ACT For Health welcomes KHPT: A game-changing innovation for TB awareness and prevention

For more than 2.6 million people across India, a persistent cough or fever is more than just a passing ailment—it’s a looming threat, a warning sign of a disease that claims thousands of lives each year. Tuberculosis (TB) remains one of India’s most pressing public health challenges, disproportionately affecting the country’s most vulnerable populations.

The government’s National Tuberculosis Elimination Programme (NTEP) has made notable progress, but critical gaps remain. Millions still go undiagnosed or do not complete treatment due to social stigma, lack of awareness, and weak frontline support. Frontline workers, responsible for over 22 diseases, are stretched thin, making it difficult to provide personalized care to TB patients

To address this, Karnataka Health Promotion Trust (KHPT), a leader in public health interventions, has developed Sangaati—a voice-based digital companion designed to enhance TB awareness and treatment adherence. By utilizing vernacular voice technology, Sangaati overcomes language and literacy barriers, ensuring critical TB-related information is accessible to the most vulnerable populations. With a validated knowledge base of over 3,000 questions from NTEP, Sangaati equips frontline workers, caregivers, and persons with TB (PwTB) with critical information to improve health outcomes. 

KHPT has piloted Sangaati in 17 districts, gathering user feedback and refine this voice-based digital companion. With a phased approach, gradually expanding to high-burden states, the goal is national integration, ensuring that the tool becomes a key component of India’s TB response strategy.  The app’s usability, impact on treatment adherence, and user engagement are being measured through longitudinal health outcomes such as improvement in adherence rate, TB literacy improvement, and user satisfaction resulting from reduced stigma and ultimately overcoming information asymmetry.

Founded in 2003, KHPT has tackled public health challenges among marginalised populations across India in areas like HIV/AIDS, TB, MNCH, Adolescent Health and Primary Health care with a focus on social determinants of health. Over two decades, it has expanded to 20 states, impacting over 15 million people through evidence-based and community-centric programs. Now, with Sangaati, KHPT is making its first foray into digital transformation, harnessing technology to accelerate and deepen the impact of its public health expertise, strong government collaborations, and a commitment to empowering and reaching the unreached communities. 

ACT For Health is now supporting KHPT to scale Sangaati by driving widespread adoption in Karnataka – which shoulders 3-4% of the national TB burden (80k-100k) -, generating robust evidence from its deployment, and rigorously testing its scalability for expansion into new languages and states. This partnership also marks a pivotal shift in KHPT’s journey—one that could open new pathways for integrating tech-driven public health solutions across its broader portfolio.

At ACT For Health, we are excited to support KHPT’s mission to empower patients, caregivers, and health workers to enhance TB prevention and treatment for India’s most underserved communities through a tech-enabled approach!

 

V-All: Making volunteering a habit through gamification

Introducing our next grant as a part of a recent pilot experiment that aims to bridge the funding gap on building bold ideas into scalable solutions!   

Founded by Bindi Dharia, V-All is reimagining volunteering as a lifelong journey through its civic action platform. India faces a $21 billion funding gap to achieve its Sustainable Development Goals (SDGs), yet only 1% of Indians actively engage in giving in any form – time, skills or money. On the other hand, nonprofits across the country face persistent challenges in attracting skilled volunteers who can provide time and expertise to advance their missions.

By building meaningful connections between individuals and social causes, V-All is helping create a culture of giving in India by making it engaging and aspirational. With early traction from partnerships with schools, colleges, and community organizations, V-All is well-positioned to transform India’s volunteering landscape.

V-All’s gamified platform makes volunteering accessible and rewarding. Volunteers can discover opportunities that match their skills, interests, and availability. Personalized quests allow users to track their impact, build a giving portfolio, and develop a lifelong habit of civic engagement. Simultaneously, nonprofits gain access to skilled volunteers, helping them deliver programs more effectively.

With ACT’s pre-MVP grant, V-All will:

  • Develop key platform features, including gamified user journeys
  • Build AI-powered matching to connect volunteers with nonprofits
  • Create a marketplace for rewards and recognition to encourage sustained engagement

In addition to funding, ACT will provide technical advisory and strategic mentorship on business model development and fundraising to support V-All in scaling their MVP effectively.

By connecting socially conscious individuals with nonprofits in need of critical skills, V-All aims to democratize philanthropy and engage over 2 million volunteers by 2027. We’re excited to support V-All as they work to build a more engaged, empowered, and socially conscious India.

Sakshm AI: Empowering college students with AI-powered skilling

At ACT, we believe technology can unlock scalable solutions to some of the world’s most pressing social and environmental challenges. Over the past three years, we’ve seen firsthand how tech-driven innovations can create lasting impact when paired with sustainable business models.

However, one critical gap is the lack of early-stage capital for tech-first innovators to build their idea into reality, and the absence of funding at the build stage often creates a talent gap during the early stages. As a part of a recent pilot experiment, ACT decided to help plug this gap and is partnering with aspiring social entrepreneurs to turn bold ideas into scalable solutions. 

Sakshm AI is one such organisation that’s addressing the need for market-ready skilling for India’s graduates. India produces over 1 million engineering graduates each year, yet nearly 44% remain unemployable due to gaps in both technical and soft skills. This challenge is particularly pronounced in Tier 2 and Tier 3 cities, where students often lack access to high-quality skilling resources and placement support.

Founded in 2024 by Apurv Mehra, Sanchit Sharma, and Kashish Mittal — all former researchers at Microsoft Research — Sakshm AI is building Disha AI, an AI-powered Socratic tutor that tailors personalized learning journeys to specific tech job roles. By mapping industry requirements and fine-tuning AI models with expert insights, Sakshm AI ensures students are equipped with relevant soft skills and hard skills, practical exposure, and accurate knowledge to thrive in the workforce.

With their deep technical expertise and understanding of Bharat’s emerging workforce, the Sakshm AI team is uniquely positioned to address this pressing need. By offering skilling solutions at the ‘price of a chai,’ they are committed to democratizing access to career-building resources for students across India.

We’re excited to welcome Sakshm AI into the ACT For Education portfolio and aim for our pre-MVP grant to help them: 

  • Build and refine their AI-driven assessments
  • Enhance their AI models to improve learning outcomes
  • Pilot their product with government and non-government partners

In addition to funding, ACT will provide technical advisory and strategic mentorship on business model development and fundraising to help Sakshm AI scale effectively.

With the ambitious goal of making 1 million students employable in the coming years by equipping graduates with job-ready skills, Sakshm AI aims to significantly improve placement outcomes and expand career opportunities for students across Tier 2 and Tier 3 cities. We’re excited to support Sakshm AI on this journey and look forward to seeing their impact unfold as they empower the next generation of India’s workforce.

 

Inviting aspiring tech-first social entrepreneurs to build for Bharat with ACT!

At ACT, we believe that technology has a role to play in solving some of the most complex social and environmental challenges we face today. Over the last three years, we’ve had the privilege of interacting with 1500+ social entrepreneurs and supporting 50+ organizations through a combination of grant capital and access to network connections and collaborative platforms. We’ve helped founders identify growth pathways, unearthing business models that serve as proof points that technology can enable high quality, sustainable social impact at scale.

At the same time, we know we need many more passionate and talented founders to solve these systemic, complex problem statements. But building tech-first and impact-first is tough. One critical gap is the lack of early-stage capital for innovators to build and test contextual solutions, and the absence of build funding means founders also struggle to attract high quality tech talent during the early stages.

Hence, we’re piloting a different approach to our business as usual – we are looking to partner with aspiring social entrepreneurs to translate innovative ideas into scalable solutions. 

