Patient Learning

P Wangchuk has his hands full. He is the medical superintendent at the government-run 150-bed SNM Hospital, one of the few health facilities available to natives and visitors at Ladakh. While the tranquillity of the hills need no explanation, the Himalayan challenges that are posed before medical facilities, on account of the region’s distinct topography, are generally unknown and neglected. While getting on board skilled frontline staff such as doctors and nurses remains the single-biggest concern, the other equally daunting task is to keep them abreast with newer skills. “When I discovered that the All India Institute of Medical Sciences (AIIMS) was using a platform to train and refresh its frontline staff, I was convinced that it will work even better for us,” says Dr. Wangchuk.

The unique training platform being referred to here, is Bodhi Health, a Gurgaon-based health worker training e-solutions start-up founded by Abhinav Girdhar. Bodhi Health produces interactive videos on varied medical processes. The modules could be as simple as communicating with patients to complicated medical procedures like conducting dialysis. Such videos are then installed on the server of hospitals or nursing colleges, which will eventually be available on each user’s computer or smartphone for learning. Most of the times, these modules serve as refresher courses.

This method of training works well for a number of hospitals, more so for Wangchuk’s facility in Leh. Trainers and healthcare materials are hard to organise in a place such as Leh. “We played the infection control module on a large screen to train 170 doctors and nurses in one go,” says Wangchuk. What’s more? The training solution is not only convenient but is also cost-effective. “The cost of organising a similar training session in Leh would be a costly affair,” points out Wangchuk.

Stepping up
The healthcare sector wasn’t new to Girdhar as both his parents were doctors from Agra. After almost nine years of healthcare consulting at major firms such as Deloitte and PwC, Girdhar looked for a problem to solve and found one worthy of being pursued. It was his idea of having tech training solutions for frontline health staff, but its execution could not have been possible without the support of his wife, Shrutika, who lent her IT expertise for setting up the venture in 2013. “The core problem is deficiency of trained health workers. While business models have been built around telemedicine in the past, we wanted to build a scalable model. We realised with the current technology you can reach thousands,” mentions Girdhar.

So, he decided to create interactive training content for prospective customers – hospitals and colleges. The initial challenge, that is faced by most start-ups, was funding. “We bootstrapped for the first two years. To stay afloat, we worked as part-time nursing instructors,” reveals Girdhar. In 2014, Bodhi participated in the last-mile accelerator programme of IIM-Ahmedabad, and won seed funding of $200,000 from Village Capital, the US-based non-profit organisation that supports early-stage ventures, as well as from Beyond Capital Fund, an impact investor. The funding helped Girdhar to start targeting hospitals and nursing colleges.

The year after, the start-up again won IIM-A’s accelerator contest. This time TAKE Solutions, a Chennai-based tech solutions provider, gave Rs.75 lakh out of its CSR corpus to IIM-A’s business incubator  – Centre for Innovation, Incubation & Entrepreneurship (CIIE). Bodhi also counts a professor of Public Health National University of Singapore, a partner with A T Kearney, Singapore and an ex-director of Goldman Sachs among its angel investors. Vipul Patel, assistant vice-president, investments, CIIE, believes Bodhi has identified a serious gap in the healthcare system. “The government wants to strengthen the healthcare system, but for that they need to first upskill healthcare professionals such as frontline workers and the doctors too. So that is the pie that Bodhi can eat into,” says Patel.

Ross Baird, founder and CEO of Village Capital, too, spells out his rationale for investing in Bodhi. “We’re excited to back entrepreneurs who are solving the world’s most important problems, and we invested in Bodhi because solving the estimated deficit of two million health professionals in India is critical to improving health,” says Baird. Village Capital claims that its investment model is based on peer selection. “We invested not because a judging panel found them impressive, but because their greatest supporters and sharpest critics—other start-up founders—believed in them the most.” While it’s barely been a year since he invested, Baird talks about the progress made. “Since we’ve invested, they’ve made exceptional progress, training nearly 20,000 health workers, and we are confident that they will improve the health of everyday Indians across the country.”

