Frugal innovation could be the answer to India’s unmet healthcare needs, provided it is backed by sustainable business strategies, finds Raelene Kambli
Way back in 2009, watching the Bollywood movie ‘3 Idiots’, I remember scoffing at one of the movie sequences where the protagonist Aamir Khan facilitates the delivery of a baby using a vacuum cleaner and an inverter made from a car battery. I somehow could not relate with the idea that a vacuum cleaner could be used as a suction pump to deliver babies. However, at that time I settled down to thinking that after all it’s from a Bollywood movie where anything is possible.
Fast forward to 2015, in October, I attended an innovator’s exhibition at Somaiya College Campus in Mumbai where around 100 students from various institutions across the country had gathered to demonstrate their innovations in areas of healthcare, art, consumables and more. There were some cool healthcare innovations such as a blood flow analyser made using laser technology, a virtual navigation stick for the blind created using ultrasonic sensor, diagnostic protocols for malaria developed using fluorescent microscopy etc., all made at a very low cost using simple technologies. This got me hooked to the subject of frugal innovation or ‘Jugaad’ in the Indian parlance. On further research, I found a host of whitepapers that spoke about people in remote villages of India converting polystyrene boxes into infant incubators to save life of babies born with low birth weight, medical technology giants creating ultralow-power screening devices to suit local conditions, so on and so forth. These citings have made me realise that India’s acclaimed resourcefulness can lead to great home-grown innovations with the potential to solve the country’s unmet healthcare needs and become a globally relevant business methodology.
For instance, the Jaipur Foot. First invented in the 1960s, it was developed to suit the needs and requirements of the people seeking it. This innovation changed the lives of hundreds of thousands of amputees. But, what makes this innovation stand out is its cost effectiveness that earned it international acclaim. Today, a complete Jaipur Foot limb costs less than $40 including a prosthetic foot made of wood and sponge rubber, which itself costs less than $ 5 and can be made in under three hours. Today, employing a hub-and-spoke delivery model, the makers of the Jaipur Foot, Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS) reach out to patients through 22 centres across the country and more than 50 mobile camps are held in remote rural areas. This highly coordinated network allows the organisation to divide its resources efficiently, reducing overhead and human capital cost, without limiting the reach of its services.
Another similar example is Arunachalam Muruganantham’s low-cost sanitary pad making machine which played a pivotal role in improving menstrual health for rural women, not only in India but also in 17 developing countries including the African states. Muruganantham is successfully running a self-sustaining sanitary napkin business, called Jayashree Industries. It has over 2000 units across India, including the Andaman and Nicobar Islands, employing 21,000 women. He was also named one of Time Magazine’s 100 Most Influential People in 2014 for his innovation and efforts. Like these examples, there are many stories that speak of India’s frugal engineering skills and its tremendous capabilities to disrupt various market. But is India’s healthcare sector equipped to drive this growth and sustain it in the long run?
Express Healthcare, in this article, seeks to find answers to this question; however, in the process finds two important aspects to the issue. One that helps in meeting the unmet healthcare needs of those at the bottom of the pyramid (BOP) and the other that bears witness to the changing business scenario. Let’s first understand how frugal innovations can serve the underserved.
Driven by needs
Necessity is said to be the mother of all inventions and it perfectly describes the case of India’s healthcare scenario currently. Driven by factors such as resource scarcity, rising cost and lack of access to health services in the rural areas, India is looking at frugal innovation for deliverance in every spectrum of healthcare.
Says Vinayak Nandalike, CEO, Yostra Labs, “India imports more than 70 per cent of the medical equipment which is designed for healthcare setups of developed economies. From clinical needs, patient affordability, accessibility and healthcare setup perspective, India presents certain unique challenges that makes it difficult for the global medical device manufacturers to go with a ‘one size fits all’ approach to medical device development. Growing need for affordable healthcare in India is opening up new avenues for entrepreneurs, and established medical device manufacturers alike to employ frugal innovations which will disrupt the market and at the same time have significant societal impact”.
“I see it in all areas of healthcare, from diagnostics to ocular, to artificial limbs i.e prosthetics, to stents or other tools required in surgery and to even telemedicine so that medical treatment could be brought to the remotest locations at a fraction of the cost using modern technologies like the cloud,” opines, Sanjeev Saxena, Chairman and CEO, POC Medical Systems.