  1. You must be a full-time founder with a legally incorporated entity in India.
  2. You must be impact first and aim to create measurable impact across one of the below areas:
    1. Focus on Bharat as target audience: Solutions targeting underserved communities (households with monthly incomes below INR 25,000) to boost education, livelihood, health or gender outcomes.
    2. Focus on decarbonisation and/or water security: Solutions aimed at enabling India’s progress across both these goals by addressing the issue at source for outsized environmental impact.
    3. Focus on enabling the social impact ecosystem: Technology-driven initiatives that enable and build the capacity of social enterprises, NGOs, and other impact-first organizations, thereby strengthening the broader ecosystem for social change.
  3. You should have a clear problem statement based on user research and a tech-first approach as a solution to the problem statement.
  4. You should have a clear roadmap to develop software technology (standalone or integrated within a hardware product). We are not looking for deployment ready solutions here.

If this is you, please reach out to us with some details by filling out this form, and if there is alignment, ACT will provide support in the form of: 

  1. Capital for technology build: Up to INR 30 lakh grant support over a 6-month period
  2. Tech guidance: Dedicated tech advisory aligned to your journey towards building a minimum viable prototype (MVP)
  3. Fundraising and business model refinement: Targeted mentor connections on fundraising and business model strategy 

UnHerd with Shreyasi Singh: Empowering women to lead and succeed

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 latest episode of UnHerd features Shreyasi Singh (Founder, Harappa – now acquired by UpGrad), in conversation with Anupama Kashyap (Manager, ACT For Women). Shreyasi shares her journey from journalism to entrepreneurship, building Harappa into a leading online learning platform and her mission to empower more women leaders in India’s startup ecosystem and beyond.

Tune in on Spotify or watch the episode on YouTube to learn how Shreyasi is driving meaningful change in workplaces and breaking barriers for women in leadership.

Anupama: Hello folks, and welcome to the next episode of UnHerd – a podcast hosted by ACT. We bring to you the stories of extraordinary individuals disrupting India’s social impact & startup landscape by challenging conventional principles.

This episode is about a topic that is very close to our hearts at ACT; more women leaders within and beyond India’s startups. Highly resonant with my own professional goals, which is why I’m very excited to be joined today by someone who I’ve looked up to, and who truly embodies the spirit of breaking barriers. From journalism to entrepreneurship, an author and a passionate advocate for women in the workplace, our guest has led with purpose. She’s built a leading online learning platform – Harappa – which has redefined how Indian professionals hone their skills for success and growth in workplaces.

Welcome to UnHerd, Shreyasi!

Shreyasi: Thank you so much, Anupama. And thank you to the ACT team, who of course I love, for having me on UnHerd.

Anupama: Shreyasi, to give our audience a quick (insight) into you and your journey – we know that it has spanned from journalism to founding one of India’s most innovative learning platforms. And I think we all have these pivotal moments in our career that prompt that switch. I’m really curious to know about your story. Tell us more about that.

The spark that lit the fire: Of career pivots and crucible moments 

Shreyasi: Yes, I think my career really confuses people. I think we all have, in our lives and our careers, these crucible moments that set the direction of our next 10 years, next 15 years. And for me, that was the last stint that I had in journalism. 

Inc is an iconic American magazine on entrepreneurship and I was the editor of the India edition for four years. This was 2011 to 2015 and this is really when the startup boom was beginning to happen in India. It almost felt like doing a PhD in entrepreneurship because every month you’re bringing out 90 pages of a magazine. So from co-founder dynamics to how do you create a brand to what’s a great incentive structure for employees, how do you do performance management. Towards the end, you meet amazing entrepreneurs and founders who have this special conviction, right? Like there is this special ring in their voice, they bring this special energy to what they do and how they talk about their work. And more and more, I think I was feeling like, maybe I could do this too. I actually find great similarities between the skills that I learned as a journalist, and especially how well those skills were deployed. As a journalist, you’re very good at asking a set of structured, smart questions. 

As a founder, you also need to do that. You don’t know everything about everything, even in the company that you’re building. But I think there’s a very efficient way of (asking) a set of questions that gets you to that answer. Second, I feel like journalists come with a great deadline orientation. The magazine doesn’t wait for you to print it. It has to come out on the same day. But third and most importantly, and I didn’t know this six, seven years back when I started Harappa, there is an urge to create, you know? You start with a conversation and an empty word draft, and something emerges out of it. So I think these three skills really, I think, transferred very well and really helped me. But most importantly, it was the inspiration that I got from covering entrepreneurs and just entrepreneurship in general that let me think that I should aspire to do this and maybe I could do it too.

I actually had two pit stops between being the editor of Inc and finally being the founder of Harappa. And those pit stops were, I spent a year writing a book, which was a business non-fiction called The Wealth Wallahs. It was on the happy eventuality of entrepreneurial success for which I interviewed over a hundred people and spent a year, year and a half working on that book. And then after, working as a part of the founding team on an 18 month women’s only MBA program. And that was my first introduction to higher education and especially alternative higher education – how different models and formats (work), especially in a country like India where there has to be almost an insatiable appetite and need and demand for learning. I think that is when it first got kindled. So I think if these two (pitstops) hadn’t happened, maybe Harappa also wouldn’t happen. I also do want to give a lot of credit to my co-founder at Harappa, who’s a pioneering educationist of his own, Pramath (Raj Sinha). And I think he said that we should really work together.

And that’s really how Harappa happened. Harappa was incorporated in March 2018, which is just six and a half years back. But Harappa has just been on this ridiculous accelerated condensed kind of cycle that I think none of us imagined. Most startups don’t work, right? So you don’t take these questions so seriously. Because you’re almost like, let me try this for six months a year. We’ll see how it goes. We raised two rounds of funding from James Murdoch’s family office. And then of course in July 2022, we were acquired by UpGrad. And as of six to eight weeks back, I’ve also exited UpGrad and Harappa has fully merged into UpGrad. 

So I think it has been the most intense six years of living the entire life cycle of a business – from conceptualizing an idea, raising funds for it, building products, going through an acquisition and then finally merging that company.

First principle lens: Lessons as a first-time founder

Anupama: Sounds like such an invigorating journey over the last six years. Kudos to you for building something so amazing! I think for ACT also, we’ve come across Harappa mostly from the sense of working with women in the startup ecosystem and how we can set them up for success? Shreyasi, I know Harappa in the last six years has done a lot of intentional work with women – in supporting them and also building workplaces that work for them, right? I’d love to understand from you, how did that come to be? What was your vision, to be able to enable something like that?

Shreyasi: So very quickly, Harappa is essentially, as we used to describe it, a learning institution. And first we used to say an online learning institution, but then of course we also did blended programs. So we used to just say a learning institution that focused on cognitive, social, and behavioral skills for working professionals, right? Because the belief is that you could be a computer scientist, a public policy person, an HR manager and the fact is that these cognitive, social, and behavioral skills are critical in each of these roles, right? They transcend industry, they transcend companies, they transcend specializations.

So there was a school for managers and we had a series of programs for managers, first time managers, high impact managers, high performing managers. It had a school for CXOs where we would do a lot of programs for CXOs. But over the last three, four years across 100 plus companies and enterprises, we’ve probably trained the most number of women professionals.

I feel like this conversation has reached a crescendo sometimes. I feel like people think that we’ve talked about it so much and we’re so talked out that it seems like things would have actually changed on the ground. But in most companies, I would say, things actually change very, very slowly. Some of us might be bored of this conversation but many of us, I know, need to keep talking and need to keep speaking and need to keep doing. And I think that as a woman leader, that conviction was very personal. The cause or the calling is to leave the world of work for women better than I found it. Whether it’s Harappa or whatever, it’s going to be a thread across everything that I do in life. And one of the things that I always say is that when given a chance, make the change.  

