Author: Purvi

Hosted by ACT, UnHerd brings you the unheard stories of individuals who are challenging conventional principles to disrupt the social impact landscape. From social entrepreneurs to venture philanthropists, dive into real-world conversations on what they’ve experienced and learned about changing the status quo.

Our third episode welcomed Dr. Akshay Jain (Co-founder, Cancrie) who, in conversation with Shazib Siddique (Manager, ACT For Environment), shares his journey and learnings as a chemical engineer who saw an opportunity in using agricultural waste to make innovative nano materials that significantly increase battery efficiency.

Listen to this episode on our Spotify channel or watch the conversation on YouTube.

Shazib – Hello and welcome to the third episode of UnHerd – a podcast hosted by ACT that delves into the extraordinary stories of individuals who are challenging conventional principles to disrupt India’s social impact landscape.

The rapid expansion of the electric vehicle and energy storage markets in India is driving the development of the domestic battery industry. As per estimates, the demand for advanced cell chemistries is expected to reach roughly 220 gigawatt hours by 2030 – however, insufficient capacity of domestic battery cell production and shortages of raw materials have become key factors limiting its growth.

Our guest today is Dr. Akshay Jain, the founder of Cancrie, who has dedicated over 10 years of his life to building more efficient batteries by improving performance and increasing their overall lifespan. He has developed a unique way that transforms agricultural waste into carbon nanomaterials that can be used in batteries and capacitors to increase their efficiency by up to 125%. This patented product uses a proprietary manufacturing process that uses 75% less energy and enables a 13x reduction in greenhouse gas emissions.

Welcome to Unherd, Akshay!

Akshay – Thank  you so much, Shazib.

The spark that lit the fire: Solving for net zero

Shazib – It’s great having you here today with us. So actually, I want to start from the very beginning because when I look at your journey so far, there seems to have been a love affair between you and chemistry. You first did your bachelor’s in technology and chemical engineering, then went on to do a PhD from National University of Singapore. Subsequently, you have worked with the Center for Innovation in Singapore as a scientist and have also been a Fellow with the United Nations Environment Program. What was the spark that lit your fire for working in the climate action space and more specifically on battery efficiency solutions?

Akshay – So first of all, I would say you know, it is a slowly developed love affair. It developed slowly because when I started my bachelor’s in chemical engineering, I had a few options. I was very much inclined towards chemistry. So that was a very simple option for me – instead of choosing electrical engineering or mechanical engineering. And from thereon, I went for a PhD and because I was still inclined towards the technical parts. I saw a lot of industrialists coming to our campus and I was always inspired by those people – the big industries they’ve made by being in that space. So looking at that, it always inspired me that, you know, we can do something big with the chemical engineering space. I went on to do my PhD from National University of Singapore and when I finished my work, it [chemical engineering] was [still] continuously evolving.

And there was always a need which came for sustainability. We have to create climate tech solutions. We have to get to net zero emissions. So slowly those things were coming up and we realized how important it is. [And] when I was associated with the United Nations, there was a clear need that until or unless you create net zero emissions, there is going to be a big problem in the time to come. So, that really clicked with me that whatever we need to do on this earth today should be in the direction that we need to save this planet.

So when I was doing my PhD, I got this option – can we do something for the recycling / upcycling process? This field was kind of expanding and expanding, and there was a clear need; that we need to create these green jobs and net zero emissions. That was the time when I was working in the Center of Innovation. It struck me [to think about] whether we can do it ourselves, whether we can do something more, whether we can create a bigger impact.

So that was the time we started this journey of taking this product – what we are doing today in the market – how we can recycle the waste, upcycle the waste, get to the market, and that which can be used in the batteries, which is, again, related to sustainability, which is again, related to creating net zero emissions. Whichever way we are doing this, maybe we are not making the batteries or making the EVs, but making this material which improves the battery efficiency is something we are contributing to from our end in creating and bringing sustainability. And that is how from the last 10 – 12 years, this technology has come so far and we’ve commercialized this technology from the very scratch.

Traversing tough roads: Lessons from early failures

Shazib – I also want to double click on your journey of innovating this material because the first exposure or the first discovery happened at your time in National University of Singapore, where you also founded a startup called Mesotope, and that was your first startup. Building a startup is not an easy journey so I’m sure there were a lot of lessons that you learned during that first startup experience. What have been the big risks, the big failures, and the larger than life lessons that continue to guide you today?

Akshay – I was working at the Center of Innovation in Singapore and when I switched on to do my own venture, that was Mesotope –  that was started in Singapore. We started in 2019, and when the journey started, it was like we already had proof of concepts; [we had] published some papers. As an entrepreneur, we thought, okay, it’s very easy to get the money from the VCs. But when we really got into the deep tech space – material science, climate tech, hard tech, we wanted to manufacture it ourselves – the reality was very different. [We realized] that unless you have your product made at pilot scale, unless you do trials at the industrial scale in a relevant environment, there will be a challenge.

So that was the first time we thought, okay, we have to put this plant, we have to make these carbons at pilot scale. We invested some amount of money, we did some trials to make these batteries, but all at a laboratory scale. That was the first time we scaled up, and it was a big failure. Why? Because we scaled it for the first time – the kind of materials of construction (MOCs) which we used, the kind of industrial grade chemicals we used, we didn’t realize that what can go wrong in that? We were very naive at that time, and we just used it – we thought that everything would be fine.

We invested a lot of money there, our personal savings had gone into it. And then when the battery came out and the performance came out, it was just an average battery, and there were a lot of water losses. We invested almost eight months into it, and then we realized that every single penny has gone into it. And the battery didn’t perform because of the money. We were out of options.

