Mobile app that leverages Short Message Service (SMS) to deliver customized dosage reminders to patients in rural India to provide accurate medical records to medical practitioners.
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Mobile Industry in India
1. Fall
08
Spring
10
Mobile Telecommunications Industry
Kelly James
Macro Economics Research Paper
2. Table of Contents
1.Introduction.....................................................................................................................3
Problem Identification.............................................................................................................................3
mHealth (mobile health) Dosage Reminder Application.........................................................................4
II.Industry Overview...........................................................................................................5
Government, Policy & Regulation...........................................................................................................6
Industry Concentration ............................................................................................................................6
Industry Buyers........................................................................................................................................7
Technologies & Structure........................................................................................................................9
Market Growth / Trends.........................................................................................................................11
III.Competitive Analysis...................................................................................................13
Mobile Telecommunication Operators..................................................................................................13
..................................................................................................................................................14
Mobile Device Manufactures.................................................................................................................14
New Entrants .........................................................................................................................................14
Barriers to Entry.....................................................................................................................................15
There are big challenges in the industry that, if unresolved, could disrupt the India growth curve and
affect the ability for new mobile players to enter the market. According to Siddarth Ugrunkar,
"Network not available" is a dreaded but common phrase many mobile subscribers hear when they try
to place a call. He contributes the explosive growth to the overused and strained networks that have
led to the diminishing quality of service. However, with the impending release of the 3G network, he
believes improvements to the quality of existing services, like the drop off rates and poor call quality,
will improve and expand the service capability for new mobile players as well. ................................15
Pricing ...................................................................................................................................................15
IV.Conclusion...................................................................................................................16
V.Works Cited...................................................................................................................18
“India lives in its villages”. --- Mahatma Gandhi 2
3. 1. Introduction
India is a large country, consisting of 29 states, six union territories, and with a
population of more than 1.2 billion people. (“CIA - The World Factbook -- India,” n.d.)
There is no national health insurance policy for the country and it has been observed that
there is a great deal of disparity in quality and access to health care between urban and
rural regions. (GE Healthcare Research, 2009)
India has traditionally suffered from the economic and social hardships of malnutrition
and communicable disease. However, India’s rapid economic growth is playing a
significant role in their public health transition. (Kahn, Yang, & Kahn, 2010) India has
evolved into one of the fastest growing economies in the world, with an average GDP
growth of 8.6% for the last 3 years. (Davies, 2006) The rapid economic growth,
globalization, urbanization and western influence are factors leading to a drastic shift in
the diet and living behaviors of individuals, families and communities. Consequently,
these changes are playing a significant role in the major public health transition that India
is facing. It is estimated that by 2020, cardiovascular disease will be the largest cause of
disability and death in India. (GE Healthcare Research, 2009) World Health Organization
estimates that India lost 9 billion dollars in national income from premature deaths due to
heart disease, stroke and diabetes in 2005, and is projected to lose 237 billion dollars by
2015. (Orpilla, 2006) A report by the Earth Institute at Columbia University warned,
“Without sustained effort on individual and national levels, the imminent heart-disease
epidemic will be devastating for the region's physical and economic health.” (Lal, 2008)
Problem Identification
“Adherence, compliance, and failure are value-judgment words often used by medical
practitioners to signify the ability of a patient to follow medical directions for treatment
and follow-up.” (“Issues in Medication Management - Global Health University - Unite
For Sight,” n.d.) Drug compliance is a significant issue in patient therapy worldwide.
Noncompliance is typically cited as occurring in 50% to 75% of patients, and the rate is
“India lives in its villages”. --- Mahatma Gandhi 3
4. even higher in patients with chronic illnesses due to the long term and complex treatment
plans. (Albert Wertheimer, PhD, MBA, n.d.) The New England Healthcare Institute
found that not taking medications as prescribed leads to poorer health, more frequent
hospitalization, a higher risk of death and as much as $290 billion annually in increased
medical costs. (Dolan, 2009) Several studies have documented evidence-based methods
for increasing adherence. One study found that interventions involving simplified dosing
regimens, reminder devices, education, and individualized care planning could improve
adherence. (“Issues in Medication Management - Global Health University - Unite For
Sight,” n.d.)