So, I take that very seriously, that I was given a chance for whatever little change that I could make at that moment. And actually through the delivery of those programs and through us meeting women professionals from across IT, finance, manufacturing across the country, my conviction that this is necessary and needed actually kept deepening. Because honestly Anupama, the sad fact is that things are even worse. The situation is still very dire.

Traversing tough roads: Women’s careers as the greatest obstacle course in history

Anupama: I couldn’t agree more. I think having worked in this space for a while as well, the challenges, I mean, we can have a whole other podcast on what they are. What would you say are some key barriers that are holding women back?

Shreyasi: I’ll speak about both threads, my personal observations and personal experiences but also some of the things that we saw, not only through observation of our learners but we started to do a lot of research around this at Harappa.

Only 7% of the women that we polled said that they felt any kind of equitable proportion of seeing women in their management teams or super senior positions. Just 7%. I call women’s careers the greatest obstacle course in history. Because one of the things that we found is there are three almost super clear stages and cusps where fall off starts to happen. The first cliff happens at what I call the broken rung, which is the 28 to 32 year old (segment) – there’s almost a 37% drop. Then it happens just before the glass ceiling. And then over the last three or four years, another phenomenon that’s been seen is what they call the glass cliff, that even for women who make it to the top, [they] are actually leaving the workforce or are being almost ejected slash evicted from their roles or are set up for roles in which success was impossible, at twice the rates at which super senior male professionals are. So, almost at no point, can you take your continued success for granted, right? And this is happening when actually from an education, graduation outcomes perspective over the last seven to eight years, India has done so well – some streams graduate more women than men and most of those women graduate with better CGPAs. So while of course, education is a big leveler, certainly for women in India, educational outcomes have absolutely not correlated to income outcomes or career outcomes. You know, there is certainly something that we are missing there. In fact, workforce participation, especially in high value work in urban settings, has actually gone down after COVID in many aspects. 

I think the most upset and angry that I’ve been was with this data point. We actually found that the greatest pay gap between male professionals and women professionals was at the CXO and CXO minus one level. I think it was Rs. 74 to Rs. 100. I was like, my god, how much more do you need to prove yourself? This can’t be about merit and skill because you are a CXO or a CXO minus one. But at the time when you felt like, my gosh, I have made it, I am a part of the senior most whatever but actually you’re possibly confronted with the greatest pay gap. 

In fact, another thing that we found in the What Women Feel report, and this is my personal experience as well, especially over the last two years and my naive imagination or my naive assumption was that the more senior you get, you’re insulated from the petty biases and microaggressions. We’ve actually not found that. Tenure isn’t a sunblock against bias.

I personally experienced that as well. I think in a way it is sometimes a woman with power and influence who pisses off the world much more than somebody who doesn’t yet have that influence. In fact, we saw that early managers, first-time managers who were women faced the most biases because maybe their newfound status and power made others around them very uncomfortable.

Anupama: I think the greatest obstacle course in history is such an apt way of describing the problem statement we’re speaking about. And I can so well resonate with this. I did my engineering. I couldn’t see a career there mostly because of the dearth of women I saw in roles of leadership or influence. And I know it’s just one part of the huge pile of challenges women have to face. But Shreyasi, a lot of times when we speak about this with people, it becomes a very ‘inclusion and fairness’ conversation. But I know it’s so much beyond it. Research after research shows that gender diverse teams actually have a great impact on business outcomes in terms of employee culture, NPS, and investors having more faith in organizations, right? But what has your viewpoint been on this, being a founder yourself, but also being an advocate for having more women in the workplace? Why do you think gender diversity is important in workplaces for organizations?  

Shreyasi: You know, both with gender as well as in gender, if we talk about women. And I think race. To me, those are the two fault lines where it’s immediately apparent who you are. The minute you walk into a room, or the minute you speak on the phone, right, or even your email ID, people know that you’re a woman.

So I think it’s so immediate, it’s so tangible. It’s also half the world, right? In many populations, it’s 51-52% of the world. What are you going to be able to achieve with half the world locked out, it’s not 5%, 6%, 8%, right? It’s half the world. How does the world progress with half the world’s talent unvalued, half the world’s talent unlocked, half the world’s talent being unfair, half the world’s talent not being given opportunities for their potential. It’s an almost unfair or unreasonable expectation to imagine that with half the world not happily, fruitfully engaged in work that has value or is valued, where they are actually engaged.  

Think about having a world where that larger number is disenfranchised in such critical ways. And that’s why it’s important. It’s not a ‘nice to have’ (conversation). I think the orientation has to be to create that, especially when it comes to women and women’s agency.

Anupama:  Even at ACT, our whole thesis also focuses on the fact that having more women in roles of leadership or roles of influence, as we like to call it, shows so much more impact in terms of organizations, policies, culture, programs that are rolled out and has an impact throughout the pipeline. In your own experience, you’re a women founder and you’ve seen women in roles of leadership. How does it change? 

Shreyasi: So immediate downstream impact, it’s very tough to establish that right? And which is why people will disbelieve it, because it’s such a longitudinal impact. It takes, like I said, decades for businesses to really say, what this will become. But I’ll tell you the immediate and clear impact I think it has.

Even when you are running the business, right? I’d like to think that the fact that I was there and doing all of these uber cool startup things like raising funding and getting acquired – I do feel like it certainly added a set of confidence to many of my women colleagues. In fact, probably the best compliment that I feel like I’ve ever got as a CEO was this young – I think she’s a computer science engineer and she used to work in our product team – very smart young woman who had seven, eight years of work experience and then she was with us for two, two and a half years. And she was wearing this stunning sari and bright red lipstick. And she said, you know, this is the first time as somebody part of the product or engineering team that I can be dressed like this, yet go to a SCRUM meeting and give directions to engineers. She said, never before in my career as part of product and engineering teams would I have dared to be so feminine, yet be doing probably some of the best quality work that I’m doing in my career. I got goosebumps.

I think we were 50% or more women. But not only that, twice a year, I would write an email to the team to say that these are the six bands that we have. This is the percentage gap or not between women professionals in our company. So sometimes it would be like, wow, women associate directors are actually getting paid more than male associate directors and I’m hoping that that becomes a way that others also do it.

Anupama: What I’m hearing you say is that you’ve seen and witnessed a shift in terms of having a good role model, building that culture of inclusion. To a lot of people who ask why gender diversity is important within organizations, I think that’s just bang on. Just switching gears a little bit, Harappa I know has worked with both big corporate clients and startups. Our research on WISER (Women in India’s Startup Ecosystem Report) shows that in representation of women, startups are doing really well. There’s a long way to go, but it’s definitely better than where corporate India is currently at. So if I were to ask you, what are some broad trends you’ve observed, especially in the startup ecosystem in terms of what’s going well or what needs more focus on, what would you say they are?

Shreyasi: So here I have to be honest that I was really surprised when I saw the first WISER report in terms of the startups doing much better than established companies. I have to say that we actually found it much easier. Most of our, I would say 90% of our revenue from the women-focused programs actually went to some of India’s and the world’s largest companies. What I’m seeing in startups, one is of course that there’s just greater entrepreneurial activity. And many women, women across all tenures, are trying to be entrepreneurial, setting up businesses. I just feel like the overall culture and attitude to risk taking, to being on your own, to being a person with multiple skills if you’re starting out even a small business. I think it’s really overall good for women professionals because that will transcend. And it creates many more opportunities within the constraints of their societal structures for them to be able to create wealth.

