Needed: Innovations in maternal and infant care

Christened as an emerging economy, India has been at the forefront of the economic boom for past two decades, partly due to burgeoning population. Ironically, considering Human Development Index (HDI), India bottoms out compared to other countries, depicting the poor state of health affairs. Many developing/ underdeveloped nations ostensibly face a similar quandary. Subsequently, Infant Mortality Ratio – per 1000 live births (IMR) and Maternal Mortality Ratio – per 100000 live births (MMR), the main contributors of HDI in India, represent an alarming quarter figures of the world. Governments, public, private and world organisations have been addressing this perplexity by introducing maternal and infant care initiatives for some time now. According to Life Science Intelligence report, the global market for products used to monitor and treat neonatal and perinatal patients will grow at a compound annual growth rate (CAGR) of 5.2 per cent to $1.5 billion by 2013.

Two million children under five years of age die—one in every 15 seconds—each year in India, also the highest anywhere in the world. Of these, more than half die in the first month of their birth. If the Indian government on one side is scuttling to curtail these figures via National Rural Health Mission (NRHM) and Rashtriya Swasthya Bima Yojana (RSBY) schemes, private organisations such as GE, Philips and other local players on the other side are addressing this conundrum by introducing innovative maternal infant care (MIC) concepts – Lullaby and Intellivue from GE and Philips are few of them.

Deciphering the mortality statistics about India, it can be observed that IMR is highest in the rural areas and Empowered Action Group (EAG) of states: Bihar, Jharkhand, MP, Chhattisgarh, Orissa, Rajasthan, UP, and Uttarakhand, which have been deprived of healthcare the most. Although, MIC equipment has been designed considering developing countries’ environment, the sophistication and price may still impede reaching out to the masses– rural and EAG states in India.

A two prong strategy to curb infant mortalities could be looked at by public authorities with the help from medical equipment firms to address different set of regions (urban and healthcare deprived areas), one utilising and improving existing solutions and the other, developing new solutions.

Rural possibilities

IMR in rural and EAG states is estimated to be 55 in India. Around half of the infants die due to malnutrition. Low birth weight babies have a greater risk of dying from diarrhoea and acute respiratory infections. Also, the limited healthcare facilities available in the country are skewed more in favour of the affluent population. Only 20 per cent of doctors, 25 per cent of dispensaries and 40 per cent of hospitals are situated in non-urban areas.

• Containing infant mortality: When addressing the mass population, it is necessary to address the predicaments in a holistic way rather than in silos. Lack of appropriate care during pregnancy and childbirth, and the inadequacy of services for detecting and managing complications explain most of the maternal and infant deaths. If these concerns could be addressed by adding/developing solutions to offer services beyond infant care and collaborating with other specialised vendors (for nutrition etc.), this disorder can be subdued. GE Healthcare has demonstrated how to address disease holistically in the past by owning a cancer disease (extending end to end support).
• Class for mass: 80 per cent of the time, baby incubators are used to only keep the baby warm. And 80 per cent of Indian hospitals use baby warmers, which provide direct heat in open cradles and are usually intended to help newborns adjust to room temperature. Embrace Innovations, an organisation analysing these facts has introduced a baby warmer that costs less than $200. With frugal innovations as exemplified by MAC 600 ECG machines and Embrace portable warmer, many medical devices firms could empower high infant mortality afflicted areas with no-nonsense solutions.
• Product configurations: Addressing the healthcare deprived areas where mass population needs to be served with limited facilities and cost, the medical equipment firms, in collaboration with government, could introduce different products targeted to specific needs rather than offering all-in-one solutions. For eg., if warming therapy, phototherapy, neo-natal monitoring and ventilation, are offered as separate products, then the cost factor comes down and more babies could be served at the hospitals or even in the primary health centres (PHCs) and community health centres (CHCs).
• Service delivery models: With 70 per cent of Indian population living in rural areas, access to quality healthcare at affordable cost is a still distant reality.Medical device vendors, by joining hands with government and low-cost healthcare providers such as ‘LifeSpring hospitals’ could deliver economical MIC solutions to afflicted areas with economies of scale. Financing models such as revenue sharing, fixed installments or monthly fees would help to reach the masses (BOP – Bottom of the pyramid).

Urban possibilities

Increased women’s participation at work, education, stress levels, food habits, and surrounding environment are few main factors leading to decreased birth rate (TFR of 2.6). Hence urban and working women are becoming more conscious about maternal care and infant care.

• Specialised hospitals for women: More birthing centres are coming up in urban areas that specialise in child birth and neo-natal care. Lady Hospitals, Cloud Nine are some of the specialised chains that operate in India. Medical equipment companies could tie-up with such hospital chains and become an official partner in supplying MIC solutions. Being able to customise solutions as per the needs of such chains would strengthen this partnership. Also, this may lead to reduction in upfront marketing costs.
• Bundling: Competition in the MIC area, especially for baby-warmers and incubators has become intense with 50+ companies offering solutions, priced as less as $500. With an array of solutions for every MIC area and other hospital needs, leading medical device firms could try offering MIC solutions by bundling them with other healthcare solutions as per the customers’ need. This differentiating factor can also fend off competition significantly.
• Multi-purpose products: Each MIC product addresses a specific area of infant care. For each area, such as warming therapy, jaundice management, ventilation and others, a specific product is in place. But, sizeable hospitals that are treading on the path of quality with minimal operational costs would be willing to adopt solutions that can address multiple infant care areas in one product. If the features such as warming therapy, jaundice management and ventilation can be combined, then the same product could be used for multiple purposes.
• Home care solutions: Wealthy parents may be willing to welcome their loved ones at home as early as possible. Infant care solutions, if designed considering the home environment, can be offered with multiple business models.

Innovations in infant care

With more developing/emerging economies committing to increased healthcare expenditure, there needs to be enough focus on combating IMR and MMR. The fact that 70 per cent of these mortalities are preventable through low-cost, timely interventions, would urge most of the nations to welcome innovative solutions in MIC area. The public sector, along with private sector, (through public private partnerships) could herald new infant care through smart and cost effective innovations, thus ensuring win-win for all.

References:

1. Sample Registration System Office of Registrar General, India, 2011
2. DLHS 3 – District Level Household and Facility Survey, India
3. NFHS 3 – National Family Health Survey, India
4. Wall Street Journal
5. Stanford Business Magazine
6. CNN IBN Portal