highest quality healthcare service to the poorest of the poor thanks to the RSBY,” says Azim.
Currently, 44 per cent of Glocal’s revenue comes from RSBY patients while the rest is from cash patients. For surgical procedures, cash patients are charged the same rate as RSBY patients. It is only in the case of conservatives – patients that do not undergo any surgery but are hospitalised and only given medication –  that there is a difference in rates. RSBY permits Rs500 per day for cost of bed, doctors, food and medication, but cash patients are charged Rs700 per day plus the cost of medication.
“We make some money even from RSBY patients for surgical procedures as the rates are very reasonable. But we lose money on conservatives because the RSBY rate of Rs500 is too low,” says Shrivastava. Glocal makes this up by levying a higher charge for cash patient conservatives. Moreover, some of the hospitals offer separate cabins for patients who are willing to pay although rates for such facilities are still far lower than for other hospitals. “All wards including those for RSBY patients and for cabins are air-conditioned as this improves cleanliness, reduces air pollution and mitigates the risk of infection,” says Shrivastava.
Rapid scaling up to gain volumes is playing a role in ensuring sustainability, Azim says. By the end of January the company’s hospitals had treated as many as 77,834 patients, conducted 3,452 surgeries and till end-December managed 274 childbirths and 2,505 emergencies including trauma and accident cases.

Number crunching: Glocal is scaling up rapidly and confidently because its model is based on ground realities. Culling data from the 2005 report of the National Commission of Macroeconomics and Health chaired by the then Union Finance Minister P. Chidambaram and Union Health Minister AmbubaniRamadoss as well as from other sources, Azim’s team found out that just 42 diseases accounted for 95 per cent of the disease load in rural areas. Eighty five per cent of the population suffered from only 17 diseases.

Glocal concluded that the healthcare needs of 95 per cent of the population could be met with secondary level hospitalized healthcare.

“The larger market is in secondary healthcare,” explains Azim. “So we decided right from the beginning that we will set up hospitals with radical changes in the design of the healthcare delivery model, far beyond the much tested approach of beginning with the tertiary model and cutting it down to suit actual health needs.”

The Glocal team worked out a standardized diagnosis and management protocol for the 42 diseases that 95 per cent of the population suffered from. These ranged from ischemic heart disease to malaria. Glocal mulled over what was needed in secondary level healthcare to treat these diseases.  Its first hospital was designed on this basis. A costing exercise revealed that on paper a tehsil or block comprising around 140,000 people could be provided secondary level healthcare at an annual cost of about Rs8 crore.

But that was not all. An even more important finding was that an average villager spent as much as Rs1,115 a year on secondary healthcare. So, totally, the population of a block spent approximately Rs16 crore a year on such healthcare.

“Even if the ground reality turned out different from what we had worked out, there still remained a big gap of Rs8 crore from the theoretical cost of secondary treatment for a block and what was actually being spent by the people. We could certainly step in, provide high quality healthcare at affordable rates and still be sustainable by making some money for ourselves as long as we dealt in volumes,” Azim says.

Appropriate design: Glocal has designed its hospitals to fit its healthcare model. “We adopted the architectural philosophy of Howard Roark, the chief protagonist of Ayn Rand’s famous novel, The Fountainhead, who believed that buildings should be designed and built to fit their location, material and purpose elegantly and efficiently,” says Azim.

Going against the grain, Glocal adopted what Azim calls a ‘zero-based framework’ where all assumptions were questioned. It developed its own modular and scalable design, which eschewed all ornamentation. Instead the focus was on what was essentially needed to provide high quality secondary healthcare. There was emphasis on being green, energy efficient and durable.

A set of rules for construction was drafted so that the company could build 28,000 sq. ft, 100-bed hospitals in just six to eight months. These hospitals look aesthetic from outside and are efficient and comfortable inside for both caregivers and patients. The technologically superior layout also ensures effective containment of infections.

The no frills approach cut costs and helped to improve efficiency. By removing clutter and smoothening traffic flows, Glocal hospitals have brought down the time that OPD patients take to get check-ups, tests and reports done from six hours to about 1.5 hours. “This means that less waiting spaces are required,” Shrivastava said.

Medical equipment was selected according to the disease load. So all fancy equipment that wasn’t required for treating the 42 identified diseases were excluded. None of the hospitals have a CT Scan or an MRI machine. Even then all the hospitals are multi-speciality. They have medicine, surgery, gynaecology, obstetrics, paediatrics, orthopaedics, critical care, trauma and emergency departments. “We are also adding eye and dental care especially in rural hospitals where there is a dearth of such basic amenities,” Azim said.