I think the other thing that startups are really useful for is there’s no place to hide, right? Everybody, especially if you’re under a sub hundred people team, certainly there’s no place to hide. Everybody needs to pull their weight. So I think startups, if you find the right startup at the right time, I think startups can really script rewarding careers. Larger companies are still much more resistant to unconventional CVs, right? Startups are that way much more like, listen, you can do the job. If you can get the job done, come and do it, it doesn’t matter what you’ve done before. 

Future forward: Making workplaces work for women

Anupama: Shreyasi, that actually brings me to a very important question. Why should organizations focus on building workplaces that work for women? What is in it for them in terms of building gender diverse teams, why should they focus on it? Where do they start?

Shreyasi: It’s so tough to get good people, right? As an employer, as a manager, as a boss, all you want is good people to build products, sell products, manage people, manage teams, manage projects, all of that, right? The fact is that you want to look in every segment of the population to be able to get the skills. I say this sometimes, it’s controversial, I actually do believe that our companies and our employers are ahead of our homes and our societies when it comes to giving women an equitable (standing). I feel like most of us, many of us, including me, could face very different realities at home, or in our extended families, or in social situations than we actually do at the workplace. 

I place a lot of faith in companies and organizations being able to keep furthering that and hopefully society will catch up. I think professionals and certainly women professionals really need to be publicly praised for their contributions.

Public recognition doesn’t mean a town hall with 10,000 people CCed. They’re very small things. So one tip, and I used to say this, calendar it, right? Once a week, I would send an email highlighting or acknowledging other women peers. And I think we have to create some of these very large societal things into mini tasks that each one of us can do without any help from anybody else. Second is manager sponsorship. I feel like that the manager relationship is really one of the most critical relationships to get right. You don’t have to change the world for all the women you meet all the time, pick one. 

Over the last three or four or five years, I’ve used my role models really well, and really opportunistically, and I encourage all women professionals to do that. Role models are a guide to your future, who you will be in the next 10 years. I have Chimamanda Ngozi Adichie as one of my five women role models. I find her incredible – her luminosity and her ability. She’s a great public intellectual, talks a lot about feminism, but her ability to talk about a lot of tough things with a smile. Particularly as a founder, I found those skills so useful. Because you need to wear, sometimes you do need in many contexts and situations, you need to wear your activism lightly for that activism to be impactful, right? So my homework for all of your listeners who are listening to me and actually, all professionals can do this, not just women professionals, is having a role model mood board. You are here, this is where you want to be in five years, 10 years, who are the people who you think are viable and for what skill? 

The last thing I always tell women, colleagues and professionals is you know when you say don’t talk behind people’s back? I said flip it. You must talk about a woman peer or colleague when she’s not in the room, but say good things. 

Anupama: Shreyasi, it’s been so lovely chatting with you thank you so much for your time and being on our podcast. 

This brings us to the end of our (season finale) episode of UnHerd. We’ll be back with season 2 in March 2025. If you enjoyed this episode, please 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 different ways. People who truly stand apart from the herd. Follow us, like, subscribe and share.

 

UnHerd with Bindu Ananth: Bridging gaps in affordable healthcare access

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 ninth episode of UnHerd features Bindu Ananth (Founder of Dvara Health Finance), in conversation with Anam Sherwani (Manager, ACT For Health). Bindu shares her journey of building NEEM, a subscription-based platform connecting rural patients to trained health workers for doorstep care and medicine delivery. 

Tune in on Spotify or watch the episode on YouTube to learn how Dvara Health Finance is  using tech-enabled innovation to transform access to affordable healthcare for Bharat.

Anam:  

Hello folks and welcome to the penultimate 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. Today, we’re diving into an issue that impacts millions of families across India – the rising cost of accessing quality (health) care. Every year, about 10% of Indians are pushed into poverty due to hospitalisation costs, and countless others skip essential healthcare altogether because they simply can’t afford it. 

Our guest for the day is Bindu Ananth, a social entrepreneur committed to enhancing the access to affordable quality care for patients in rural and underserved areas. As the founder of Dvara Health Finance, Bindu has developed the NEEM program, a tech-first subscription-based platform solution that provides patients access to a network of trained local health workers who deliver quality care and aid medicine delivery at their doorstep.  

Bindu, welcome to UnHerd! Thrilled to have you with us!

Bindu:  

Thank you Anam, pleasure to be here.

Anam:  

Bindu diving right into it, you come from a finance background. You’ve worked with companies like ICICI, chaired Northern Arc Capital, and have been a member of three RBI committees. How did you land up on public healthcare as a problem statement? Why did you decide to solve for it?

The spark that lit the fire: Identifying gaps in access to healthcare financing

Bindu: 

So most of my career has been focused on financial services for the poor. And I have done this within different institutions – first in ICICI Bank, where I was part of the wholesale banking team. I think ICICI was a real pioneer in some of this work – this was about 20 years ago – and then I had the opportunity to set up, along with my co-founders, an organisation called Dvara.

And there again, continuing with the same theme of what will it take for India to make its financial markets deeper, make formal access available to every last village in the country, what are the new innovations that are needed? And it was also an exciting time because at the same time that we were doing Dvara, you had all of these wonderful, bold experiments happening in the background of Aadhaar. And so, I think it was just a wonderful confluence of many entrepreneurs doing interesting work in this space, but also terrific policy work, terrific regulatory work by the RBI. But the common theme in all of this is thinking about, what are low-income households (facing) in India? What gaps are they facing? What are the shocks that finance is helping them deal with?

If finance works well, it should absorb a lot of the uncertainty, the anxiety in people’s lives and that state is what one might think of as being financially included rather than having access to product A, B, and C. 

And so, if you think about finance more broadly, we’ve done very well, I would say, in the last 20 odd years in terms of just physical access. But if you think, if you dig deeper and you think about, “How is people’s financial well-being? What are people doing with the money that they have access to?” I personally started to see many more gaps in that picture. For example, the fact that a lot of borrowing that our clients do essentially finds its way back to healthcare and hospitalisation, either for themselves or for a loved one. And that’s at least a good 25-30% of what probably constitutes all of lending to the poor. Now, it’s not necessarily a bad thing. I think if you have a loved one in hospital, really any source of money that helps get them the best treatment is fantastic. But if you think about what happens afterwards – hopefully the relative does well, comes back home. But there is a period of recovery both for the person who was hospitalised as well as the caregiver. And it won’t be an instant going back to things as they were. And now the additional point is that you have this sword hanging over your head, of this loan that has to be paid back pretty soon, starting next month onwards. That creates a very different sort of pressure. We find that borrowing for healthcare typically triggers a set of reactions that creates a lot more financial stress. And then to repay that loan, people potentially have to borrow from elsewhere or they have to sell assets. So all of this is somewhat of a negative spiral.

And so for me, the motivation was really that, well, a lot of the foundations of financial inclusion etc. seem to have been done well. Let’s think about what are some of the unsolved problems. And for me, certainly, this struck a deep chord to say that, can we think about better ways for people to pay for healthcare such that it does not end up creating this much financial stress? Surely there must be better ways to do this than the emergency sort of borrowing. What might that look like? How can we structure it? How can we deliver it at scale and offer it as a meaningful alternative to the microfinance type model that happens today? So that was, and I would say really for me, an important sort of starting point. 

