frugal innovation india’s most valued resource the india biodesign programme
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Frugal Innovation : India’s most valued resource: The India Biodesign Programme
CEUTEH 2014
Professor Balram Bhargava MD, DM, FRCP (Glasg), FRCP (Edin), FACC,
FAHA, FAMS, FNASc Professor of Cardiology,
Executive Director, Stanford India Biodesign,School of International Biodesign
All India Institute of Medical Sciences, New Delhi, INDIA
“This is what it takes to be India’s best public hospital. The Government-run hospital, with about 2,000 beds, treated 3.5 million people, achieving mortality and infection rates comparable to the best facilities in the developed world – for fees that come to about $1 a day for inpatients”
AIIMS: An Oasis for India’s Poorest
Newsweek International, October 30, 2006
Indian Healthcare Issues: Insurance Markets
• Mostly Self-Pay Market dominated by out-of-pocket spending
• Medical insurance sector is weak and fragmented• Benefits of insurance unavailable to the most vulnerable• Voluntary, contributory and community-based health schemes limited
• New government schemes like NRHM, RSBY for better care• Government has committed to increasing public spending in
healthcare to 3% of GDP by 2017: Universal Health Coverage
Insurance (or lack of it) starting to influence patient and physician choices in consumption of medical technology and healthcare
39 M…Fall back below the poverty line because of health related expenses
• Indian Med Tech industry low on innovation: • Only 1% of sales invested in R&D (vis-à-vis 11% in the west)• 65% of Indian manufacturers focused on low end medical disposables • Very few Class III devices• Trained Talent nonexistent
• Med Tech ecosystem in infancy
Indian Healthcare Issues : Innovation Landscape
80 % FOR 20%• Price of imported technology is a major concern• Limited capital for high-risk ideas• Regulatory and IP changes good but slow• Limited facilities for product testing, validation and accreditation
• A decade of rapid economic growth• Fast rising literacy• More girls in schools• Relentless spread of mobile phones• Economy worth $2 trillion (10th biggest)• Income per person is up• Rural poverty down• Polio has been eradicated• Paved roads becoming more widespread• The country is stable• It is young, big and fast growing
The Economist September 29th, 2012; India in search of a dream: Aim Higher
The Indian Economy: Current status
Healthcare spending over $200 billion by 2025
Healthcare Growth Driver: Increasing healthcare spending
India’s Innovation Hotspots: Geographical View
2,500 miles
Frugal Innovation in India: “More for less for more”
• Abundant culture of ‘jugaad’ or creative improvisation• A huge market with a growing, aspirational middle class
• Indian consumer extremely price-sensitive and willing to experiment• Major gaps in service stimulate demand for low-cost solutions
• New sources of social finance (E.g. grants and small business loans) are lowering the cost of investing in frugal innovations
• National Innovation Council’s inclusive science and innovation policy is prioritising getting ‘more for less for more’
OUR FRUGAL FUTURE: Lessons from India’s innovation system, Nesta 2012
Frugal innovation: A new approach pioneered in the Global South
Frugal ‘Jugaad’ Innovation
The art of overcoming harsh constraints by improvising an effective solution using limited resource
• Gambiarra or jeitinho in Brazil
• Jua Kali in Kenya
• Zhizhu Changxin in China
• DIY in the US
• Systeme D in France
• Bricolage in Australia
Defining Characteristics of Frugal Jugaad Innovation
• Responds to limitations in resources: financial, material or institutional
• Turns constraints into advantages by minimising use of resources in development, production & delivery in new ways
• Successful frugal innovations are not only low cost but outperform the alternative and are available at a large scale
• Often have an explicitly social mission!
Busting Myths about Frugal Innovation
Frugal Innovations
• Low cost does not mean low–tech• Includes services, not just products• Implies re-design, not just de-featuring or simplifying
‘Jugaad’ Innovators: ‘FIRST’
• Frugal and Flexible• Inclusive and Intuitive• Redesign and Recombinant• Socially Sensitive• Talented with Tenacity
Jaipur Knee
• GE ECG machine
• Tata Nano car
• Aakash tablet PC
• 1298 ambulances
• Aravind eye hospitals
• Swach water filter
• Narayana Hriduyalaya
• Bharti Airtel mobile services
• SELCO solar power
• Jaipur prosthetics
Some frugal innovations from India: Six in healthcare
Frugal Innovations: Examples
Embrace™
Jaipur Knee
GE Mac 400 Portable ECG
Fetal Heart Monitor
Impact of Frugal Innovation: Higher Value at Lower Cost
HighOne Hundreth -
MediumOne Tenth -
LowTwo Thirds-
Low Efficient Dramatically Reduced
Relative Decrease in Product Cost
Aravind Eye Care
Jaipur Foot
Reverse engineered Vaccines
Jaipur Knee
NH- Heart SurgeryGE Mac 400
Relative Decrease in Innovation Cost
Adapted from Nesta, “Bound and Thronton, 2012
Generic Competition to drive prices down
ARV : Triple therapy (Lowest prices per patient per year)
• Upwards of 40% of Indians:
• Are unbanked
• Are off the electricity grid
• Have limited access to healthcare and education
• The west can gain by engaging with India
• Frugal, flexible and inclusive innovation can improve lives!
