Here and there – India
We’re looking at a village somewhere in India. A young man is entering a compound. He is missing part of one leg, and he’s using a crutch: it must have been a while ago, as he’s very adept. As he enters, it becomes clear that this is a rural medical centre, and it appears to be rather basic. What is not clear if this young man was expected, but we see him speaking to an older man, and there’s an assistant there, a woman, who is asking him questions. Now he goes into one of the wooden huts, and we have to wait. Time passes, and it is something like 3 hours later when he finally emerges. As he comes out, we can see he now has an artificial leg attached, and he’s walking carefully. As he picks up confidence, he walks a little quicker. He goes around the compound, and within a few minutes he’s running. He must have been expected to be there for a fitting, and it seems to have gone well, very well indeed.
Let’s step back. We have just been watching a video, commissioned by C K Prahalad, and we need to fill in a few more details. What we have just seen wasn’t a fitting for an artificial leg that had been modified over a number of visits, but this was a one-time exercise. It seems hard to believe, but that young man had never been to the clinic before. He lived hours away. After arriving, and in the course of a morning he had been provided with an artificial limb, and was able to use it, even to run, in just a few hours. Before you think ‘Gosh, he was lucky’, he is one of thousands who have had the same experience, lives transformed in just a few hours. And yes, before you add ‘It must have been expensive’, it wasn’t. This is in rural India, in what in Australia we might call a bush clinic, offering services at ‘bush prices’.
For business school students over the last two decades of the 20th Century, C K Prahalad and Gary Hamel were generally regarded as two great thought leaders in strategy and innovation (along with a few others). Their book, Competing for the Future, remains a classic, and their 1990 Harvard Business Review article, The Core Competence of the Organisation, is still one of the journals most cited papers thirty years later. A ‘core competence’ is an organisational capability, something in which a business excels, through which it performs better than the competitors, and which drives the business’s competitive advantage and success. The concept remains one of the central ideas in helping enterprises develop business strategy. When I used to teach in a business school, Prahald was one of the (few) people whose books I encouraged returning businesspeople to read, and he was a key figure in the field. Organisational capabilities and the nurturing of key strategic competencies remain important in business today, even if the pace of digital transformation can see an advantage one year surpassed and superseded the next.
However, beyond MBA courses on strategy, it was another of his books that I found even more important, one that has been part of my personal set of recommendations ever since I first read it. That book was The Fortune at the Bottom of the Pyramid; it is subtitled Eradicating Poverty through Profits. Prahalad’s approach was simple. Companies make things and provide services. However, most of their customers live in the more affluent parts of the world. What he wanted his readers to understand was that if you work at it, you can find ways to harness the power of corporations to deliver what is needed for those less well off, those who comprise 80% of the world’s population, the people at the ‘bottom of the pyramid’ and yet still made profits for the business and an excellent return for shareholders.
Among many examples, one of the most telling was an initiative by Hindustani Lever Limited, part of the Unilever group. At the end of the 20th Century, most Indians still lived in under-resourced areas, away from the cities. These were home to more than three quarters of the population, and the figure is probably similar today. Surviving on very low incomes with poor diets and a compromised environment, health was a major challenge. Without adequate medical facilities, even simple illnesses like diarrhea could have a devastating effect, and infant mortality was high. One factor that made a big impact was hygiene, and the Indian Government constantly sought ways to introduce and sustain better practice.
The government developed a Public Private Partnership (PPP), and Hindustani Lever joined with government agencies and marketing specialists to get soap to rural families. Inability to clean hands was the dominant issue; clearly, the regular use of soap would make a significant difference. The story has many aspects, but one element illustrates Prahalad’s approach. Traditionally, soap had been seen as an expensive beauty product. Hindustani Lever took up the challenge, and reformulated their Lifebuoy brand, adding an antibacterial agent, and changing the manufacturing process to produce a cheaper, denser, smaller, and longer lasting bar. They changed the additives to a more neutral aroma. The result was a far more affordable soap, easy to distribute, and although the profit per bar was tiny, sold in large quantities it would cover all the manufacturing, marketing, and distribution costs, and still make a small but adequate profit for the company.