Equipment was not bought off the shelf.  Instead, Glocal infiltrated the supply chain of equipment makers, identified their original component manufacturers and got their equipment assembled at costs much lower than what most hospitals pay for the finished product.

Glocal has also adopted a number of innovative techniques to cut down equipment costs. For example, GHSPL attaches a low cost Chinese made camera to an analogue X-ray machine to digitalise the images at a much lower cost than a digital X-ray machine.

“We have a radiologist sitting in Lucknow. All X-rays done in the morning are sent over the Internet to him. The radiologist sends them back with his expert opinion by 2 pm. Similarly, all X-rays done in the afternoon come back with his opinion by 8 pm,” says Shrivastava.

This radiologist in Lucknow peruses the X-rays of all five hospitals.

“What differentiates us from others is our in-house technology division,” says Soura Bhattacharya, Glocal’s Chief of Medical Technologies. He graduated from IIT Kharagpur and Harvard Business School. “We have pioneered the use of technology to integrate all aspects of the hospital. Our hospitals are digitalised, paperless and Wi-Fi enabled. Each hospital is linked over a 2 Mbps link to a data centre. There is a very high level of technology integration.”

“Apart from tele-radiology, we routinely use tele-consultation, tele-pathology, tele-sonology and tele-endoscopy so that our clinical experts can convey their  opinion to doctors and patients in remote locations from the comfort of their offices,” Bhattacharya said.
“We have also integrated clinical intelligence with process flows and pioneering applications for which patents have been filed,’ he said.

To trim diagnosis and disease management costs, Glocal has adopted a standardised Medical Diagnosis & Management System (MDMS) that is connected to the Hospital Management Information System (HMIS). This is an artificial intelligence system that helps in diagnosis, in choosing medication, preventing drug interaction, contra-indication and adverse drug reactions.

“The MDMS is an expert learning system. As soon as a doctor begins to attend to a patient he or she feeds in the symptoms and clinical findings on an already formatted online form. The system provides the necessary prompts at every stage so that the whole process of diagnosis and management is standardized. The system itself provides results. Based on symptoms and clinical examinations, it suggests the pathological tests needed to arrive at a diagnosis. If no such tests are needed, the system itself will say so. We started with an initial version developed by DrAzim which focused on a protocol for diagnosis. With constant feedback from attending doctors, the interactive and learning system has gradually got fine tuned and we now have certain set processes for disease management,” Shrivastava said.

While the system’s in-built reference helps in diagnosis and treatment, doctors are free to exercise their judgement. If a doctor does not agree with what the system prompts then he can prescribe differently but he has to give detailed reasons why.
Finally, actual outcomes are fed back into the system. If the doctor was right and the system was wrong the system automatically gets updated. On the other hand, if the doctor was wrong and the system was right, the doctor learns why and where he went wrong.

To ensure high quality feedback, Glocal also routinely measures healthcare delivery outcomes. “Most other hospitals only ask about a patient’s experience at the hospital at the time of their discharge. Our tele-callers call up patients a week after their discharge to find out whether their health problems have been resolved,” Shrivastava said.

This makes the entire process of diagnosis and management fully transparent and documented. It ensures that an accurate diagnosis is arrived at quickly without unnecessary medicines, pathological tests and procedures. The whole process is also auditable so the scope for management or doctors to make patients undergo unnecessary tests and procedures is ruled out.
“To cut medication costs, we are trying to do away with branded drugs completely. But there are issues like spurious generics. So although we have to sometimes fall back on branded versions, we are constantly identifying and eliminating poor quality generic producers and replacing them with high quality ones,” says Shrivastava.

“All this means lean healthcare management and predictable and controlled costs. We have cut the need for all kinds of in-house super-specialists. Even an MBBS can manage hypoglycaemia or any such disease as specialist knowledge is either built into the system or a specialist’s help can be sought through our tele-medicine backbone,” explains Bhattacharya.

Glocal has about six full time super-specialists and another 10 to 12 specialists on an empanelled basis in each hospital. The system helps delegation of more work to MBBS doctors under the guidance of specialists.

Attracting talent: Glocal’s professional, technology driven environment and its emphasis on quality healthcare has helped it attract talent.

DrArunMathur quit Apollo Hospitals to join Glocal’sKhargram hospital as chief anaesthetist.

