In the second installment of this four-part series, David Robinson shares his team's experiences in initial partner meetings with Indian companies, clinical sites, and collaborators.
We all know what it takes to clinically validate a medical product, to test it with your customers and ensure it can be reliably deployed into the resource settings in which it will be used. In our case we’re working to develop a new class of Point of Care (POC) sensors for the screening and, ultimately, for the diagnosis of Tuberculosis (TB) and other diseases. In this second installment of our four-part series, I share our experiences in having initial partner meetings with Indian companies, clinical sites, and collaborators.
One of the most challenging aspects of doing business in any country other than your own is understanding the business, cultural, and community dynamics. Anyone who thinks it's possible to simply move in and open up shop is either out of business or on their way out of business.
Due to the cultural complexity, doing business in India requires strong partnerships, so one goal of our trip was to seek out the locations and partners who can help us to understand how to be successful in India.
During our trip we were fortunate to have Dr. Ashok Joshi, an entrepreneur with ties both at my home in Utah and throughout India, as our host. He understands our business and both cultures, and helped schedule a trip that bridged what may have otherwise been a divide we'd never be able to cross.
By the end of the trip, Dr. Joshi had earned the honorary title "Baba A.J." from all in our group. Baba is an honorific title that translates to “Father” in India, and usually denotes very great respect—in our case for his mastery of business and international diplomacy.
During our trip, Dr. Joshi helped to set up meetings with Reliance Innovation and Reliance Health Care on the business side—as well as with the Mahatma Ghandi Medical (MGM) Institute of Health Sciences on the clinical aspect of our approach. At each meeting, we were fortunate enough to be able to meet with the most senior people in charge of strategy, manufacturing, and clinical testing.
The people of India take their professional meetings very seriously, and each meeting followed a similar cultural flow. We first met with our host or meeting coordinator—who explained how the meeting would be conducted, who would be there, and what should be expected. In some meetings there was a ceremony to honor us and to bless the meeting. Our presentations were well received and we had a lot of polite questions.
But we discovered some confusing cultural issues as well. Indians generally won’t challenge a guest, especially an honored guest with academic credentials they respect. Therefore, we missed some opportunities to dive deeper into technical subjects—as they were given too little attention, and we would have welcomed the scrutiny.
In addition, where meetings in the U.S. generally end with some kind of “wrap up” and even “action items,” every meeting in India seems to end with a commitment to deep thought on the matter that was discussed.
Even when the audience was receptive, we had a difficult time understanding what the next step might be—or if there would even be a next step. Meetings also tend to incorporate a snack and tea and take place over many hours. With the traffic in Mumbai rivaling that in New York or Los Angeles, we were limited to just one meeting a day.
One of our most interesting and productive meetings was with Anil Kokhadar, the former Chairman of India’s Atomic Energy Commission and current holder of the Satish Dhawan Chair, and the team at MGM.
MGM is an impressive facility and it was clear they’ve worked very hard to establish their credibility as one of India’s leading medical colleges. The staff who attended our meeting included the entire senior staff of the organization—a testament to Dr. Kokhadar’s influence and the challenge TB presents to India.
From the very beginning, the entire group was engaged at an entirely different level. They all knew the national, regional and local politics and clearly understood the national priorities of India. Further, they had even defined a clear role that they expected to play in it and had a more western approach to the business goals.
In contrast, our meeting with Reliance Health Sciences—while certainly technically oriented and engaging—was more focused on “market response” than strategy or national priorities. I found this curious—that a company that’s part of a $100B empire in India didn’t have a clearly defined strategy, or a defined role in India’s future health economy as its national expenditures rise.
And defining that role will be increasingly important. India’s spending on health care is among the industrialized world’s lowest at approximately 1% of GDP. But if the spending in the United States (8.4%), and even China (3.1%), is any indication—that number could triple in the next decade as India’s blistering hot economy continues to grow.
And India has some big health problems. TB is rampant here—the country already has 25% of the total TB cases worldwide and the fastest growing rate of infection. Communicable diseases of all kinds continue to plague India’s poor with HIV, leprosy, small pox, guinea worm, and other infectious diseases that are still not well controlled.
India and China have similar problems, but a sustained effort to control these diseases in China has put them at least a decade ahead of India. Reforms to end systemic corruption and nepotism in all areas of business, including health care in China, has help to fuel direct foreign investment of more than $40B into China versus just $2B into India in 2012.
Our meetings ended with some hopeful new partnerships with clinical partners, but without a clear direction for partnering to support the commercial development of our products. But we’ll be back—and the next time it will be with the support of the United States Commercial Services Gold Key program that helps connect U.S. companies to partners overseas.
In the meantime, we’ve had our eyes opened to a new culture and a new way of thinking about business—one that’s based as much on relationship as the opportunity ahead.
Stay tuned for the next installment in this 4-part series as we continue our research journey within India.
The nuviun industry network is intended to contribute to discussion and stimulate debate on important issues in global digital health. The views are solely those of the author.