Healthcare Landscape Of India: The State Of India’s Healthtech Startups

While technology has touched nearly every aspect of lifestyle in the urban context in India today, there’s a long way to go before India can match up to the technologically-advanced cities in the Western world, as it enters the Age of Startups. There’s been great progress in the past decade in logistics, ecommerce and online consumer services, but one area that’s lagging behind considerably is healthcare. While there are a number of healthtech startups in the Indian ecosystem, the scope of these startups is usually very narrow.  

With technologies such as artificial intelligence (AI) and Internet of Things (IoT) ushering in Industry 4.0, machine intelligence has impacted all major industries from agriculture, to recruitment, to entertainment, transport, and a lot more.

Due to the lack of expert healthcare professionals, the healthcare industry offers a huge opportunity for AI to enable faster and efficient healthcare delivery. Most startups in India are focussed on improving access to healthcare and critical care. This is the biggest need at the moment. According to the available statistics, over 45% of WHO Member States have less than 1 physician per 1000 people.

Further, in India doctor to patient ratio in the allopathy sector stands at 1:1596 (far lower than the 1:1400 WHO standard) and the country is ranked 145 among 195 countries on the healthcare index. This goes on to show the huge potential lying in front of healthtech startups in the 1.3 Bn-plus people economy.

Healthcare industry in India is said to be one of the fastest growing sectors backed by India’s rising income, health awareness, and access to insurance, but also due to the increase in lifestyle and stress-related diseases. The IBEF has estimated the Indian healthcare market to be valued at $372Bn by 2022.

The Indian government has also contributed to improving access to healthcare growth with policies such as Pradhan Mantri Jan Arogya Yojana (PMJAY), which promised to provide health insurance worth INR 500K  ($ 7.1k) to over 100 Mn families annually.

Healthtech Startups In India: Funding And Models

According to Inc42’s The State of Startup Ecosystem Report 2018, there are a total of 4,892 startups in the Indian healthtech space. Last year saw an overall increase of 45.06% in the total investments in healthtech startups. Overall, the healthtech startups in India raised a total of $504 Mn between 2014-2018.

While sector analysis clubs all startups in this space under one classification, the truth is that healthcare is possibly the most varied sector out there. In many ways, it mirrors the breadth of the pre-digital healthcare system, which had a lot of moving parts. This breadth and variety of services, products and offerings makes healthcare one of the most challenging aspects of the economy and this is reflected in the glacial pace of development, when you look at each individual vertical within healthcare.

These healthtech startups can be broadly classified under 11 categories including online pharmacy, telemedicine, personal health management, home healthcare, fitness & wellness, diagnostics, biotech R&D, medical devices, healthcare IT, biopharma and genomics. Within India, startups are operating in one of these verticals and are using AI, ML and other modern technology to improve access, affordability and quality of health care.

Healthtech Startups In India: Telemedicine

Telemedicine startups essentially help patients get doctor consultations virtually through apps or web-based videos, chats and voice guidance. Generally, these startups are focussed on solving the lack of specialised doctors in Tier 2 and Tier 3 Indian cities.

According to Mckinsey report, India could save up to $10 Bn in 2025, by using telemedicine instead of in-person doctor consultations. Prominent telemedicine startups in India include Practo, mfine, Lybrate, and Docsapp.

In early 2017, Bengaluru-based Practo had raised $55 Mn Series D funding round led by Chinese conglomerate Tencent. With this round, the company is estimated to have raised about $179 Mn in total funding from a list of investors including Sofina, Sequoia India, Google Capital, Matrix Partners, and more. Practo was included in the Inc42’s soonicorns list in The State Of The Indian Startup Ecosystem Report 2018.

While Delhi-based Lybrate had raised $10.2 Mn in Series A funding from Tiger Global Management, Ratan Tata and existing investor Nexus Venture Partners in 2015. Later in 2017, company was reported to have raised another $3Mn from undisclosed investors.

Meanwhile, Bengaluru-based DocsApp has raised $1.6Mn from a venture debt lending firm InnoVen Capital earlier this month. With the latest funding, DocsApp has so far raised a total of $10 Mn from investors such as Bessemer Venture Partners and Japanese investment firms Techmatrix Corporation and DeNa Networks. DocsApp was part of the Inc42’s Healthcare Startup Watchlist of 2019.

