The Race to Provide Healthcare to Rural India
By Arunima Rajan
COVID is reshaping working patterns and business model of this health service provider. Ujala Cygnus Healthcare Services has set up 16 hospitals in five Indian states, comprising 2100 employees and revenue of INR 350 crore.
What is it like being the founder of a company which offers healthcare services to India’s small towns? Dr Shuchin Bajaj, founder-director of Ujala Cygnus Healthcare Services, says that it's a very fulfilling journey.
He starts the conversation by stating he "comes from a very resource-crunched background". "My parents were refugees from Pakistan, and they came to India with nothing but their clothes," he adds. Bajaj's father started selling kites for a living and lived on the rooftop of a horse stable. He believed that education was the only way out of poverty and made his children study very hard. "Thanks to the Indian education system, I could study medicine at Rs 400 a year," he adds. After finishing his education, he returned to Delhi and started practising at a multi-speciality hospital in the capital.
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His humble beginnings made Bajaj empathetic towards the hardships of poor patients in India's rural areas and led to the creation of Cygnus Healthcare. "Even today, most of my family members are not financially well-off. Because I was a doctor, they used to call me and inform me that somebody had a heart attack or a head injury. On the one hand, I felt nice that I was able to help my friends and family." he adds. On the other hand, his family travelled five-six hours in a jeep to visit a doctor, and this fact kept nagging him. "Sometimes, some of my relatives wouldn't even make it. They would tell me that the patient passed away during the journey, and they had to return home."
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Some of the difficult questions in front of Bajaj were: why did rural patients have to travel hundreds of kilometres to reach hospitals in cities? Why do they have to sell their houses to afford care at a city hospital?
"It was heart-breaking to hear close relatives saying that it is good that the patient passed away before reaching the hospital because the last one who did reach had to sell all their property but still lost his life. These personal stories forced me to think about how to set up affordable, high-quality health centres next to rural communities, rather than setting up hospitals in big cities," adds Bajaj.
The first clinic of Cygnus Healthcare was set up on a shoestring budget. "My initial budget was minimal. I had struggled to buy glucometers, nebulizers and clinics," recalls Bajaj.
However, it soon changed with the help of support from friends, family and investors. Today Ujala Cygnus has 16 superspecialty hospitals under its wing in five North Indian states, focusing on quality care and emergency services. The bed capacity of each hospital is around 100-250 beds. "The focus is on providing services at an affordable rate, during the golden hour, when you are at risk of losing your life. Our focus areas are cardiology, neurosurgery, intensive care and dialysis. The hospital has also been empanelled in Ayushman Bharat scheme," explains Bajaj.
Furthermore, the hospital has a policy that they don't deny access to care to any patient due to financial reasons. The long term aim of the hospital is to completely disassociate financial, social and geographical status from a patient's ability to access healthcare.
Naming and Challenges
Why Cygnus? Cygnus is a constellation of stars, and it's the brightest constellation in the night sky and a swan-shaped constellation. "Most medical conferences highlight the potential of tier 2 and tier 3 cities. Everyone knows that metropolitan cities are saturated now. But no one's willing to go there. So, challenges do remain. The main challenges are financial— the community doesn't have enough money to pay for healthcare services. Doctors demand more money to work in the rural areas because many consider working there as a punishment. Most people work hard to shift to big cities and work in hospitals in Delhi, Mumbai or Bangalore. It's sporadic that somebody who works in a big city wants to shift to a small town," adds Bajaj.
Bajaj points out that he had faced failures, including closing hospitals and departments and parting with friends, but he decided to move forward rather than focus on failures.