Although there has been extensive research conducted to understand noncompliance in
developing countries, little research has been done to identify noncompliance triggers in
developing countries. The objective of this paper is to explore the use of mobile phones
as a delivery medium to improve cardiovascular treatment compliance in India. The
research presents an overview of the mobile industry from the perspective of Porter’s five
forces framework, which examines the market opportunities, the competitive landscape
and the future trends of the mobile telecommunications industry in India.
mHealth (mobile health) Dosage Reminder Application
From the above considerations, I came up with the idea to facilitate a mobile health
application that leverages Short Message Service (SMS) to deliver customized dosage
reminders to patients in rural India to provide accurate medical records to medical
practitioners. In addition to dosage reminders, the application will ask patients to record
side effects or concerns with the cardiovascular drug(s) via SMS and then send medical
practitioners appropriate risk assessment alerts. The application will be built for the
second-generation (2G) mobile network, which is the most popular network in India and
will work across various mobile devices.
The application will be free for patients and the cost of the daily SMS messages will be
monetized through advertising revenue. The application is intended to bundle with
cardiovascular disease medication as an education tool to provide health tips and
announcements relevant to the drug or disease. Additionally, the data collected can be
“India lives in its villages”. --- Mahatma Gandhi 4
5. syndicated and sold as an additional revenue stream.
Figure 1 mHealth Mobile Application Process Flow
II. Industry Overview
Less than one decade ago in India, mobile phones were considered luxury goods. Today,
India’s mobile telecommunications industry is the fastest growing market in the world
and the considerable underclass are almost as well connected as the rich. Over the last
decade, the liberation of the mobile industry, coupled with the availability of low-cost
devices, reduction in tariffs, better network coverage and affordable services helped the
industry undergo a major process of transformation. Siddarth Ugrunkar, founder of
bSmart mobile, said that one can now see almost every Indian in Mumbai on his or her
“India lives in its villages”. --- Mahatma Gandhi 5
6. mobile phone, whether they are executives, businessmen, shop owners, students,
housewives, drivers or even rickshaw pullers. As a society, India has readily embraced
the mobile culture, which has provided the country with prosperous economic rewards.
According to The World Bank estimates, every extra 10 mobile phones per 100 people in
a typical developing country can boost GDP growth by 0.8 percentage points. (Devraj,
2009) India is expected to hit 893 million mobile users, which is 64.69% of the
population, by 2012. (Telecom Regulatory Authority of India , 2009)
Government, Policy & Regulation
The liberation of mobile telecommunications in India began in 1980 with Prime Minister
Rajiv Gandhi. He formed the Department of Telecommunications (DOT) as part of the
Department of Posts and Telegraphs and this was his declaration to “lead India into the
21st century. (Telecom Regulatory Authority of India , 2009) Later that year, he created
Mahanagar Telephone Nigam Limited (MTNL) to serve Delhi and Bombay, and Videsh
Sanchar Nigam Limited (VSNL) to operate international telecommunications services,
both DOT owned corporations. In 1985, he liberated the industry competition by
demonopolizing mobile phone equipment, which allowed private companies to
manufacture phones. However, the mobile market did not really take off until 1997,
when the government set up its first independent telecommunications regulator, Telecom
Regulatory Authority of India (TRAI); the TRAI Amendment Act was subsequently
passed in 2000, which allowed foreign investors to enter the telecommunications market.
Today, India possesses one of the most progressive mobile telecommunications market in
the world. (“COAI :: Cellular Operators Association of India,” n.d.)
