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Skoll World Forum Interviews: Spotlight on India's Health Care System

September 17, 2024

By Skoll Foundation -

As the health care system in India struggles to meet surging demand, hundreds of millions of people are being left behind—and made more vulnerable to disease and chronic health conditions. The problem is especially acute for the so-called “missing middle,” some 500 million middle-class individuals who are ineligible for government assistance yet unable to afford care on their own. But social innovators are finding creative solutions to address this gap and ensure Indians don’t fall through the cracks.

On this World Patient Safety Day, which calls for global solidarity and coordinated action to improve patient safety, we’re honored to highlight Skoll Fellow Aakash Ganju and Saathealth, the digital health platform he co-founded. Saathealth provides patients with information, insights, and data they can use to advocate for and influence their own health care decisions. Equipped with tailored, digestible information, patients can make informed choices about how and when to seek care—setting a swath of the population on a path toward greater health. Watch highlights of Ganju’s interview, listen to the complete podcast conversation, or read the transcript below to learn more.

Dr Aakash Ganju is a healthcare entrepreneur and the CEO of Saathealth, an impact focused digital health company building AI powered tools for targeted interventions and positive outcomes for health workers and consumers.

Trained in medicine and management, Aakash started his career leading research teams at Pfizer and Johnson & Johnson and developing mobile health solutions for underserved populations across Asia and Africa. He has been a health technology entrepreneur since 2011, working at the intersection of behavior change sciences, user centred design, health and technology to develop and deploy sustainable health technology solutions serving patients in infectious diseases, women and children?s health and chronic diseases.

Aakash is passionate about integrating human-centricity, technology and collaborative solutions to build healthcare experiences of the future.

Dr Aakash Ganju

Click to show transcript of Aakash Ganju Interview


Introduction (00:02):
Welcome to Role Models for Change, a series of conversations with social entrepreneurs and other innovators working on the front lines of some of the world’s most pressing problems.

Aakash Ganju (00:12):
My name is Aakash Ganju. I’m based in India. I worked in healthcare for over two decades now. About five years back, we set up a social enterprise called Saathealth. Our main focus is to reach low and middle income families across India, introduce them to preventive health content, financial literacy content, raise awareness, and then connect them with providers of health and financial resilience products and services. We’ve been doing this for over five years now, but before that, for about 15 years, I spent a lot of time working with low and middle income families across India who are just beginning to start spending on health for themselves and their families. And our big passion and our big focus is how can we get the consumers to engage?

(00:59):
How can we inform them, educate them, and how can we meaningfully allow them to make better health-seeking choices? So before we started Saathealth, we did a lot of work building similar digital platforms for patients with HIV/AIDS. We did a lot of work in maternal and child health, and along the way we saw this rapid adoption of digital technology in India across different strata socioeconomically, and just having the digital revolution in India just makes it easier for us to get to the end users, which are our families, engage with them, give them rich content, and just really empower them to make the choices they need for a resilient lifestyle, so that’s what we are doing at Saathealth.

Matthew Beighley (01:46):
Talk to me about the problem. Why is there a need for this organization?

Aakash Ganju (01:50):
Yeah. So if you look at India, it’s a huge country. Everybody knows that, we have about 1.4 billion people, and we tend to think of the Indian population in a pyramid that has three slices. So there’s about 300 million people at the top who everybody is going after to serve their needs. There’s about 500 million people at the bottom that are very close catastrophically or below the poverty line, and they really are eligible for government programs and schemes as they should be. But there’s a huge population in the middle called the missing middle in India. This is about 500 million people. They are too rich to be poor and too poor to be rich, and this is a huge population. They are largely uninsured. They pay for health, housing, education out of pocket. They spend 10 to 14% of a household income on healthcare every month. And as we have found recently, this population is beginning to bear a disproportionately high burden of health conditions within their families.

(02:51):
There aren’t too many people that are looking to serve the needs of this population, but we believe this is a huge population that is aspirational. It constitutes India’s emerging middle class. These people in the next 10 years, 20 years, their children will really be the foundation of India’s aspirations and growth. And hence, it is really important to support this population with the right health and financial resilience products. These products need to be fit for this population. They also need to be priced for this population, and that is a very, very important thing that we are trying to bring to our supply-side partners.

