Four million babies die every year because of a lack of adapted incubators

According to a study conducted by the World Health Organization (WHO) in 2005 almost twenty million premature and low birth weight babies are born every year in the world.

Preterm birth rates are higher in developing countries than in developed countries. Moreover, the WHO underlines that inequalities exist between developed and developing countries in terms of the survival chances of a preterm infant: “In many developing countries, infants weighing less than 2000 g (corresponding to about 32 weeks of gestation in the absence of intrauterine growth retardation) have little chance of survival. In contrast, the survival rate of infants born at 32 weeks in developed countries is similar to that of infants born at term”.

These babies suffer from hypothermia as they do not have enough fat to regulate their body temperature and almost four million die within the first four weeks of life. But even babies that do survive often face life-long debilitating diseases such as diabetes, heart disease and weak brain development.

Infant incubators are the only way to save these babies whose internal organs are not fully developed at birth. But traditional incubators cost around 20.000 US Dollars and are too expensive to be bought and used in most of developing countries maternity hospitals.

In 1990, world leaders at the United Nations Millennium Summit pledged to reduce the deaths of children under 5 years of age by two thirds by 2015. This number falls from 12,4 million in 1990 to 8,1 million in 2009: there is still huge progress to do in order to reach this goal.

Embrace developed a low cost infant warmer that could save 100.000 lives by 2013

In 2007, four students at Stanford’s Institute of Design were assigned to come up with a low cost incubator to tackle the premature babies’ mortality in developing world. Jane Chen, Rahul Panicker, Naganand Murty and Linus Liang designed an infant warmer that could contribute to reach this Millenium goal.

The infant warmer is a miniature sleeping bag with a removable wax insert, which can be heated safely over and over again. The hot wax can maintain the device at 98 degrees Fahrenheit (37°Celsius) for four to six hours to keep the premature or low birth weight newborn at a healthy body temperature.

Embrace developed two versions of this device: one for clinics equipped with an electric heating system for the wax insert and a second one using a hot water heating system that can be operated without electricity for mother and midwives in rural area. This infant warmer costs less than two hundred dollars, so less than 1% of classical incubators cost.

By 2013, Embrace team expects the enfant warmer will be able to save more than 100,000 babies in India and prevent illness for as many as 800,000.

An interesting process to design a new product adapted to the bottom of the pyramid… and to developed countries

To design their infant warmer, the four students went to Nepal to understand the problem and the needs of the mothers in third world countries. They identified that access to modern medicine and hospitals was a problem: as in many developing countries, the majority of premature Nepalese infants are born in slums or villages where hospitals are scarce. Their product would then have to be transportable and operable without electricity. They designed their product without taking the existing incubators as a model: they really designed a product to answer developing countries specific needs.

After this experience, they set up their organization in India, the country with the largest number of premature and low birth weight babies in the world. They have spent the past year conducting trials and manufacturing the product. They expect to release it on the market in India in 2011.

During their clinical trials, both in developed and developing countries, the team figure out that the transportable infant warmer was more appreciated by mothers than the classical incubators because it enables them to keep their children with them. For this reason, Embrace infant warmer could also become an interesting product for developed countries hospitals.

Embrace now plan to design other products for base of the pyramid consumer. To develop its activities Embrace, that is for the moment an association, plans to change its status to a limited company and to hire new team members.

Embrace is a finalist at the renowned INDEX competition. You can help them casting your vote for Embrace on INDEX: People’s Choice Award (scroll down and find Embrace). Spread the word.

Bangalore is India’s third more populated city with 5,4 million inhabitants. The city once called the pensioner’s paradise has become the IT moguls’ paradise and is now called the Indian Silicon Valley. Infosys and Wipro, two of the largest Indian software companies, are headquartered in Bangalore as a myriad of technology start up like Forus Health(understand For Us Health). I met its representatives during the Sankalp Forum in Mumbai and I was impressed by the device they had developed so I decided to visit them in Bangalore.

Health for all of us: Forus Health

Forus Health was set up in Jan 2010 by Dr. Shyam Vasudev Rao, president and CTO, and Mr. Chandrasekhar, CEO. Their objective is to address health crisis in developing countries through innovative products and solutions combined with innovation in a deployment in an inclusive environment. Their strategy is to develop solutions to enable screening and treatment of patients outside the hospitals, in camps or health kiosks for example, to lower costs and reach more people.

Their motivation to set up this company came after a meeting with Dr Venkataswamy, founder of Aravind Eye Care, a financially-viable healthcare system which operates low cost cataract surgeries. Mr. Chandrasekhar and Dr. Shyam Vasudev Rao got a good understanding of problem of needless blindness and constraints like availability of ophthalmologists and high cost of diagnostic equipments that may potentially limit organizations like Aravind to treat more patients in Rural India. Naturally, the first device developed by Forus Health is then dedicated to tackle blindness.

