Available, accessible, affordable: VitusCare is focusing on the 3 As of kidney care in Tier II and III India
When Prabhat Kumar Srivastava’s father required a critical dialysis service, he and his family were unable to find a decent dialysis centre in their hometown, Jabalpur. This ordeal finally forced Prabhat and his family to shift base to Delhi, taking an emotional toll on them.
Having gone through this ordeal, Prabhat was well aware of the typical small-town challenges prevalent in India, or Bharat, as he calls it. This is why he made it his personal mission to bridge the gaps in the kidney care ecosystem in India’s hinterlands with the launch of his dialysis delivery startup.
“Our aim is to provide services to patients near their houses. And when I say near their houses, we mean the dialysis care facility should be available within one kilometre,” says Prabhat, Co-founder and Director of VitusCare Dialysis Centres.
Founded in July 2017 by Prabhat, Dr Saurabh Pokhariyal, Co-founder and Director; and Pankaj Tandon, Co-Founder and Director, VitusCare was conceived with the idea to provide quality dialysis therapy to the bottom-of-the-pyramid population, which finds accessing the kidney care ecosystem a challenge.
The factors that contribute to the challenge range from lack of quality secondary and tertiary-care facilities in non-metro cities as well as various socio-economic conditions, among others.
Prabhat says amid the gaps in public healthcare delivery the company saw an unprecedented demand during the pandemic. As most hospitals were largely overburdened, dialysis care services came to a halt. Unfortunately, the mortality rate is high among chronic kidney care (CKD) patients in case of interrupted care. It’s a desperate need and the service can’t be stopped at any stage.
“Patients were suffering as they were not able to get dialysis. All our centres were operating in full force during the pandemic, and we ensured we served each and every patient through the entire cycle,” he shares.
Chronic kidney disease in India: Challenges and Solutions, a study published in the National Centre for Biotechnology Information, reveals that the burden of CKD in India cannot be assessed accurately. However, the approximate prevalence of CKD is 800 per million population.
A 2018 estimate put the number of patients on chronic dialysis in the country at about 175,000, accounting for a prevalence of 129 per million population.
Global Dialysis Perspective: India, a study by Joyita Bharati and Vivekanand Jha, reveals dialysis services in India are predominantly driven by the private sector, reflecting low public spending on healthcare. The study highlights how the number of deaths attributable to CKD in India rose from 0.59 million in 1990 to 1.18 million in 2016.
India also has one of the lowest nephrology workforce densities worldwide. There are only about 2,600 nephrologists (1.9 per million population), and there is a chronic shortage of dialysis nurses and technicians.
Several inequities exist in access to dialysis. Two-thirds of the population of India lives in rural areas, where the availability of hemodialysis (HD) is limited. According to one study, almost 60% of patients on dialysis had to travel more than 50 km to access HD, and nearly a quarter lived more than 100 km away from the facility. The burden of travel increases costs and exacerbates loss of wages. Further, women are under-represented, and there are few paediatric dialysis services.
This is where the care model of a company like VitusCare fits in.
Aiming to make dialysis care accessible and affordable in Tier II and Tier III towns of India, VitusCare leverages data analytics and offers an innovative delivery model.
Prabhat explains that exhaustive paraphernalia is required to run a dialysis centre in an organised manner. It includes a clinical team for the enforcement of SOPs, a biomedical team for the management of machines, an administrative staff, and a network of delivery therapists, nursing staff, nephrologists, operations teams, as well as patient-experience and awareness teams.
“The innovative delivery model implies that the hub-and-spoke arrangement where we have identified the optimal size and the arrangement of resources (manpower and equipment) for each hub-and-spoke clinic ensures better reach to patients in the hinterlands and assures the best possible degree of clinical quality without compromising on financial viability,” he says.
The company claims to have brought about some key operational and clinical efficiencies to ensure lower cost of treatment and improve care accessibility.
The services include in-centre HD and nephrology OPD (outpatient department) and consultation services. HD is considered to be the most common renal replacement therapy (RRT) modality in India. Their centres are built in partnerships with hospitals and leading nephrologists.
It also provides therapy at stand-alone centres and in the comfort of people’s homes (especially for the geriatric population) under its home dialysis initiative. This also allows patients to control their treatment schedule.
Currently, VitusCare conducts dialysis sessions for more than 1,500+ patients and aims to take this up to 5,000 plus patients on a monthly basis. The startup, which conducts up to 1,25,000 dialysis sessions each year, wants to offer up to 10,00,000 dialysis sessions annually.
“Tier II and III still remain unsolved by private players in this field and by the government,” says Prabhat, although he applauds the union government’s Pradhan Mantri National Dialysis Programme.
“The entire healthcare system is very fractured and fragmented across the country. So, it has its own challenges. We are trying to create an equal space where we can bridge the gap to accelerate last-mile delivery of dialysis,” he adds.
Even in Delhi, VitusCare primarily targets parts of West Delhi, which is relatively underserved as compared to other posher parts of the capital.
VitusCare presently has a presence across 30 cities and is planning to start more centres across Uttar Pradesh, Delhi-NCR, Rajasthan, Haryana, Punjab, Gujarat, Madhya Pradesh, Uttarakhand, and Himachal Pradesh.
The healthcare startup wants to expand its footprint and plans to establish 150+ centres over the next three years. Apart from North India, it will “aggressively focus” on central and the western parts of India.
However, Prabhat points out a critical and persistent challenge: getting skilled manpower.
“That is why we also run various homegrown schemes within VitusCare at all 30 centres. Essentially, we provide talent with further skill development and training opportunities with a combination of SOPs, monitoring, and regular refresher courses, from time to time,” he says.
This is an additional cost to the company but the management envisions it as a long-term investment to develop top-class skilled manpower in the dialysis ecosystem.
Tech and the three A’s
“Availability, accessibility, and affordability are the three fundamentals on the basis of which we have been developing our platform and care chain. A critical means to this end is to bridge the gap between the patient and the doctor,” Prabhat says.
There are three agents in this entire ecosystem: the service provider, who provides services relating to dialysis and kidney care; the doctor who advises patients; and a platform like VitusCare (which acts as the enabler or bridge between the hospitals/healthcare providers and the patient, and the doctor and the patient).
“We have innovated in dialysis care with our tech-enabled dialysis medium that connects patients in Tier II and III towns with a nephrologist far from them. Top nephrologists could be anywhere in India, but we are enabling patients from underserved pockets to connect with them,” Prabhat says.
Essentially, VitusCare helps them book an appointment or avail expert opinion on critical care.
“We have three revenue models, in principle. The box-in-box model where we provide dialysis services to a hospital. Then we have our standalone centres. Finally, we have homecare services where we cater to the patients with less mobility and of advanced age,” says Prabhat.
The startup competes with Nephroplus, Apex Kidney Care, and DCDC, but there’s a difference.
”While others are focused on urban and international geographies (South East Asia), VitusCare is focused on solving the gaps in the kidney care ecosystem of Bharat—Tier II and Tier III towns of India,” Prabhat says.
The company has raised an undisclosed amount of funding in its pre-Series A round, from angels and institutional investors.
(This story has been updated to correct a factual error.)