India Wharton Trip Recap 2022
(I have translated this article to Spanish)
In October, 2022, I traveled for the first time to India with a group of MBA Wharton students, visiting Bangalore, Jaipur, Delhi, and Agra in a span of 9 days.
It has been the most eye-opening adventure during my MBA to date. This is the first of many posts where I describe the exciting innovations happening in India.
The speakers we met are world class entrepreneurs and national heroes, leveraging the power of digitalization to solve India’s problems in admirable and unique ways. Quite literally, this trip brought several business cases to life with the very practitioners who invented them for India. I strongly suggest any student of Emerging Markets to understand the innovation leader in their region and in addition to do a thorough deep dive in India.
This journey was not led by Wharton professors as is the case in Wharton Global Modular Courses, GMC for short (read São Paulo Wharton GMC Recap). But it almost felt like one. Our excursion leaders were Bhanu Agarwal and Kshitij Jain, two rockstar native-Indian second-year Wharton MBA students, leading 35 of us non-Indian Wharton MBA students through a healthy dose of intellectual and cultural experiences (Figure 1). They have co-founded Wiztrek, an educational travel platform to bring in-context learning about emerging markets to all schools and communities. You can learn more about their work and reach out through their website link.
Below an outline of my post:
Part 1: Context of India
Part 2: Entrepreneurs As National Heroes
- India’s CTO Nandan Nilekani
- India’s Heart Surgeon Dr. Devi Shetty
Part 3: Takeaways
Figure 1:
CONTEXT ON INDIA
Before diving into some of the speakers we met and my key takeaways, it is important to understand the sheer size of the country. India is the world’s largest democracy, with a population of 1.4 Billion (B), officially surpassing China’s population. That represents 17% of Earth’s population, and is more than 10x Mexico’s, nearly 7x Brazil’s, 4x USA’s.
Even regionally, India’s population wins: it is 2x all of Europe’s populations (0.7B), more than double Latin-America’s (0.6B), and equal to the entire population of the African continent (1.4B). In fact, as shown in the below infographic in Figure 2, the population of approximately 40 countries is the same as India.
Needless to say, the land where states became countries has uniquely influenced how the Indian government thinks of policy and how entrepreneurs think of innovation. By default, Indians think at scale; we must learn from them.
Figure 2:
ENTREPRENEURS AS NATIONAL HEROES
Two of the most impactful lectures happened in Bangalore, regarded as the Silicon Valley of the East. Indeed, everyone you meet there is either working in a VC, a startup, or in technology.
India’s CTO
We first visited the southeastern part of Bangalore known as “Electronic City”. After touring the beautifully green Infosys’ campus (Figure 3), one of India’s powerhouse IT companies, we then traveled to an unassuming building some 10 minutes away. Inside was a small classroom, with several white boards, a projector, and English tea. In the middle stood the legendary fintech entrepreneur, billionaire, and one of the most transformative leaders in India : Nandan Nilekani, often hailed as “India’s CTO” (Figure 4).
Figure 3:
Figure 4:
Mr. Nilekani spoke to us of his ventures as a father speaking proudly of his three accomplished children. First he explained how he founded Infosys back in the 1970s and helped it grow into the 3rd largest employer in India, employing 335,000 Indians as of 2023.
Then he explained how in 2009 the Indian government asked him to create the Indian Aadhaar Authentication system, the nationally-used biometric system which facilitated bank account creation for all Indians, raising the percentage of banked Indians from 35% to 80% in 6 years and helping create the underpinnings for a financially inclusive society.
He proceeded to explain the final project he led, the Unified Payments Interface UPI system. The UPI enables payments for all transactions, from small shop owners, to street vendors, to ecommerce merchants. The system is free, with no merchant fees, and was made to enable the smallest of transactions. Monthly UPI processes ~ $140B USD worth of transactions, and represents a daily volume of 220 million transactions. To see the UPI in action and it’s benefits, I strongly recommend you watch this video:
Figure 5:
India’s Heart Surgeon
The next day we ventured deeper into the rural parts of Bangalore. After being stopped on the road by a handful of cows, we made it to “Health City” , directly adjacent to the “Electronic City” we had visited the day prior.
There we met the charismatic cardiac surgeon and social entrepreneur Dr. Devi Shetty, founder and chairman of the profitable private hospital chain Narayana Health Clinic. His story is also legendary. He was the personal cardiac surgeon of Mother Teresa, the first cardiac surgeon in India to perform a neonatal open-heart surgery in the country, and by many, he is seen as the Henry Ford of heart surgeries in India (Figure 6).
Figure 6:
Quick context: cardiac care in India is particularly dire. Back in 2001, nearly 2.4 million Indians needed heart surgery every year, but only 60,000 surgeries were conducted due to a lack of any affordable treatments. It is still a problem today, with Indians accounting for 60% of the world’s heart disease as recent as 2022, Genetically, people of South Asian descent, which includes countries like India, Pakistan, and Nepal, have four times the heart risk of the general population. The marginalized classes in India suffered the most for lack of access to treatments.
