Frugal Innovation Enhancing Healthcare Access in India

As an exponentially growing population with an increasing life expectancy strains the medical care system worldwide, healthcare emerges as a major area of innovation. This is most prominent in emerging markets like India, were the cost of healthcare is as important a factor as the quality of the product or service being provided. As a result, India has become a hub for frugal healthcare innovation, demonstrating what is possible in a resource strapped environment struggling with the natural constraints of development.

The healthcare system in India is fragile, to say the least. Although reports vary, India ranks the lowest globally in terms of percentage of GDP spent on healthcare—only 4% of its 1.84 trillion dollar economy.  More significantly, 70% of this spending is borne directly by individuals and families without Government support. According to The ENS Economic Bureau, the Indian government spends a meager $43 per head versus Sri Lanka’s $87, China’s $155, and Thailand’s $261. (For further reading on India’s healthcare spending versus the other BRICS countries, here’s a good article from The Times of India)

To compound the struggle of a resource strapped healthcare system, India lacks enough trained doctors to serve its population of 1.2 billion.  With just one doctor to treat 1,700 people, there just aren’t enough to go around. Compare that to one doctor for every 950 in China, 900 in Brazil and 300 in Germany, and it is clear that India is lagging far behind.

Despite a lack of resources, or maybe because of it, India has emerged as a hub for some of the most innovative and entrepreneurial healthcare solutions in the last decade. Wanting to understand the patterns that govern innovation in this space, I researched a range of products, services, business models and ideas that are creating impact. Over the next few posts, I will share a sampling of my learning, highlighting some of the examples that have successfully extended the reach of healthcare services across the country.

In this post I examine two product-focused innovations, Jaipur Foot and Biosense Technologies, both of which have made life-changing products accessible to India’s under-served population. But, these two organizations are being highlighted here not simply for their products, but also as examples of the holistic approach to innovation that both creates a revolutionary product and addresses the existing system and behaviors within which it must function.

Disruptive innovation, by its very nature, ruptures existing systems. This is the challenge and the immense responsibility facing frugal innovators in India, tasked with creating an integrated innovation ecosystem. Successful product innovations must therefore employ an efficient delivery process and a well-designed financial model that enables products to reach users further, faster, and at affordable prices.

Affordable Excellence – Bringing Mobility to Rural India

Although a prosthetic foot may not seem revolutionary, Jaipur Foot’s low-cost, high function prosthetic foot and limbs have changed the lives of thousands of Indians, giving them back their mobility and their dignity.  By standardizing the process of constructing and fitting a prosthetic limb, Jaipur Foot has drastically reduced cost without sacrificing functionality (even enhancing it in some cases).

According to the publication Prosthetics in Developing Countries, the cost of a prosthetic limb in developing countries ranges from $125 – $2,000. Although this is well below the US’s $5,000 – $20,000 price tag, it is still out of the reach of many poor Indian families. Alternatively, the 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 3 hours. The foot is then attached to a prosthetic limb. The entire process from fabrication to fitting takes as little as a day.

Though highly standardized and low cost, the Jaipur Foot has maximized functionality. Uniquely designed to meet the rigorous demands of the Indian wearer, the foot’s rubber exterior gives a natural look as well as protects the wood interior from water damage. The latter function is especially important for farmers who must regularly wade through rice paddy and other marshy terrain.  The flexible design of the foot also allows the wearer to squat, climb, run, ride a bicycle, and navigate uneven dirt roads—all of which are necessary functions for a rural Indian wearer.

However, an innovative product is irrelevant if it doesn’t reach those who need it most, and Jaipur Foot has succeeded in creating an effective service delivery model that minimizes overhead costs while reaching remote users efficiently.  Employing a hub-and-spoke delivery model, Jaipur Foot reaches patients through 22 centers across the country as well as  50+ mobile camps held in remote rural areas.  This highly coordinated network allows Jaipur Foot to divide up resources efficiently, reducing overhead and human capital cost, without limiting the reach of its services. The main campus in Jaipur also provides free residential facilities for families that arrive from all over the country for treatment. Additionally, the organization provides access to livelihood generation activities for people with severe disabilities. This robust network of initiatives enables Jaipur Foot to extend the reach of its core product deep into underserved communities.

By supplementing a traditional delivery model with mobile camps, and by eliminating the unnecessary complications of an overly customized product—standardizing where possible and simplifying production—Jaipur Foot provides world-class quality at an affordable price directly to an under-served Indian patient. This is holistic frugal innovation at its finest.

Simplified Technology to Empower Local Health Workers

Like Jaipur Foot, Biosense Technologies brings high quality, low-cost products to the masses. A medical engineering firm, Biosense develops diagnostic tools that employ mobile devices for use in local clinics across India. Where Jaipur Foot excels in simplifying the production of their product, Biosense simplifies the use, making it a viable solution in remote areas where trained medical professionals are few and far between. Like hub-and-spoke delivery, “de-skilling” emerges as another trend in frugal healthcare innovation in India.

With several products in their portfolio, Biosense provides a comprehensive diagnostic solution for rural clinics and helps mediate the unnecessary impact of preventable diseases. Take Anemia for example. Even with a simple test and accessible and affordable treatment, Anemia contributes to thousands of deaths each year. Most of these deaths occur during childbirth because the delivering mother’s Anemia was undiagnosed. To address this issue, Biosense developed the ToucHb, a portable, needle free anemia-screening technology that requires no expensive equipment and little training to use. The ToucHb allows local health workers to painlessly test patients, immediately read results, and administer treatment where necessary.

Further their attempt to bring simple-to-use diagnostic tools to remote parts of India, Biosense developed two additional products the uCheck, a smartphone based portable urine screening tool and the SüCheck, a basic blood sugar testing device. The uCheck and SüCheck utilize a cloud-based operating system, function via a smartphone, and can be used and read with minimal training.

The innovation in Biosense’s technologies is manifold.  Firstly, by reducing the size and complexity of their products, Biosense enables small community clinics to purchase and use effective diagnostic tools.  Secondly, by eliminating the need for skilled technicians, these tools have increased the efficacy of local health workers.  Finally, by operating via smartphone technology, Biosense has created a limitless system that will continue to grow as the availability of cloud-based information increases.  Simultaneously innovating the product, the delivery, the use, and the content, Biosense technologies represent some of the best of frugal innovation at work.

But, these are just two examples of interesting, integrated health product innovations in India. Others to note include Low Cost Standard Therapeutics (LOCOST), a company making essential medications affordable; Embrace Innovation, designing low cost infant warmers for use in resource strapped hospitals; and Aravind Eye Care’s Aurolab, which designs low cost Intra Ocular lenses for cataract patients.

Each of these examples demonstrate the power of products that employ a frugal approach to innovation, dramatically reduce cost without sacrificing quality, and employ an efficient and effective delivery mechanism to reach relevant markets. Disruptive products alone are not enough to create impact, and effective innovators embrace this as an opportunity to create an ecosystem to support their products.

In the next post I will share some interesting delivery focused healthcare innovations that utilize complex and highly effective networks to get goods and services to patients across India. Stay tuned.

About the Author: Research & Project Manager at Innovation Alchemy, Hannah Rosenfeld explores the intersection of design & social impact and supports entrepreneurs in thoughtfully crafting products and services to transform underserved communities. 

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