Matthew Beighley (03:28):
Is there a way to describe this whole process from just one patient’s experience and how they engage with you and how they benefit from your work?

Aakash Ganju (03:36):
Oh yeah, absolutely. So imagine a young woman who’s 30 years of age living in a small tier two, tier three town in the north of India. We do a lot of work with Hindi-speaking populations in the north of India. She will discover us. She has a smartphone, so she has access to phone. She will discover Saathealth and Saathealth’s content and preventive health assets on a wide variety of platforms. So we are an omnichannel platform. She could either find us on our web app, our mobile app, or social media assets, or through interactive chatbots. We typically don’t lead the conversation with this woman, let’s call her Anita so we can think about Anita. We don’t typically talk to Anita about a product or a service because that presumes that she knows what she wants. Very often, Anita doesn’t know what she wants. There’s a lot of data to show that women postpone, for example, health-seeking behavior, but Anita’s beginning to have symptoms of hypothyroidism.

(04:34):
We talk to her with our creative and creative content team. We create content around symptoms of hypothyroidism, what she should be watching out for. She sees this content. We then invite her to take a self-diagnostic assessment to understand if she could be at risk of hypothyroidism. She takes that, by the way, all of this is in local languages. We use that content to help guide her. If she is moderate or high risk for hypothyroidism, we connect her to a telehealth partner that can provide her those services. If the telehealth partner can finish providing those services online, that’s great. Otherwise, we then connect Anita to a partner secondary or tertiary care certified center in the geography of her location. So we are really holding Anita’s hand through this entire journey. We don’t stop there. We know Anita is 30 years old. We know that we might have fixed hypothyroidism for her, but she might need other things in the future.

(05:30):
So we create a longitudinal integrated local language chatbot journey for her. She gets content, services, information from Saathealth every week, and we want to continue to hold her hand. She might get pregnant tomorrow. She might need support around that. She might be suffering from postpartum depression. She might need support for that. So we are really holding onto the hands of these consumers, helping them walk through this journey. Our focus is purely on the consumer and what he or she wants, and then there’s a lot of supply side partners that we work with. We bring them in. Sometimes we bundle these products and services so it makes sense for Anita, so that’s the journey of a typical consumer that we are engaging with.

Matthew Beighley (06:13):
What are your obstacles in your work? What makes it difficult?

Aakash Ganju (06:18):
I think two things. One is just the scale of the population that we are trying to reach, right? On the one hand, it’s extremely exciting, and it’s almost a privilege to be working to serve the needs of this community. On the other hand, even if we have a million consumers that we are working with, we know that we are 499 million short of what we really want to get to. So I think that is a little intimidating, but it’s also very exciting. I think the other big challenge that we face is just the supply side partners, right? I mean, there are not enough supply side partners who are thinking creatively and innovatively about designing products for this population. Again, let me just remind you, I’m talking about 500 million people, which is the population of Europe.

(07:00):
This is not a homogeneous population. It’s extremely heterogeneous, and we need supply side partners, whether they’re doing financial products, whether they’re doing health products, health services. We need them to think more creatively about designing services and products that are different, tailored more to the needs of this population, but also priced differently. Because I think at the end of the road, the reward is the ability to tap into this huge population base of 500 million, but you can’t price these products the way you would price them for the top 300 million people. I think they’re making progress, but we wish that there would be at least twice as many products and services ready to be taken to our partners.

Matthew Beighley (07:43):
Can you measure impact? Do you know, is this working?

Aakash Ganju (07:46):
Oh, yeah. So we are very happy that we are part of Google’s SDG program for impact. We have been measuring impact for the last five years. We reported on a monthly basis, and that is what really makes us a social enterprise. We are very committed to measuring and reporting impact. There are multiple metrics we use for measuring impact, but there are three big ones, and then they break down into smaller ones. I think the first one is how many people are we reaching with our preventive health content? I’m very happy to share that over the last five years, we’ve reached more than 60 million people across India with our preventive health content. That’s a start. That’s the top of the funnel. The second key metric for us is how many of them are engaging back with us? And that really is a surrogate for demand.