Since its inception in 1997, TRAI has remained focused on regulatory growth initiatives
and policies to help move the mobile industry from a monopolistic market to a more open
and competitive market. TRAI has listed tariff regulation, protection of consumers’
interests, and the monitoring of quality of service as their top focus. (Telecom
Regulatory Authority of India , 2009)
Industry Concentration
India’s mobile telecommunications industry is regarded as one of the most competitive in
“India lives in its villages”. --- Mahatma Gandhi 6
7. the world, which is a significant change from its monopoly ten years ago. For example,
India’s mobile telecommunications Herfindahl-Hirschman Index (HHI) is 2000, which is
comparable to the US and UK markets at 2529 and 2309 respectively. (Anand, n.d.) By
HHI index standards, 2000 is considered “highly competitive”, and this is reflected in the
conventional price cut practices implicit in a crowded market. (Anand, n.d.) To undercut
the rollouts from new mobile providers and gain additional market share, large mobile
operators are cutting their prices by up to 50%, which has triggered massive tariff wars in
the mobile market. (Ribeiro, 2010a) But, a recent study by Lirneasia, a communication
technology non-profit, found that price cuts are not likely to make a significant dent in
the mobile providers existing subscriber base. In the survey, 37% of the respondents said
they would not even consider switching to a cheaper package, while only 15% of them
said they would shift. The rest of the respondents remain undecided. (“Competition
among telcos ensures customer retention-Telecom-News By Industry-News-The
Economic Times,” 2009) These survey findings indicate that mobile subscribers expect
free market forces to keep prices comparable among competing service providers.
Although the price cuts are not likely to move existing subscribers from their service
provider, the rock bottom prices are however extending the market to include a new and
unconnected subscriber base.
Industry Buyers
"There's an insatiable hunger for mobile phones permeating all layers of society," says
Pankaj Mohindroo, president of the Indian Cellular Assn. (Lakshman, 2006) The Indian
rural market is massive. Rural households make up 72% of India’s total households, or
720 million people, of which only 15.2% account for the total mobile subscriber base.
(Lakshman, 2006) According to industry estimates, 70% of all new subscribers will
come from rural areas. (“Why Companies See Bright Prospects in Rural India - India
Knowledge@Wharton,” 2009) Over the last decade, the rural purchasing power and
disposable income have increased due to a number of contributing factors, which include
the increase in procurement prices (the government sets the minimum support price for
many farm products), the increase in agriculture employment boosted by a series of good
harvests, the government plans like National Rural Employment Guarantee Scheme
(NREGS) that guarantees 100 days of employment to one member of every rural
“India lives in its villages”. --- Mahatma Gandhi 7
8. household and reduced rural underemployment and raised wages. (“Why Companies See
Bright Prospects in Rural India - India Knowledge@Wharton,” 2009)
These figures indicate that rural India is on the verge of becoming a large untapped
market, from which mobile operators and manufacturers can greatly benefit. Indeed,
Mobile device manufacturers are now tailoring their products to this market. Nokia, for
example, launched a basic mobile phone with an alarm clock and a torch to appeal to the
large parts of rural India that don't have electricity. (“Managing Technology,” 2007)
According to Pankaj Gupta, practice head, consumer & retail, Tata Strategic Management
Group, total income in rural India, roughly 43% of the total national income, is expected
to increase from around $220 billion in 2004-2005 to $425 billion by 2010-2011, a
CAGR of 12%. (“Why Companies See Bright Prospects in Rural India - India
Knowledge@Wharton,” 2009) Figure 5 represents both the mobile and fixed penetration
rates in rural India from 2002-2008.
Figure 2 Telecommunication Density in Rural India
Moreover, India’s under 25-age population is the largest segment in India and represents
the largest under 25-age group in the world. This growing demographic suggests future
sales for first-time mobile subscribers. (Lakshman, 2006)
“India lives in its villages”. --- Mahatma Gandhi 8
9. Technologies & Structure
The mobile technologies currently in use are Global System for Mobile Communications
(GSM) and Code Division Multiple Access (CDMA). There are primarily 9 GSM and 5
CDMA operators providing mobile services in 19 telecommunication circles and 4
metropolitan cities, covering 2000 towns across the country. (Telecom Regulatory
Authority of India , 2009) The licensing regime for the mobile services are divided
between the 23 telecommunication circles, namely, Delhi, Mumbai, Chennai, Kolkatta,
Maharashtra, Gujarat, Andhra Pradesh, Karnataka, Tamil, Nadu, Kerala, Punjab,
Haryana, Uttar, Pradesh (West), Uttar Pradesh (East), Rajasthan, Madhya Pradesh, West
Bengal and Andaman & Nicobar Islands, Himachal Pradesh, Bihar, Orissa, Assam, North
East and Jammu & Kashmir. (Telecom Regulatory Authority of India, 2009) Figure 2
below represents the Indian states with the largest subscriber base.