Breaking through
Bodhi’s e-learning based solutions include highly interactive demo videos. In all there are 20 courses which include those on infection control, basic nursing procedures, dialysis techniques, dental courses, and soft skill courses. For the social enterprise, the most crucial institute to gain entry into was AIIMS. Not only did the hospital have a massive 6,000 nurses on its rolls, but getting endorsed by it would serve as a big credibility and morale booster. “When we first gave them a demo, they were not sure whether we could deliver what we were promising. A pilot project was okayed after a lot of effort,” recalls Girdhar. 

What worked in favour of Bodhi was that its module addressed two big pain points. “Organising a physical refresher or a training course for a staff of 6,000 was next to impossible. Second, the staff at AIIMS is most of the times almost always overburdened. With Bodhi, they didn’t need to pull out nurses from duty hours and, further, the courses could be taken any time on any available computer,” points out Girdhar. Since then Bodhi has approached several other hospitals and nurse training institutes. UP government’s ‘mSehat’ programme, Columbia Group of hospitals, government hospitals  in Jammu and Kashmir, and SNM hospital are its other clients. The company has also worked with leading private hospitals such as Park Group and Kokilaben Dhirubhai Ambani Hospital in Mumbai. 

Bodhi now wants to move beyond mere videos and scale up the value chain. It has developed two gamification products for training through smartphones. First, is an infection control game for junior doctors and nurses and the second is an instrument-identification game for dentist undergraduates. The infection control game is set in an operative room. It has several disinfectant bottles to choose from. One needs to mix the right liquids, in the right quantity, in the correct sequence to win the game. The two products are still in beta-testing mode and are yet to be released. Given that the entire platform is IT-based, Bodhi as of now has just 10 employees. “We have four nursing educators, they either have a Masters degree or a PhD from AIIMS and Christian Medical College in Ludhiana,” reveals Girdhar. These educators become the face of the videos, that are developed in several languages. 

Patel believes that despite its limited staff strength, Bodhi has done a commendable job. “Identifying and preparing new content is a time-consuming process but despite their limited resources they have managed by leverage the network that they are connected to,” he says. The ‘mSehat programme, under the National Health Mission in UP, is a rather interesting one for Bodhi. The task involves training 12,500 midwives or nurses, who have been provided smartphones by the state government. Since the e-learning solutions have to be deployed in the hinterland, new challenges spring up. Some of them include unavailability of computers and related infrastructure and an unreliable internet connectivity. To overcome the issue, Bodhi has made the courses internet-independent. “Modules once uploaded on a computer or a smartphone can then be used without an internet connection,” says Girdhar. 

Big picture
The business model of Bodhi is pretty simple. It is a B2B technology player that licences e-learning modules to hospitals and institutions. The uniqueness of Bodhi’s solution not just lies in its simple learning management system, but also in its ability to work with low-cost IT infrastructure. 

It charges the hospital on per user basis with slabs to choose from, depending on the number of users. The contract period is generally for one or two years, wherein a hospital typically asks Bodhi to manage training for one of their verticals. Depending on the tenure, the cost is agreed upon and can be revised only at the time of renewal. For a quarter-long e-learning module, Bodhi Health charged SNM Hospital Rs.500 per healthcare professional, whereas a similar training using conventional methods would cost Rs.3,000-4,000 per healthcare professional. In FY16, Bodhi had 18,000 users. “This year we are looking at 60,000 users and are aiming for two lakh users over the next two years,” says Girdhar.

To scale-up the venture, Bodhi is also planning to introduce assessment and recruitment based products for hospitals. The other plan is to connect nursing colleges and hospitals through an interface, which will help the latter recruit the best available staff from nursing colleges. “Bodhi can also create its own certification course that will help workers get employment,” feels Patel.

Bodhi is also planning to target the African market. “We were selected as a part of the Social Entrepreneurship Accelerator at Duke University in 2015. Companies from South Asia and Africa are selected in this programme. We are also part of the innovation and health network of the World Economic Forum, Duke University School of Medicine and McKinsey,” says Girdhar. He thinks such exposure will help him get beyond Indian shores.

While the first year was entirely cash burn, revenue has started kicking in eventually. This year Bodhi is targeting a revenue of Rs.2 crore. Girdhar believes that he can break even in the next two to three years. “We want to be the Coursera of health education,” he says. Coursera happens to be a leading global e-learning venture where Ivy League professors are involved in creating content. Ambitious, though it seems, Bodhi has got its priorities right.