Spreading Empathy through Entire Organization
The financial DNA of big hospitals is also very different, according to Bajaj. They are not used to setting up value-for-money hospitals. Bajaj claims that his hospitals also offer the same quality of care at big tertiary chains without the frills. "Big hospitals spend a crore or two to set up beds. So, if you are setting up a 200-bed hospital, you will be spending at least INR 200 crore. We don't invest in land or buildings and also don't gold plate our assets. Our cost is 10 percent and offers the same services. We set up our hospitals for around INR 10-20 lakh per bed. We also understand the pain points of doctors, their triggers and don't force them to do any unethical work. That's why our attrition rate is meagre. We have an extremely sticky relationship with our specialists and superspecialists," he adds.
The Ujala Cygnus Healthcare Services works on volumes of scale. Most of the patients are low-paying, so they rely on volumes. Most of the costs of the hospital are fixed, like rentals and doctors salaries. "So, once we cross a certain level of financial numbers, most of the top line starts flowing into the bottom line for us. That's how we have solved this complex problem of setting up hospitals in small towns. We are happy to see that we are inspiring others also," explains Bajaj.
The Ujala Cygnus model sets an example to doctors working in small towns that it's possible to provide high-quality health care to rural areas. Doctors operating in the markets also try to match up to big players, which leads to creating a medical ecosystem. "When we started operating in Sonipat, we were the only hospital with a cath lab and neurosurgeon. Currently, there are three cath labs in Sonipat. People have seen it's possible to offer such services in smaller towns,” adds Bajaj.
Tie Up with Amar Ujala, a newspaper company
Amar Ujala tied up with Cygnus, as they were pleased with the kind of work done by Cygnus, notes Bajaj. "Amar Ujala has been there since the 1940s. They also work with communities in small towns, and their base is solid in UP and Uttarakhand. They wanted to set up hospitals in these areas, but they lacked management bandwidth. They became a strategic investor of Cygnus in 2019. Now, they are the largest shareholder in the company. The company was renamed Ujala Cygnus. And now we have three hospitals in both Uttar Pradesh and Uttarakhand. We are planning to open at least five more hospitals in Uttar Pradesh. Cygnus is also setting up a new hospital in Jagatpur in Kashmir to help support the government's initiative to provide quality healthcare to masses," adds Bajaj.
The focus of Cygnus is going to be on North and East. According to Bajaj, there are reasons behind it; he is based in the North and understands the pain points of northern states; South India has better healthcare services; North and East have scarce resources, so that's where the group's focus is going to be for the next couple of years.
The core team of the chain has grown along with Bajaj. Most of his first clinic members, which was set up in 2008, had stayed with him. "At that time, it was called Altius Healthcare. When other "star" doctors joined the organization, we named it Cygnus," explains Bajaj.
COVID and Hospitals in Small Towns
The first wave didn't hit hospitals badly, as per Bajaj. However, the number of elective surgeries came down to zero. Most of the hospitals were empty. As we didn't want to lose touch with patients with chronic illnesses, the chain started teleconsultations. "We were doing 35,000 teleconsultations every month," claims Bajaj. However, the second wave was quite bad, and Ujala Cygnus set up a 1000 bed COVID hospital along with the Delhi government in seven days.
What values does the chain look for in employees?
"Empathy, soft skills and hard skills are three qualities that we look for in employees," adds Bajaj.
Bajaj points out that one of the essential life lessons he learned as an entrepreneur is going after Saraswati and not Lakshmi. "Perseverance is also crucial for success. We have had many setbacks and had many issues. But we decided to stick to the model because we thought it was the correct model, working with communities, small towns and rural areas," he explains.
Most of the doctors are on fixed salaries with minimal variable pay. So, the doctors are not incentivized to do any unnecessary surgeries. "We have removed one or two doctors in the chain due to unethical behaviour. Reputation is extremely crucial for us, so we regularly conduct clinical audits at hospitals," says Bajaj.
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Bajaj points out that most CXOs work not for money or fame but for the joy of creation and for the joy of seeing what you have built can stand on its own.
"More than personal legacy, institutional legacy is more important to me. If I could dissociate financial status with access to high-quality healthcare and inspire other private players to work towards that, it would be my legacy," concludes Bajaj.