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Most rural markets, which were unviable even a few years back, have now
become a do able and profitable proposition. Even if they have yet to become
revenue generators, pharmaceutical companies are thinking beyond larger cities
and plugging into rural sectors, purely to ramp up volumes. Although urban
markets are still more lucrative and will continue to be the focus for the industry,
the untapped potential of Indian rural markets is now seen as the next volume
driver.

Indian pharma market is regarded as one of the fastest growing pharma markets
in the world. In 2007-08, this market was valued at $7 billion. Interestingly, as per
industry estimates, the rural segment is a remarkable share of this market.
Metros and cities remain major revenue generators, accounting for approximately
60 percent of Indian pharma market. However, driven by factors such as rising
rural incomes and a strong distribution network, India͛s rural pharma market is
also experiencing strong growth. Estimates say that while small towns contribute
20 percent to the country͛s pharma market, rural areas account for 21 percent. In
2006-07, the rural Indian pharma market was estimated at around $1.4 billion.
According to a Ranbaxy spokesperson, as a percentage to the total market, the
rural market in India has evolved from 18 percent in 2006 to 21 percent in 2008.

It is expected that although driven by a huge patient base, increasing incomes,

improving healthcare infrastructure and stron penetration of health insurance in
the rural areas of India, the pharma market in villages and small towns will double
in size in the next five years. McKinsey report published in 2008, Indian Pharma
2015-Prescribed growth, states that compared to 2005, by 2015, millions more
will suffer from chronic, costly-to-TREAT DISEASES SUCH AS DIABETES, ASTHMA
AND CANCER. This will have a major impact on growth rates of these markets
since they are dominated by acute ailments. According to the McKinesy report,
upcoming small cities and rural centers will contribute almost as much to pharma
growth as metros and top-tier towns.

c

 cc

According to experts, there is a huge gap between population residing in villages

and quality treatment and medicines reaching these villages. Nearly 70 percent of
India͛s total population lives in rural areas where healthcare infrastructure is
significantly low as compared to urban areas. Only 20 Percent of Indian͛s total
healthcare infrastructure is in rural areas. While Indian pharma market comprises
predominantly of urban areas, the reason for rural markets lagging behind can
mostly be attributed to lack of facilities and experts in rural areas. Hence, this gap
represents a huge opportunity for pharma companies.

Although the rural markets are still more or less dominated by acute ailments, of
late they have started showing interest in lifestyle related treatment as well. The

Increasing penetration of lifestyle-related diseases is expected to fuel growth of

drugs targeting chronic diseases. According to industry sources, chronic therapies
now comprise nearly a quarter or 24 percent of the entire market, both rural and
urban. At an overall level, like more developed markets, India too is gradually
shifting to lifestyle disorders, this like more developed markets, and India too is
gradually shifting to lifestyle disorders. This trend is likely to dictate the fortunes
of various therapeutic categories in the future. Besides, infectious diseases such
as respiratory infections, skin infections, and pelvic inflammatory diseases are still
very dominant in these areas. Deficiencies in micro-nutrients aggravate the
situation as they make villagers more prone to disease. There are also many ill
treated/ignored health problems in mothers and children.

Until recently the rural market was a neglected story, however many big pharma
companies have lately realized the importance of this large enough share of rural
markets. Given affordability and accessibility, the rural consumer will have a lot
more disposable income than his counterpart a decade ago. The simple rationale
behind this argument is that food, shelter and primary education are virtually free
in rural areas, whereas a substantial chunk of the income in urban areas is spent
on these necessities.

Therefore, spending on healthcare in rural India is also increasing. The increase in

rural income has also further enhanced the propensity to spend on medicines.
According to estimates of the planning commission, village dwellers have started
spending 12 percent of their household income on healthcare.