Another telemedicine startup, mfine banks on the patient’s trust on established hospital brands and enables patients to teleconsult with doctors from these brands through its app, among other features. The company counts SBI Holdings, SBI Ven Capital, Prime Venture Partners, BEENEXT, Stellaris Venture Partners, Alteria Capital and Mayur Abhaya CEO of stem cell banking company LifeCell, as its investors. It has raised a total of $22.9 Mn across three funding rounds.

Healthtech Startups In India: Online Pharmacy

Simply put these startups are ecommerce sites but only deal with medicines and medical Also known as epharmacy, this segment has players such as 1MG, Pharmeasy, Netmeds, MyraMed and SastaSr.

According to a 2018 Research and Markets report, India currently has over 850K independent pharmacy retail stores but they are able to meet only 60% of the total demand. This highlights the huge untapped market opportunity for epharmacy startups in India. The report estimated the online pharmacy space will grow at a CAGR of over 20%, to reach the $3 Bn mark by 2024.   

The epharmacy space has been able to garner attention from marquee investors such as Sequoia Capital, Kae Capital, Eight Roads Ventures India, and Nandan Nilekani-backed Fundamentum Advisors.

According to Inc42 Datalabs, 1MG has raised a total funding of $97.4Mn across its five funding rounds till now. While, Pharmeasy raised $108Mn over six rounds and Netmeds raised $99.3 Mn across four funding deals. Sofina-backed HealthKart, which is the parent company of 1MG, has raised $68.7Mn across five funding rounds.

Along with growing investor interest, epharmacy startups have also overcome protests and legal challenges by offline pharmacies and a subsequent High Court ban on their operations in 2018. However, the government later introduced draft regulation guidelines for the epharmacy segment to standardise the registration process, which has given more clarity to the businesses entering this space.

Healthtech Startups In India: Personal Health Management

Indians are getting more and more health consciousness thanks to increased awareness of health problems as well as fitness activities. This has also led to the rise of health advisory content aggregators such as MyUpchar and CureJoy, along with personal health tracking apps like Pregbuddy and Maya, which help women track periods and pregnancy.

Delhi-based myUpchar has raised a total funding of $5 Mn from Nexus Venture Partners, Omidyar Network, and Shunwei Capital in 2018. CureJoy too raised a comparative $5.5Mn over its two funding rounds, from investors such as Accel Partners.

Further, Maya has received funding from ex-Google VP Rajan Anandan before getting acquired by a women community startup SHEROES in January 2019. Meanwhile, Bengaluru-based PregBuddy had only raised an undisclosed seed round from Indian Angel Network (IAN) in 2018.

Healthtech Startups In India: Fitness And Wellness

Going beyond imparting health-related knowledge, India has also seen a rise in the number of fitness and nutrition startups with the likes of Fitternity, Cure.fit, HealthifyMe, GoQii, HealthKart along with mental health and wellness startups like Yourdost, and InnerHour. While they all adopt a different model – Cure.fit manages the entire fitness stack, while GoQii has a wearable device along with dedicated remote trainers – the ultimate objective is to get users working out, eating right and generally fit.

This month, Mumbai-based fitness discovery and booking startup Fitternity secured $4 Mn in a fresh funding round from consumer-focused venture fund Sixth Sense Ventures.  It was closely followed by Cure.fit which raised a round of $75 Mn from Piramal Group’s Anand Piramal, Accel Growth, Kalaari Capital, and IDG Ventures India, earlier this month. This brings the total funding raised by Hrithik Roshan-backed Cure.fit to about $245 Mn.

Recently last month, another Mumbai-based fitness startup SARVA had raised about $6 Mn – $8 Mn from celebrities such as Jennifer Lopez, American baseball player Alex Rodriguez, Indian actress Malaika Arora, and along with fitness brand Zumba. SARVA provide its users access to yoga, mindfulness and wellness solutions through two approaches – physical and digital. The physical or offline approach includes the company’s state-of-the-art brick and mortar studios and lifestyle products, backed by the accessible and interactive digital platform.