So that was the time we applied for Techstars, and we said this is the last option we had. We get this money based on the idea and the theme. We [told ourselves] that we will proceed further,  otherwise there is no money to carry on. Because being in a deep-tech and hard-tech space is so expensive. Each and every characterization of the material, each and every characterization of the test on the battery costs us a lot. When [we] applied for Techstars, we were bootstrapping that time, we were only getting support from Nidhi EIR that was Rs. 30,000 a month. We all know that we cannot run a company with that. Me and my co-founder Mahi Singh, we just continued for a few months like that. But luckily Techstars believed in us.

Techstars gave us another chance, and they said, okay, we will give you another chance based on your idea and the capabilities you have. That was somewhere in April 2021 – we got the offer from them and in July 2021, we went to the U.S. and were there for six months. And then, we just continued. And then the journey never stopped. So the learning we had from Mesotope was one very clear thing – that you have to be extremely, extremely careful on the machine types you’re choosing, how you are approaching the market and how much money you have. And you have to be really, really planned a little ahead in terms of the fundraise, calculate the runway you have and take calculated risks. But we have learned a lot of lessons, which definitely made us what we are today at Cancrie, because we have learned those lessons at Mesotope.

First principles lens: Challenges and opportunities in climate-tech

Shazib – That’s so interesting to know that all these struggles and hardships have brought you to this position today where you have developed Cancrie into an advanced materials research company, and you’re developing advanced grade carbons that outperform the incumbent fossil derived carbon black, which is produced out of a very energy-intensive process. Your solution is a delight for any battery company in that regard, because I mean, you currently are already working with some of the largest battery manufacturers, like Luminous, Laurus, Sparco, and Future Energy. But I want to understand from you, what are the unknown struggles of an early stage climate tech entrepreneur that we do not often talk about?

Akshay – Whenever we are talking about these clients, they’re currently getting these carbons from Indian companies and also from abroad – definitely the companies or the manufacturers who are sitting in India, they prefer to have these kinds of carbons, indigenous solutions so that they have a continuous supply. And of course, in terms of the other benefits – in terms of pricing, in terms of the local solutions – these [benefits] are always there [from Indian manufacturers]. Now, what we are bringing to the table is very unique because one, like you already mentioned, is about the energy efficient solutions – that we are getting or making these carbons with much less intensive solutions or lesser intensive processes.

Once we get these carbons out, there are certain parameters, which play a very big role for the battery manufacturers or the batteries rather, for the performance of these batteries. What we are building at Cancrie from this 10 years of experience is that we are optimizing the properties in such a way that we are improving its porosities – like poor areas, poor volumes, conductivities, functionalities, poor volumes, particle sizes, purity levels. There are a lot of parameters. We understood what each and every level is going to play a role in the performance of these batteries.

Now, when we reached out to these players, definitely battery being a very sensitive industry, everybody has these challenges. “Do we have to try this product?” Because number one is, it [trying a new product] is always a time consuming job, right? You have a brand name in the market, and if something goes wrong, you’re all gone. Therefore the manufacturers were not accepting this so easily. To do the trials, we have done the product development for almost one to one and a half years with just one customer. We have shown all these performances after all these certifications, after all the tests at third party international laboratories. And once we had all those things with us, that was the time we reached out to more players, because otherwise it was a challenge for us.

All those challenges which came and everything needs money. There was a time when customers said to us that, see, we are not ready to take that risk, and we are not going to pay you for this because this is new, you are trying out something. Definitely when we reached the investors and the VCs, they were also [hesitant] – whether they are going to take that risk because we did not have any revenue. So this gap was there and we faced it in a big way. And that is where a lot of grants came very handy, that have de-risked us in a step-by-step process. First, we expanded the facility. Second, we made the batteries. Third, we did the industrial-scale trials. Fourth, we did the relevant environment testing, and that is where the grants like [ACT really helped]. Definitely extremely thankful for ACT For Environment who have supported us and believed in us.

But that is where the bridge needs to happen.

Shazib – ACT happens to be one of your supporters, but there are of course, other initiatives and a lot of them, that you have been beneficiary of – like government initiatives with respect to early stage climate tech innovations. So, while there are already a lot of incentives and work being done from the government side on promoting the adoption and the manufacturing capabilities of domestic batteries in India – schemes like the Production Linked Incentive scheme (PLI) specifically, which are focused on the advanced chemistry cells which is a strategic initiative to promote domestic manufacturing and also promote the wider adoption of electric vehicles and renewable energy storage so that we can meet the intermittency challenge.

Akshay – Yeah see, this is extremely important. If you look at this space of climate-tech, of batteries and of recycling materials, there is a lot of scope which can be taken care of. What the government has done already is that they have stated that these are the things by which we can control climate change. Can we ourselves, as a company, first bring ourselves to net zero emissions?

And can we support other companies to do that? Because we know that in the manufacturing setup, in the production sector, there will be some emissions which are going to come in, but we don’t want that to happen, and therefore we have to negate that. So we have to think one step ahead. We just don’t want ourselves to be net zero. But what we really want is we really want to make this world a net zero place to live in so that there are no emissions.

And that can be done by bringing sustainability [to] the mainstream, and which can be supported through the help of all these kinds of small developments.

Future Forward: Insights on building a sustainable business

Shazib – And that’s a good segue for me to also come to my next question, which is that your work in itself is very unique. You are building a material science company which is very hard to build, but your approach is also rooted in helping the local community. Tell me why is that so important to you, and what’s your definition of a truly sustainable business?