No wonder, pharma companies want to be present in these markets before their

competitors. Wooing this new target audience would also mean capturing a large
and significant share of domestic market. Revenues earned from this segment will
in turn cushion these players from fluctuating foreign exchange rates on their
exports, Rural markets have evolved very fast in the last few years. Consumer
brands have grown remarkably; cellular phones have become widespread,
aspirations for better health has risen. For these reasons, demand has increased
and it has become relatively easier to serve this market. However, the purchasing
power is often low, distances are great, and qualified doctors are sometimes few
and far between. Therefore, we see rural areas becoming an increasingly
important market in a durable way. However pharma companies with high
standards of quality and ethics to not expect rural markets to be a ͚lucrative͛
market for many more years.
 Äcc

However, the fact remains that Tier two markets (Class II, III &IV towns and areas)
are driving the Indian growth story. The rural pharma market has grown at about
40 Percent in 2006-07 as against 21 percent and nine percent in the previous
years. While pharma companies have noticed this tremendous growth, they are
now more open to target and reach the rural consumer than ever before. The
growth of the GP-driven segment outstripped the growth of specialist-driven
segments.

Most pharma companies have chalked out specific business and marketing pans
to capture the goose. Pharma companies catering to rural markets are setting up
focused distribution channels and developing locally trained sales personnel. They
also focus on regularly updating rural physicians on their product portfolios and
on any other developments in specific therapeutic segments. Pharma companies
also feel that there is a sheer lack of skill sets, expertise and experience in
reaching these unexplored territories.

As there is no mass media reach in these areas, communication need to rely on a

direct, person-to-person or person-to-group communication, in local languages,
using visual presentation supports. Therefore, pharma companies generally opt
for the community-welfare route to educate rural consumers about a particular
disease segment and make them aware of treatments available.

For instance, Novartis has chosen to approach rural markets in a way similar to
FMCG companies. Their marketing strategy is based on a four ͚A͛ approach. The
company works by creating ͚Awareness͛ at different levels, improving
͚Affordability͛ and ͚Attractiveness͛ (e.g. usability) of products, making them
͚Available͛ close to the patient. The company has also begun a pilot project one
model somewhat similar to the model of e-Choupal by ITC in India. They intend to
make presence in rural markets durable and beneficial to the community. Besides
making people aware, the company also offers drugs targeting serious ailments
like tuberculosis. They look at medicines focused on therapeutic areas. For
example, as leader in TB through our generics arm Sandoz, TB is one of our areas
of focus, for patients who have elected to be treated by a private specialist
doctor.

Experts say that rural areas are also susceptible to counterfeit and spurious drugs
and hence there is a huge space for quality medicines. Companies like Lupin are
working with this in mind. Novartis marketing strategy in the rural areas is to
provide patients with quality medicines at competitive prices. They follow a four
point strategy of product people, price and promotion. The company aims at
reaching out to uncovered medical practitioners in these markets. The four ͚P͛
strategy of the company works to supply the right set of medicines (product) by
recruiting, training and developing local persons (people) as ͚Medi-Pracharaks͛,
who are best equipped to service the needs of local community and doctors. The
company also ensures that quality drugs are made available at an affordable
price. As part of its promotional program, the company organizes various
knowledge campaigns like ͚Arogya Jagriti Mela;, ͚Swastha Mela͛.
 ¢c¢c

In spite of the growth rate increasing interest of pharma companies and efforts
made to target rural markets, the sales and distribution system which plays a
critical role in catering to these markets remain almost unfazed. The significant
share of Tier two markets a can be credited to a large extent to the strong
wholesale distribution system. Rural markets are complex and sales infrastructure
has always been an area of concern not only to pharma companies but for
consumer goods companies as well. The rising importance of Tier two markets
has an important implication for pharma companies. Sales infrastructure
deployed in Tier two markets does match the current revenue share or the future
market potential of these markets. As per information in the public domain, in an
average mass product sales division, only 20 to 30 percent of the sales force is
deployed in Tier two markets. The number is even lower for specialty products
divisions. Demand pulls generated by medical representatives and sales force has
to be met by adequate supply of pharma products in a timely and cost effective
manner. At present the rural distribution models are complex and sub-optimal.

