Milli Polinsky @Polinskycop

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We reviewed 800+ health startups in India this year. Met 200+ founders in person. These are entrepreneurs building across health tech, fitness, nutrition, software for doctors, diagnostics, healthy food, longevity, sports, elder care, women health, lifestyle management & more. This is a long post on everything we've seen and observed in 2024. If you're an entrepreneur, investor of health enthusiast, this is for you. 1) There is a telemedicine fatigue- The post-pandemic boom in telemedicine has plateaued. While accessibility improved, sustainable consumer engagement still remains a challenge due to weak doctor-patient relationship and lack of differentiation. Patients want emotional and personalised engagement. Most companies are overusinng AI in the disguise of scale. Opportunity is to solve for depth (chronic disease management) rather than breadth (generic consultation marketplaces). 2) Overload of premium fitness and wellness Apps- Apps targeting high-income urban users are oversaturated. Most startups overestimate the willingness of users to pay for digital fitness content. Opportunity is to focus on communities, hybrid models (offline + online), or affordable mass-market solutions. India is still not ready for Peloton content. We breathe YouTube. 3) Selling SaaS tools to Doctors- Doctors in India are notoriously price-sensitive. Most SaaS products fail due to limited willingness to adopt technology and low ROI visibility. Maybe companies should emphasize on simplicity and immediate value delivery. Job of a Doctor is to deliver treatment to patients and not learn how to use software. Need to huamnise software in primary and secondary health care. 4) Longevity buzz- Longevity startups sound exciting but cater to a niche. Everyone loves the idea of a pill or device that adds 50 years to life. But longevity is 80% lifestyle and 20% intervention. Startups chasing the 20% often overpromise and underdeliver. Without a strong clinical base or mass appeal, they will remain limited to aspirational urban elites. Opportunity is in integrating into broader wellness solutions rather than standalone ventures. 5) Healthy food & nutrition- Overcrowding of “healthy snacks” and “superfoods” where differentiation is low and margins are squeezed by Quick commerce and logistics. Maybe companies should move beyond buzzwords like “organic” or “keto” and solve for authentic, local, and culturally aligned nutrition. India is a country of a million palates. 6) Chronic disease management- Diabetes, hypertension, Weight loss and mental health requires long-term engagement and behavior modification. While the space is competitive, there is room for solutions that prioritise patient journeys and retention over time. Driving outcome has to be the focus. Everything else is a vanity feature that doesn’t earn trust. Paid marketing will get expensive customers who won’t stick around. 7) Health Literacy for Tier 2 & Tier 3 Cities - Bridging the gap between urban, asemi-urban or rural populations can unlock massive markets. People in these areas need better education on health, nutrition, and fitness. Someone should build a scalable vernacular platform that combine tech and offline models. 8) Elder Care- There are 150 million people over the age of 60 in India. 30% live in metros, thats 45million elders. Majority of them don’t go to a gym today. I think there is an opportunity to create specialised fitness solutions to this audience. This is a largely untapped market. There can be an opportunity to build services for affordability and trust, with models combining human touch and technology. As the awareness amongst millennials and Genz increase towards health, more money will be spent towards keeping their parents health. 9) Affordable diagnostics - There’s growing demand for diagnostics in areas beyond urban cities. Setting up lab infrastructure and technicain talent is not easy to setup. Plus availability of non-invasive testing can increase the velocity of frequent checkups. I think the opportunity is to create AI and point-of-care solutions to reduce dependency on expensive labs. This may help build focus on distributed networks that simplifies diagnostic processes. 10) Women’s health beyond maternity - Women’s health startups are slowly moving beyond maternity and fertility into under-discussed areas like menopause, PCOS, period care and hormonal health. These are still early but promising markets. Companies should focus to build communities around taboo topics and prioritise education-first models. 11) Sports academies- Most academies target middle-class parents eager to involve their children in sports but offer basic coaching across multiple sports. The majority lack specialised training, proper infrastructure, and long-term athlete development frameworks. This leads to high churn and low impact. Should focus on actual program quality and coach the coach rather than brand optics. Using video analysis, wearables, and performance tracking apps can improve training outcomes. 12) Sports arena- Pay-and-play arenas are booming, especially in metro areas, but most operators overestimate demand sustainability. These spaces often struggle with with repeat customers and operational costs - rent and maintenance. Feels like the market is saturated in metros. Scalability lies in Tier 2 and Tier 3 cities, but with pricing that aligns with affordability. 13) Software for mid-sized Hospitals - While big hospital chains dominate headlines, mid-sized hospitals and clinics in India are ignored and under served for efficient software solutions. Tools that can improve operations, patient flow, and billing. There could be an opportunity to build modular, cost-effective products that solves for topline and bottomline of these customers. 14) Community-led health- Platforms that anchor health-related communities (e.g., for runners, fitness enthusiasts, or chronic condition patients) will gain more traction. Communities drive retention and trust. Companies who leverage storytelling and peer accountability can find it easy to launch products to monetise at scale. Macro Observations 1) Indian consumers value trust over tech. While technology enables scale, trust remains critical, especially in health-related services. Building authentic brands is as important as the product itself. 2) Price sensitivity is real- Products must balance affordability with value. Startups relying solely on urban elite segments risk missing India’s massive middle-income market. 3) Hybrid models work better. A blend of online tools and offline touchpoints could be more effective in healthcare, especially for diagnostics, elder care, and fitness solutions. 4) Distribution trumps product- A great product means little without effective distribution channels, Founders who build distribution first create a unbreakable moat. Thoughts for- Entrepreneurs: Focus on solving real problems, not creating aspirational solutions for a niche urban market. Investors: Look for startups with distribution moats, affordability, and customer stickiness. Avoid overcrowded, fad-driven sectors. Health enthusiasts: There has been never a better time than now to build your own health system with so many tools and solutions available in India. Become a user and give feedback to the creators to make a better and healthy India. If you find this useful, share it with someone you know who could also benefit. I'm at @kmr_dilip for any comments and thoughts you like to share. At @Rainmatterin we are always open to cheer for entrepreneurs solving for health in India.

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