Adding to this, Elizabeth Bailey, Director, CAMTech informs, “Frugal innovation is happening across the healthcare continuum in India, driven by the vast array of needs. One common theme that has emerged is innovations addressing the shortage of healthcare workers. There is a need to create smart products that do not rely on a high level of skill by a clinician. This kind of task shifting will help bring quality healthcare to underserved populations. Again, the focus is on simplicity and ease-of-use, combined with affordability. We see this in mobile health applications that aid in decision support, all the way to interventional devices that address postpartum haemorrhage and new diagnostic tools for cervical cancer diagnosis. The technology innovation enables people with less skill to provide the same level of care as a trained physician, and we will see more and more tools working toward that end”.
Citing few examples, Probir Das, MD, Terumo adds, “India has already started the process of innovating to deliver low cost, high quality healthcare to increasing populations. Our lowest procedural costs as compared to the rest of the world, gradually succeeded in health schemes such as Rashtriya Swasthya Bima Yojana (RSBY), Yeshaswini, Arogyasree, etc. These are a testimony to the innovation that is unfurling on the delivery side.”
Some noteworthy frugal innovations making an impact on public life in India today are as follows:
LifePhonePlus: A team of Intel researchers in India is finding ways to tackle healthcare access problems in the hinterlands of India. With LifePhonePlus, patients can keep track of their blood-glucose levels, undergo electrocardiography testing (ECG) and obtain a specialist’s advice without leaving the town. The device was launched in 2013 and last year the device won the South Asia E-Health Summit Award for mobile health innovation. Kumar Ranganathan, leader of Intel India’s biosignaling lab who has led this project says LifePhonePlus has been successful because it was developed specifically for Indian patients by Indian innovators who understand the ground realities and have first hand knowledge of the country’s healthcare problems. It was developed and manufactured in the most basic and least expensive manner possible. Currently, various clinics and hospitals currently provide diagnoses to patients using the device.
GE’s innovations: GE revamped its operations in India to tap into the country’s growing demand for medical devices. GE isn’t just marketing low-cost medical devices in India. The company is also taking account of local conditions when it develops and tests new products, conditions which include power outages, voltage fluctuations, high levels of dust and pollution, and intensive equipment use. One of the most successful products to come out of GE’s efforts in the field of ‘frugal innovation’ is the Lullaby baby warmer, which provides direct heat in an open cradle and is used to help new-born babies adjust to room temperature.
The Lullaby warmer is cheap compared to the baby warmer that GE sells in the US, that starts at $12000 and which, on top of the basic warming function, performs other functions such as monitoring a baby’s pulse and weight. The Lullaby warmer was launched in India in May 2009 and is now sold in 62 countries, including Belgium, Brazil, Dubai, Egypt, Italy, the Russian Federation and Switzerland.
Another example is, GE’s MAC 400 Electrocardiograph machine that takes a $10,000 device, adapts printing technology used in India’s bus terminal kiosks, and turns it into a $1,500 device, or just $1 (50 rupees) per patient. More recent versions bring the cost down to just Rs 10 per patient.
Two-tier telecardiology framework: In a bid to provide reliable healthcare delivery in remote areas at low cost, the faculty from IIT Hyderabad are developing a two-tier, telecardiology framework where ECG records can be transmitted even when available resources such as power and bandwidth are limited. The device has the capability of verifying sample signals as normal or abnormal. Using minimal power and bandwidth, the signals can be transmitted to the local sub-centre. The sub-centre will evaluate this data according to the algorithm. If the signal is abnormal, it will be sent to the diagnosis centre. The technicians at the diagnosis centre can look at the reconstructed signal acquired by other devices.
After this, it’s easy to diagnose the issue and send back the diagnosis through SMS. This saves a lot of time so that patients with serious issues can immediately meet a doctor to get treatment. This venture is funded by the Ministry of Communication and Information Technology (MCIT) under the Department of Information Technology.
Polystyrene baby incubators: In a tribal village called Dahanu in Maharashtra, students from Boston University’s School of Public Health use polystyrene (better known as thermocol, or styrofoam) boxes as baby incubators. In this particular village, babies are born with low-birth-weight and their chances to survival stands extremely low. But a grassroots intervention is helping reduce the risks. These boxes look very similar to the beer coolers that you find in the United States and cutting four holes on two sides is all that is done to convert it into a baby incubator. The project was initiated by SR Daga, formerly a paediatrician at Cama Hospital in Mumbai, India, whose goal was to find an inexpensive way to prevent hypothermia among babies in low-resource areas. The polystyrene boxes are a good answer: they are inexpensive, easily accessible, and can be used by anyone.
Narayana Hrudayalaya’s low cost cardiac surgeries: The hospital’s cardiac unit began providing heart surgeries costing between $2,000 and $5,000, compared with $20,000 and $100,000 in the US, by using philosophies of mass production and lean manufacturing. For poor patients, it provides several free operations per week and is still able to turn a higher profit margin than the average American hospital.