However, Indian companies are devising their own strategies to increase rural
penetration. For instance, Lupin has a strong brand franchise in anti-infective,
pain management, and gastrointestinal and these segments accounts for 40
percent of domestic formulations sales. The company has a dedicated rural field
force of more than 300 people and rapidly expanding it. Presently, they are
operating in ten states including Andhra Pradesh, Tamil Nadu, Madhya Pradesh,
Chattisgarh, Bihar, Uttar Pradesh, Punjab, Haryana and Rajasthan and catering to
35,000 rural medical practitioners. The company is also planning to expand its
operations to the remaining states in its next phase of expansion.
Nicholas Piramal India Limited (NPIL) has also announced a new initiative to target
the mass market, focused on general practitioners, to cater to rural markets. This
with a field force of approximately 800 people. In a recent development, the
domestic pharma industry has proposed that the government utilize post office
space across the country to sell Over the Counter (OTC) drug. The initiative is led
by Novartis͛ Vice Chairman and MD Ranjit Shahani who is also the ex-president of
Organisation of Pharmaceutical Producers of India (OPPI). The post office is a
dynamic organization that has already entered a number of new commercial
activities. Novartis has already started an awareness campaign using their services
and selling products through them may come next, provided there is government
support. The move besides increasing the reach would also substantially increase
the market.

While companies like Ranbaxy and Ajanta Pharma already have major presence in
rural markets GSK is also reportedly planning to enter these markets in a big way.
However, going forward, the emergence of organized pharma retailing,
improvement in infrastructure and growth in third party logistics players will not
only lead to more profitable and efficient distribution system but will also
increase the overall profitability of companies focused on these markets.

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Although rural markets are high growth markets, there are challenges galore to
hinder the entry of pharma companies. Some of the major challenges include lack
of communication, language barriers; high penetration of spurious drugs, lack of
adequate infrastructure such as marketing and distribution is one of the major
problems that pharma companies face. The biggest hurdle in the entire process is
supply chain management since regular stockiest do not supply to interior areas.
Developing a permanent rural field force takes time and effort, even for ambitious
companies, It is difficult to reach many parts of the country, either because of
inadequate transportation or insurgency income places. There are many places
where business becomes arduous and the patients any not benefit as quickly from
access to medicines as compared to other regions.

Besides, as rural markets are still dominated by the acute and infective therapy
segment analgesics, anti-infective and respirator, pharma companies still choose
to market their product range which has a low-risk involvement. Rural marketing
activities of many pharma companies have been traditionally restricted to
markets with stocks of the concerned product. Most of the products that are
being advertised and marketed aggressively are the low risk-low involvement like
pain balms, lozenges, and cough and cold syrups. The high risk-high involvement
products like cardiac or cancer products are not advertised or marketed through
media as regulatory guidelines prevent this. Whereas, companies have often only
taken the community-welfare route to educate the rural consumers about a
particular disease segment and make them aware of the treatments available,
The challenge lies in ensuring medicines reach the rural areas rather than
concept-selling of drugs. Companies are conducting healthcare workshops in the
rural areas by tapping the doctors there. Such programs offer mutual advantages
to both the parties concerned. Hence, the challenge before Indian companies will
be to focus on not just ensuring product access, and building robust sales and
marketing capabilities but also creating new markets and crafting differentiated
business strategies to service these markets.

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The Indian rural pharma market is estimated to be growing ahead of the overall
pharma market by five to eight percent. Undoubtedly, the road to the village is
full of promises for pharma companies willing to invest. Going forward, rural
markets will have a meaningful share of the Indian pharma market. While the rise
in rural healthcare expenditure, emerging rural middle class and improving
infrastructure facilities are encouraging pharma companies to invest in these
markets, government is also implementing several programs to facilitate basic
healthcare amenities in these areas. This will help ensure strong growth of these
markets.
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In a move to penetrate deep into the Indian rural market, Novartis India Limited
as initiated its efforts through its new business model Arogya Parivar.

In what can be termed as a first of kind effort by a Big Pharma in India, through
this strategic initiative Nocartis plans to specifically address the health needs of
rural India-where about 72 per cent of the country͛s population lives-by meeting
the medical needs of the population.

The Arogya Parivar initiative is expected to address common diseases rampant in

rural areas, including tuberculosis, respiratory infections, skin and gynecological
infections, diabetes, micro-nutrients during pregnancy and childhood, intestinal
worms, acid reflux, cough and cold as well as allergies.

As part of the initiative, Novartis India would employ health educators to create
awareness among the rural population on diseases, prevention and treatments.
Under the system, the health educators would also refer patients to doctors,
apart from making the products available in pharmacies and briefing the
physicians about the programme and treatments.

The project would initially focus on 24 product form the Sandoz generics and
consumer healthcare over-the ʹcounter business unit that address tuberculosis,
mother and childhood malnutrition, respiratory and gastro-intestinal problems.