Anam:  

As an organisation and as a founder, you’re really building a tech-first healthcare solution. There’s a massive behaviour change that you have to address, right? Underserved communities do have a preference for in-person consultations with doctors and they do believe in restorative rather than preventative healthcare. When one thinks of subscription-based models for these households, the CAC (Customer Acquisition Cost) is very high, and the ARPU (Average Revenue Per User) is not as high, initially at least. So what were some of the (early) failures for Dvara, and what were the learnings that followed which allowed you to build better as an organisation for these households for this specific customer segment?

Bindu:

Let me just start with the fact that, yes, each low-income household or each informal sector household perhaps individually represents a fairly modest spending power or purchasing power. But if there’s one thing that financial inclusion, some of the other successful models in social enterprises, have taught us, it’s that the real power is in aggregation. So, if you put together the total spends of these households, it’s really in that sense a volume game. You cannot make this work by working with a modest number of households. It’s really about small amounts multiplied into millions and hundreds of millions. That’s what creates the magic. For our work right now at Dvara Health Finance, we are fairly focused on, I would say, the missing middle in the context of, let’s say, health insurance, which is to say people who are not working in organisations like Infosys or Wipro or ICICI Bank and hence covered by corporate insurance covers etc. Neither are they employed in the government, whether it’s railways or State Bank of India, and therefore covered by government funded insurance schemes. Neither are they poor enough to be eligible for social insurance programs like Ayushman Bharat. Because often some of this is confusing because you have so many different pieces of the puzzle. There’s really this large missing middle, you know, 200, 300 million people, who are not poor, who have enough cash flow, so to speak. 

Let’s just put a face to this person. Think about this as somebody who in town of Satara is running a shop, is running a stall near the temple, is somebody who’s on his feet for 12 – 14 hours of the day. The number one issue that this individual running the shop is facing is that he’s time poor, which is to say that if he’s not at the shop, he has to put the shutter down. It’s literally a one-person enterprise. Now if you tell this person, “Listen, travel 4-5 kms away, there is a friendly neighbourhood clinic, go wait for an hour and the doctor will see you,” you’ve lost the person’s attention. So I think the thing to appreciate is that there is a very large segment that values convenience enormously, because time is money for them, as much as it is for a person running a much larger business. And therefore services that are conveniently delivered, ideally at the doorstep or at the shop front. This is the core insight that microfinance tapped, because there was always this puzzle to say here are banks willing to provide loans at 8%-10%. How come customers are borrowing money from microfinance lenders at 24%. That just seems irrational. But I think the missing piece was the one that was available at my doorstep, whereas in the other I had to travel, I had to wait. And these are real costs. So that’s the opportunity that we are going after.  

But if you think about the total spending that this group does on healthcare out of pocket, it’s a pretty large number. So in India, the overall out of pocket expenditure is roughly in the region of three lakh crores or three trillion rupees. That’s a pretty big chunk and a lot of that comes from this segment that doesn’t have insurance. 

But I would argue that the bigger problem is what are they spending that three lakh crores on? 80% of that is curative in nature. And within that, specifically spends at hospitals, typically specialty type centres. Very little of it is primary preventive. And even within that 80% of curative, there’s a lot of unnecessary diagnostics, expensive medication that I didn’t need. I had a headache. I went to a nearby doctor and the doctor just immediately sent me to get an MRI done, so there is a lot of wastage. Clearly, there’s a large number of people who today are paying out of pocket. However, that is not yielding any meaningful results for them in terms of good health outcomes. What if we really focus sharply on that market and deliver a consistent, reliable, convenient service. Our experience on the ground is certainly very, very encouraging in terms of adoption. I think a lot of the things to figure out is about how do I deliver it consistently and at scale. Those are the real challenges. 

Traversing tough roads: Pivoting from a financial service to a health product

Bindu:  

I will say that one of the things that we did early on which did not work and probably because of my own background is that we approached it too much as a financial services problem. The first version of our offering was actually something called a health savings account in which we said, “Let’s just help people instead of borrowing at 30% rates of interest for health. Why don’t we help people save for emergencies?” And savings represents a kind of lower cost for the household. And so we built a lot and we created a fintech type proposition, all of it of course aimed at health. And that simply did not work out at all because in some sense, it did not resonate with the customer.

Health as an issue was well understood but savings specifically for health that just did not, I think, feel right to the customer. So we, in some sense, completely pulled back from it. And instead of a health savings account, effectively we then launched a health subscription product. And the big difference between the two is that the first one feels like a financial product. The second one feels like a healthcare product, in which I’m subscribing to NEEM, what do I get in return? I get actual access to a healthcare team. I get a health worker who comes to my home, takes my vitals, monitors me, delivers me affordable medicines, all of that, which feels a lot more tangible. And of course, in the process of accessing the subscription from us, the household did save quite a bit. Because, for example, we provide generic medicines for chronic diseases, which are a good 50%-60% cheaper than what they would buy from the local chemist. So the intent in both cases was the same, to bring down the monthly expenditure on healthcare for the household. But the first version of it was the financial offering. And this is given that my experience and my lens tends to be financial.

Whereas the improvement on that spoke to the customer a lot more because it felt real, felt tangible and felt like it had a services component, not just a financial component. So that pivot was critical for us.  

Anam: 

How did you build out the user-centricity within NEEM as a program? 

Bindu: 

We have to be deeply focused on the customer and as we already talked about, even rural India for that matter is many many segments all bunched up. So it’s always helpful to have a clear sense, like in any company that you would do, to say exactly who are you building for, what problem are you solving. But going with the hypothesis and keep iterating to say, okay, maybe this segment is already well served by government schemes and it would be hard for them to get a good value perception of what NEEM is. So for example, we’ve crystallised many things such as the fact that our typical customer underneath would be somebody with a monthly household income between let’s say Rs. 18,000 to Rs. 40,000. But the question is, is NEEM the right solution for them? If you bring in a fairly low-income person into a subscription program, then the month on month payment is soon going to become a challenge because of income uncertainty. 

Start with some clarity, refine it as we go along and then start to crystallise many of these things for the team at the frontline. Because I think one mistake that many of us founders tend to make is the assumption that we operate sometimes at 30,000 feet and it’s all clear in our head, of course. But if your execution is happening, let’s say, through a frontline sales team or a frontline service team, who’s local, you owe it to them to provide them clarity in terms of this is a criteria for people who you want to bring into this service or this offering. These are the five benefits that we will provide. These things we do not provide because there’s also a fair bit of confusion in terms of what does the government do versus what do you do, what do private hospitals do. So I would say that’s really important and as much as possible, we’ve tried to write these down and document it so that people when they go out have a sense of exactly what to do. I think that’s really important for scalability.

If you listen carefully to your teams, make sure that your teams are listening carefully to customers, then that whole feedback loop starts to build, which is fundamental for any organisation, particularly anybody in the social impact space. 

Anam:  

That’s super interesting, Bindu.From a founder’s perspective, what really keeps on driving your conviction?

Bindu:  

Yeah, I think 2-3 things. My team and my conviction in subscription is coming from, I would say, almost a conceptual angle to say that, can we take the one-off, Rs. 1,00,000 payment to the hospital, which is what we think of as a problem, and instead of that, break it into small chunks of 100 rupees, 200 rupees paid for every month so that we don’t end up with that Rs. 1,00,000 situation. So our approach to this is very much rooted in the customer and what will make sure we produce good outcomes there. But that’s my point of view. Now the whole challenge in all of this is to say what does the customer think about all of this? And particularly in healthcare, it’s very well known behaviour that people would much rather pay for things that are curative when it comes to that, rather than demand for primary care services.  