State Subscriber’s (in millions) Mobile Density
Maharashtra 58,789,949 51.96
Uttar Pradesh 57,033,513 26.32
Tamil Nadu 45,449,460 63.66
Andhra Pradesh 37,126,048 42.58
West Bengal 32,540,049 34.28
Karnataka 28,867,734 46.76
Rajasthan 27,742,395 39.09
Gujarat 27,475,585 45.49
Bihar 27,434,896 25.04
Madhya Pradesh 24,923,739 33.09
All India 471,726,205 37.71
Figure 3 Top Mobile Subscriber States as of September 2009 (Telecom Regulatory Authority of
India , 2009)
GSM is the more popular mobile technology with Nokia as the dominant mobile player
accounting for 63% of their installed base. CDMA’s biggest mobile player is LG
accounting for 48% of their installed base. For the combined GSM/CDMA installed base
“India lives in its villages”. --- Mahatma Gandhi 9
10. in India, Nokia and LG are at the top with 54% and 14% installed base markets
respectively. (Telecom Regulatory Authority of India , 2009) According to the Telecom
Regulatory Authority of India, at the end of September 2009, 371 million subscribers
used GSM, in contrast to 101 million subscribers using CDMA. (Telecom Regulatory
Authority of India , 2009) Figure 3 below represents the top mobile manufactures in
India and their respective mobile technology install base.
Brands Installed Base
GSM CDMA Total (GM & CDMA)
LG 4.4% 47.6% 14.4
Motorola 7.8% 5.4% 7.2%
Nokia 62.6% 24.3% 53.7%
Samsung 9% 11.2% 9.5%
Sony-Ericson 8.9% 6.8%
Figure 4 April 2009 ending quarterly Average - India Urban Mobile Phone Users (N=5,775)
Indian mobile telecommunication operators BSNL, Bharti Airtel, Hutch, Idea, Aircel,
Spice and MTL are on the GSM networks whereas Reliance Communications and Tata
Indicom are on the CDMA networks. (Telecom Regulatory Authority of India , 2009)
The following chart represents the GSM market share for the mobile telecommunication
operators in India, which was reported from The Cellular Operators Association of India.
GSM Providers Subscribers (in millions) Market Share
Tata Teleservices 60.0 30.86%
Bharti Airtel 121.7 30.86%
Vodafone Essar 94.1 23.87
IDEA 59.8 15.19%
BSNL 59.4 15.08%
Aircel 33 8.38%
Reliance Telecom 15.7 4%
MTNL 4.6 1.17%
Loop Mobile 2.7 .69%
“India lives in its villages”. --- Mahatma Gandhi 10
11. Uninor 2.5 .64%
STel 0.5 0.13%
Total Users – 395 million
Figure 5 Mobile Telecommunication GSM Market Share
Third generation (3G) wideband mobile communication is the latest mobile
telecommunications technology to launch in India, which enables super fast multimedia
streaming and data transferring access to mobile phones. On April 9, India’s government
finally started the 3G auction and on April 11 the broadband wireless access (BWA)
auction. (Singh, 2010) Mobile leaders Vodafone Essar, Bharti Airtel, Reliance Telecom
and six other’s are competing for three slots of bandwidth to offer 3G services in each of
17 service areas and four each in the remaining five areas. (Luna, 2010) The auction
winners will be allowed to offer 3G services on a commercial basis from September 1st
2010. The Federation of Indian Chambers of Commerce and Industry estimates that there
will be 90 million 3G mobile subscribers by 2013 and that annual sales of compatible
mobile phones will reach 81.3 million units by 2013. (Telecom Regulatory Authority of
India , 2009)
Market Growth / Trends
Today, India is the world’s second largest mobile telecommunication network, behind
China, with 563.73 million mobile phone users, an overall mobile density of 46.8%, and
subscribership is currently growing nearly 15 million per month. (Leahy, 2010). As of
September of 2009, the rural tele-density in India is 18.97% as compared to rural mobile
density of 101.38% and the country’s overall tele-density is 44.87%. (“COAI :: Cellular
Operators Association of India,” n.d.) Over the last decade, the mobile sector has shown
remarkable growth boosted mostly by the extraordinary demand from a new and growing
subscriber base. The compound rate of growth (CARG) for India’s mobile
telecommunications between 1999 and 2008 was 83%, with this uptrend in growth
expected to continue at a CAGR of 10% between 2010 and 2013 to reach 850 million.