͞We have already launched Arogya Parivar in the villages near Ghaziabad like
Dujhana. We have outsourced enough manpower to conduct health camps in
rural areas to impart general health information and check-ups to rural
population and prescribe branded generics to them, in an attempt to build image
within them. We would also ensure that these branded products are available at
stockists and pharmacists across the country͟, said, Ranjit Shahani, vice chairman
and managing director, Novartis India Ltd.

However, he made it clear that there won͛t be any compromise on the cost of the
drugs sold in the rural parts of India. ͞The medicines would be sold at the same
prices in other parts of India, but packages would be mad small so that the rural
population need not spend a huge sum one at a time͟.

Asked whether as part of Arogya Parivar, Novartis India would invest in research
and development of medicines to address India specific infectious and tropical
diseases, he quipped no, saying Novartis Institute for Tropical Diseases in
Singapore would concentrate on development of medicines to address these
diseases across the globe.

Though Novartis India didn͛t throw light on the investments made in this project
and the strength of workforce to meet the goals in tier 3 and tier 4 markets of
rural India, it revealed that Arogya Parivar would be made fully operational in the
country soon with the cooperation from hospitals and big NGOs.
 ccccccc c c

Novartis India has adapted its organization and product offering to the rural
markets. Arogya Parivar follows a decentralized model where the field force is in
autonomous cells (170 cells by year-end 2008). Each cell has health educators and
supervisors who collaborate with local health professionals, pharmacy chains and
NGOs to address the whole ͞patient flow,͟ including education, diagnosis,
treatment, delivery, and availability and accessibility of medicines.

A key differentiator is offering patients integrated solutions to health problems

rather than mainly selling products to health professional. Products selected for
the initiative are simple to use and packages are reduced in size to keep out-of-
pocket costs low. During the pilot phase, Arogya Parivar focused on diseases
where Novartis could offer solutions with Sandoz and OTC products. These
included tuberculosis and other respiratory infections, cough, cold, allergies, skin
and genital infections, mother and child malnutrition, diabetes, intestinal worms
and digestive problems- important challenges in rural communities.

Recently, two cells in the central state of Uttar Pradesh have piloted solutions
from the Novartis pharma division for locally prevalent diseases. The basket of
products also has been expanded to include products from partner firms, covering
additional therapeutic areas and needs such as anti-malarial bed nets.

The project would initially focus on 24 products from Sandoz, the generics arm of
Novartis, and Consumer Healthcare OTC business unit of Novartis.

The project is organized around a central marketing and planning team

responsible for creating materials for public awareness such as leaflets, posters,
training manuals, short films in various local languages. Medicines are offered in
simple-to-use packaging and at affordable costs to villagers. The target is to reach
50 million rural patients by February 2011. Independent cells, managed by a
supervisor and assisted by health educators, will create awareness among
villagers on diseases, prevention and treatments, refer patients to doctors, brief
physicians about the program and treatments, and make products available in
pharmacies.

Arogya Parivar has opened 4 cells in villages near Ghaziabad and expects to have
close to 200 cells throughout India by the year-end, said Shahani.

In India, rural areas represent 58percent of the national disposable income, with
villagers having an average spending capacity of over $2 a day.