“Here I am asked to heal patients, not to make money out of them,” he says. Well-known  gynaecologistDrNikhilenduMahapatra is known as the “bloodless surgeon” since he conducts most surgeries without requiring blood transfusion. Glocal has rightly placed him at Khargram where there are no blood banks and getting blood in an emergency is often impossible. “I love the challenge of serving people in such an area,” he says proudly.

Patients are equally happy. HabiburMullick, 60, lodged in the male ward at Glocal’sBolpur hospital is recovering from surgery. He doesn’t have the RSBY card but he is  effusive in his praise.  “The nurses, doctors and attendants should be given prizes for the excellent care they have taken of me,” he says.  Asked why he chose this hospital when Bolpur also has a government hospital, he said “I have been to PG Hospital in Kolkata and hospitals in Burdwan, Bolpur and Siuri. But no hospital is as clean as this place. Most importantly, people promise but don’t really deliver. Here the service is so good. I don’t know how they got such good people,” he wondered aloud even as Shrivastava and other members of the management team stood around.

RSBY challenges: Azim gives a lot of credit to Anil Swarup who devised the RSBY for Glocal’s success. “The RSBY is an absolutely amazing and highly intelligent scheme. Anil Swarup  should get  the Nobel Prize for it,” gushed Azim. “What RSBY has done is to use market forces to ensure free but high quality healthcare for the poor. It has encouraged private players like us to quickly build health infrastructure even in the most underserved areas,” he said.

“There are concerns that RSBY has resulted in hospitals carrying out unnecessary surgeries so that they can get more money out of the scheme. No system will be perfect. What we do need to note is the low percentage of fraud that is possible under the RSBY system,” said Azim.

“The premium is collected by insurance companies and they do not want to pay unnecessarily. Therefore, they have an incentive to conduct thorough audits. We also have an incentive to ensure that we get paid on all claims so if a doctor in our hospitals does too many procedures, the audit system alerts us too. I can say the RSBY system uses market forces to ensure that both service providers as well as insurers actually end up working together to reduce fraud,” explained Azim.

There is an unmet need for surgeries that has built up over the years. Glocal hospitals report that people live with hernias, hydroceles and debilitating growths for years because they cannot afford the so-called free treatment being provided by public hospitals. RSBY has provided a mechanism to fulfil this unmet need.

The problem is that in most states there aren’t sufficient healthcare providers even when RSBY patients can pay. “But when other private players see that we are making money serving RSBY patients, they too will set up health infrastructure in rural areas,” says Azim.

The post Low cost hospitals are game changers appeared first on Elevar Equity.

Rural supply-chain solutions firm MokshaYug Access has launched its dairy brand Milk Route in Bangalore. The company will sell pasteurized toned milk, ultra-high temperature (UHT) processed toned milk, and UHT low-fat milk.
MokshaYug, the investors of which include Unitus Equity Fund, Khosla Impact Fund and Unitus Impact, began buying milk over the past 18 months in three districts of Karnataka. “We are procuring nearly 100,000 litres of milk per day from 15,000 farmers across more than a thousand villages,” said CEO Harsha Moily.
Moily, son of petroleum minister Veerappa Moily, founded MokshaYug in 2006. The company initially focused on the microfinance and health sector in rural areas, but decided to enter the milk sector in 2009.
MokshaYug will have to battle the incumbent Karnataka Milk Federation, India’s second-largest milk co-operative after the Gujarat Cooperative Milk Marketing Federation. The Karnataka Milk Federation procures nearly 3.8 million litres of milk everyday compared with MokshaYug’s 100,000 litres.
Moily said that MokshaYug is investing in improving milk yields in terms of quality and quantity by concentrating on animal husbandry practices.
The firm will work with farmers in cattle breeding, feeding, housing, and improving milk production standards. “Through our services, we hope to improve yields from an average of 4 litres per day to 15 litres per day in three years”, he said.
The firm has outsourced the processing and packaging of milk to other dairy processors. MokshaYug expects to expand it’s network in southern and western India and generate revenue of Rs 500 crore.

The post MokshaYug Access launches Milk Route in Bangalore appeared first on Elevar Equity.

Glocal is now expanding operations beyond West Bengal with plans to open 50 hospitals in Uttar Pradesh, Bihar, Chhattisgarh, Jharkhand and Orissa by December 2014.

It was the untimely death of his father that led Azim, a trained medical doctor, to launch Glocal in July 2010. “My father died due to unnecessary treatments. I thought, if this can happen to me, a doctor and an IAS officer, what about others?” says Azim, who found an early supporter in M Damodaran, the former Chairman of Securities and Exchange Board of India (Sebi), who became the Chairman of the venture. Azim has known Damodaran since his time as Secretary to the Chief Minister of Tripura, a position he held between 2004 and 2006.

