India: Marketing family planning in a land of one billion people

THE DISPATCHES: Amit Sinha, David Plink, Julie Earne, Mona Gavankar, Dhruti Patel

Our final field report, and bidding good-bye to the Janani family

With this installment, Amit Sinha, David Plink, Julie Earne, Mona Gavankar, and Dhruti Patel conclude their dispatches from India.

Julie’s birthday party made us nostalgic for the consumption functions at Haas. Having now seen the wild side of the ever-so-dedicated Janani staff, we knew that we had more common ground: we play hard and we work hard. Soon, our work for the last six months would be held up for client evaluation in our final presentation. It was now judgment day, and we went all out to awe Janani with our work.

The common myth is that presentations are forums where MBAs throw business jargon at unsuspecting clients. Right? Wrong! When the project is inspiring and insightful, the team creative and hardworking and the client supportive, ideas flow. That’s what we found as we compiled our final products for Janani: various financial models, a final presentation and a report with our recommendations.

By the time we sat down to compile the report, our work had expanded to six key deliverables. Some of them we had been working on during the spring semester at Haas; others were recent additions. In between the last bites of excellent food, we compiled the last bytes of our final report and presentation. The day before the presentation, our team trained managers at Janani how to use our financial models in planning, budgeting and sales. Work went at frantic pace as we struggled to keep up with our internal project deadlines. We made our final presentation on Friday morning at 9:30 a.m., and for about four hours we all discussed our recommendations as an extended team — something that had grown to be the hallmark of our relationship with Janani.

Valuation models for new Surya Clinics
Janani is expanding its network to 360 clinics and required an appropriate model to understand the financial implications. Our financial model projected the clinics' profitability, the capital expenditure required and provided flexible menus of services, patient volumes and prices. Janani managers said that this tool would be immensely valuable in planning and decision-making.

Evaluation of various ownership structures
Once we had valued the capital requirement and profitability of the 360 clinics, Janani would need to raise the capital. We explored various loan and equity options; from fully owned Janani clinics to franchisee clinics owned by practicing physicians, from independent women entrepreneurs to groups of Titli Centers (staffed by informally qualified Rural Health Practitioners who dispense contraceptives and educational literature), and even a combination of some of the above. Our interaction with various Indian commercial banks, rural banking institutions and micro-finance schemes was very helpful.

Inclusion of laboratory and diagnostic services
The diversification of Surya Clinics into diagnostics and laboratory services seemed intuitive to our Janani contacts. However, they needed to understand the market and analyze its profitability before committing scare organizational resources to the idea. We analyzed the diagnostics and laboratory markets, backed by an in-depth financial valuation model, and Janani agreed with our recommendations.

Inclusion of immunization services
Our recommendations that Surya Clinics include immunization services seemed counterintuitive to Janani at first. The Indian government provides free vaccinations and immunization services to the children, while poor availability of electricity makes refrigeration of vaccines undependable in the private sector. However, adding immunization would provide end-to-end maternal services through Janani. We recommended a wheel-and-spoke arrangement using a Super Surya Clinic (with reliable electricity) and five neighboring Surya Clinics, which would reduce operating costs and make the proposition viable. Janani managers were keen to test the idea immediately.

Inclusion of health insurance
With only 6 percent of India's citizens possessing some form of health insurance, we realized that insurance would be key to health care affordability. Janani, with its rural reach and service capability, was adequately positioned to exploit this opening. We advised that Janani leverage the liberalized insurance sector in India by including health insurance servicing in Surya Clinics, selling insurance policies through its vast network of Titli Centers, and partnering with insurance companies to develop new customized health insurance policies for Janani’s clientele. Our team provided break-even actuarial models for pregnancy and maternal care insurance based on disease and demographic information. Janani found our recommendations actionable; it is working on implementing a pilot project.

Pricing of clinical services
Janani advertises their low and fixed prices of services to attract clients, which requires them to maintain uniform prices across the state (and also reduces administrative complexities). While we appreciated their point of view, we felt that the region had enough economic variations to accommodate differential pricing. This was the only area where Janani differed with us, but we were glad that we provided alternative price increase mechanisms.

Janani appreciated our in-depth inquiries into some of their most pressing problems, and found our work worth taking action on. With this the project concludes, but our — and Berkeley’s — relationship with Janani will live on. In the process, as Janani's Project Director Gopi put it, "the Haas team members are empowered ambassadors of Janani," and we indeed are proud to have worked with the Janani team.

Each of us has been deeply affected by our week here. I [Amit] will continue to work with Janani by contributing to the insurance initiative over the next year. From a professional perspective, I learned to work in the health and social development sectors; personally, I have made lasting relationships. Janani employees are excellent examples of integrity and dedication, as well as hospitality: from them I gained insights on both working and having fun as a team. And the opportunity to contribute to the province where I was born and raised was personally very satisfying. I know the challenges that Janani faces there, and I admire the way they turn them into opportunities. I am glad that future Haas International Business Development (IBD) programs will continue to provide similar opportunities to students to make meaningful and direct contributions worldwide.

David: "Working with Janani for the past weeks has been a tremendously enriching experience. It was great to feel a part of the Janani family, and a family it is. The tightly knit culture, openness and warmth of the people made us feel welcome and part of the team. Bihar is certainly one of the hardest places in India to work: the poor infrastructure, lack of resources and certainly the summer climate. Therefore, it's even more amazing to see Janani's drive and determination to overcome the various barriers. It is a miracle at work and it was an honor to be part of it!"

Julie: "For an MBA/MPH candidate, Janani was the perfect IBD project. The combination of business practices like franchising and marketing, paired with public health issues like reproductive health and family planning, shows how the worlds of government, for-profit and nonprofit can come together to solve some pretty daunting problems. Working with Janani has provided me with tremendous insight into the obstacles facing the health services industry in India. What I have learned at Janani will act as a foundation as I move on to work with Population Services International (PSI), Janani's sister social marketing organization, for the rest of the summer. My experience this summer will always remind me of putting mind over matter, and of how it is possible to do so much with so little."

Mona: "This closing dispatch is by far the most challenging one to write. It is so difficult to distill the rich and intense experiences of the last three weeks! I am struck by what an inspirational work environment Janani was. The importance of its mission, the challenges the organization faces, and the contagious enthusiasm of the employees were incredibly motivational. The discomforts I was originally worried about — the heat and the electricity black-outs — all quickly faded as I dived into the work. I was also moved by the generosity and friendliness of the Janani staff. They embraced the team instantly, treating us like family members. I feel very lucky to have worked with such an inspirational group and am thankful to the IBD program for creating this opportunity. I look forward to remaining involved with the project and learning more about health care provision in India."

After our presentation, the entire Janani team gathered in the foyer to wish us good-bye. Further fun awaited us when we met up with other Berkeley IBD teams in Delhi and then in Amsterdam airport on our way back to Berkeley. Well, that’s another story…20 Berkeleyans on a transatlantic flight are awesome company!

—Amit Sinha

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