Akshay – We are recycling the agri-waste, upcycling the agri-waste [and] we always have this vision – can we help the local community there? Farmers who are into this, who are getting certain prices for their waste, or rather they’re just simply burning it or they’re simply throwing it. Can we bring some value to that waste and help that local community earn some benefits from there? We are also thinking in the long term, can we have the distributed units of our plant where these farmers can be employed there, where they can sell their waste there and we can use it in their industry.

Second, very, very important thing, [with] every battery, there are certain rare earth materials which go inside there. What our Cancrie carbon does is, it increases the performance of the batteries and it increases the active utilization of the material which is present inside. What it means is when you say, if you need a hundred grams of the rare earth material, what we are now saying is, instead of a hundred grams, maybe you will get the same performance of the batteries in 95 to 90 grams. Then that means we are saving those rare earth materials by 5-10%. That means that the need for mining is being reduced.

How that is helping the local community is definitely from the health hazard point of view, because now we are not relying more and more on mining. We want to reduce that, and of course, saving the earth from digging it more and more, and of course, saving the people who are into that industry and saving them from health hazards too.

Shazib – Being a founder is not an easy job. You are wearing multiple hats all at once and getting your hands dirty. As an entrepreneur, things can take a downturn at any moment. So how do you prepare yourself for the unprepared nature of this job?

Akshay – See there are definitely unknown challenges in whatever path you take, right? Even when you’re working or, or when I say working, that means if you’re employed somewhere, if you’re doing your own business, or if you’re not doing anything and sitting at home, there will always be challenges which will come and which are always unknown. So, one thing that I’ve learned is that whatever challenge is coming, if it is unknown, don’t think that something [bad] is going to happen. Preserve that energy for the time when it comes, save that energy and fight with the challenge when it comes, because the majority of the things happen only in our mind.

I think my dad told me that, “Akshay, why don’t you write things which you really worry about? Just write it in the diary and see if it is happening with you or not in the future.” I’ll tell you the day I started writing it, until now, none of those things have happened. None, not even one. I’ve written more than a hundred times – it didn’t happen. I [also] meditate a lot. Even in the morning when I come, even in the night when I go [home] before my dinner, I do meditation. I feel that that gives you a lot of power in some way, which I didn’t realize when I started it, it was all for physical reasons, maybe because of my physical health, but it has given me much more than that.

And one more thing which I also do, although I’m not getting a lot of time, I still try to do – is play at least one sport. It gives me some energy, some form of energy, if I play out and go out and do these things. But I think these are some of the things which I feel I can really rely on, which keeps me going.

Shazib – That’s amazing. What are the opportunities that young budding entrepreneurs can tap into? And what advice would you give to young founders who are excited about building in this particular space?

Akshay – One thing that all entrepreneurs should think about is that you should do something that is needed. That’s extremely important. Don’t do your own fanciful things. Don’t do things just because you want to become an entrepreneur or because you want to have your own startup – because these are the things which are going to hit you hard because you want to sell, but [what if] people don’t want to buy? So determine that, take some time and focus on that. Once you get into that, there will be a lot of challenges, which are going to come. But once you are settled, once you have determined that this is something which you really think is going to contribute in some way, then don’t change the pathway.

You have to make your own path. So what we did was we were like, okay, we have these many papers, we have patents. Let’s go to the VC market and we’ll get the money. But the reality was different. And that was the time we learned. Whenever the money comes, it’ll come. We will try, we will keep trying. Grow slow, no problem. Don’t try to rush into things. Grow slow. Because the most important thing, if you have determined that you have to build this, then you will build it.

Shazib – Right. That’s very well said. Thank you so much Akshay for being so candidly open about sharing your experiences, and it was a pleasure speaking to you today and hosting you today on this episode.

Akshay – Thank you Shazib.

Shazib – This brings us to the end of our third episode of UnHerd – a podcast presented by team ACT. If you enjoyed this episode, subscribe to our Spotify and YouTube channels where we’ll bring you more unheard stories of people who are passionate about creating impact at scale in differential ways. People who truly stand apart from the herd.

Hosted by ACT, UnHerd brings you the unheard stories of individuals who are challenging conventional principles to disrupt the social impact landscape. From social entrepreneurs to venture philanthropists, dive into real-world conversations on what they’ve experienced and learned about changing the status quo.

Our second episode welcomed founder, investor and passionate venture philanthropist Sandeep Singhal who, in conversation with Alankrita Khera (Director, ACT), shares his insights on the public healthcare space, decodes the idea of user centricity for health-tech founders who are building for Bharat and delves into the venture approach to philanthropy. 

Listen to this episode on our Spotify channel or watch the conversation on YouTube.  

Alankrita – Hello folks and welcome to the second episode of UnHerd – a podcast hosted by ACT that delves into the extraordinary stories of individuals who are challenging conventional principles to disrupt India’s social impact landscape.

Solving complex social challenges and creating lasting change takes commitment, time and effort. But more importantly, it needs serious philanthropic capital. Traditionally, this has come in the form of CSR support and institutional or individual funding towards programmatic initiatives. But in recent years, India has witnessed a rise in the venture philanthropy model of giving as well. The idea of providing patient yet high-risk philanthropic capital that’s ‘invested’ in innovative opportunities that have high potential to generate transformative social returns at scale that are both tangible and measurable.

Our guest today is a pioneer of the Indian venture capital space and a philanthropist in his own right. Over the last 35 years, he has been an entrepreneur and investor in equal measure – co-founding eVentures in 1999 as one of the earliest Indian VC funds that catalysed market leaders like MakeMyTrip, moving on to building Medusind in 2002 as a revenue cycle management solution for healthcare and then Nexus Venture Partners in 2006 that focuses on powering disruptive companies across AI, SaaS and Fintech in India as well as globally. Today, he continues to be a senior advisor to both Nexus and Avaana Capital, and as a passionate venture philanthropist, anchors ACT as a board member as well as an investment committee member for our healthcare vertical.