At present, the overall fitness market in India is valued at $3 Bn and is said to be growing at 18%, with a mere 4% of the market comprising of organised gym chains or digital fitness startups. But workouts and fitness activities are just two aspects of overall health and fitness. Many startups such as Cure.fit vertical Mind.fit, Yourper, Headspace are focussing on mental wellness as well.

On the wellness end of the spectrum. Mumbai-based online psychological wellness platform InnerHour had raised $450K in its first round of funding from financial advisory firm Batlivala & Karani Securities, investment firm Venture Works and others. Bengaluru-based YourDOST, had raised $1 Mn in Pre Series A funding from venture capital firm SAIF Partners and others in 2016. With this, the startup had raised a total of $1.2 Mn funding.

But the mental wellness segment is currently under-addressed in the Indian context, with only a handful of startups using technology to disrupt the market. According to WHO estimates, India’s burden of mental health problems is massive at the moment. For every 100K people, the organisation found 2400 disability-adjusted life years. This means among the lifetime of every grouping of 1 Lakh in the population, 2400 years cumulatively are spent managing mental disability or trauma.

Healthtech Startups In India: Home Healthcare

One of the biggest pitfalls in the traditional healthcare system in India is the lack of access to adequate and critical care for many patients, especially those outside the metros and Tier 1 cities. Many healthtech startups are solving this by bringing healthcare services to the homes of patients. India’s home healthcare segment has actually evolved from simple tests to elderly care, oncology or cancer support, at-home doctor consultations, pathological tests sample collection and report delivery, physiotherapy sessions, home nursing and more.

Some startups operating in this space include Gurugram-based Healthians backed by cricketer Yuvraj Singh; CallHealth which has investors such as Times Group,  Telugu actors Chiranjeevi Konidela and Nagarjuna Akkineni; Portea Medical and Healthcare At Home .

The IBEF has predicted the home healthcare market will  reach US$6.21 Bn by next year. India is said to have the second largest geriatric population (above 60 years of age) in the world with 87.6 Mn people above the age of 60. Secondly, the busy lifestyle in urban cities has also contributed to the rise in home healthcare.

Healthtech Startups In India: Diagnostics

While access to healthcare is a problem, another big issue is the time taken for disease diagnosis, especially for chronic illnesses. Among startups working in the field of medical diagnostics, the focus has been to develop medical devices, software for diagnostic centres, AI and ML tools to assist in disease discovery, and infrastructure for providing diagnostic services remotely or on-site.

Diagnostics startups operating in India include the likes of Qure.ai, SigTuple and NIRAMAI Health Analytix. These and others are using deeptech to enable faster and more effective diagnosis based on radiology, medical imaging and pathology reports.

In the healthcare market, the commercial use of AI is expected to reach $36.1 Bn by 2025, at a CAGR of 50.2% between 2018 to 2025. AI forms a critical aspect of diagnosis, because it removes India’s burden of having a lower doctor to patient ratio. This tech-centric approach has gained traction among startup ecosystem enablers.

Both SigTuple and NIRAMAI Health Analytix were named among India’s most innovative startups in 42Next by Inc42 in 2018. Qure.ai along with SigTuple were recognised by government think-tank NITI Aayog’s CEO Amitabh Kant as notable AI startups.

SigTuple has raised a total of $45.4Mn across six funding rounds from investors such as  Accel Partners, Chiratae Ventures, Pi Ventures, Binny Bansal, and Trifecta Capital. While, the breast cancer focused startup, NIRAMAI had raised a total funding of $6Mn till now. Its investors include Japanese venture capital firm Dream Incubator, pi Ventures, Ankur Capital, Axilor Ventures, Binny Bansal, and BEENEXT.

Founded in 2016, Qure.ai is targeting affordable AI-based diagnosis from chest X-rays, CT scans and MRI reports. Qure.ai’s software tool drastically reduces diagnosis time of respiratory diseases and brain trauma. The startup has received an undisclosed seed amount from Fractal Analytics, which has also incubated the product.