(“COAI :: Cellular Operators Association of India,” n.d.) By 2015 the industry is
projected to have ‘one billion plus' mobile users, regarded as one of the fastest growing
mobile telecommunication sectors in the world. (“India to have 'billion plus' mobile users
“India lives in its villages”. --- Mahatma Gandhi 11
12. by 2015: executive-Finance-Economy-News-The Economic Times,” 2009) This
remarkable growth trajectory indicates the industry is in its growth stage.
SMS usage continues to grow every year, as more innovative ways of utilizing its
potential are coming to the forefront. Based on TRAI data, the average Indian sends 29
SMS per month. (Sinha, 2009) A research study conducted to look at SMS usage in urban
India found that SMS is effective for getting the message out to potential customers or
retaining existing ones. Roughly 8% of urban Indians have seen an ad in a SMS they
have received, while 65% of those who have seen have also read the advertisement
message. SMS also proved to have higher conversion rates than other conventional
mediums like TV or radio. (Sinha, 2009)
Figure 6 SMS users in 2009
Today mobile phones have moved beyond their primary role of placing a call and have
graduated to become an essential communication device for consumers in India. India
witnessed the launch of high-end phones in 2009 and mobile consumers bought nearly
700,000 high-end Smartphone’s in the April-June quarter of 2009. (“Why Companies
See Bright Prospects in Rural India - India Knowledge@Wharton,” 2009) Experts
believe 3G will be essential to the development of the value-added services market by
reducing barriers to entry for the mass market. (“India to have 'billion plus' mobile users
by 2015: executive-Finance-Economy-News-The Economic Times,” 2009) According to
“India lives in its villages”. --- Mahatma Gandhi 12
13. research, the number of 3G mobile subscribers is expected to grow at a CAGR of roughly
130%, reaching 60 million consumers, between 2010 and 2013. (“India to have 'billion
plus' mobile users by 2015: executive-Finance-Economy-News-The Economic Times,”
2009)
III.Competitive Analysis
Mobile Telecommunication Operators
The mobile telecommunications market is made up of two state-owned companies
MTNL and VSNL, private Indian companies and foreign invested companies. The
deregulation in telecommunications law and policies over the last ten years has
significantly impacted the private sector market share, which has reached 77.44% against
5% in 1999. (Telecom Regulatory Authority of India , 2009) India’s five leading mobile
operators are Bharti Airtel, Reliance Communications, Vodafone Essar, BSNL and Idea
Cellular. (“Communications in India - Wikipedia, the free encyclopedia,” n.d.)
Service Provider Subscriber’s (in millions) Market Share %
Bharti Airtel 124.61 22.11
Reliance Communications 99.41 17.72%
Vodafone Essar 97.22 17.25%
BSNL 66.75 11.95%
Tata Teleservices 63.15 11.07%
IDEA 62.14 10.99%
Aircel 34.86 6.06%
MTNL 4.99 .90%
Uninor 3.55 .47%
Sistema Shyam 3.17 .60%
Loop Mobile 2.77 .50%
STel .71 .09%
HFCL Infotel .327 .06%
“India lives in its villages”. --- Mahatma Gandhi 13
14. Figure 7 Mobile Services Market Share as of January 31, 2010
Figure 8 Mobile Providers Market Share as of January 31, 2010
Mobile Device Manufactures
When India’s government opened up the country’s telecommunications market to the
private sector in 1994, many of the large global mobile device manufacturers entered the
market as they recognized its potential. (“Managing Technology,” 2007) Today, Nokia
is the most established manufacturer in India with a dominant 63% share, followed by
LG with 13% market share, Motorola with 8.5% market share and Samsung with 3.5%
market share. (Telecom Regulatory Authority of India , 2009)
New Entrants
The Indian mobile device space is fierce; as price sensitive consumers are demanding
more entry-level models and the high-end 3G Smartphone’s enter the Indian market.