Welcome to UnHerd, Sandeep! 

Sandeep – Good morning Alankrita, good morning everyone. 

The spark that lit the fire: The journey towards social impact

Alankrita – Thrilled to have you with us, and I want to start by going back to where it all began. You’re an electrical engineer from Stanford with an MBA from Wharton, who has been in the shoes of both a founder and a VC. That’s an incredible reservoir of wisdom and perspective from both ends of the table. When and how did you begin to channel that perspective towards social impact?

Sandeep – So Alankrita, I lived in the US. I did my undergraduation in the US and worked at organisations that were quite active in philanthropy through employee matching programs. So, you know, whatever causes we supported, the institution would match that cause. And in many cases, companies like McKinsey had programs that they recommended where you could get involved as a volunteer, as well as places where you could give money. So, it exposed us to philanthropy at a very early stage in our professional careers.

Alankrita – Did it start with McKinsey, with these employee matching programs, or was there some kernel of a thought or an inspiration that struck you much earlier that took shape in the later years?

Sandeep – So, I grew up in Kanpur and there are lots of problems to solve in small cities in UP. And so, that idea of philanthropy and the impact that you can have, particularly in the Indian context, has been there from the very start. Charity always starts at home. My father is a cardiologist. So we grew up in an environment where giving was part of the profession itself. And I got to see him do a lot of free treatment, right? His thesis has always been, pay me whatever you can. So I saw that actually from a personal angle at home.

So when we (Sandeep and his wife Anjali Bansal) chose to return to India in 2000, it wasn’t that I was entering into philanthropic activities in India from scratch. Stuff that we had been doing, both me and my wife had been doing, while we were in the US, we just continued to build on that. 

When we came back to India, I was actually supporting educational initiatives because that was some of the stuff we had done while we were in the US. We were passionate about educating the girl child but also, more broadly, serving underserved communities. If you can educate people and make them literate, it has an impact on everything, including health outcomes, including their ability to live meaningful lives. And that was where we started till I came back to health partly because of my father’s experience.

Alankrita – I think this is where my understanding of your story begins. It’s when the pandemic hit and it hit all of us pretty hard. And I know you along with a bunch of other folks decided to start ACT. Tell me a little bit about that. What was going on in your mind? What were you thinking? How did it evolve?
Sandeep – At eVentures and subsequently at Nexus, I was looking at healthcare investing. And so, I had a pretty good understanding of the healthcare entrepreneur landscape in India. And so when COVID hit, one of the things that was driving the formation of ACT was really this large pool of very passionate entrepreneurs and investors who felt that they could bring their collective capabilities to address COVID relief. It was really a groundswell where you said, okay, anybody that has a point of view on how we can bring innovation, how can we bring the passion to solve healthcare issues should get together and make something happen. And given my experience with companies at Nexus, we had a good understanding of what was required. Health access, health delivery access has (always) been a challenge in India. And one of the learnings has been the fact that there is both a commercial aspect to it, but there is also an impact aspect to it. And I think in the Indian context, impact still trumps the commercial aspect, particularly when it comes to digital health. So, ACT was a perfect platform to say, how can we bring our experience as investors, as founders of companies and so on, to help people who are trying to have an impact on healthcare delivery?

Traversing uncharted paths: The venture approach to philanthropy

Alankrita – And I mean, I have to ask this because I know I get asked this a lot. This is the idea of venture philanthropy at the end of the day – essentially what you’re doing is you’re applying VC principles to the idea of social impact. Why this approach, Sandeep? 

Sandeep – So, the VC approach is fundamentally to say–can this founder or can this team really have impact at scale and build something large? So when you think about it, when a person starts a company, that company has always started to solve a problem. The question is, what is the end outcome of solving that problem? At the end of the day, in some way, it’s making the life of us as human beings better, right? Whether it is Sam Altman building OpenAI or whether it is Jo building Wysa, they’re both using AI to solve a problem, just different problems. And so I look at it from that standpoint and say, the fundamental starting point is a problem. The fundamental starting point is an individual that is looking to solve a problem.

What is the outcome and what are we thinking in terms of what are we measuring as success? And so, in the context of a VC, obviously everybody looks at our IRRs and our returns. Everybody says, okay, how much capital did you generate? Or, what was your return on capital and so on? Sometimes you can have impact outside of capital returns. And so, what you’re looking for from a venture philanthropy perspective is bringing that other element, which is impact for impact’s sake. You’re not looking at it from a standpoint of just commercial returns, but you’re looking at it from a standpoint of scale, impact at scale. And that’s important because there are certain solutions which are targeting segments that don’t necessarily have the ability to pay – those segments typically get addressed by government support. 

One of the reasons why governments exist, and everything is not just a private sector, is because there are requirements that we have. Policy is important – you couldn’t put policy into a private company and expect to get greater terms. It has to be something that is done as a public good. And some of those public good requirements cannot necessarily be met by the government at all times. So innovation and the whole idea of innovation-driven public good is something that the government can’t take on. The government is not necessarily the starting point for innovation. Innovation typically comes from an individual. So the thought was, how do we marry this idea of impact at scale in the public good context with the way we think about impact at scale from a commercial standpoint? Now the two places where they sort of interject are really the sustainability of an enterprise. A startup, when it’s in the initial stages, will raise money, but eventually has to get to a level of scale and profitability that can run on its own. Similarly, enterprises that are doing public good. You know, at the starting point they can raise grants, but at some point has to show enough sustainability that either there is an ongoing grant or the government is giving them money to run programs. Or they get to a point where there is enough value in what they are building that even the bottom of the pyramid customers are willing to take that one rupee or two rupees or five rupees, whatever is needed to get access to that. 