Healthtech Startups In India: Biotech R&D

If AI-based diagnostic is about solving big problems for large sections of the global population, biotech research focuses on the individual. The Indian government’s department of biotechnology has predicted the Indian biotechnology sector is predicted to reach $100 Bn by 2025. In 2017, India’s biotech industry held 2% of the global market share and was pegged as the third largest in the Asia-Pacific region.

Startups such as MitraBiotech have developed biotech solutions such as CANscript which enables doctors to choose the most optimal drug combination for a patient. CANscript tests a tumour sample against various drug combinations in a controlled environment that is similar to the real-life human tumour microenvironment.

Another Bengaluru-based startup Pandorum Technologies works on tissue engineering and regenerative medicine. The flagship product of the company, 3D printed human liver tissue, can be used in medical research for drug metabolism and disease modelling. Pandorum is backed by Binny Bansal, Indian Angel Network and other angel investors.

The designed product can perform the functions of a human liver tissue including detoxification, metabolism, and secretion of biochemicals such as albumin and cholesterol. The startup aims to make personalised human organs like lungs, liver, kidney, and pancreas on demand.

Healthtech Startups In India: Medical Devices

While biotech is about using biological and technological advances to repair health and wellbeing, humans have been using technology to self-diagnose diseases for years, The medical devices industry in India is estimated to be $5.2 Bn, pegging it as the fourth largest market for medical devices in Asia, including for BP measurement,  blood sample analysers and digital imaging devices. Some of the medical devices startups in India include UE Lifesciences, Forus Health, BeatO, Wellthy Therapeutics, and vTitans.

UE Lifesciences has built a low-cost device ‘iBreastExam’ that helps in detecting breast cancer even at an early stage. It is a portable handheld scanner that can be paired with any smartphone through Bluetooth and scans the results over the screen. The company was founded in 2009 and has raised funds from billionaire entrepreneur Kiran Mazumdar Shaw, Unitus Ventures, and Aarin Capital

Bengaluru-based Forus Health manufacturers eyecare-centric devices. Its flagship product 3nethra can be used for digital imaging of the posterior and anterior surfaces of the human eye to support the treatment of ocular diseases.

Tamil Nadu-based vTitans has developed smart infusion pumps which are used to administer drugs intravenously. Company has launched AccuFlow SP-550 Syringe Pump and AccuFlow IBP-550 Syringe Pump for Indian market in 2018. These pumps are intended to be used in critical care areas to provide intermittent or continuous flow of syringe infusion therapy to patients.

Delhi-based BeatO is a diabetes care and management platform which uses a smartphone-based glucometer for blood glucose monitoring. BeatO’s mobile app allows users to keep a record of their readings and also connects them with doctors for real time guidance. The app can also sends out instant alerts to family and caregivers based on the patient’s readings. The Delhi-based company has raised a total $2.9 Mn funding till now. BeatO investors include Orios Venture Partners, Blume Ventures, and Leo Capital among others.

As per the WHO data, India tops the list of countries with the highest number of diabetics; and is expected to rise by more than 100% in the year 2030 to account to a whopping 79.4 Mn.

Other startups such as Wellthy Therapeutics, and Fitternity have also developed products targeting the diabetic patients in India. Wellthy Therapeutics mobile application allows patients keep track of their meals, monitor blood sugar, track medicines, and also interact with its chatbot. The company has raised $2.1 Mn Seed funding from Beenext Ventures, GrowX Ventures, Currae Healthcare and others.

ten3T is another a wearable device startup which has multiple sensors to collect clinical grade data, along with continuously streaming signals from ECG, pulse, SpO2, respiratory rate and temperature, all of which is analysed and reported in real-time. The company had raised angel funding from pi Ventures in 2016.

Healthtech Startups In India: Healthcare IT/Data

A lot of healthcare relies on data from patients, doctors, as well as medical, anthropological and sociological research. This is where healthcare IT companies with their SaaS offerings are making a big difference in access, insurance and care.

NASSCOM has pegged India’s IT industry at $167 Bn in 2018 and predicted it to grow at 8% year-on-year rate. At this rate of growth, it is expected to take India another 25 years to reach the $1 Tn value.