“He is my first sounding board for any idea. When I think of introducing something new, my first thought is ‘how will Mr Damodaran react?’” he says. At Glocal, his team has come up with a protocol-driven model, where the computerised system will help the doctor automate diagnosis of 42 diseases, ranging from ischaemic heart disease to malaria, which they identified as affecting 95% of the patients.

Other affordable ventures are also attempting to cater to the semi-urban and rural market. Like Glocal, eight-yearold Vaatsalya also sets up hospitals (smaller than 100 beds) in small cities and towns with a focus on primary and secondary care. However, Vaatsalya leases out pre-existing hospitals and other buildings and upgrades them to high-quality hospitals. Azim, a fan of Fountainhead—Ayn Rand’s paean to individualism, wanted to design a hospital with just essential infrastructure.

Timely backing from investors helped convert the idea into a business. “I had a 30-minute meeting with Sabahat and he spoke about focusing on a limited set of diseases that constitutes 95% of healthcare issues in the country. I was hooked by this powerful idea,” says Elevar’s Farias.

Sequoia’s Managing Director GV Ravishankar says Glocal fit their requirement of backing good entrepreneurs in large and attractive markets. Glocal charges patients around onefifth of the fees a hospital with similar infrastructure would otherwise charge. It charges Rs 10,000 for a caesarean section, which costs about Rs 50,000 in other private hospitals.

Azim points out that he is able to charge lower fees due to lower cost of infrastructure and by eliminating unnecessary procedures. While a typical 100-bed hospital is about 70,000 square feet in size, Glocal has been able to restrict it to 30,000 square feet thus keeping cost of construction lower. At around Rs 8 crore for a 100-bed hospital, a Glocal hospital is built at about 50% of the cost of a private secondary hospital. The company aims to reach over Rs 28 crore in revenue in fiscal year 2014. As Azim begins Glocal’s expansion beyond West Bengal, he is not resting on his laurels. “It has been exciting so far but there is much more work to do,” he says.

The post Glocal Healthcare Systems: IAS officer-turned-entrepreneur plans to open 50 more hospitals appeared first on Elevar Equity.

Today, Sachin Bansal and Binny Bansal’s Flipkart has 2,500 people on its rolls and its monthly revenues are estimated at about Rs 200 crore now. By any measure, it is India’s largest e-commerce company. And Business Today’s listing too has undergone a name change, we now call it ‘India’s Coolest Start-ups’.

We feature four out of 15 coolest start-ups. To read more, grab the Feb 3, 2013 edition of the magazine now. Keep watching this space for more: Hector Beverages | Emart Solutions India | Hatti Kaapi | Edutor Technologies

With more funding options available, the number of start-ups in the country is rising exponentially. It is difficult to estimate their exact number, but the pitches made to venture capitalists (VCs) every year can be an indication. The Indian Angel Network, for instance, evaluated 3,400 pitches in 2012, shortlisted 82, and ended up funding 13, says Sharad Sharma, one of its investors.

The year before, it had received just 2,000 pitches. Deal tracker Venture Intelligence says the number of early-stage VC investments have grown 71 per cent in 2012 against 2010 levels. The 15 start-ups featured this time straddle diverse sectors – retail, e-commerce, social media, technology, health-care and biotech. They were chosen – as always – after hours of brainstorming in the office, multiple conversations with VCs, the companies concerned, and their competitors. We used three main criteria: they should all have started after January 1, 2009, should have witnessed early revenue traction, and most important, should have a differentiated service or product. They should all have thought out of the box.

Is there a Flipkart in the making among them? Why not?
INDIA’S 15 COOLEST START-UPS
Hatti Kaapi
Pixpa Digital
MindTickle
CloudMunch
Aurus Networks
Glocal Healthcare Systems
Hector Beverages
peel-works
Cocoberry Restaurants and Distributors
Emart Solutions India
Qyuki
Mitra Biotech
Edutor Technologies
Navigene Genetic
Bluestone

The post Glocal featured amongst India’s 15 coolest startups appeared first on Elevar Equity.

Business is not in his genes, and with all the pulls of north Indian small town middle-class moorings, 37-year-old Sabahat S. Azim, feels that he could have ended up with a typical nine-to-five job.

However, his urge to ‘create something’, perhaps, made him move to entrepreneurship from being a bureaucrat.