I think by going on the field, talking to customers, listening deeply to customers, you figure out what is the right balance to strike. So the focus area for NEEM, for instance, given this constraint is to say, it’s going to be really challenging for me to work with a person who feels completely well, whose vitals are normal and then say, okay, pay me something every month to make sure you remain in the pink of health and so that you dont get hospitalised. But the customer’s point is, “Who’s thinking about hospitalisation anyway? I’m not going to get hospitalised because I’m in the pink of health.” So that would have been a very hard challenge. And we realised that quickly.

Bindu:  

And we said, okay, maybe the real opportunity here is to focus on people who are newly diagnosed, let’s say, with blood pressure, newly diagnosed with diabetes, a stage one or stage two. And now it’s not about preventing diabetes from occurring. The conversation really becomes about, if you don’t do anything about your health, you could end up with a significant event like hospitalisation etc. Work with us so that we can keep you managed at your home and so, maybe closer to thinking about it as what one might think of as secondary prevention rather than primary prevention. And again, that’s where I think all the detail comes in because healthcare is such a vast space.

Somebody could be working on smoking cessation. Somebody could be working on health or weight loss. All of those are valid. You have to figure out where the circles intersect in terms of where you can make an impact, where it’s meaningful, and what is the customer willing to pay for. 

So back to your question Anam, around what makes subscription tick. I think one is making sure that your offering speaks to a real felt problem of the customer, not something that I think is good for the customer to do, but the customer has to feel it. One of the things we did, for example, again, based on feedback is that we were initially doing only diabetes and CVD, cardiovascular diseases. A lot of patients told us, “Listen, one of the things that I’m spending a lot of money on is pain – lower back pain, neck pain.” And remember, we talked about our typical customer being somebody who’s on his feet for 12 hours a day or a woman who’s working on the farm for long stretches of time. So just the physical wear and tear. They said, “If this is about us, then why not include that in your offering rather than talk about things like diabetes, which frankly, I don’t right now care a lot about.” And you know, health workers brought that message back to us and we’ve now integrated chronic pain into a subscription because it felt widespread enough of an issue. So one, think, get the kind of core segment value proposition right to the specifics of what is included in your subscription has to be the right mix of things that affect the customer here and now, versus things that are more sort of medium term impact because the longer the time frame, the less salient it feels today for me, right?  

And then finally, the number one most important thing Anam, is the front line. I think one of the most differentiating aspects of NEEM is the fact that it’s delivered by a local trained health worker, the name is Sakhi. She is somebody who is the face of the program. This is not, at least for this market, a pure tele-medicine type approach or an app based approach. We are convinced it’s not the solution at all for all the reasons that we talked about. There needs to be a strong, obviously, technology backbone, but it has to be what one calls an assisted model.

So the health worker is really driving a lot of that action. She’s driving a lot of the adherence because, in chronic diseases, there is no magic. I mean, what has to be done is very clear. The medicines have all been around for many, many years. But the key question is, can you persuade your patient to stay on medication for extended periods of time, even if she feels better? That’s where a lot of the programs go off the rails and that’s where the health worker engagement is so critical and at least in our case that those set of reasons seem to be contributing to pretty good retention rates on the subscription.

First principle lens: Raising the bar on what trained healthcare professionals can do

Anam: 

That is very fascinating, Bindu. How did you approach integrating this component of a NEEM Sakhi into your tech based model?  

Bindu:  

Before I started Dvara Health Finance, right before that, I worked with this wonderful company called Niramai (another ACT For Health portfolio startup), which has a unique technology for breast cancer detection using AI and thermal imaging. Working in that setup, one of the things that surprised me early on is that we do these Niramai screenings for a whole bunch of women. And at that point, it was not a diagnostic technology, it was a screening technology. So, for every 100 people that we screened, perhaps for 6 or 7, we’d say, “Listen, it seems that there is some suspicious activity, a suspicious looking lump. Please get it confirmed using an ultrasound was the typical recommendation.” And that would be signed off by a doctor. To my utter surprise and shock, almost nobody would go on to do that confirmatory ultrasound.

So they do the screening, they take the trouble to come do the screening with us, take that fairly troubling report to say there’s some suspicious activity and then disappear. And during my early days in Niramai, I would tell Geeta (Founder, Niramai) to say, “I am going to chase these women down.” I said, okay, maybe it’s just that travel is a problem, planning is a problem. So we’d get appointments for them to do their ultrasounds. And I personally said to a few women to say, “I’ll come with you. Let’s go do this ultrasound. Can I pick you up from the passport office?” “Yes, yes, madam. I’ll be there at 10 a.m.” And they would simply not show up. So it was a surprise for me. But if you talk to people who are veterans in healthcare, in cancer care etc., loss to follow up is a very widespread phenomenon, which is just people who don’t pursue the next logical step of whether it’s diagnosis or treatment. And all of these things remind you that, gosh, how in this context then are you going to go in with a pure tech solution? Because you need to have a muscle around persuasion, kind of getting the job done, right?

Your first instinct is to say that in all healthcare, the human should be a doctor so that you have the least issues with respect to expertise, compliance of law etc. But again, the penny drops that listen, if you want to serve the vast parts of our country, not just tier one, tier two, tier three locations, there are simply not enough doctors who can provide that sort of coverage. And there are, again, many people before us who figured that out. When we scanned the space, we saw fantastic examples of health worker-led models. What we did notice was that there was a distinct difference in the level of ambition that Indian programs had for their health workers relative to some of the global exemplars. If you look at the Indian health worker experience, it’s fairly low skill, low trained, often unpaid volunteers.

I think what helped us is that we went in with a little bit of that clean sheet of paper and said, we are going to push this as hard as we can within what laws permit us to do so I think we approached that health worker role with fresh eyes. We did not think that this was some low-level unpaid work, we immediately said this is full-time work. This is not an individual who’s a volunteer. I also walked away from this notion that the health worker should be some sort of entrepreneur, generating sales to pay for her salary to say, why would we do that? The service is conceptualised by us. She’s the one delivering the service. If we are confident that what we have designed is good for the customer, it will be adopted by the customer. We should not let the health worker take that revenue risk. So we pay the health workers like it’s a full-time job, because it is. And then this revenue risk is taken by us. That freed up the health worker. 

And we found them not surprisingly, immensely trainable, very hungry to pick up new skills. Manisha Adkari, one of our best health workers – she comes from a small village in Mhasward in Satara. She used to work at a wonderful local bank called Mandishi Mahila Bank, who was one of our early partners. She used to be one of their savings agents. And remember I told you our initial sort of product was a health savings account. So the initial cadre were people who were encouraging people to save, leaders of self-help groups. Again, no clinical background at all. But what does it mean that they really knew how to do well? It was to connect with people. It was to sort of understand what their anxieties are vis-a-vis themselves, their kids.

What are your fears with respect to this medicine, why you’re not taking it regularly, what’s going on?

So we are not going to spend any time training Manisha Adkari on, “These are the body systems. This is the left ventricle. This is the right ventricle.” If you think about clinical education, there’s a good reason why doctors take at least 10 years to get to a minimum level of training. But that’s not what we’re trying to do here. We are trying to get this health worker well-versed in using, for example, an electronic health record system. She has to be well-versed in taking accurate blood pressure measurements. Tomorrow, we’d like her to be well-versed in taking a blood draw and preparing a sample. So these are very different skills. You’re not creating a mini doctor or a low-skilled person, you’re really creating a new set of skills. So I think the fact that we were able to approach it without any of that legacy around how health workers usually behave helped us a lot.  