All these above mentioned innovations provide good quality services at low cost and in a small environment footprint. Further on, these exemplars of frugal innovation also reflect a new mindset that today’s innovators, entrepreneurs and organisations possess which explains the second important aspect to this concept – creating a business model.
Driving business models
Innovation and leadership advisors, Navi Radjou and Jaideep Prabhu explain that frugal innovation is more than a strategy. It denotes a new frame of mind to do business: one that looks at resource constraints as opportunities rather than obstacles. These innovators do not seek to charm customers with technically sophisticated products, but instead strive to create good quality solutions that provide greater value at the lowest cost. They further believe that frugal innovations bring about a radical change in the business environment. Agreeing to this doctrine and applying it to the Indian context, Gaurang Shetty, Research Innovation Incubation Design Lab, RiiDL, Somaiya Vidyavihar says “Frugal in the Indian context is not necessarily a product. Frugal solutions are just one dimension of a larger picture. Frugality can extend to the entire supply chain and even be established as a business model. This concept can be applied to the value you can bring to customers.” The Jaipur Foot, Jayashree Industries, Narayana Hrudayalaya Group and Aravind Eye Care have already set precedent in this area. They have created a business model that thrives on frugal innovation and what gives them sustainability is their attitude to continuously foster a frugal culture in their own organisations.
Therefore, it’s important to note that for any frugal innovation to sustain in the long run, innovators, entrepreneurs and organisations will have to adopt a culture of constant innovation to match up to the increasing needs of those at the bottom of the pyramid. Failure to do so might cause the entire concept to collapse. This comes as a warning sign, especially for start-ups in healthcare that are built on the premise of frugal innovation.
Cashing in on opportunities
Nonetheless, experts believe that frugal innovation is a trend that’s here to stay. Giving a global view, innovation incubator, Bailey mentions, “CAMTech believes the future of healthcare innovation will see clinicians, sitting side by side with engineers and entrepreneurs, co-creating new medical technologies that will transform the way healthcare is delivered globally.”
Saxena agrees with Bailey on the potential of India’s frugal innovations. He further compares other markets and speaks about where the opportunities lie. He says, “I think, India has the opportunity to leapfrog ahead. However, it is important for India to simplify its laws and administrative procedures. India is still living in the dark ages, where India says it encourages innovation, however it truly doesn’t as it doesn’t give any room for failure to its entrepreneur. If one fails they are penalised. In the US, if a company fails the entrepreneur who has already lost his company and his money does not have to worry about paying back debts to the banks and the rate of change (ROC) etc., an unnecessary burden which prohibits people from taking risks and without risk there is no innovation. China, on the other hand, gives grants to its people to start companies and doesn’t expect it to be paid back. Same is the case in Mexico and Brazil. So, while China had a setback to its economy, you find it’s bouncing back as the innovators and entrepreneurs were never penalised when their companies failed. About opportunities for India, our country is speeding ahead. India has a major advantage. As Prime Minister Modi said in his speech at the SAP centre in California, “We have a major brain gain. Now India gets to harvest the brains it sent to US decades ago.” It doesn’t mean that the people come back to India but it means they utilise the knowledge that they have gained to help India leapfrog ahead of others.”
“The solutions that will make us survive therefore will build a ‘Create in India, Create for the World’ momentum, much larger than just ‘Make in India’ or ‘Made in China’. Yes, there are bottlenecks to that. Our academia – business – government partnerships are still a long way from ideal; our healthcare procurement systems do not encourage innovation; we have shortage of seats and programmes in Biomedical Engineering & Material Sciences and this list could go on. But we have started addressing these problems. The stakeholders are coming to a symphony of togetherness. Therefore, it is just a matter of time before India is recognised globally as the next health innovation hub,” sums up Das.
On the government’s front, campaigns such as Make in India and Digital India are opening up avenues for homegrown innovations. In a recent development, Communications and IT Minister Ravi Shankar Prasad at the Intel’s innovation event announced that the Department of Electronics and IT (Deity), in order to promote innovators in various fields, is developing a separate portal where people can put up their innovative products to receive government help. Indeed, this is a welcome move.
All in all, the industry is convinced of the potential of frugal innovations in healthcare. This indeed keeps the buzz alive for frugal innovations to flourish. However, with several healthcare start-ups going bust, a cautious approach is also advised. Innovators, entrepreneurs and organisations must spend time to test the product and test its viability, rather than hastily rush to the market with their innovations to meet business objectives.
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