To tackle this problem, Dr. Shetty started Narayana Health Clinic back in 2001 with one mission: to build a low-cost and high-quality “Health City” for the masses. Specifically, Dr. Shetty would first focus on cardiac care, but eventually expand his execution to include other areas, such as oncology, neurology, nephrology, and orthopedics.
Today, Narayana Health is performing nearly 3.5x the amount of heart surgeries as Boston Clinic in a year, and nearly 8x the average daily amount of heart surgeries performed in other Indian hospitals. Narayana Health is a profitable and lean operation, owning 24 different hospitals in India, and offering a total of 67 specialized treatments. They currently have 1 hospital in Cayman Island as they explore exporting their module outside of India.
HBS wrote a case study on Narayana Health Clinic, emphasizing the synergistic entrepreneurial inspiration between both Electronic City and Health City:
“ ‘Look,’ [Dr. Shetty] said, pointing in the direction of the neighboring Electronic City and Infosys…‘They are world class because their quality keeps going up as their costs decrease. Healthcare is a peculiar beast where in spite of all the new technology, costs keep going up all the time. That is a strange paradox. We are out to buck that trend. We cannot afford to let the masses be deprived of top-class tertiary care.” — Dr. Shetty, HBS Case
Figure 7:
Takeaways From Indian Leaders
In addition to those two speakers, we also heard from the following remarkable lineup:
- Hemant Mohapatra, former A16Z partner & current partner at Lightspeed Venture India
- Manjot Pahwa, former CEO Stripe India and current VP at Lightspeed Ventures India
- Nikhil Kumar, Cofounder Setu, Fintech Startup
- Sanjay Jaju, Additional Secretary, Department of Defense, Govt. of India
- Santosh Desai , Columnist Times of India & CEO Futurebrands Consulting
All speakers are experts of India’s economy, society, politics, and technology. Regardless of their occupation, all displayed the same 3 characteristics outlined below:
- Fearless Against Complexity: The first common thing among all Indian leaders we spoke with is their deep desire to impact their country, despite the country’s overwhelming complexity. Adding to the complexity of size portrayed in Figure 1, the large socioeconomic imbalance in India aggravates the complexity. Roughly 1% to 3% of Indians live as good as Americans, 10% as good as a developed society, 40% live similar to the economic realities of Pakistan and Bangladesh, and the remaining 50% of Indians live as poorly as the poorest countries in Africa (Nilekani). Only 150M Indians speak English; to truly understand the magnitude of this, that means 1.25 B Indians do not speak English, and there are 24 different languages across the country (Nilekani).
- The Promise of Technology: Obviously, impunity, poverty, corruption and injustice are also present in India, just like in any other country. That said, the Indian leaders we spoke with were not pessimistic, but embrace a technology-first, fighting-chance optimism regarding their prospects. Yes, the situation is daunting, but with a smart enough team and the proper use of technology, they truly believe they can fix India’s society and economy. The rural and most isolated towns of India are finally plugged in with increasing use of smartphones and internet penetrations, and with that comes the spread of small town energy and creativity. As mentioned by columnist Times of India, new ideas are spreading to all corners of India, including ideas on women’s rights, education, and entrepreneurship. Dr. Shetty’s use of digital X-rays, telemedicines, and a versatile electronic medical record (EMR) system were some of the many strategies Narayana Health Hospital employed in their obsession to keep their costs down. Mr. Nilekani and the government as a whole has been digitizing large portions of the economy as a strategic policy and economic priority (Read more in India: Government As A Digital Champion, link coming soon). This is one of the main reasons experts predict India will become the third largest economy in the world in 2023, surpassing Germany and Japan.
- Solve For Volume: Linked with the point above, technology is particularly more valuable in large nations with a large poor base, as you can impact the lives of those at the bottom of the pyramid at a much lower cost. Dr. Devi Sheety’s Narayana’s Health Clinic was able to provide healthcare for the masses at an affordable cost by focusing on volume. Because of the volume of surgeries they managed, they could negotiate better deals from their suppliers; instead of purchasing expensive machines, they would pay their supplier a monthly rent and again, because of the volumes of surgeries they used, the unit economics made sense for both Narayana Health and the supplier’s bottom line. (Read more in Reimagining Healthcare for the Poor, link coming soon).
Absolutely amazing trip in one of the most unique countries I have visited. Thank you India! Your energy and use of technology to create a more financially and healthcare inclusive society is inspirational. My entire blog cannot do justice to all the exciting things that are happening in India, and the nuances for the country’s future. Below I have included further reading for the ambitious Emerging Market student:
- India Ascending
- Can India Change the World
- Stacking Up Financial Inclusion Gains in India
- Building the India Stack: UPI, Aadhar and Data Empowerment
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The Rise of the Emerging Market Entrepreneur