80% of blindness is “needless” in India

“There are globally 45 million blind people in the world, 25% of whom are living in India. In addition, India counts 41 million diabetic people, 20% of whom could develop diabetic retinopathy” states Mr. Chandrasekhar. Forus Health considers that blindness results in a loss of productivity that exceeds 50 billion US dollars in India and that 80% of this blindness could be avoided if people were diagnosed early and treated.

The low doctor to patient ratio (only one doctor for 1.500 people in India and as low as one for 50.000 in some African countries – it is even worth for ophthalmologists with one for 60.000 in India) coupled with illiteracy, lack of rural reach and scalability can explain this high rate of “needless” blindness as well as why healthcare in general is a serious problem in developing countries. Forus Health sees technology as a means to solve to this complex and severe problem.

Screening 20 million people by 2014

The first device developed by the Bangalore based company is the 3nethra, a low cost portable, non-invasive, pre-screening ophthalmologist device that can detect diabetic retinopathy, cataract, glaucoma, cornea problems and provide accurate refraction index measurements that constitute 90% of blindness. This device can be operated by a minimally trained technician outside a hospital environment in a rural Indian village significantly reducing operation costs thereby enabling reach. The screening only last three to five minutes and gives an automated “Normal” or “Need to see a doctor” report. The complete information collected (that includes images of eye) during the screening is also directly sent to an online cloud based platform that enables remote diagnosis through telemedicine by ophthalmologists from their care centers that will be communicated to the patient.

The device is sold around 500.000 Indian rupees (7.600 Euros or 10.900 US dollars), which represents only one fifth of the price of classical screening devices. Already 25 units are in use in hospitals and clinics which use it for outreach programs. The cost of screening for the patient is determined by these hospitals and clinics and are usually ranging from 20 to 150 Indian rupees (0,3 to 2,3 Euros or 0,4 to 3,3 US dollars).

“The cost of 3netrha which is usually financed by bank loans can be recovered within a year” says Mr. Chandrasekhar. 600 units should be sold next year and the company plans to install 5.000 units before 2014. In addition to hospitals and clinics, Forus Health also targets opticians and ophthalmologists, who appreciate the low cost and high quality of the device, as well as diabetic centers, Government vision centers, rural entrepreneurs and common services kiosks. According to this plan, 3nethra should be able to scan 20 million people and change lives of at least 1 million people in the next three years.

Screening is good, treating is even better!

If 3nethra is obviously an adapted answer to enable a large scale and low cost screening, it only enables screening and diagnosing but it does not treat the patients. For this reason, Forus Health
is setting up a cloud based platform, the Forus’s Data Centre, helping connect identified patients with eye care ecosystem to enable them to get the right treatment. Eye care ecosystem (hospitals, pharmacies, NGO and specialists) can then provide affordable and scalable treatments enabled by affordable and scalable screening. Forus Datacenter will not only provide basic EMR and image storage /retrieval for doctors/ophthalmologists but also assist potential patients to connect with doctors of specialty to get access to treatment. “We are currently looking for new partnerships to expand and strengthen this ecosystem” adds Mr. Chandrasekhar.

Forus Health which has started its revenue generation plans to develop new devices, using similar technology as the 3nethra, to screen ROP (Retinopathy of Prematurity). ROP affects 10% of the 2.7 million premature babies born every year in India. Screening and treatment facilities are available only in major cities due to a lack of trained people and adapted devices that are too expensive for the moment. The company also plans to expand the scope of the Forus’s Data Center to dermatological and bones density applications, and of course develops devices to screen these fields.

If India is the Mecca of Social Business, Sankalp Forum could be social entrepreneurs’ hajj (see note 1). I attended the 3rd edition of Sankalp Forum from the 4 to 6 May in Mumbai. It was definitively the place to be to meet Indian social entrepreneurs and investors.

Before going to India I sent a few emails to various Indian social business organizations in order to set up meetings. Unfortunately, I did not receive any answer. But I knew that there would be one place where I could without any doubt meet a lot of them: Sankalp Forum.

This event is organized by Intellecap, a consulting firm specialized in building innovative business solutions for low-income markets. During two days, it brought around 800 delegates together in the luxurious Taj Land Ends Hotel. The place looked even a bit too luxurious for an event whose aim is to discuss solutions to cope with poverty or environment issues but as the fee to attend remained reasonable compared to other Forum there is no point to complain. The majority of the delegates were Indians; investors, social entrepreneurs and experts seemed to be equally represented.

The Sankalp Forum highly promotes business relations between investors and social entrepreneurs. A special room was dedicated to the “investors/investees” meetings and a side session was organized to enable shortlisted entrepreneurs to pitch their projects in front of a panel of investors. This initiative cannot solve in itself the “pipeline issue” discussed during the Skoll Forum in March but can at least foster a better comprehension between investors and social entrepreneurs. Even in India, social entrepreneurs discussed “the curious case of missing Indian Impact Investors”. During this session, the panelists, including some Indian impact investors, gave some reasons to this general feeling they did not share: one explained that rich Indians were still culturally giving more money to God, financing temples, than to social businesses; another stated that every professional investor managing less than one hundred million dollars should be considered as doing impact investment as he invested in small companies creating jobs (I do not really agree with him… do you ?); and a last one explained that Base of Pyramid markets were interesting markets above all and investors were doing impact investing as Molière’s Mr. Jourdain was doing prose, without even knowing it! They all agreed to say that more and more funds were coming to finance social business and that should please social entrepreneurs and close this case!

