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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

  1. 1. Frugal Innovation : India’s most valued resource: The India Biodesign Programme 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 CEUTEH 2014
  2. 2. AIIMS: An Oasis for India’s Poorest “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” Newsweek International, October 30, 2006
  3. 3. 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
  4. 4. Fall back below the poverty line because of health related expenses
  5. 5. Indian Healthcare Issues : Innovation Landscape • 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
  6. 6. • 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
  7. 7. The Indian Economy: Current status • 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
  8. 8. Healthcare Growth Driver: Increasing healthcare spending Healthcare spending over $200 billion by 2025
  9. 9. India’s Innovation Hotspots: Geographical View 2,500 miles
  10. 10. 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
  11. 11. Frugal innovation: A new approach pioneered in the Global South
  12. 12. 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
  13. 13. 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!
  14. 14. 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
  15. 15. Some frugal innovations from India: Six in healthcare • 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
  16. 16. Frugal Innovations: Examples Embrace™ Jaipur Knee Fetal Heart Monitor GE Mac 400 Portable ECG
  17. 17. Impact of Frugal Innovation: Higher Value at Lower Cost High One Hundreth - Medium One Tenth - Low Two Thirds- Low Efficient Dramatically Reduced Relative Decrease in Product Cost Aravind Eye Care Jaipur Foot Reverse engineered Vaccines Jaipur Knee NH- Heart Surgery GE Mac 400 Relative Decrease in Innovation Cost Adapted from Nesta, “Bound and Thronton, 2012
  18. 18. Generic Competition to drive prices down ARV : Triple therapy (Lowest prices per patient per year)
  19. 19. Frugal ‘Jugaad’ Innovation: Indian Mindset! • 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!
  20. 20. Opportunity for Frugal Innovation Healthcare Industry Healthcare Innovation Inventors Device Manufacturer Academic Institutes Investors Unique opportunity to lead with affordable Med Tech innovation
  21. 21. Opportunity for Frugal Innovation: Areas
  22. 22. Capturing Opportunity: 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 at AIIMS *SIB (Stanford India Biodesign)
  23. 23. SIB Stanford University, CA AIIMS, New Delhi IIT, Delhi
  24. 24. 29 Fellows + 49 Interns trained Pushkar Ingale, Product Designer Ritu Kamal, BioMed Engineer Nitin Sisodia, Industrial Designer 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 Sandeep Singh, Cardiologist Srinivas Jaggu, Electronics Engineer Avijit Bansal, Chest Physician Ayesha Chaudhary, BioMed Engineer Mridusmita Choudhary, Elect. Engineer Chinmay Deodhar,Mechanical Engineer 2008 Emergency Medicine Jagdish Chaturvedi, ENT Physician Jonathan Pillai, BioMed Engineer Siddhartha Joshi, Industrial Designer Siraj Bagwan, Product Designer 2009 Emergency Medicine 2011 Pediatric Care 2010 Pediatric Care 2012 Gastroenterology
  25. 25. The Biodesign Process 1.1 Strategic Focus 1.2 Observation & Problem Identification 1.3 Need Statement Development 2. NEEDS SCREENING 2.1 Disease State Fundamenta ls 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. DEVELOPMENT STRATEGY & PLANNING 5.1 IP Strategy 5.3 Clinical Strategy 5.5 Quality & Process Management 5.6 Reimbursement Strategy 5.2 R&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 IMPLEMENT INVENT IDENTIFY 3.1 Ideation & Brainstormin g 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 5.4 Regulatory Strategy 4.1 Intellectual Property Basics 4.3 Reimburseme nt Basics
  26. 26. Clinical Immersion
  27. 27. Community Medicine Immersion
  28. 28. 456 172 50 15 3 Intuitive Screening Impact, Market, Feasible outcome Physician Feedback + Research Team Priority Need Filtration
  29. 29. A novel way to manage fecal incontinence in non-ambulatory patients ▻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 1. 2. Visceral Nerves Somatic Nerves
  30. 30. 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 CONSURE Medicals • FIM Safety and Feasibility trial successfully concluded at AIIMS. • Long-term Efficacy and Functionality study successfully concluded • Multi-centric RCT in progress
  31. 31. Consure: Fecal Incontinence Device: USFDA Approved 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
  32. 32. A better way to gain intraosseous access in emergency patients Pediatric Neo-natal Cardiac Arrest Hypotension Trauma Geriatric Shock Obstetric Emergencies “IO infusion should be the first alternative to IV in cardiac arrest patients”
  33. 33. 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 Placement Insertion Remove Guide Infuse
  34. 34. A better way to temporarily immobilize lower limbs in trauma patients 15Million Road Traffic Accidents (RTAs) per annum in India 5.4 Million Incidence of Lower Limb Injuries in RTAs
  35. 35. A disposable splint manufacturing in Delhi box factory: Hi CARE LIMO Cost per unit estimate: Rs 40 (~$0.75) Commercial product launched from SIB AIIMS
  36. 36. Birth asphyxia* claims 811,000 lives each year Effective resuscitation can help prevent these … Project NeoBreathe A novel integrated solution for Effective newborn resuscitation at all levels of care A better way to resuscitate neonates
  37. 37. NEOBREATHE: Funding and Awards Supported by: Department of Biotechnology
  38. 38. 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 • 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
  39. 39. 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
  40. 40. Prototype Development – Funded by Welcome Trust (UK) 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 Preliminary Proto Revision-1 Proto Revision-2 Proto Revision-3 Proto
  41. 41. Bioscoop TM Accu- feed Accufeed
  42. 42. 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
  43. 43. Better & Affordable Healthcare with Frugal Innovation Photo Courtesy: National Geographic, Jamkhed, Maharashtra State, India
  44. 44. School of International Biodesign Stanford India Biodesign (SIB) AIIMS and IIT, New Delhi BCIL, DBT; Government of India Stanford University, USA
  45. 45. SIB – Thinking and Philosophy Never give up: FIGHT Frugal Innovation for Global HealthTechnologies GANDHI Global Affordable Need-based Development in Healthcare Innovation
  46. 46. 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
  47. 47. iFellowship indigenous international innovation Fellowship indigenous Fellowship in Frugal Medical Technology Innovations (Biodesign) Experiential learning of multi-disciplinary teams 2 Yr long fellowship
  48. 48. iFellowship-milestones • Call for Applications - Sep 2014 • Interviews - Oct / Nov 2014 • Expected no of fellows - 12 ( 8 national + 4 international ) • Fellowship starts - Jan 2015
  49. 49. iFellowship - Year 1 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
  50. 50. iFellowship - Year 2 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
  51. 51. 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 !
  52. 52. 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 !
  53. 53. Welcome to the 8th Indian Medtech Summit Dec 12, 13, 2014 New Delhi Thank You!