So for us, it’s really trying to find that sort of middle ground, which says, here’s an idea, here’s a solution that is addressing public good and is able to do that in a way which will be sustainable in the long run without the need for me to keep giving grants.

Alankrita – When I look at how philanthropy is viewed, irrespective of the approach that is adopted, what I’ve seen is that it’s often articulated as this larger than life idea of nation building. But at its core, it’s usually very closely aligned to something that you deeply feel, like a deeply felt personal passion for solving a very specific social challenge that’s close to your heart. What does this actually look like for you? And why do you choose to focus your philanthropic efforts there at this stage?

Sandeep – So in the Indian context, philanthropy is really programmatic in nature, right? Now, there has been a shift in that. You look at Akshay Patra, a great example of how effectively a program that continues to run. They’ve shown impact. And they were able to scale and build more and more grant support as they went along. On the other hand, you take an example of a company like d.light, which we had back in Nexus days, which were doing consumer solar lighting.d.light at a certain point was able to charge people enough, who saw enough value in the light that they were purchasing, to create an ecosystem where d.light is today. So, programmatic is good, but programmatic always runs into this issue of ongoing grant requirement. 

The first part of what drives my impact is actually promoting venture philanthropy. Because I think that from that basic lens, I actually think that this approach allows for philanthropy at scale, right? If I can get companies to work in the public good space, in the public good sector, they may be running a business that is profitable somewhere else. But if they continue to provide a subsidised mechanism or provide focus on public health, public education, public environmental issues and so on, I actually think that the private sector has a big role to play there.

So bring in more catalytic models rather than just programmatic models into our philanthropic discussions.

Sandeep – I initially started with the mindset that health access, health delivery, access is an issue. And if you’re sitting in a large metro, you never realise the gap between the quality of healthcare delivery that you have in say a Bombay or where I’m sitting or Delhi or anywhere else versus what a person in a village in some outskirts of Orissa is dealing with. You just don’t see it. And I can tell you, for example, we had patients that would show up at home at 9.30 in the evening for my father, right? And they would say, is Dr. Singhal available? And you would say, but you know, he’s either in bed or he’s going to sleep or whatever else. They said, yes but this is the only train we could get to come here. And you realise that this is the pain point – that to get to a cardiologist, the only way they can do that is that they come to Kanpur. And Kanpur is not that large a city. So again, this notion of a hub and spoke model and then bringing it all the way down to the spoke, the quality of treatment, the quality of access to care and so on, is a huge gap. And so, my initial thought process led me to make investments from a commercial standpoint. 

But my learning along that way has been that there is still a gap. Even if you have telemedicine, there is a big gap in the patient’s ability to get comfort that they’re getting high quality treatment. And so that gap has to be addressed with a physical element to it, right? So healthcare is still a very physical sort of need. How do you create that omni-channel delivery system? And so, the learning was that a lot of that has to be done through grant giving rather than just giving money to companies. The kind of person who needs that access doesn’t necessarily have the comfort to pay for those digital tools. 

As part of one of ACT’s field studies, we actually visited these places outside of Odisha, maybe about 80 kilometres outside of Bhubaneswar, and we met with some people at this PHC, the Primary Health Center. You could see the state of treatment that was happening at the PHC. They had the space, they had doctors, but clearly overworked. And across the road, from the PHC was this chemist. And this chemist would organise a visit from a specialist in Bhubaneswar twice a month. So every fortnight, this specialist would come and would treat people from that region. And people would pay whatever his fees were, 500 rupees or 1000 rupees, whatever he was charging. And so, we asked the people at the PHC, what is this? So he says, ‘we would prefer to come to the PHC and we would even be okay paying’. So, it’s not that I want free treatment from the government. I just want treatment, which I can get – the best treatment and I’m willing to pay for it. There is openness to pay, there is ability to pay. The question is, how do you get the system to that scale? 

So, one of the things that we are doing at ACT is supporting innovators in helping the government improve the quality of delivery in the primary healthcare centre or at the community healthcare centre or at the district hospital. So that’s what’s driving my interest.

First principles lens: Building user centricity in tech-led social innovations

Alankrita – You alluded to this just a little while ago and if I were to just dive a little bit deeper into this need gap that you identified within public health care. It’s a high inertia space, right, from both the patient’s and the care provider’s end? You also talked about innovation and technology. And we know that one of the evolving hypotheses has been that tech can be this bridge, it can play a role in solving this ‘access to affordability’ gap for Bharat. What is the most successful example that you have seen that actually gave you conviction that the use of tech or the use of innovation can actually create real impact for underserved populations?

Sandeep – So from a government side, obviously we have been working with the e-Sanjeevani program. We helped roll that out in Odisha. We visited PHCs where they were actually doing calls with doctors that were at district hospitals. And then we visited the district hospital to see the other end of the doctor taking the call and trying to understand the incentives on both sides. Why would a doctor take out time from their busy schedule to do this telemedicine and vice versa? Why would a patient be comfortable doing this telemedicine call from a PHC? So one of the PHCs that we visited, there was a nurse practitioner who was the same person who was running the PHC. We asked her, I said, ‘why are you doing this?’ She says, ‘sir, I grew up in this village and this is something I have to do for my people’. So this was such a service mindset. The government had given her a BSNL SIM card for connecting to the district hospital. She says, ‘sometimes it works, sometimes it doesn’t work. So I got my own data connection from, I think it was Airtel or Jio, and I used that’. So she’s paying out of her own pocket for getting access to telemedicine.