 
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India͛s rural population of over 700 million represents one of the biggest
healthcare challenges in the world. The complexity created by inadequate
infrastructure, poverty and illiteracy is compounded by the fact that most
pharmaceutical companies in India have tended to concentrate on areas with a
developed healthcare infrastructure- the urban market. The rural masses, as a
result, are primarily served by the public health system, which is over stretched
and significantly inadequate, with many local and national NGOs attempting to
provide a buffer. But to benefit from this opportunity, companies need to be
innovative, creative and inclusive; for what works at the top of the pyramid does
not, and will not, work at the bottom. Couple this opportunity with the corporate
philosophy of the Novartis Group of providing medical care to those who have the
most need for it and yet the least access, and it forms a compelling reason to
embark on an innovative social ʹmarketing initiative-Arogya Parivar-a first-of-its-
kind in the Novartis world. Launched after the running of a successful pilot
program in 2007, Arogya Parivar today covers seven states and a population of
roughly 25 million people in 18,000+ villages. It is a holistic program covering
everything from health awareness at the grassroots level through meetings with
villagers using audio-visual aids to educating healthcare professional and
organizing health camps. The differentiating factor for Arogya Parivar is that it
aims to achieve social good in a ͞For Profit͟ business model. The goal now is to
double the reach by the end of the year. Along the way, the Company has had to
unlearn several traditional aspects of doing business and earn others. For has had
to unlearn several traditional aspects of doing business and earn others. For
example, traditional pharma marketing primarily consists of detailing product
benefits to doctors. But this assumes a certain level of patient awareness and that
he or she will ask for medical help when things go wrong. In a situation where
ignorance and blind faith leads to people believing that a disease like TB is a
curse, creating grassroots level awareness is critical. Even more important is to
target diseases because of lack of awareness and understanding. This awareness
is only possible if the organization takes a holistic approach, involving all
stakeholders- the people, the pharmacies, the doctors, the government and the
NGOs. Arogya Parivar͛s inherent success lies in its reliability. Once you understand
basic DNA of how it works, it can be replicated across cultures and geographies.
There is no single template that can be followed and each intervention has to be
customized to the local environment, but the broad learning͛s are applicable in
any bottom-of-pyramid market. No doubt efforts such as these by private
companies can only attempt to bridge the gap that exists in our public health
infrastructure. What is really needed is much stronger government intervention-
both at a policy and execution level. Greater government investments in building
healthcare infrastructure and monitoring will all go to improving healthcare
access. Government measures are key to widening the scope of inclusive
healthcare through partnerships with industry and through measures such a
reduction in transaction costs of medicines, imposing zero import duties on life-
saving drugs and greater incentivizing of R&D, especially for solutions aimed at
the rural sector.

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As the sun beats down on the by lanes and dirty tracks of Dujhana village near
Ghaziabad in Uttar Pradesh, Sunita makes her way on her moped across rough
terrain, reaching out to men, women and children, spreading the vital message of
health awareness. Empowered as a Supervisor with Novartis͛ Arogya Parivar
initiative, Sunita is a familiar sight for the vulnerable and poverty-stricken
villagers. In these rural areas where medical aid is difficult to access, she
represents hope and sense of greater wellbeing. She forms part of a team of eight
health educators and supervisors in the region who visit weekly open-aim
markets, fairs and festivals, where they address groups of people and distribute
pamphlets increasing health awareness. Sunita and her colleagues help organize
health camps, interact with workers to reach out to women and children, work
with local pharmacists to ensure stocks of medicines are always in supply and
liaise closely both with doctors and patients to ensure patient compliance. Sunita
is among the 220 third party supervisors and educators carefully chosen from
across the country for Arogya Parivar, a unique program that has proved to be
both a humane initiative and a sound business model. Overseeing their work is a
team of dedicated Novartis managers. Born of Novartis͛ strong corporate
philosophy of providing medical care to those who have the most need but the
least access to it, Arogya Parivar, this means ͚healthy family͛ in Hindi, works at the
grassroots level with local resources. Candidates are recruited for their social
equity and community acceptance, among other things, with the help of local
doctors, non-governmental organization (NGOs) and other similar groups; local
face with familiarity is a must-have qualification. However, this is certainly not
enough; they then undergo rigorous training, both on the field and informal
settings, to equip them for the important task of ensuring healthcare in areas
where illiteracy and disease are rampant. Arogya Parivar is a unique social
marketing exercise that is not only profitable, but in tune with the Novartis
Group͛s firm commitment to the improvement of healthcare of the ͚not-so-
privileged͛ millions, where the smallest of interventions tend to make the largest
of impacts.