Frugal ‘Jugaad’ Innovation: Indian Mindset!
Opportunity for Frugal Innovation
Healthcare Innovation
Healthcare Industry
Inventors
Device Manufacturer
Investors
AcademicInstitutes
Unique opportunity to lead with affordable Med Tech innovation
Opportunity for Frugal Innovation: Areas
Capturing Opportunity: Stanford India Biodesign
SIB at AIIMS
*SIB (Stanford India Biodesign)
• Only a few program/centers promoting medical device innovation worldwide
• Stanford India Biodesign (SIB) established at AIIMS is first such program in Asia.
SIB
Stanford University, CA
AIIMS, New Delhi
IIT, Delhi
Pushkar Ingale, Product Designer
Nitin Sisodia, Industrial Designer
Ritu Kamal, BioMed Engineer
Geeta Handa, Physician
Darshan Nayak, Physician
Pulin Raje, Product Designer
Asokan T, Mechanical Engineer
Rahul Ribeiro, Material Scientist
Amit Sharma, Industrial Designer
Jayant Karve, Product Designer
Nish Chasmawala, Plastics Engineer
Srinivas Jaggu, Electronics Engineer
Sandeep Singh, Cardiologist
Avijit Bansal, Chest Physician
Mridusmita Choudhary, Elect. Engineer
Ayesha Chaudhary, BioMed Engineer
Chinmay Deodhar, Mechanical Engineer
2008Emergency Medicine
29 Fellows + 49 Interns trained
Jagdish Chaturvedi, ENT Physician
Siddhartha Joshi, Industrial Designer
Jonathan Pillai, BioMed Engineer
Siraj Bagwan, Product Designer
2009Emergency Medicine
2011Pediatric Care
2010Pediatric Care
2012Gastroenterology
The Biodesign Process
1.1 Strategic
Focus
1.2 Observation &
Problem Identification
1.3 Need
Statement Development
2.1 Disease
State Fundamental
s
2.2 Treatment Options
2.3 Stakeholder
Analysis
2.4 Market
Analysis
2.5 Needs Filtering
4.6 Final
Concept Selection
1. NEEDS FINDING
3. CONCEPT GENERATION
5.1IP Strategy
5.3 Clinical Strategy
5.6 Reimbursement
Strategy
5.5 Quality & Process
Management
5.2R&D Strategy
6. INTEGRATION
5.8 Sales &
Distribution Strategy
6.2 Business
Plan Development
6.3 Funding Sources
5.9 Competitive Advantage &
Business Strategy
6.1 Operating
Plan & Financial
Model
2. NEEDS SCREENINGID
EN
TIF
YIN
VE
NT
IMP
LE
ME
NT
3.1Ideation &
Brainstorming
4.5 Prototyping
4.2 Regulatory
Basics
4.4 Business Models
3.2 Concept
Screening
4. CONCEPT SELECTION
5.7 Marketing & Stakeholder
Strategy
6.4 Licensing & Alternate Pathways
5.4Regulatory Strategy
5. DEVELOPMENT STRATEGY & PLANNING
4.1 Intellectual Property Basics
4.3Reimburseme
nt Basics
Clinical Immersion
Community Medicine Immersion
456 50 15172 3
Intuitive Screening
Impact, Market, Feasible outcome
PhysicianFeedback
+Research
Team Priority
Need Filtration
▻Diapers1 and Catheters2 are not effective
▻Painful for the patients and not user
friendly
▻Costs: $10,000/patient
Novel Approach:▻Above the rectal valve
▻No interference in physiologic
functioning
▻Works outside ICU’s
▻For a motivated family member
Visceral Nerves
Somatic Nerves
1. 2.
A novel way to manage fecal incontinence in non-ambulatory patients
A new standard of care for management of fecal incontinence that:
• improves clinical outcomes• reduces operating costs• grows the overall market
Designed for 16M Indian patients Value proposition for 100M Global patients Market: $5 Billion plus global potential
• FIM Safety and Feasibility trial successfully concluded at AIIMS.
