Emerging economies drive frugal innovation

A host of new and reliable low-cost medical devices specially adapted to needs of low- and middle-income countries is on the way, driven by increased demand for cost-effective health care. Ajanthy Arasaratnam and Gary Humphreys report.
How do you do blood transfusions when you have no medical equipment, no donors and no blood? This is a question that comes up all too frequently in sub-Saharan Africa, where blood donations in many countries fail to meet the demand for transfusions and where clinics, particularly those in remote rural areas, are underequipped. In the absence of blood and equipment, patients in need of transfusion – such as women haemorrhaging as a result of a ruptured ectopic pregnancy – are forced to fall back on a crude form of auto-transfusion using kitchen equipment.
Dr Kathleen Sienko, an assistant professor of Biomedical Engineering at the University of Michigan in the United States of America (USA), explains: “Blood pools into incisions in the woman’s abdomen, before a sterilized gallipot or soup ladle scoops it into a basin of anticoagulants. From there, it filters through a gauze-lined funnel, feeds into a blood bag and drips back into her body.”
Such crude measures, while doubtless saving some lives, underscore a failure or inability on the part of health authorities in the countries concerned to provide adequate health care. But these measures also reflect the global medical device industry’s traditional focus on the needs of wealthier countries. According to Espicom, a United Kingdom-based company that gathers data and does market analyses of the pharmaceutical and medical device industry, global spending on medical devices in 2010 is estimated to have been around US$ 260 billion, the bulk of those sales generated by a handful of manufacturers based in high-income countries.
Medical device use is similarly concentrated in high-income countries, with just 13% of the global population accounting for 76% of global medical device use.
In the past, when medical device companies did address the needs of low- and middle-income countries, they tended to remove the features from high-tech products that were designed for more developed countries to market them in poorer countries, an approach known as “glocalization”.
According to Denise Kruzikas, Director of General Electric’s (GE) Healthymagination, a GE initiative committed to promoting health-care innovation, the industry is increasingly recognizing that stripping out the bells and whistles is seldom sufficient to adapt medical devices for health workers, who may lack training and technical skills and who are working in environments that aren’t always equipped to handle the technology.
For example, power-hungry devices – conceived to function in high-income countries with electrical power grids – can leave hospitals and clinics in poorer countries struggling to find generators or scavenging for batteries. Moreover, devices that are not designed to cope with heat, humidity and dust or to be used intensively are unlikely to last very long.
These kinds of issues have contributed to a situation in which a large proportion of medical equipment in developing countries may be partly or totally unusable. In sub-Saharan Africa up to 70% of medical equipment stands idle, according to WHO’s Guidelines for health care equipment donations.
As companies begin to recognize the market potential in low- and middle-income countries, their approach looks set to change. Radha Basu, director of Santa Clara University’s Frugal Innovation Laboratory in the USA state of California, believes that one of the big drivers of change is the increased demand for effective and robust low-cost medical devices from emerging economies, notably China and India.
China’s current five-year plan (2011–15) allocates US$ 41 billion to the development of new hospitals and the upgrading of the country’s grassroots health service system, while India’s latest five-year plan includes a commitment to increasing the government’s share of total health-care expenditure by 2017. “The development of emerging markets brings new reasons to create appropriate, affordable and accessible medical innovations for low-income markets. It is no longer just something that ‘well intentioned’ people do to reduce health-care disparities. It is now a profitable activity,” Basu says.
GE is a prime example of a company that sees the commercial potential of what has become known as “frugal innovation”. Recently 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.

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