In April, when 39-year-old Shweta Upadhayay and her two teenage children came down with COVID-19 symptoms, she called the helpline of the local healthcare center. After listening to her describe their signs of illness, the person she was speaking to gave her a different phone number and told her to contact the representatives of BigOHealth—a health tech startup that connects patients with doctors online.
Upadhayay had used other health tech apps before, such as Practo and 1mg, to get medicines delivered to her mother, but she had never heard of BigOHealth. With few options, she tried the service anyway. “I wanted to speak with a doctor as my kids and I were running high fevers and had severe headaches. The company not only set up a call with a doctor, but also arranged to get the swab samples for COVID-19 tests, collected from our home,” she said.
Shubham Shreyas, co-founder of BigOHealth, told KrASIA that since last year, government hospitals in the remotest parts of Bihar and Uttar Pradesh, two of the poorest states in India, have been seeing a surge in queries related to COVID-19. “Now, whenever government health officials get a call from patients who can be treated at home, they put them in touch with us so that they are not overburdened,” he said.
Upadhayay hails from Patna, a tier-2 city that is the capital of Bihar in North India. It has one of the most deficient healthcare infrastructures in the country. BigOHealth’s service of sending a lab technician to her home was a huge relief for Upadhayay. She had already contacted several labs, but none were able to arrange tests in this manner.
So far, BigOHealth has facilitated over 1,500 COVID-19 tests for people in the interior cities of Bihar, including Motihari, Siwan, and East Champaran.
Getting into the doctor’s office
Started in 2018 by Shubham Shreyas and Gaurav Rajput, BigOHealth allows patients to schedule appointments as well as consult with doctors on its app. And as Upadhayay found out, users can also book tests to be conducted from home.
Shreyas and Rajput started the company when they were in their second year of engineering college. Although they had incorporated the company and had a rudimentary website, actual operations were dormant, because the co-founders were in the process of learning the ins and outs of India’s healthcare infrastructure.
“Gaurav and I are both from the interior cities of Bihar, and we have seen how bad it can be for patients to get treatment in time. In many cases, either the doctors are not available in the hospital or the hospital is not equipped to treat the patient as their equipment is not working,” Shreyas said.
Many a time, patients from smaller towns would travel to their state’s capital city, as government hospitals as well as private clinics are more prepared to diagnose and treat patients.
Since there is a massive influx of patients from Bihar’s tier-3 and tier-4 cities to its capital Patna, doctors have a long waiting list of patients on any given day. People who wish to seek medical help have to line up early in the morning to book an appointment, yet even that does not guarantee time with a doctor on the same day. “In case the doctor has to travel for any emergency, patients learn of their unavailability only once they reach the clinic. We wanted to change this mismanagement,” Shreyas said.
When BigOHealth’s co-founders spoke with doctors and patients, they found an immediate imbalance. Patients were open about trying their website, but doctors were reluctant to peel away from how they managed their workflow, even if the startup pointed to processes that could be streamlined. In 2018 and 2019, BigOHealth only convinced 40 doctors to come on board.
Quick, successive validation
In 2019, BigOHealth was accepted into Nexus Startup Hub, an incubation program run by Alliance for Commercialization and Innovation Research (ACIR), and funded by the U.S. Embassy in New Delhi. “Until then, we thought we were just students who were dabbling in this in our free time. But after getting into the Nexus cohort, we felt that our idea had been validated and that we were actually on to something,” Shreyas said.
After completing the ten-week program, BigOHealth received an undisclosed round of seed funding from the incubation center of IIT Patna, an engineering college.
By March 2020, when the novel coronavirus began to spread in India, BigOHealth had only been up and running for a couple months. Shreyas and Rajput faced a moral dilemma—continue charging patients for virtual consultations with doctors, or provide free services that were normally out of reach to those who needed them the most.
The pair chose the latter option. To deal with an increasing number of cases and generate awareness around COVID-19, BigOHealth set up a toll-free number for patients to call and speak to a doctor. At the same time, it started hosting webinars where doctors could educate people about the coronavirus, what it does, and how to avoid infection.
Like many people in India, the founders of BigOHealth thought the worst was over as months went by, but the current wave has stretched hospitals beyond their capacity. There is a severe lack of beds, and people who have mild COVID-19 symptoms prefer to check in with doctors over the phone. BigOHealth’s helpline receives over 200 calls a day from patients like Upadhayay who wish to speak with doctors during their home quarantine.
Apart from this, Shreyas said, the company is receiving more appointment requests from patients with other diseases who are unable to visit their physicians. BigOHealth charges these patients for online consultations.
So far, BigOHealth has serviced 2,500 paying customers. It has facilitated 8,000 free consultations related to COVID-19. Right now, the startup is concentrating on managing the surge in demand from smaller cities in Bihar and Uttar Pradesh, Shreyas said. The company plans to go online in 40 semi-urban and rural cities in the next three years.
“We have set this target consciously, as it’s not easy to crack into the public healthcare system and convince them [doctors and hospital management] to use digital tools for consultation. But we are hopeful, as this healthcare tragedy has already sped up the digitization process,” Shreyas said.
“Tales from India’s Towns” is a series where KrASIA shines a light on technologies that are changing lives in smaller Indian cities, where 500 million internet users will come online in the next few years.