One of the most interesting sessions to me was the presentation of “Technology for development” projects. During this conference I was seated next to Ms Nythia from Forus Health whose idea is to develop a low cost pre-screening ophthalmology device to enable any rural villagers to get an affordable check up to detect early stage diseases and ophthalmologist doctors to spend their time only on needy patients. This innovation is of course very useful for all developing countries, but it could also be used in developed countries: in the USA, where the high costs of private healthcare insurances or doctors consultations prevent some Americans to benefit from a good health follow-up; in France where the actual Securité Sociale system is dangerously in deficit every year and where it becomes more and more difficult to find a doctor in rural areas. This business model, enabling the distribution of a service (either education as Bodh Shiksha Samiti
in India or health services like Forus) at a large scale and at a low cost by moving the human professional expertise (teacher or doctor) from front office (where it is not always useful) to back office (where it can be more efficiently used) seems to me to have a great future.

As I expected it, I left Sankalp Forum after having set up meetings with very interesting social entrepreneurs to fill in my agenda for the rest of my travel through India.

Note1: Hajj is the annual pilgrimage to Mecca, Saudi Arabia. It is the largest annual pilgrimage in the world, and is the fifth pillar of Islam, a religious duty that must be carried out at least once in their lifetime by every able-bodied Muslim who can afford to do so (source Wikipedia).

You can now find the DISCOVERY Notebook blog posts on Youphil Media, a website dedicated to social business

I attended the eighth edition of the Skoll World Forum
in Oxford last month. It was the first stop of my one-year Social Business world tour and it could not have been a better place to be to meet social entrepreneurs from all over the world and experts in every field of social business.

The Skoll World Forum is a reknown social business Forum created by Jeff Skoll, former president of eBay. The Skoll World Forum is a programme of the Skoll Foundation and is co-produced with the Skoll Centre for Social Entrepreneurship at the Saïd Business School, Oxford University. The theme for the 2011 Forum was “Large Scale Change – ecosystems, networks and collaborative action.”

The Forum welcomed remarkable and inspiring speakers as Desmond Tutu, who represented the Elders, definition of the Elders - an independent group of eminent global leaders, brought together by Nelson Mandela, who offer their collective influence and experience to support peace building, help address major causes of human suffering and promote the shared interests of humanity - and Bill Drayton, the founder of Ashoka. Another myth of social business has also been celebrated despite his absence: Mohammad Yunus who is facing legal troubles in his country, Bangladesh, was ovationned by the delegates during the opening session. But the most interesting was to meet the “anonymous” social entrepreneurs and investors who attended the Forum. I met many impact investors during these three days. I attended two conferences dedicated to the theme of impact investment and the relations, or sometimes absence of relations, between social entrepreneurs and impact investors.

During these conferences, we were presented the last trends of impact investment and the shift from classical grants, when financers celebrated the millions distributed without efficient monitoring on how it was use, to grants monitored as loans or even equity where the results are celebrated more than the amount given. The spectrum of financers is wide and includes grants, loans, equities and combination of the three according to the maturity, the proven sustainability of the social business and it legal structure (for profit or non profit or a combination of both).

But what was highly discussed between the delegates of the conferences dedicated to impact investment was the “pipeline issue”: impact investors are willing to invest, social entrepreneurs are looking for money but connections between these two actors are not easy. The discussion showed some reasons for this pipeline issue.

First, impact investors are looking for the “million dollars deal” when most social entrepreneurs are only looking for thirty to fifty thousand dollars investments. As a result just a few very well known social businesses receive the majority of impact investment fund and the majority of social entrepreneurs are still having difficulties to find financing.

Despite the reassuring speech of the impact investors present during these conferences, social entrepreneurs also have the feeling that they kept their classical investors “reflexes” and are still looking for high rate returns that they cannot provide; and the more intermediaries there is between the initial investors and the social entrepreneurs, the higher will be this expectation. However, the impact investors assured that 6 to 8% was perfectly acceptable as rate returns for social businesses.

But the most important problem that was raised was the difference of culture between these two actors: impact investors were reproached to use an incomprehensible financial language and social entrepreneurs were said to lack business culture and skills to meet the investors’ requirements.

Social entrepreneurs are willing investors to be more passionate and to show more involvement in their businesses in order to help them to meet their goals and are looking for consulting services in addition to funding . The social entrepreneurs would also like, and that was discussed in almost all the conferences I attended, to find all the information on impact investment in a common place, on a dedicated platform: who are the actors, what are their investment philosophy and what can they propose to social investors. It could be a tool to solve the “pipeline issue” without adding intermediaries between the actors. Does anyone have a existing platform to recommend for this?