A recent edition of TED Talks featured Myshkin Ingawale a co-founder of Mumbai-based Biosense which has invented a needle-free, handheld haemoglobin measuring device. This is big for a country where anaemia or low haemoglobin count is the leading cause of maternal mortality even though iron supplements are cheaply and plentifully available.
Many of these deaths can be averted with early diagnosis but women often lack adequate and timely access to healthcare facilities and don’t know they need iron supplements.
Biosense’s product ToucHB is a point-of-care device which means it takes diagnosis to the patient rather than the other way around. So, for instance, in a rural area a woman will not have to trek several kilometers to a primary healthcare centre if a government worker can visit her with ToucHB and test her on the spot. Since it’s non-invasive (no needle pricks necessary), it also addresses another problem – the unwillingness of women to give blood samples if they don’t feel ill. Anaemia does not always manifest itself in overt symptoms like say, morning sickness does.
The product is currently undergoing testing.
Biosense’s product is a good instance of how something made to address an urgent public health need can also have a wider market that could create enough volume to make the project feasible even successful.
In urban areas, for instance, “people would have the paying capacity to buy such a product for constant monitoring,” says Abhishek Singh, head (healthcare) at Crisil Risk and Infrastructure Advisory. Direct selling could be done through clinics and pharmacies, he says.
That would be a better bet in the short term than the rural market which is best tapped in partnership with the government. The National Rural Health Mission has targeted a reduction in maternal mortality rates to 100 per 100,000 live births from 212 in the period 2007-09 (the last reported official estimate).
Ingawale said in a conversation with me last week that while the government would be an “impact player” this being a new technology with “rough edges” getting its buy-in would take time. Assuming it clears testing, the initial adoption would most likely be from “risk-takers” such as clinics run by private foundations, individual doctors with CSR budgets or non-profits. Maybe even pharmaceutical companies who have strong haematinic portfolios who want to do free camps, he said.
“It won’t happen overnight,” he said. “We have to show results.”
The company’s ambition is to take the cost per test to Rs 10/ which is a fraction of what it costs using conventional technology in a city like Mumbai. It also wants to use ToucHB as a point-of-care platform for other tests.
Biosense is but the latest instance of homegrown medical device companies doing product innovation. This is doubly interesting because for years now the medical technology sector has been the poor cousin of the Indian drugs industry for a variety of reasons.
A critical mass of synthetic chemists, favourable policy and entrepreneurial vision has led to a revolution in the Indian generic drugs industry. But medical technology has found it tougher on all counts.
For one, the sector needs a variety of unrelated capabilities such as medicine, engineering, design and so on to be available in plenty and work together at a similar level of competence and quality not just within the organisation but also its vendors. In India, that has been lacking. For instance, Biosense gets its processors made in the US, its LEDs from Japan and its boards from Germany.
Two, regulation has been a travesty. Barnyard operators have operated with impunity tarring the entire indigenous industry.
Importantly, the market for medical technology in the form of hospitals and laboratories has been very limited until recently not justifying the risk and investments called for. And even those who dared usually made cheaper versions of western innovations.
A few things are changing – med tech start-ups are now buoyed by relatively more avenues of funding such as venture capital and impact investing. And they have a growing market – private healthcare is taking off and the government too plans to commit more funding to healthcare.
But there’s still need for world-class regulations. Even now, important legislation governing medical devices is in limbo and device companies are governed ad-hoc under the Drugs and Cosmetics Act since 2005 in a kneejerk reaction to a court order. There is also need to create global quality manufacturing so that various capabilities can be sourced efficiently and indigenously.
Entrepreneurship in med tech has emerged against the odds. It won’t hurt to even things out a bit.