• Long-term Efficacy and Functionality study successfully concluded
• Multi-centric RCT in progress
CONSURE Medicals
Technology Platform:
▻Pliable lattice that diverts liquid and formed stool
▻ICU’s, wards, nursing homes, rehab facilities
▻No pain sensation
▻Minimal training required
▻Eventually an OTC product
▻Designed for 16M Indian patients
▻Value proposition for all 100M Global patients
▻Market: $5 Billion plus global potential
Consure: Fecal Incontinence Device: USFDA Approved
PediatricNeo-natal
Cardiac ArrestHypotension
GeriatricTraumaShock
ObstetricEmergencies
“IO infusion should be the first alternative to IV in cardiac arrest patients”
A better way to gain intraosseous access in emergency patients
Key features• Manual operation • Ergonomic design• Sterility maintenance• Needle guidance & visibility
Value proposition• Controlled access• Resource constrained environment • Suitable for both pediatric & adults• Affordable
Device: INTRA -OZ
InfuseInsertion Remove GuidePlacement
15MillionRoad Traffic Accidents (RTAs) per annum in India
5.4 MillionIncidence of Lower Limb Injuries in RTAs
A better way to temporarily immobilize lower limbs in trauma patients
Cost per unit estimate:
Rs 40 (~$0.75)
A disposable splint manufacturing in Delhi box factory: Hi CARE LIMO
Commercial product launched from SIB AIIMS
Birth asphyxia* claims 811,000 lives each year
Effective resuscitation can help prevent these …
A novel integrated solution for Effective newborn resuscitation
at all levels of care
Project NeoBreathe
A better way to resuscitate neonates
NEOBREATHE: Funding and Awards
Supported by: Department of Biotechnology
• Next generation medical bed sheet
• Unique composite polymers for comfort & functionality
• Patient transfer ability when needed
• Salient features – works with different height, gap and alignment
• Globally 200M of surgeries & billion plus market
TRANSFERLIFE: A better way to transfer patients in hospitals
Shifting patients from the stretcher to the bed is a dangerous process for both the patient and the caregiver
Cardio-pulmonary Resuscitation (CPR) Device
Sudden Cardiac Arrest (SCA) is one of the leading causes of death in both developed as well as developing countries.
Estimated annual burden of the SCA is 4-5 million across the world and 0.8-1 million in India.
Annual Incidence – Sudden Cardiac Arrest
World 4-5 million
USA 0.3-0.4 million
Europe 0.6-0.7 million
India 0.6-0.8 million
Prototype Development – Funded by Welcome Trust (UK)
Preliminary Proto Revision-1 Proto Revision-2 Proto Revision-3 Proto
Key Features
Integrated automated resuscitation system usable in resource constrained environment
Novel proprietary technology based on underlining physiology
Automated device with minimal training requirement
Portable device
Accu- feedTM
Bioscoop
Accufeed
The results so far......2007-14
• 29 fellows and 59 interns
• 22 different devices; 5 products in clinical trials
• 24 patents filed; 12 in progress
• 7 technology transfers
• 4 startups
• 7 medical technology summit and workshops
• National curriculum launched
• 1 product launched in MOH; 1 USFDA approval
Better & Affordable Healthcare with Frugal Innovation
Photo Courtesy: National Geographic, Jamkhed, Maharashtra State, India
School of International Biodesign Stanford India Biodesign
(SIB)
AIIMS and IIT, New DelhiBCIL, DBT; Government of India
Stanford University, USA
SIB – Thinking and Philosophy
Never give up:
FIGHT
Frugal Innovation for Global HealthTechnologies
GANDHI
Global Affordable Need-based Development in
Healthcare Innovation
SIB – Goals‘More for less for more’
• To become the epicentre of Frugal Medical Technology
Innovation
• To train People in MedTech Innovation building on the Biodesign
process
• To innovate for the unmet clinical needs with focus on developing
countries
iFellowshipindigenous international innovation Fellowship
indigenous Fellowship in Frugal Medical Technology Innovations (Biodesign)
Experiential learning of multi-disciplinary teams2 Yr long fellowship
• Call for Applications - Sep 2014
• Interviews - Oct / Nov 2014
• Expected no of fellows - 12 ( 8 national + 4 international )
• Fellowship starts - Jan 2015
iFellowship-milestones
Jan 2015 Informational training
Feb, Mar, Apr 2015 Clinical Immersion
May, Jun, Jul 2015 Concept Selection
Aug, Sep, Oct, Nov 2015 Product Development
Dec 2015 Presentation at MedTech Summit
iFellowship - Year 1
2 Months Industry externship
3 to 6 Months Visit to partner institution (tech development / animal testing)
1 to 2 months Clinical Testing / First in man (Ethical clearances)
3 to 5 months B-Plan competitions, Acceleration, Secure Funding, Licensing
Dec 2016 Fellows Graduate at MedTech Summit
iFellowship - Year 2
Innovations in Medicine
• Applicability in different geographies• Ignite more Innovations
• Devices | m-Health | Systems | Processes | Health IT
• Can impact healthcare access & affordability• Often interdisciplinary• Aravind Eye, Sri Chitra Heart, Boat Clinics, Stroke detection
app, Card-board splints
They need a platform !
BMJ Innovations• First International interdisciplinary journal focused on
Innovations • A melting pot of ideas that will fuel more innovations• 1st Global Launch at 8th MedTech Summit ( Dec 2014 )• International Board : US, UK, Singapore, Japan, Australia,
Israel, more…• Everyone’s invited !
Thank You!
Welcome to the 8th Indian Medtech
SummitDec 12, 13, 2014
New Delhi