§




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Despite being among the fastest growing economies in the world, India presents
complex public health challenges, most of them born out of poverty, poor quality
of basic infrastructure and ignorance. According to estimated, only around 30% of
rural India has access to potable water and just 19% of the people have access to
proper sanitation. Malnutrition is also a serious problem, with 47% of children
undernourished, and India Leading the global statistics in terms of iron deficiency.
As many 66% of all deliveries that take place are with the help of untrained hands
and 51% of children have never been vaccinated. India has over a third of the
world͛s TB cases, the majority in rural areas. Aggravating the challenge is the poor
quality of India͛s public health infrastructure. According to the World Health
Organization (WHO), over 65% percent of India͛s population has limited access to
healthcare. This is compounded by India being largely a self-pay market with less
than 4% of the population being covered by some form of insurance, putting
healthcare further out of reach for the millions who live in grinding poverty. The
fundamental irony is inescapable. India is a country with the largest number of
USFDA approved plants outside the USA. It is the nation, which in some sense, is
redefining the global generics industry. Yet it is also a country that is unable to
provide 65% of its population with affordable and quality healthcare. In large
swathes of the country it is easier to find a bottle of aerated soft drink than it is to
find a simple medicine like paracetamol. India was thus a natural choice for
initiating this innovative health outreach model. It made perfect business sense
too. India͛s 600,000 villages house a population of over 700 million. The Indian
pharmaceutical industry is estimated to be about US$8.3 billion. It is growing at a
compounded annual growth rate of 12.3% and is expected to be around US$20
billion by 2015. Interestingly the share of the rural spend in medicines is expected
to increase from 18% to about 21%. The represents an aspiration that needs to be
met. After initial research and learning from the pilot, the Company launched
Arogya Parivar in July 2007. The vision: ͞Arogya Parivar shall improve access to
healthcare for the ͚under-served͛ millions in Rural India, using an innovative social
business approach͟. The ambitious program had several elements-to create
Novartis͛ own capabilities around community education and advocacy of health
through socially trained educators; create special rural specific products and
packs to suit local affordability and address rural disease burdens; to motivate
local doctors as well as partner with large hospital chains to reach village through
health camps- especially where healthcare infrastructure is weak/poor; and to
build last mile availability of medicines at pharmacies in villages. Arogya Parivar is
designed to motivate healthy living, especially for the rural Indian woman and
child. The idea was to enhance access to medicines for the weaker sections of
society; build strong bonds with the local community, and ensure long term
market leadership in bottom ʹof ʹthe ʹpyramid locations. The partners in the
program come from varied backgrounds, and there are instances where even a
city stockiest is willing to participate. The one thing they have in common is their
zeal to reach out to the less privileged members of society. In fact, what lies at the
root of the program͛s success is this ability to reach across various stakeholders,
coupled with the ability to work with a diverse range of people in a language and
style that they can relate to. It is a task that calls for both sensitivity and through
approach. Efforts are made to find like- minded and talented field staff, partner
with local NGOs for a wider reach, and use vernacular and multi-lingual collaterals
and audio-visual communication tools for user-friendliness. Once the recruitment
process is complete, the field staff is then trained and supervised rigorously to
empower them with the skills and knowledge to play an active role in the
program. Field operations are structured into independent cells, each covering a
radius of approximately 35 km or 20 miles (the most that can be covered in a day
with a light motorcycle on dirt roads). Each cell is managed by a supervisor,
assisted by a few health educators. Each cell serves a cluster

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The cell supervisors are responsible for tying up with local doctors to jointly
address the villagers, and with hospitals for health camps, among other things.
They have at their disposal micro-vans capable of showing audio-visuals on health
to help create awareness.

The health educator͛s job is to engage directly with the community, ensure
village-to-member of the partner NGO. Along the way, the initiative has had to
overcome several challenges, including lack of basic awareness amongst people
on healthcare issues. For example, there were several myths around disease and
cures. TB continues to have several myths attached to it with many villagers
believing it to be a curse, and fatal. Another challenge was the fact that relatively
low importance has been attached to women and child healthcare. Limited
affordability is another issue; daily wage earners see medical expenses as being
an unnecessary burden. There were other practical difficulties, such as poor
availability of medicines, pharmacies and doctors, and low literacy levels, leading
to alienation towards names, brands and logos that are in English. Arogya Parivar
workers have also found that consumers are willing to invest in health but mostly
͚pill-by-pill, and being daily wage earners, they prefer a fast acting drug to avoid
loss of daily income.

Non-compliance as a result of this is very high. Rural consumers also take a long
time to build trust in brands, but tend to stay loyal once converted; medicines are
also more appealing when they are sold under an umbrella vernacular brand
name, with icons. Such customers do not respond so well to international brands.

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Arogya Parivar has tackled these challenges by adopting four cardinal principles ʹ
the ͚4 As͛ ʹ Awareness, Acceptability, Affordability.