A physician by training from Aligarh Muslim University, he joined the Indian Administrative Service. Between 2000 and 2006, he worked in the districts of Tripura before he became secretary to the Chief Minister.

When he found that he was not “creating” much, he left the administrative service to look for an independent creative space. He drifted to Kolkata and co-founded Sahaj E-Village Ltd, a rural information and communication technology-based venture with the Srei Group.

He parted ways after differences with the partner over the direction of the venture.

But by then Azim got the hang of a private enterprise and learnt the potential of technology in managing a business organisation that can experiment, innovate as also create. A team of like-minded professional managers was also ready to travel with him on a new journey.

In 2011, he floated Glocal Healthcare Systems Pvt Ltd, a Kolkata-headquartered and private equity-backed rural hospital company. Now, he and his team run a chain of five hospitals in West Bengal, providing affordable and efficient healthcare for the rural poor. Venture capital firms Sequoia and Elevar Equity have invested in Glocal Healthcare.

Equipped with a business model that can profitably deliver, Glocal Healthcare is currently implementing an Rs 400-crore project for 50 new units across six States.

BUSINESS MODEL

Glocal spotted the business potential in a space – primary and secondary healthcare — where organised private investments were conspicuously absent.

Azim also identified early a possible linkage of Rastriya Swasth Bima Yojana (RSBY) to their business plan.

“Our business model lays emphasis on providing financially self-sustaining price points that can work towards expanding the market opportunity. During our initial research, we found that taking the tertiary healthcare option and cutting it down to suit actual health needs is not the right approach to reach the rural hinterland.

“Glocal followed three critical cost and quality efficient design principles – zero-base approach, standardisation and technology-driven delivery — for creating a scalable and sustainable healthcare model for itself,” Azim explained.

The findings of the National Commission of Macroeconomics & Health, which studied common disease occurrences in the country, came as handy reference point for formulating Glocal’s business plan.

The Commission, set up in 2005, revealed that 42 diseases comprise 95 per cent of the country’s disease load. Glocal designed its business solution to cater to 95 per cent of the disease load.

COST REDUCTION

“We were focussed on cost reduction. Forty-two diseases made inventory management cheaper. With an eye on capital expenditure reduction per bed without compromising quality of services, we focussed on a smaller subset of disease types and providing high clinical excellence in those versus servicing all disease types. Our hospital bed cost comes to Rs 8-10 lakh including land, building, equipment and doctor residences compared to Rs 25-30 lakh for private hospitals in urban India,” he added.

PROTOCOL-DRIVEN MODEL

Instead of being a doctor-driven model, Glocal created a protocol-driven model facilitated by doctors.

“While good doctors are the core of any healthcare service, protocols allow for ensuring good quality care that is independent of the skills of the doctor. All processes in the hospitals from diagnosis to management are standardised to ensure error free delivery. From diagnostic algorithms to standard treatment protocols, not only are all processes defined but also well measured. Glocal follows the principles of “Toyota Production Systems” to ensure processes inside the hospitals are continuously improved to ensure highest quality care,” Azim elaborated.

Azim’s team also developed Health Management Information System (HMIS) and Medical Diagnosis and Management System (MDMS) that integrate all processes from disease epidemiology, electronic health records, e – prescriptions and telemedicine to outcome management. The ICT backbone connects all hospitals with one database that ensures that the hospitals focus not only on surgeries or procedures but also on health outcomes. The patient-centric MDMS continuously improves its accuracy from feedback of outcome measurement.

Glocal hospitals, as a result, deliver healthcare at costs, which even small nursing homes with poor infrastructure cannot match. Azim, however, feels that the high point of his “creation” was a Glocal system that made sure outcome of services are measured only in full recovery or in complete cure.

The post A prescription for low-cost rural healthcare appeared first on Elevar Equity.

In the three decades he worked for CitiGroup and Bank Muscat, Samit Ghosh picked up every nuance of the banking business. That experience along with his family background (of being born in a middle-class family where he saw his parents’ fortune change with the 1985 revolution in the financial services industry) made Ghosh want to move to his next professional challenge, of making financial services available to the working poor by providing them loans. He founded Ujjivan Financial Services, a microfinance venture, in 2005, and in the past seven years, it has disbursed more than $580 million among a million customers. Interestingly, Ujjivan has also won the Great Place to Work award three times. Ghosh’s secrets to making that happen are simple— don’t work after office hours and ask employees to go home on time.

Click here to read a PDF copy of the article.

The post The Way I Work | Samit Ghosh, Ujjivan Financial Services appeared first on Elevar Equity.