Inspired by CK Prahalad’s book on the “The Fortune at the Bottom of the Pyramid,” Novartis was exploring the possibility of building a sustainable business at the BOP in India. The goal was to create a business that would improve access to healthcare for the poor while being financially profitable, unlike Novartis’s traditional philanthropic and corporate social responsibility approaches. To successfully develop a sustainable business Novartis needed to answer a series of strategic questions: Which BOP patients were the best targets for reaching the social and financial goals of the program? Which diseases should the program cover, and with what types of products (patent protected, generics, OTC)? Which stages of the patient journey should the program address? Which stakeholders should be targeted? What communication channels should be used? What should be the program’s scale? Where to put the social business group in the Novartis organization?

There was a large segment of low-income population comprising about 1.2 billion people, with incomes between US$2-5 a day with no bank accounts, no access to modern financial services, no phones, dependent on informal or subsistence livelihoods and lacked access to amenities and basic healthcare. Addressing these unmet needs could create significant market opportunities for businesses while also contributing to social goals. This was particularly true in the healthcare market, where the BOP had long been underserved. Many Asian and African countries, where the BOP typically were, faced the double burden of infectious diseases and increasing rates of non-communicable diseases such as diabetes, cardiovascular diseases etc. Novartis decided that it was time to seriously consider the possibility of commercial opportunities amongst the world’s poor, notably India.