And The Million Dollar Hult Prize Goes To A Doc In A Box

It's being called the million dollar faint.

Ram Lakshmanan and his team were onstage at the Clinton Global Initiative annual meeting in New York on Tuesday evening. They were finalists for the Hult Prize, which each year awards $1 million to the best plan for addressing global problems. They were making their pitch for a better healthcare plan that would include something they're calling "Doc-in-a-Box."

And then the 30-year-old entrepreneur collapsed.

Ahmad Ashkar, the founder of the prize, grabbed the microphone.

"It's a high-pressure situation up here."

That's an understatement.

The five-year-old Hult Prize has been called "the Nobel Prize for students" by Muhammad Yunus, and he should know. Yunus, a pioneer in the field of microcredit, is himself a Nobel laureate. He's also one of the judges for the competition. Teams of undergraduate and MBA students spend a year preparing innovative business plans to address global problems.

This year's prize challenge focused on proposals to improve life for the 250 million people living in slums and suffering from chronic diseases like diabetes, high blood pressure and heart disease. Slum dwellers often can't afford medical care or live too far away to reach clinics. The care they can obtain often focuses on emergency services rather than long-term health.

Laskhmanan turned out to be fine. And the four other team members were fine, too. After the faint, the spring 2014 graduates of the Indian School of Business in Hyderabad resumed their presentation and fielded questions from the five judges. That night they learned that they had won the prize.

The winning project, called NanoHealth, proposes hiring and training community health workers, and equipping them with "Doc-in-a-Box," a diagnostic tool the team designed that can measure basic indicators like blood sugar, blood pressure and blood lipids and create an electronic health record for the patient.

The health workers are called saathi [friend], and are hired from the community, trained and certified by the organization. They run screening camps to diagnose patients and refer them to partner healthcare organizations, and then follow up with the patients frequently to make sure they are taking their medicines or implementing lifestyle changes.

The team originally conceived a narrower project, simply to help slum dwellers with chronic diseases stick to their prescription plans. But the students quickly discovered that many patients didn't know what medicines they were supposed to take — if they had even been diagnosed.

"Let's get some doctors to verify their diagnosis," Aditi Vaish, 35, remembers thinking. "But no doctors serve these slums. So let's get a screening device." Once they'd conceptualized the Doc-In-A-Box, they decided to set up "camps" in the slums to meet with the residents and get their medical information.

Of necessity, their project became more holistic. "One part was not enough," says Ashish Bondia, 32. "For the urban slum dweller, the entire healthcare journey was missing."

"In order to have an impact in chronic care, whether that is in an urban slum or for anyone, you need to treat all the pieces of the problem," adds Vaish. "There's underdiagnosis, poor treatment and poor compliance."

The Hult Prize competition process began last September, but these five friends had been working toward this moment for much longer. Bondia is a former Indian army physician, Pranav Maranganty managed a healthcare NGO, Vaish came from marketing and Lakshmanan is a former Goldman Sachs employee. Manish Ranjan has worked in consulting, but comes from a family of doctors. Despite their diverse backgrounds, they always found themselves "sitting around discussing healthcare and different ideas to fix it," says Maranganty, 33.

When they heard about the Hult Prize, they were motivated to create a plan that focused on areas they might otherwise have ignored.

"If we were just told to start a business, we would have been incentivized to go outside the slums," says Lakshmanan. "To bring down the cost so these people [in slums] can afford it was an incredible challenge."

While developing their plan, NanoHealth received funding from GVK Bio, India's largest biotechnology research organization, and partnered with a local manufacturer to create the Doc-in-a-Box supplies at low cost. They were able to launch pilot projects in slums in Hyderabad and Patna, hiring three saathis who saw 2,852 patients through screening camps. Of that group, 46 patients signed up for follow-up from the saathis.

"We were told that when you enter a slum, you are entering someone's territory, someone's fiefdom," says Maranganty. "But we found that everyone was very happy to work with us."

"We also learned that when people come to our screening camps, they expect something in return every time they come," says CEO Manish Ranjan, 32. "If they show up, they want you to give them something." So the group added mobile printers to the Doc-in-a-Box kits, allowing health workers to give patients a copy of their test results to take home with them.

Ahmad Ashkar, a Palestinian-American, was an MBA student at Hult International Business School in Cambridge, Massachusetts, when he came up with the idea for the prize in 2009. Funded by Swedish entrepreneur Bertil Hult and operating in partnership with the Clinton Global Initiative and Ashkar's alma mater, the prize and competition are restricted to students and recent graduates because young people are "audacious," Ashkar says. "I give a challenge to a CEO of a development company or a charity, he tells me it's impossible. My [Hult Prize] entrepreneurs don't just tell me it's possible, they shorten the time frame."

Last September, 11,000 teams of students from around the world sent in proposals to six regional competitions. Each region produced one finalist team that was invited to spend July and August at the Hult Prize Accelerator, where they perfected their business plans and presentations in time for their September pitches.

A team from the University of Pennsylvania, one of two undergraduate teams among the finalists, developed Sweet Bites, a chewing gum that's 100 percent xylitol, a natural sweetener that prevents tooth decay. Another team proposed training bees to detect diabetes and cancer from a person's breath. A team from Spain wanted to teach slum dwellers how to make eyeglasses, which they could then sell to their neighbors. Though these three teams didn't win the big prize, they now each have a strong, tested business plan for a start-up—and they just presented to a room full of development leaders, whom they can only hope were intrigued.

As for the NanoHealth team, after they're done shaking hands and receiving congratulations in New York, they will go back to India and back to work. They plan to continue focusing on their pilot areas for now. By 2016, they hope to have expanded their project to seven states in India, and after that, to the world.

"We have made everyone believe that we can do it," says Lakshmanan. "Now we have to do it."