2c  c Education is the key to start the change process and given
the close co-relation between health and economic- which is stark within
the target community ʹ this is one point that the field educators stress on.
They address and educate the community, especially women, on health
issues. They encourage people to consult doctors whenever unwell rather
than ignore the disease and thus suffer further loss of income because of ill
health. These efforts have been well appreciated by local doctors who were
willing to go further and add value by agreeing to conduct field camps and
reach out to those who had not yet got the message.

2c !c In an environment where healthcare is not seen as a

priority and medicines are perceived as expensive and unattainable,
acceptability proved to be a special challenge. Arogya Parivar͛s multi-
pronged strategy has developed a variety of innovative solutions, in dealing
with all aspects of the problem- brands, people and rural specific
medicines. The key to gaining this acceptability was to develop special
solutions to address local diseases besides recruiting workers from the
community. Small packs at affordable prices also played a major role in
ensuring acceptability.

2c ! Along with smaller packs, all communications, and even

multi-lingual training is adapted to local conditions so that it does not
 intimidate local. The Arogya Parivar message makes its way to the people
through several media, including leaflets and post cards in the local
language.

2c !cAll the efforts being made to create health awareness would

prove completely futile if the medicines were not actually available to the
people at prices that they could afford. The program, therefore, ensures
last-mile together to ensure that healthcare is available locally, in the
smallest of villages. This is a radical departure from traditional pharma
marketing, which usually involves mainly doctor detailing.

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Thanks to its very nature, the Arogya Parivar initiative has proved to be an
even stronger marketing tool, because it goes far beyond, reaching to
directly to the target audience, and offering long-term benefits through
greater awareness of health issues. The health educator is seen, not as
someone trying to sell medicines, but as a true friend the villagers can turn
to in times of need. The bonds being built touch the entire family, and they
will certainly last for a lifetime.
 c&c c
Though diseases in rural Indian can vary according to the location, there are
some that can be found everywhere. Tuberculosis, mother and childhood
malnutrition, respiratory and gastro-intestinal problems are among the
common problems that need to be tackled in the rural areas. Diarrhea is
also a major cause of death. The National Family Health Survey III reveals
that Uttar Pradesh has the highest infant mortality rate in India, with 76
children out of every 1,000 born dying in the first year of their lives. With
just a few variations, it is a story that is repeated across the states. Novartis
India has developed drugs that are specifically designed to deal with these
problems; for instance, the Company has developed a World Health
Organization approved ORS+Zinc formulation, available in an anise flavors
making it more palatable for all and increasing acceptability, especially
among children. The formula is available in easy-to-use sachets, to be
dissolved in a litre of previously bolied and cooled drinking water. Arogya
Parivar͛s Zinc Sulphate, to be co-prescribed with the ORS combination, has
a long lasting effect, reducing the severity and duration of diarrhea, and
preventing subsequent episodes of the disease. Malnutrition is another
serious problem in rural India. According to a recent World Bank report, the
prevalence of underweight children in India is among the highest in the
world; approximately 60 million children are underweight in India, and child
malnutrition is responsible for 22% of the country͛s burden of disease. The
report pointed out that given its impact on health, education and
productivity under- nutrition is a major obstacle to human development
and economic growth in the country. Much of this child malnutrition is
mostly the result of high levels of exposure to infection and inappropriate
infant and young child feeding and caring practices, and has its origins
almost entirely during the first two to three years of life. The report adds.

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The Arogya Parivar program hopes to address some of these problems even
before they occur by educating villagers on issues such as sanitation,
importance of following proper infant feeding and caring practices and
general health awareness.

In the future, Arogya Parivar hopes to increasingly partner with NGOs that
will complement Novartis͛ efforts and add to the healthcare
basket/solutions. While the broad approach is well defined, its very nature
does not allow for a specific solution as a temple. Given the model of
partnering with various stakeholders and varying figures for each cell,
employment generated could be both direct and indirect. The Company has
to consider the population and doctor density, availability of pharmacies,
geographical spread and a host of other factors while deciding deployment
of resources. A cell may need anything form just one dedicated supervisor
and a health educator to a few of them. As the Indian government͛s efforts
at social and financial inclusion accelerate, efforts like Arogya Parivar will
make a significant contribution. What makes Novartis India͛s Arogya Parivar
initiative even more special is the fact that the model, which has proved
without doubt to be a success, is a replicable one, and can be used
effectively in other geographical locations with similar healthcare
challenges.