It was at this point that the partnership with government and rural agencies became important. Promoting soap, which required selling it as a health benefit rather than a beauty product, and promoting the concept to tiny villages, required a major rethink. Marketing had to be simple and cheap, using locals to explain the benefits. Distribution was based on how goods were traded across large areas with small numbers, and the central role women played as traders (especially in rice, the main rural product). To Hindustani Lever’s credit, they were willing to rethink every element of the business they knew for this new context. The results have been impressive. Slowly, health outcomes in rural India have been improving.
While Prahalad had looked to a major company in developing access to soap, he was also interested in other successful endeavours undertaken at the ‘micro’ level. One of these was Jaipur Foot, whose activities were the subject of the video. Loss of a lower limb or foot is a common and extremely disabling event affecting some 25m or more people worldwide, and at least 5m in India. For those at the bottom of the pyramid, it can mean that work is even more difficult to obtain, and managing everyday life becomes hazardous. Prosthetic feet and lower limbs have been available for a long time, but they are expensive. When I looked at this a couple of decades ago, the price for a prosthetic in the US ranged between $10,000 and $50,000; fitting was an expensive process, and on top of that, most prosthetics only lasted 3-5 years of normal wear and tear. A completely prohibitive price and not an option for the poor.
It wasn’t just cost. Ram Chandra Sharma was a sculptor and engineer who could see that those Indians who did manage to get fitted with one of the existing artificial lower limbs or feet faced problems. Prosthetics were designed for use by Westerners, whose lives were very different from those of rural Indians. What was needed in India was an artificial limb that responded to four distinctive needs: squatting (rather than sitting in a chair); sitting on the ground cross legged; walking on uneven ground, both dry and wet (when working in paddy fields); and walking barefoot.
With Dr P K Sethi, an orthopedic surgeon, Sharma set about designing an alternative and much cheaper artificial limb that would meet Indian needs. The eventual design of the Jaipur Foot used many simple components such as PVC piping, wood, sponge rubber and vulcanized rubber (he got that last idea from looking at car tyres). He also worked to streamline fitting, so that an amputee could have a Jaipur Foot in place and usable with just one visit to a clinic. The cost of the raw materials was just $12.54, and the total cost, including fitting, was $30. As the video showed, the idea worked brilliantly.
I thought about the Jaipur Foot story when I was running some training courses in India. The company was Cisco, and it had a huge operation in Bangalore. My workshops were to be held in the Cisco Campus in Bengaluru (or Bangalore as I knew it). The journey to the campus was almost bizarre. I arrived at the overcrowded and old airport, left in a taxi, and set off for Cisco Building 25 (I guess they number their buildings all over the world, just as they do in San Jose!). The road out of the airport was fine, but soon it became busy, then very busy, with little sign of anyone following the equivalent of a highway code. Finally, it deteriorated even further into nothing more than an extremely uneven dirt road, with potholes and the remains of what might have been a concrete section. Suddenly, the taxis drew up at a tall security gate. I was checked in, and once through, almost magically I found myself in compound with modern buildings, walkways, and lawns, and, I soon discovered, snack bars and a restaurant. It was the closest I have come to leaving this world and entering another!
That enclosed campus, in what is now known as Embassy Tech Village, was a physical reminder of the reality of India. As I’ve already mentioned, back in the 1990s more than 80% of Indians lived in poverty, many in rural areas, but millions in the slums of the major cities. The remainder, above the poverty line, were further divided, with only a small percentage receiving incomes like those received by citizens in most post-industrial countries. However, there was another important factor here: India was far behind in developing its manufacturing economy, relying on a services sector, significantly driven by IT support.
Inside that compound, I was in that tiny part of India that drove its economy and employed a very small percentage of its people. It was almost like an upside-down version of Australia. Australia has a large percentage of its population living well above the poverty line, and doing so in enjoyable surroundings, with a relatively small, often invisible part of the population living in poverty, many of whom are its Aboriginal People. India had, and still has, a large percentage of its people living well below the poverty line, and doing so in appalling situations, with a small, almost invisible part of the country living wealthy lifestyles, and many of these the well-educated working in the IT sector.