Anam:  

I want to shift the gears a little bit here and really understand what your journey has been like as a founder in the social impact space. Because you’ve been at it for a while and (having spent time with) a lot of time with social entrepreneurs and founders in this space, it becomes more about how they’re always looking for a silver lining that keeps them going without really having a (silver) bullet in the hand. What has that journey been like especially given the multiple pivots, the new learnings and deeper insights that you’ve uncovered? What has really kept you going at it?  

Future Forward: Staying aligned with your mission and with happenings on ground

Bindu: 

I think most people in this space are here because of a deep sense of mission. And I think that’s a given. Otherwise, you would not be here trying to do these things. And if you’re one of the people lucky enough to assemble a team around you, that shares that mission. I mean, I think to me, that’s really critical. And that keeps you going. It can be a co-founder but it can also be, I think the rest of your early team. And that’s something that I’ve been incredibly lucky to have. 

It’s the health workers, it’s the sales team, it’s the program management team. And one of the things we consciously do is to make sure that you’re very tightly connected to that team.  

So I would say, you know, always surround yourselves with people who give you that energy. And that’s the fuel that we need because none of these problems, if they were all easy they would all be done by now. So we do need to build that mental energy for the marathon. Ultimately, in some sense, how do I, how do the teams have a sense of progress? Typically, it’s customer volumes, transaction volumes, etc. but I think for enterprises like us, it’s good early on to start to measure outcomes much more directly. So one of the things that I’m very grateful for is that our medical advisory board pushed us on is to say that, “I want to see you publish almost in real time your data in terms of what’s the change in status on blood pressure, what’s the change in status on diabetes, what’s the change in status on chronic pain.”

Make the data very visible, right from the CEO down to the health worker, to our partners, so that there’s a sense of this is what drives us. So we recently celebrated the fact that at the end of September, we had achieved 70% control among all our hypertensive patients, which means that when they came into the NEEM program, they were hypertensive. Anything over 140 by 90 at the time of entering the program. And in the most recent home visit that the health worker did, 70% of people were below 140 by 90, which is what represents control in the context of diabetes. So, 7 out of 10 people and the balance 30% may not have achieved control, but are starting to show significant improvement. And I think aligning everybody to that kind of north star, that in my experience also provides just more enduring motivation of the type that’s very different than a quick win. You do need some of those.

Anam:  

Thank you for sharing that Bindu and honestly couldn’t agree more on that one. How do you see the financial inclusion space within the public health care system evolve? What do you feel is something that needs to evolve for meaningful impact to get created at scale for India? 

Bindu: 

I would think about it as how do we deliver financial protection to all Indians, which is to say, you often hear this in our circles, that most Indians are one hospital visit away from poverty, right?

That’s really what I think we need to change. How is that going to happen? It’s going to happen when more and more people have that safety net of saying, if something happens to me, I don’t have to draw on my own personal resources to pay for that event. It may or may not be insurance, but some pooling that’s happening so that it’s not literally just me left to my own devices to pay for that one lakh rupee hospital bill, right? And like I said, it’s not just a problem of poor people in India. We saw during COVID how vulnerable we are even in terms of the upper middle class, how one would think of it. If the hospital bill jumps from one lakh to three lakhs, you’re another 20% of the population that will go into poverty. So that’s the overall kind of problem statement in terms of how we solve that at scale. I think certainly organisations like Dvara but many more people are working at the primary care level.

Bindu:  

We need, I think, hundreds of organisations relative to what we have now working on primary care. And using interesting payment models – we are big on subscription, but there surely are other models out there. But the whole point is to say, don’t wait for the patient to walk in and pay every time they see you.

The problem with fee for service is that you will come only when you fall sick. We want to figure out payment models where the patient is incentivized to come to you with everything. I have a cold, my kid has diarrhoea. The more you come to us, the happier we are, right? It needs to be that sort of approach at the primary care level.

So that I think that has to evolve a little bit. There is a fantastic role for technology to play there to say, how can that layer of primary care organisations now start to do a lot more? I certainly see in the not too distant future, our health workers being able to do a fair bit of cancer screening using mobile ECGs etc. So a lot more information action can happen at the primary care level. That starts to become substantive.

I think a significant piece of digital public goods infrastructure that needs to get created is between players like us and where the hospitals and the insurers currently sit. Today, the links between these two simply don’t exist. We are doing our own thing. They are doing their own thing. Is there a way to build the connectivity between these two layers such that only

people who pass through a primary care organisation, they get referred to a specific hospital, let’s say for surgery. So that it starts to rationalize some of these flows a little bit more, rather than people directly ending up at the hospital for something that could have been resolved at the primary care layer. So I think about this more broadly Anam, you need to build a little bit more middleware that helps connectivity between primary care and secondary tertiary care. And the middleware is typically around protocols for payments, protocols for referral, insurance, sort of participation, claim settlement. I think the path to scale is in leveraging the work of primary care organisations, but making sure that the handshake to the rest of the system is also getting built out properly.

Anam:

With your journey in perspective, what would be your advice that other founders can also keep in mind as they try to build for this problem? 

Bindu: 

Rural healthcare is a tough nut. There is no willingness to pay. CAC is too high. I personally think that you got to go deeper and solve for this at a segment level. And hey, this is India, right? Any micro segment you take is a hundred thousand plus people. So we should not be afraid of going deep.

And the second piece of it is what are you bringing to this whole problem statement? And in my case, I’m acutely aware that I am not a health expert.

You can think about my lack of health background as a disadvantage. I think of it as an advantage because I’m able to look at it with a different pair of eyes. Having said that, you do need genuine expertise, if you are offering a healthcare program. So build a personal advisory board that will give you that guidance, be willing to give you tough, harsh feedback early on. Because you may not always get that from investors. So I think building that group around you is always helpful. 

And then I think the third thing Anam, that you had asked me earlier on, is around keeping the veil of motivation always running deep. Which is getting in knowing that there is not going to be a quick win, right? So build stamina to stay in it for a while and pivot as needed, driven by customer feedback. But you know that the payoff when it happens is going to be huge because that’s the nature of the problem. I do think thinking of it as a marathon rather than a quick sprint is really important.

Anam: 

This, Bindu, has been an incredibly inspiring conversation. Thank you so much for joining us today! 

Bindu: 

Thank you so much, Anam.  

Anam: 

This brings us to the end of our 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 different ways. People who truly stand apart from the herd. Follow us, like, subscribe and share.

Women in startups: Transforming the leadership landscape 

Launched by ACT For Women in 2023, the Women in India’s Startup Ecosystem Report (WISER) found that women made up 35 percent of the startup workforce in 2022 (the corresponding figure for the corporate sector was 19 percent) and indicated that, with timely and targeted action, that number can rise to 50 percent by 2030. However, it also highlighted the need for deepened focus as 10 years into their careers, 8 out of 10 men in startups occupy Director-level positions or higher, compared to only 5 in 10 women. 

At ACT, we believe strongly that the problem is not women but the systems around them and so, to build on this actionable insight, we partnered with Harappa education (now acquired by UpGrad) through a strategic grant to pilot a transformative Women’s Leadership Program designed to bolster the representation of women leaders within Indian startups. The pilot cohort of 28 high-potential women managers from varied backgrounds were given the opportunity to hone critical skills such as personal branding, professional networking, and negotiation in male-dominated settings over a 12 week period. The program included 6 self-paced virtual courses, 2 strength assessments, 3 live masterclasses, fireside chats and an in-person city meet. For instance, the “Networking: The Skill That Never Stops Giving” course taught participants the nuances of creating meaningful professional relationships, while the “Get Out of Your Own Way” session addressed internal interferences like imposter syndrome. The cohort also benefited from Thrive Drills, which reinforced these concepts in practical scenarios. The program also went well beyond the learner and engaged a sponsor from the startup on a parallel journey of learning gender-agnostic decision making, inclusive leadership techniques and more. 