Startups such as Innovacer, HealthPlix, Pharamarack, Attune, CareStack, Live Health, and Practo are working in this space, gathering and processing data from various sources and structuring it for their models

Innovaccer is a big data SaaS startup focussed on helping healthcare organisations accelerate decisions around healthcare and insurance based on key insights and data-driven predictions.

Bengaluru-based HealthPlix is a full-stack SaaS based EMR (electronic medical records) platform which incorporates protocols and clinical guidelines to assist doctors at the time of treating patients.

Chennai-based Attune Technologies has a software platform that interfaces with equipment such as lab analysers and ICU machines to absorb data from diagnostic labs, clinics and hospitals into its health network.

Healthtech Startups In India: Biopharma

Biopharma is the field within biotech which deals with manufacture and production of drugs that are manufactured from biological process. Biopharma drugs are manufactured using living organisms such as bacteria, yeast and mammalian cells instead of the chemical process used to make allopathic drugs.

The prefix ‘bio’ essentially denotes the process of drug production. The biopharma sector in India includes startups such as antibiotics-focused Bugworks Research, Vyome Therapeutics, and PlasmaGen Biosciences which specialises in plasma protein therapy.

Vyome Therapeutics is aimed at developing dermatology products and had raised $22Mn from Mumbai-based venture growth fund Iron Pillar in January this year. 

The Biopharma industry in India makes up a decent chunk of the overall pharma market. The total annual revenue for biopharma touched $275 Bn in 2018, accounting for more than 25% of the total pharmaceutical market.

Healthtech Startups In India: Genomics

Genomics sector include startups focusing on innovation in the field of genome research, DNA studies and gene editing. Some startups operating in this space include Mapmygenome, Genebox and MedGenome. While gene editing is about to change the face of food, medicine and health around the world, Indian startups are most focussed around genetic testing for disease discovery, diagnosis as well as non-invasive treatments.  

Hyderabad-based Mapmygenome combines customer’s genetic data and health history to  provide health-related guidance to individuals and their physicians. Mapmygenome has raised over INR 7 Cr in a Pre-Series A round led by Aarti Grover, MD,CMS Computers, Rajan Anandan former VP of Google India, Arihant Patni, managing director at Hive Technologies and Satveer Singh Thakral, CEO of Singapore Angel Network among others.

Bengaluru-based MedGenome has developed diagnostics tests which has led to many breakthroughs for genetic diagnostics including the first proprietary liquid biopsy (OncoTrack) for monitoring cancer treatment, a non-invasive prenatal screening test (NIPT) for pregnant women, carrier screening for couples planning for children, and whole exome sequencing for cost-effective identification of rare mutations.

MedGenome has last raised a $10 Mn funding from HDFC Ltd., HDFC Life and HDFC Asset Management to complete its Series C round of $40 Mn in 2018. Other investors in the company include Sequoia Capital, Sofina, Kris Gopalakrishnan of Infosys, and Lakshmi Narayanan, former CEO of Cognizant.

The Future Of Healthtech In India

As healthcare in India continues to grow with the overarching technology, the ripple effect of tech advancements are likely to be felt all across the sector.

With healthcare data becoming more comprehensive, data analytics and predictive healthcare is bound to become more accurate. This will tackle the problem of access to healthcare, while the improvement in accuracy of predictions will increase the personalisation aspect of fitness and wellness products, and also reduce the time taken to treat patients. Personalised treatment will not only be able to target diseases more efficiently, but also help in developing the biotech, biopharma and medical devices industry.

A flourishing modern healthcare ecosystem is underpinned by technology penetration and adoption, which in turn will contribute to the availability of data in this sector, which can be tapped by healthcare IT startups. This data-rich healthcare ecosystem is likely to have a major positive impact on research in the field of genetics and genome, as well as delivery of ancillary services such as insurance.

This goes to show the interdependence among the many specialisations that businesses have adopted, which is stronger in the healthcare sector than most other startup sectors in India.

Update: May 31, 2019 | 11:51 AM

Earlier version of the article mentioned that Bugworks Research had raised funding from Iron Pillar. This has been edited to reflect that Vyome Therapeutics had raised $22Mn from Mumbai-based venture growth fund Iron Pillar. 

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