(08:28):
People saying, “Yes, I want to engage back with you.” We’ve engaged with about 1.2 million people over the last five years, which gives you a sense of how strong the demand is for tailored products and services. And the third thing for us is how many transactions, how many of those people have you actually guided towards a health product or a health service, or a health transaction? We’ve done about 150,000 of those in the last five years. So the way we look at it is we have helped 150,000 people find appropriate products and services. We’d like it to be much higher. Our frustration is the 1.2 million people demanding products and services can only translate to 150,000. That number needs to go up significantly, but we do have this metric, and we have a goal of reaching more than a million transactions in the next two years, supporting these low and middle income families to find the right products and services for them.

Matthew Beighley (09:28):
I’m curious, what led you personally to this world, to this work? Did you have an experience that made you want to work in this sector?

Aakash Ganju (09:36):
I want to say I had an epiphany, but really not. I come from a healthcare background. So I did train as a physician. This was quite some time back. I then worked in the private sector for about 12 years. But what really excited me, and I think I feel very passionately about it, is that the way healthcare is delivered is very unidirectional. It’s not different from a hundred years back where we depend on doctors to tell us what to do. And it could be doctors, it could be nurses, it could be healthcare workers, and I think the world is very different now. I mean, people around the world don’t want to be told what to do. They want choices, and health consumers are consumers in other aspects of life. They’re used to choice. They’re used to autonomy, and so we feel this is a huge opportunity to empower consumers.

(10:22):
So if you look at the consistent theme of our work over the last 15 years, it’s been how do I get to health consumers? How do I empower them to take more charge of their own health? And by the way, we need to do this because if you look at trends around the world, whether it is in the US, most developed countries, or emerging markets, the demand for healthcare is massively outstripping the supply. And at least in my lifetime, I don’t see us training enough healthcare workers, doctors and nurses to address that demand. So we need to figure out a way to not just tell patients, “This is what you should do,” because we don’t have the resources to do that, but can we empower them to start taking charge of their own health?

(11:01):
We are very passionate about consumer empowerment. That’s the area that if you have to ask me, that’s a theme that really underlines our work, consumer empowerment, so that we can really reduce the burden on doctors and nurses, and just have consumers take better charge of their own health. So my work with the last 15 years with HIV/AIDS, maternal and child health had that consistent theme. And so I don’t think it was a watershed moment, but I think it’s a lot of these experiences over the last 15 years that’s really built out a conviction for what we are trying to do at Saathealth.

Matthew Beighley (11:37):
Where do you see this work that you’re doing in 25 years? What’s your vision for the future?

Aakash Ganju (11:41):
Well, that’s such a great question. Given all the uncertainty around the world, it takes a lot of courage to think about the next 25 years. But I think there are some trends that are very clear, right? India is at a very interesting inflection point. We are uniquely poised to grow significantly over the next 25 years. I think those are some of the positives. Some of the challenges that we see is the health of our population. We are increasingly beginning to see a lot of morbidity and mortality in younger people in India, people in their 30s and 40s suffering from and paying for chronic diseases like cardiovascular diseases, diabetes, so on and so forth. We have an opportunity of making sure that this young population continues to be healthy, and continues to contribute to India’s growth and the global growth over the next 25 years. The con of that is if we don’t address the needs of this population, they really won’t be able to service the growth of the country and of the world.

(12:40):
So I think in 25 years time, I’m hoping that Anita still is a part of our community. We continue to serve Anita’s needs. Her needs will evolve. She’ll now maybe have children. She probably will need some aging care for herself. She probably has a daughter who needs support for hypothyroidism or PCOS. So we want to continue to support Anita through this journey with getting her access to the right information, products and services, but also hopefully in 25 years, we don’t need to go to Anita to educate her. She comes to us and starts demanding what she now knows she needs for building a better life for her family. That’s our vision, that’s our dream, and that’s our hope.

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