Mobile phone sales in India recorded a 6.7% increase to 100.9 million in the year ended
June 30, as compared to 94.6 million the year before. (Ghaswalla, 2009) Due to this
rapid growth of sales and profit margins, new mobile device makers are entering the
market giving rise to more and more competitors. To put the market competition in
perspective, 27 new mobile vendors entered the Indian market in the fourth quarter of
2009. (Ghaswalla, 2009) Both Mindtree, the Bangalore-based IT company, and Coolpad
Communications, the Chinese wireless technology company, decided to enter the mobile
“India lives in its villages”. --- Mahatma Gandhi 14
15. device business in 2008 and are already set to retail their mobile phones in the Indian
market later this year.
As the 3G network rolls out to the market later this year, the Indian government believes
this will open the door for more foreign players to make an entry into the mobile
telecommunications market. (“Competition among telcos ensures customer retention-
Telecom-News By Industry-News-The Economic Times,” 2009) Currently, there is no
cap on the number of 2G service providers in each circle. For the 3G network, the
government is planning to allow three to four private players in each circle depending
upon the spectrum availability.
Barriers to Entry
There are big challenges in the industry that, if unresolved, could disrupt the India growth
curve and affect the ability for new mobile players to enter the market. According to
Siddarth Ugrunkar, "Network not available" is a dreaded but common phrase many
mobile subscribers hear when they try to place a call. He contributes the explosive
growth to the overused and strained networks that have led to the diminishing quality of
service. However, with the impending release of the 3G network, he believes
improvements to the quality of existing services, like the drop off rates and poor call
quality, will improve and expand the service capability for new mobile players as well.
Another big challenge that can drastically affect the market and deter new entrants is the
massive amount of funds needed to improve the existing infrastructure and expand
coverage to the rural regions. As the urban Indian cities like Mumbai and New Delhi
reach their point of mobile saturation, the future growth of the mobile industry is in dire
jeopardy unless the infrastructure improvements ensue in the rural communities. "A lot
depends on how fast the players roll out their networks into the rural hinterland," says
Kuldeep Goyal, a general manager with the government-owned telecom carrier BSNL.
(Lakshman, 2006)
Pricing
To extend the breadth of India’s subscriber base, mobile operators are offering cheap
“India lives in its villages”. --- Mahatma Gandhi 15
16. mobile services to attract consumers in rural areas and slums. The intense competition
has led to significant drops in the voice rates as low as 0.01 Indian rupees (US$0.0002)
per second and revenues. (Ribeiro, 2010b) Earlier, voice calls were typically charged by
the minute. Bharti, for example, reported flat revenue and net profit growth in 2009, even
though their customer base grew by 40%. Idea Cellular, another large mobile operator,
reported a drop in their “average realized rate per minute” by 9% between the third and
fourth quarter of 2009 (Ribeiro, 2010a).
As the revenue opportunities for mobile operators and manufactures rapidly increase in
India, markets in Europe, Japan and the US are hitting their points of saturation and the
US mobile manufacturers like Nokia, Motorola and LG Electronics are looking to India
as a key revenue driver for the industry. (Lakshman, 2006) Mobile device manufacturers
are tailoring their models and prices to reach a consumer that lives in impoverished areas
and makes less than $2 per day, a consumer no one would have considered targeting five
years ago. (Lakshman, 2006) For example, Early this year, Voafone introduced a pair of
mobile phones for less than $20 that support voice calls, SMS and mobile payments.
(Grove, 2010) Mobile phone manufacturers are also planning to launch 3G phones as
cheap as 2,800 rupees (60 U.S. dollars) to tap into India's rural markets. (Ghaswalla,
2009)
IV.Conclusion
As mobile technology increases in flexibility, it has the opportunity to play a key role in
the new health care delivery model. Seventy five percent of the health infrastructure in
India, is concentrated in urban areas, where only thirty percent of the population lives.
(Kahn et al., 2010) Consequently, India is faced with some of the most challenging tasks
in providing health care to the suburban and rural population in the country. With cheap
and easy access to mobile phones, the exchange of health information can occur with
anyone, anywhere and enable better utilization of limited health care resources.
To conclude, by leveraging mobile technology to improve the ability to track
cardiovascular disease and provide timelier, more actionable public health information,
“India lives in its villages”. --- Mahatma Gandhi 16
17. the mobile health application can influence people to manage their health better and
reduce the high costs associated with healthcare neglect.
“India lives in its villages”. --- Mahatma Gandhi 17
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