And she says, ‘it’s so helpful because my patient, and she pointed to this old lady that was sitting there, I just can’t see her travelling 80 kilometres to Bhubaneswar to consult a specialist. It’s just impossible for her to do that, both from a cost perspective, the frailty of the person, and so on’. That model showed me this thing can happen at scale.

Assam, you’re seeing similar activities happening. Nagaland, when we were in COVID, we saw this. I can point to many examples during COVID period where we were able to bring in innovative technologies – whether it was testing at home, whether it was oxygen concentrator delivery. We actually did work with a very interesting organisation out of Cochin, this was a training organisation called Pupil First. And they built in the very early days because Ernakulam was the first place where COVID hit. So they worked with the Ernakulam district authorities and they built a system to actually map the entire healthcare delivery network, whether it was a public hospital, private hospital, ambulances. They mapped it out on a single system and they called it CARE.

And so, we started working with them very early in that journey. We funded their development. That whole experience of bringing software, bringing devices, all of that into a government environment sort of said, okay, as long as we don’t get innovation stuck in the government procurement system, we can actually bring innovation to the government. 

It’s not that the government doesn’t want innovation. The government is seeking innovation because the government also realises, both at the central level and the state level, that innovation is going to be a very important part in making healthcare available to the masses at scale. But see the kind of problems they’re dealing with at scale. The health secretary sitting in Delhi is addressing the whole COVID issue across India, right? You and I never have to deal with that kind of scale. So they have a very strong understanding of scale, but they are so busy in their day-to-day jobs and because of the issue with managing vigilance and all that stuff, they cannot just say, okay, here’s an interesting idea, please bring it to the government, right? They have to follow certain processes when it comes to procurement, when it comes to deployment and so on. Tomorrow if something were to go wrong with the innovation, that’s a huge problem for them. The government can’t deal with that kind of risk. So understanding the limitations under which the government has to work, how do we bring innovation into this system? And the way to do that is to both educate the innovator that this is how public health works, as well as taking away the need for going through a procurement system.

And so initially we’ll do that with certain guardrails, right? We’ll put certain guardrails to make sure that the government is not put at risk. Typically we’ll work with innovations at least that are clinically validated, but even on those, you end up finding edge cases when you are actually in the field. And so once we get more comfortable that edge cases can be addressed, at that point working with the government is to bring that into procurement, rolling that out. Interesting example of a company called Dozee – so Dozee has built a solution where you put a bunch of sensors under a patient’s bed. And those sensors then provide vital information to the nursing station that could be located away from that bed. That was extremely valuable during COVID times because you didn’t expose healthcare delivery staff to go and take vitals. So, Dozee showed the value of the technology, but the technology had some issues. There were some things that had to be worked out. During COVID, we got feedback from the people like the government institutions, charitable institutions that were deploying it saying, ‘we like this product, but here are the five things that it needs to do better.’ And there was one thing as simple as, ‘oh, they have this device that connects to the bed, which looks like it’s an expensive device. Somebody just comes and takes it away. As an innovator, I would never think about that. And you would never say, somebody would steal something from a patient’s bedside, but it happens. 

So we did simple things – like just putting a means to lock it to the bed so it can’t be removed. So they got feedback. They improved it. The government got data saying that this works. So now they are actually, and it’s a private company, they’re expanding quite rapidly. And it’s (their technology) being used, it’s being procured by the government. So again, examples like this just tell you that there is a need for innovation in public health. There is a desire to bring innovation into public health.

Alankrita – Yeah. I mean, you were talking about CARE a little while ago, and I just want to share that they’ve actually been, if I’m not mistaken, they’ve been recognized by the UN as the world’s 50th digital public good. And they actually went on to do tele-ICUs and now are moving on to smart-ICUs, connecting doctors pretty much anywhere in the country to rural and remote hospitals.

Sandeep – It’s an amazing story. It started as a COVID relief project and it has now gone much beyond that. They have built a full solution for managing ICUs remotely. So one of the things that we are seeing is the ability for the work that we are doing in India to have global impact. So at ACT, we are actually quite excited that what we are doing has been accepted by the UN as a digital public good.

Alankrita – That’s right. I mean, taking India to the world, I think that’s the big aspiration. Sandeep, I want to actually just play devil’s advocate. But at the end of the day, if you think of tech-led innovations and the adoption of this kind of innovation or the adoption of this kind of technology, I imagine that depends very heavily on just influencing behaviour change. 

And it comes from my own example. Like a couple of weeks ago, my son was not feeling well, he’s about to be three, and it was quite late in the night. And I have the option of being able to video consult with my paediatrician at the hospital. But the first thing that I thought of as a parent was, I need to be able to see the doctor and I want the doctor to be able to examine him, take his vitals and then tell me what’s wrong. Now, if this is happening with me, this is absolutely happening at the rural Bharat level. So for entrepreneurs who are building in this space, Sandeep, given that this is a consideration, what do you think is the right approach for them to adopt?

Sandeep – My experience with investing in this space at Nexus and looking at this also from what we did with COVID relief at ACT is that the Indian patient is still behaving very similar to what you said. In particular, you are a literate person. You understand how video conferencing works. So you understand that apart from the actual taking of vital signs and so on, a lot of the conversation can happen on the phone. For a person who is not familiar with technology, it’s even harder. When we use the word vital signs, we both know what we are talking about. You go and talk to somebody in the village, what is the information that they need to give to a doctor? They don’t know. The doctor knows what they are and it’s not even like their description of their problem is also challenging, right? So in those cases, the doctor has to ask 10 questions to get to that answer. 

