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Vision India 2020: Care

Posted on Sunday, Sep 21st 2008

I have written a series of columns on healthcare over the last several weeks. Most of them were focused on healthcare for the rural and under-served population. This column addresses a business opportunity for the growing affluent class in India in the healthcare sector.

The number of millionaires in India rose 22.7% to 123,000 people, the fastest growth in the world in 2007. The number grew to 1.23 million in 2020.

It is this segment that we focused on for our venture, Care.

Simply put, Care was founded to offer a reliable, trained pool of in-home caregivers to address the needs of families with elderly people, patients with cancer, Parkinson’s, Alzheimer’s, stroke, etc., as well as mental illnesses like bipolar disorder, schizophrenia, depression, and myriad other types of illnesses that required some form of assisted living.

Some statistics would help us frame the problem. There were an estimated 2.5 million cases of cancer in India at the time. Mental illness was estimated to be in 65 per 1000 in 2007, which translated to about 70 million patients. There was only one trained psychiatrist for every 100,000 patients with a mental illness. Psychiatric treatment was considered a taboo, by and large, and went untreated. About 77 million elderly people needed to be looked after.

Having watched American society up close – an isolated, individualistic society, long on achievement, short on compassion – I believed it was clear that as India becomes increasingly developed and successful, it would face certain choices about how to address these issues of caring for its non-producing citizens.

It is a long, complex subject, and by no means did I have any illusions that Care could solve the entire problem. However, we felt that training 100,000 women who were otherwise not hugely qualified for other jobs, to provide nursing and in-home care, could achieve two things: (a) help a segment of the population with means in caring for their in-need family members, and (b) train and create jobs for a large number of women who were otherwise unemployable.

In our hiring, we collaborated with the best NGOs all over India who worked with abused and battered women, helping them become self-sufficient. We, Care, became one of the ways these women could become self-sufficient through training and job placement. It was also important that these women were living at homes, and the dynamic of being part of a family was key to their rehabilitation.

It was a perfect win-win formula. The families, as we explained our double-bottom line mission to them, understood that.

As a result, by 2020, word-of-mouth helped Care become an integral part of the affluent Indian society’s formula for care-giving. We succeeded in placing 350,000 women, some of them with children, with families. And, we succeeded in creating a sustainable solution for caring for the elderly and the sick.

As India becomes increasingly more developed, we expect to be able to spread the model to address a much larger population. For the moment, it is interesting to look at the numbers.

Our revenue, in 2020, is $1.65 billion, with a 20% operating margin. By all standards, this is an excellent P&L.

To expand into households with lower income levels, we have to accept a lower profitability equation. There are also some challenges around living space, as the middle class does not have quite the same luxury of being able to afford 24-hour in-home help due to space constraints.

Our market research reflects the need for specialized assisted living homes, which is probably where we will invest next, to extend the Care brand into a different segment.

In all this, we realize, the poorer population still remains unaddressed. Our plan is to create a non-profit foundation to build a network of Care facilities for the base of the pyramid. This is, however, not an easy task, and I have admittedly less confidence for the moment to say whether it would work or not.

Nonetheless, I hope you see the merit of the Care model.

Note: Vision India 2020 was subsequently published as a book. You can order it from, etc.

A call to Indian entrepreneurs everywhere, Vision India 2020 challenges and inspires readers to build the future now. In this “futuristic retrospective,” author Sramana Mitra shows how over the next decade, start-up companies in India could be turned into billion-dollar enterprises. Vision India 2020, which encompasses a wide range of sectors from technology to infrastructure, healthcare to education, environmental issues to entertainment, proves how even the most sizeable problems can be solved by exercising bold, ambitious measures. Renowned in the business world, author Sramana Mitra conceived Vision India 2020 from her years of experience as a Silicon Valley strategy consultant and entrepreneur. Well aware of the challenges facing today’s aspiring entrepreneurs, Mitra provides strategies, business models, references, and comparables as a guide to help entrepreneurs manifest their own world-changing ideas. 

This segment is a part in the series : Vision India 2020

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S, this makes sense on the face of it. By analogy, consider the significant number of women care givers who come to the US and Canada as “nannies” and domestic helpers. Many of these very qualified women come from less advantaged (compared to NA standards) backgrounds which are, nevertheless, rich in love and respect for the elderly. And many many (most) have significant and appropriate educational qualifications that signal a high standard of care. As Baby Boomers (and pre-BB) age and require more in-home care — those who can afford it — the demand for quality domestic help and support here in NA is growing.

By analogy, the model you outline for Indian upper class needs should work and has much to recommend it.

With appreciation, 🙂

Bob Kirk Sunday, September 21, 2008 at 2:04 PM PT

PS wrt to source countries above need in NA, I was thinking Philipines but there are many others including Vietnam, etc.

Bob Kirk Sunday, September 21, 2008 at 2:06 PM PT