The results have been promising. A significant majority of participants reported increased confidence in building their professional networks, crafting personal brands, and supporting other women in their fields. Many experienced positive shifts in self-awareness, with 73% showing improvements in networking and 59% becoming more adept at handling challenging conversations. Feedback from participants highlighted the program’s impact, with several noting newfound confidence, enhanced communication skills, and a commitment to support other women. 

As ACT For Women continues its mission to foster a diverse and inclusive startup ecosystem, the Women’s Leadership Program stands as a powerful model for nurturing future women leaders in India holistically without solely putting the onus on women themselves. 

Khushi Baby joins the ACT For Health portfolio

Across India, over 1.3 million community health workers —including ASHAs (Accredited Social Health Activists) and ANMs (Auxiliary Nurse Midwives)—work tirelessly to bring healthcare to the nation’s hardest-to-reach communities. These health workers are often the first and only link to healthcare for populations in rural areas, urban slums, migratory groups, and families with low health literacy. Yet, despite their invaluable role, community health workers face immense challenges due to inefficient, paper-based reporting systems and fragmented digital health tools. These issues contribute to data inconsistencies, misaligned health targets, and delayed remuneration leaving community health workers overburdened and spending over 25 million hours each month on redundant data entry. Without real-time, high-quality data, public health officials are limited in their ability to drive targeted actions and data-driven decision-making.

Khushi Baby is a non-profit organisation dedicated to improving primary healthcare through digital tools by empowering health workers, partners, and governments to build integrated health systems and enable data-driven decision-making. With its Comprehensive Integrated Health Platform (CHIP), Khushi Baby has created a single, unified interface to streamline data collection, remuneration, and real-time tracking across primary healthcare programs. This allows community health workers to focus on what truly matters—caring for their communities—while providing public health officials with hyperlocal insights to make informed, data-driven decisions.

Founded in 2014 by Ruchit Nagar and Mohammed Shahnawaz, Khushi Baby has grown from a maternal and child health solution to a health system solution using a tech-first approach. This is evident through Khushi Baby’s CHIP model.. Initially launched in Rajasthan, the platform has onboarded 75,000 community health workers and integrated 12 vertical health programs, reaching over 46 million people across 40,000 villages. By digitizing health records, Khushi Baby enables seamless data sharing, facilitates early interventions in high-risk pregnancies, improves vaccination rates, and supports community health workers in reducing malnutrition as the technical nodal partner to the Ministries of Health.

ACT For Health is now supporting Khushi Baby to scale this proven model to the state of Karnataka, building a new and improved version of CHIP as an open-source Digital Public Good (DPG) and laying the groundwork for similar efforts in Maharashtra. “ CHIP 2.0” is projected to reach a total of 100 million citizens at the last mile and empower a total of 150,000 ASHA workers at a cost per beneficiary of 2.62 INR. This open-source approach not only provides a pathway for Karnataka but also paves the way for other states to adopt and tailor similar digital health solutions.

At ACT For Health, we are excited to support Khushi Baby’s mission to empower health workers and enhance primary healthcare delivery for India’s most underserved communities through a tech-enabled approach!

ACT For Environment welcomes Alt Carbon to its Portfolio

The Carbon Dioxide Removal (CDR) sector, though still in its early stages globally, is emerging as a key driver for achieving net-zero emissions. While traditional emission reduction strategies could reduce emissions by 11%, prioritising CDR offers a potential 38% reduction annually. As an area with exponential growth potential, the CDR market is primarily fueled by voluntary carbon credits, which are expected to expand 20-fold to reach $1 trillion by 2037. And within this VCM market, removal credits—particularly engineered solutions like Enhanced Rock Weathering (ERW)—are gaining traction. ERW stands out for its capacity to store carbon for over a thousand years, ensuring high levels of permanence and offering robust verification protocols.

Positioned as India’s frontrunner in ERW, Alt Carbon is leveraging this technique to capture CO2 by applying finely crushed basalt, rich in essential minerals like magnesium and calcium, to agricultural lands. This process binds atmospheric CO2 with soil minerals, transforming it into stable carbonates that sequester carbon in the ocean for thousands of years. Beyond its carbon capture benefits, ERW also raises soil pH, a vital improvement for the highly acidic soils of tea estates in India’s North-East, where declining productivity has long challenged farmers.

Founders Shrey and Sparsh Agarwal, fourth-generation tea estate owners with deep ties in the tea community, have secured access to 2,000 hectares for expansion, with partnerships covering an additional 8,000 hectares and potential access to 40,000 hectares across Darjeeling, Assam, Tripura, and Uttarakhand. With rigorous measurement, reporting, and verification (MRV) protocols established in partnership with IISc, the company is close to obtaining certification for its removal credits. With a solid foundation and early results, Alt Carbon has attracted $7 million in forward purchase orders, including $500,000 in pre-purchase from Frontier, and is well-positioned for further growth.

To drive scalability, the company is now establishing the Darjeeling Climate Action Lab (D-CAL), an in-house MRV facility that will allow it to process over 600,000 samples annually, enabling credit commitments to Frontier and NextGen starting in 2025. This internal facility is also projected to bring credit costs down to $100, improving the economic viability of carbon removal. For the broader ERW ecosystem, D-CAL offers a cost-efficient MRV service to help other ERW players achieve market viability.

Backed by a dedicated team of 35, including geochemists and business development experts, Alt Carbon is on a promising trajectory with clear targets: removing 0.23 million tons of CO2 by 2027 and scaling up to 1 billion tons by 2040. At ACT For Environment, we’re excited to support Alt Carbon’s journey as they set new standards in scalable, scientifically rigorous carbon removal, advancing India’s progress toward net-zero emissions!

ACT For Health doubles down on AdagioVR

India’s mental health crisis is a silent epidemic that affects over 197 million people, with 70-90% of mental illnesses remaining untreated. Factors such as lack of awareness, deep-rooted stigma and a significant resource gap – with <1 psychiatrists, psychologists, and social workers per 100,000 people – contribute to the growing severity.

 

To address these challenges ACT partnered with AdagioVR in 2023 – an early-stage start-up making Eye Movement Desensitization and Reprocessing (EMDR) therapy available to the vulnerable communities through virtual reality. The therapy program entails working with the user to  identify core target issues and delivering personalised VR sessions with facilitator support. With ACT’s support AdagioVR launched their first pilot in India, delivering EMDR therapy to 150 members of the transgender community in partnership with MITR Trust. The pilot helped validate the effectiveness of AdagioVR’s solutions with:

 

  • A 93% reduction in depression/ stress levels and 90% reduction in trauma impact
  • Unlocking a partnership with the Directorate General of Health Services (DGHS) for an ICMR-funded clinical study in leading hospitals in Delhi
  • Onboarding various NGOs and Corporates as clients in B2B segment

 

Given such strong outcomes and traction, ACT For Health is excited to double down on AdagioVR with a follow-on grant to help them establish a product market fit for the Bharat audience through product testing on a diverse user cohort of 3-5K, and to enable them to experiment with pricing models to identify a revenue generation model viable for grassroots and government, while building a strong team. 

 

We look forward to partnering with AdagioVR in making quality and affordable mental healthcare accessible to Bharat!

 

ACT Capital Foundation For Social Impact is a not-for-profit company incorporated and registered under Section 8 of the Companies Act, 2013. All donations made to ACT Capital Foundation are eligible for income tax deduction under Section 80G of the Income Tax Act.

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