So the point you bring up is extremely valid. This need for a physical connection is very critical. And the government recognizes this. The whole ASHA worker model, the ANM model is driven by the fact that you need that physical touch point. You need somebody in the local ecosystem. You need somebody who is trusted to be able to deliver healthcare at the end of the day. Because if I go to a woman today and I say, I need you to be screened for cervical cancer, it is an invasive procedure in some way, right? How would that woman take it if it was somebody just giving that, making that ask? So trust is very important in the context of healthcare delivery. And so, your point about behaviour change fundamentally starts with building trust. That trust gets built from a very hyper-local standpoint going up. 

What we are realising over there is that to really scale that and to really be successful, one has to really think about this as building capability at the ground level in people that the patients trust. So this is what I was talking about in the context of the PHC. The patient goes, his first point of connect is either the local doctor or the local PHC.

Today we are working with a company that has built cervical cancer screening tools and we are working in some of the backward districts in Maharashtra to provide screening capabilities that if they were done with the naked eye would not provide as much accuracy as we can do with this device. We have been working with this organisation called Mahan Trust. So Dr. Ashish Satav runs this. I have to really sort of look up to people like them. These are people who are living in the remotest parts of India. Dr. Satav is running Mahant Trust out of Melghat district – Melghat district is this tribal district in Maharashtra. 

Recently, we had done a pilot there in Melghat around digital microscopy and being able to provide pathological services remotely. They were working with somebody in Nagpur and they discovered a cancer patient that would have been missed otherwise because the care would not have been available at Melghat. So I think those are the kind of changes that need to happen at the ground level that will drive behaviour change. So once this patient that was diagnosed with cancer goes back to their village and they’ll say, hey, we went to this thing and we got this, they’ll spread the word. So a lot of it is about trust and building comfort. And we have to work with people that have already built that trust and then equip them with more and more innovation.

Future Forward: Wisdom and insights for health-tech founders

Alankrita – Yeah, I mean, Sandeep, we do know that innovation can actually re-write the playbook pretty much completely. But we’ve been talking about how tech works, or how well it works, or the potential that it has. But if I were to look at it from the philanthropic level, these are high-risk philanthropic investments. And given that you, as a venture philanthropist, you’re looking at all of this with a very clear sort of approach and a very clear set of lenses – in your experience and from whatever that you’ve seen, what is the biggest insight you’ve garnered on what absolutely does not and will not work?

Sandeep – Going back to this point of programmatic versus catalytic, we work with the assumption that not every sort of investment we make or every intervention we do will be successful. That’s the nature of catalytic capital. Programmatic works very differently. Programmatic works with the assumption that wherever they’re making an investment, that program will be successful. So there is a little bit more of a desire to not have things fail.

Two things happen because of that. Number one, hopefully we will make decisions faster because we are less risk averse in that sense. The learning, one big learning, for us is that regardless of whether this is a VC investment or whether it is an impact investment where the primary driver is impact at scale, we have to work with people that are thinking of scale in the design of their solution. So one of the challenges, and I think Pramod Verma put this very well. He’s the architect of Aadhaar and he made a very interesting point based on his experience at Aadhaar. He said, the reason why Aadhaar has been successful, is we knew the scale we needed to achieve from day one. And one of the things that we see with people who are working in the impact space is that they work at the local level first, with the idea that if we can solve a problem at the local level – because there is a reason for that. You typically will work on a problem that you see around you. It could be that people are dying of hunger or people are not getting water or whatever else, and you see it around you. And you say, okay, I need to solve this problem. So what they do is they solve the problem at the local level, and then they say, okay, let me scale this. So they don’t necessarily design their solution to be a solution that doesn’t need them or is designed for scale from day one. We are looking for people that are designing for scale from day one.

Alankrita – Yeah. I want to actually now, given that you’ve been talking about this, I want to shift gears a little bit and just to bring this to a bit of a conclusion. If I were to look at it from the social entrepreneur end, there are a couple of things, right? Early stage social entrepreneurs who are trying to pioneer these tech-led innovations, they’re often navigating pretty much everything from clinical validation to build an MVP to business development to crack PMF entirely on their own. At the same time, they’re also trying to balance purpose with business sustainability, because like you very rightly pointed out, that is critical. You have to be able to make your enterprise sustainable to be able to create that impact. What are resilient social entrepreneurs made of, from everything that you’ve seen?

Sandeep – I think the starting point for that resilience is really passion. It’s the passion about the problem you’re trying to solve. It’s actually, I would say, no different between any entrepreneur. Whether it’s a social entrepreneur, whether it is a for-profit entrepreneur or whatever. And many of our entrepreneurs are for-profit entrepreneurs that we have repurposed to work in the public space, right? We’re looking for entrepreneurs that want to solve social problems. So resilience is really around the ability to sell and listen. Those  two are easier said than done. You’re constantly selling – you’re selling to the government about the efficacy of what you have built, you’re selling to your funders, investors that, hey, you know, if you give me money, I’ll bring about major change. You’re trying to sell to your employees that come work for me at half the salary that you’re making elsewhere because you’re having fundamental social impact. The other part that I talked about is about listening. 

So let’s say I am today working at ACT. I’m working on problems that I have personally never experienced. I have never had to deal with not having electricity 24/7. I have never had to deal with having to go get water in the morning by six o’clock because otherwise the well is dry or the taps are dry. So that’s the kind of the need for empathy and listening is very critical. Being able to relate to the person whose problem you’re trying to solve is actually very, very critical for the point you made on behaviour change. I have a very personal story. My son was in, I think, seventh or eighth grade, and he was studying at a private school in Bombay, and they had to do a community project. He went and taught at this mobile creche. So for construction workers, there’s an organisation which runs mobile creches for their kids. So he went and he was going to teach them. And he had gone with a lesson plan. He had prepared everything. And I think he was going to talk about the solar eclipse and stuff like that. So he’s teaching them and then, he sees glazed faces in front of him. So he stopped and he said, what are the questions that you have? And he said that when they started asking questions, the kind of things that they were asking in one way were so basic but in other ways showed him that what he had come in with as, hey, this is what I’m going to teach, was completely off. He said, it was a learning that if you are trying to work in the social sector, you have to be in the shoes of the person who you’re trying to help. And I think that is a very important part about this resilience of the social entrepreneur.