In that brief visit to Bangalore, I saw the challenge C K Prahalad was trying to address in asking companies to rethink what they did to make goods and services available to people living with woefully limited resources. The Fortune at the Bottom of the Pyramid puts a positive spin on an almost overwhelming challenge. In the next couple of years, India will reach a total population around 1.38bn, about the same as China: China’s population has stopped growing, but India’s will continue to get larger, and will surpass China somewhere around 2024, and is expected to reach 1.7 bn in 2050.
If the size of the problem were not enough, party politics is aggravating the issues, as the BJP quietly, or occasionally overtly and aggressively, pushes its divisive policies to support Hindus at the expense of Muslims, in a country with 200 m Muslims. A giant population resting on a huge powder keg of religious tension: It’s a miracle there haven’t been more than the occasional riots that have taken place in recent years, following the major riots that took place in 1992 in Bombay and in Gujarat in 2002, where some 1,000 and 2,000 were killed respectively, mainly Muslims. Most recently, there have been riots in Northeast Delhi with multiple waves of bloodshed, property destruction, and rioting, beginning on 23 February 2020 and caused chiefly by Hindu mobs attacking Muslims. Of the 53 people killed, two-thirds were Muslims who were shot, slashed with repeated blows, or set on fire.
Would I have known anything about these destructive religious tensions inside the calm Cisco campus, running a program for very smart engineers on radical innovation? Of course not. Part of the privilege enjoyed by affluent Hindus is to be insulated from the poor, and poor Muslims in particular. Indeed, until recently while they might have known about major riots and violence, they could have remained unaware of the everyday incidents in the slums or away from the cities, possibly even not even knowing many such events were happening.
What has changed is access to information. Digitisation and the internet have completely reshaped our world and what we know about it. You can find out about social entrepreneurs helping disadvantaged groups. You can discover the emergence of new techniques to make products and services available to millions for the first time. You can read about violence and tribal behaviour in the India subcontinent, in Africa, in Asia and in Europe. You can explore trends and changes in politics, economics, business, the arts, sport, whatever topic you want, on any aspect you can imagine. You can hear about everyday riots in city slums.
Were I to go to Bangalore today, travelling through its wonderful new airport, not only would it look very different from the shambolic city I saw before, but I would have access to guides, information, suggested itineraries, themes to explore, explanations of religious iconography, symbolism and Hindu and Muslim holidays and traditions, even where to go to experience a variety of cuisines, let alone lists of museums, temples, shrines and mosques to explore.
All of that makes it clear there is the problem. Is there a business like Jaipur Foot I could go and study? There are thousands. I might want to look at how industries from motor car manufacturing to telephony have been transformed, and the hundreds of strategies being implemented in rural India to improve the health, food and the broader environment in which poor villagers live. I could spend a year chasing up fascinating issues, and just as much time reading about them. At the end of all that, more will have changed, more will be available, and my ignorance will remain substantial in the face of so much change unfolding. I would like to know more about Bollywood, and how that film industry is changing. I’d like to find the ‘Peter Singer’ of Kolkata and understand how he or she sees awareness of people and their needs developing. I’d like to visit one of the outsourced medical diagnostic centres in Mumbai and see how Indian IT experts are developing better and better diagnostics systems to analyses the millions of scans sent there from North America.
The availability of information is such that India is beyond my reach, beyond that of most outsiders, and probably beyond Indian governments at the national and provincial levels. Indeed, I suspect the only way for most people to navigate a meaningful life in the 21st Century is to keep ignoring things. Just concentrate on a few news sources, follow a few blogs and commentaries, read books, both fiction and non-fiction, and remember to carve out time everyday where you are not paying attention to what is going on (I hide in the world of music, classical, often baroque, but romantic and modern, too). Apart from that, spend time on relationships, talking with family and friends, regularly. Relationships are what really matters. What did Kenneth Gergen suggest in last week’s blog? He reminded us we become who we are through our interaction with others: “we sense ourselves as both constituted by, and constituting, the other”. Hermits make for great stories and cartoons, but in real life we are nothing without having people around us. Easy to do if we are talking about family and friends, but how can I keep in touch with the wider world, with life in India today?