Entrepreneurship is a very lonely journey, right? So in that lonely journey, you need these small wins. And by being in the shoes of your recipient, the beneficiary, and seeing the small wins, it just gives you the resilience to keep going.

Alankrita – And that’s wisdom right there. But if I just go back to philanthropy, and if I look at what it was about a decade ago, it looked very different, right? It was, and we talked about this earlier as well, it was a little bit more programmatic. And today, we are starting to see that shift where philanthropic intentions are veering towards being a little bit more catalytic with models like venture philanthropy. But at a larger level, if we were to just go beyond ourselves and what we believe in, what’s your personal point of view on the philanthropic approach that is needed to really, really build better for Bharat?

Sandeep – I would say that all types of philanthropy I would welcome, right? I think the number of problems we have to solve and the level of impact that we can have, I think whether it is programmatic, whether it is catalytic, whether it’s venture philanthropy, whether it is your traditional grant giving, whether it is the money that came through religious organisations, whether the money comes through your local charity. 

Today, there is a shift in the narrative and that’s being driven by organisations like ACT, the Nudge Foundation, Central Square Foundation, Giving Pi, AIN, Ashoka Fellowship. There are many organisations that are now creating a bridge between money that wants to go towards philanthropy and causes that are scalable, sustainable in nature. Our role is to provide a bridge and provide that comfort to the investor, to the philanthropic capital. That if you go work with Veena at Periwinkle, or if you go work with Dr. Manjunath at Niramai, or if you work with Dr. Naresh at Navya, the impact that they’re having is a good use of your money. And I think that is what is changing. The narrative is changing today to say there are entrepreneurs, there are innovators, there are private institutions and public institutions that are working towards having impact and they’re having impact at scale.

Some interventions, like I mentioned, will continue to be programmatic, and will continue to require grants. There are others that will migrate towards more sustainable growth, either with the government taking it on or with the people who are the beneficiaries paying for it and so on. But there are going to be catalytic solutions as well. There will be discoveries that will happen in new ways of giving. I don’t know yet. But crowdfunding is a new thing that came up. So a Ketto, a Milaap – they were able to build a platform around philanthropy that I would never have expected in India. This notion of giving money to any random person who puts a request on Ketto, it happens. So I think that there are new forms of philanthropy that are emerging. And my goal is, again, to promote as much philanthropy as possible.

So the idea is that you don’t need to be 50 to start giving money. As I was explaining my own experience, you can start giving money much earlier. And we’ve seen a lot of wealth created in India with very young founders, with next generation family members and so on. And our goal is that not everybody has the time or the sort of inclination to go and set up their own foundation or their own philanthropic sort of infrastructure. So what ACT is doing is giving people an opportunity to come and work off of an existing platform, work with people that have similar goals, maybe not the same goal. It doesn’t need to be the same goal, but provide a platform where people can bring their own interests, their own areas of philanthropy and work off of a single platform.

Alankrita – Amazing. This has been absolutely amazing, Sandeep. Thank you so much for joining us for this conversation.

Sandeep – Thank you. It was wonderful talking to you. 

Alankrita – This brings us to the end of our second episode of UnHerd – a podcast presented by team ACT. If you enjoyed this episode, subscribe to our Spotify and YouTube channels where we’ll bring you more unheard stories of people who are passionate about creating impact at scale in differential ways. People who truly stand apart from the herd.

Tuberculosis (TB) remains a significant public health challenge in India, home to the highest number of TB cases globally – about 25% of the global TB burden. Each year, over 2.7 million people in India are diagnosed with TB, predominantly affecting marginalised and economically disadvantaged groups, including migrants and those in overcrowded environments.

In response to the TB crisis, especially in tribal areas, ACT For Health collaborated with Basic Health Service (BHS), a non-profit organisation dedicated to providing comprehensive healthcare in remote regions. BHS serves vulnerable tribal communities through its primary care clinics located in tribal regions of Rajasthan. Their decade-long work has underscored the high TB risk groups among migrant workers, who are more susceptible due to poor living conditions, nutrition, and hygiene. A significant challenge in addressing TB is the lack of availability of diagnostic tools like chest radiography, sputum tests, and the cartridge-based nucleic acid amplification test (CBNAAT) in underserved regions.

To combat these challenges, ACT collaborated with BHS to help equip Public Health Centers (PHC) and primary care clinics with X-ray machines and cassette readers to bolster their diagnostic capabilities. X-ray imaging plays a pivotal role in the fight against TB. It especially proves to be vital in low-resourced settings where advanced testing is not available, significantly aiding in the early detection and management of TB. The grant led to the successful treatment and management of over 7,000 TB patients within a year and helped reduce the costs and time for diagnosis and treatment. 

Recognizing the need for X-rays as an essential primary care imaging solution, ACT for Health is renewing its support to BHS for the deployment of mobile cassette readers (CR), also known as an X-ray detector, at their primary care clinics. The availability of a mobile CR machine will allow BHS to serve multiple clinics more efficiently, ultimately enhancing their ability to serve a greater number of patients by reducing overall turnaround time. We’re excited to support BHS in decreasing loss-to-follow-up rates and ensuring swift diagnosis and treatment, thus increasing BHS’s capacity to serve more patients and improve health outcomes significantly in these communities!