At some point or the other, exasperated doctors across the world have used toys, balloons and lollipops to lure little kids into getting their shots, injections that can protect them from dreaded communicable diseases and detect preventable ones. But what happens when instead of colicky children, pregnant women at risk of developing anaemia resist a simple, syringe-based blood test that can save their lives?
With next to no trained staff at rural primary healthcare centres (PHCs), no medical infrastructure to conduct tests, reused syringes not being sterilised or disposable syringes being reused, who can blame them from shying away from the test? It doesn’t help that the long drawn procedure involved means loss of a day’s pay for rural women, often the breadwinners of the household.
During their tenure at Nair Hospital in Mumbai, doctors Abhishek Sen and Yogesh Patil were faced with this quandary very often. “Because of the negative associations of syringes, there are a lot of superstitions surrounding their use — including one that says giving injections to pregnant women will make the baby’s complexion darker,” says Patil. Though it takes just one simple blood test per trimester to check for anaemia in pregnant women, India still has high prevalence of the disorder among expecting women.
According to a National Family Health Survey (NFHS) report, 70-80% of children and 70% of pregnant women in India suffer from anaemia. So when a 2009 World Health Organisation (WHO) report said that 52% of all pregnant women and 1.6 billion people worldwide were anaemic, the doctors knew they had to do something.
With the help of their engineer friends Myshkin Ingawale and Aman Midha, the doctors set up Biosense Technologies and decided to develop a device that would help rural patients undergo instant blood tests without the use of syringes. “We wanted to do something for the masses and the healthcare sector was in dire need of affordable innovation,” says Patil. While researching diagnostic methods that don’t involve needles, the team chanced upon the concept of using different wavelengths of light for blood tests.
IIT Bombay funded and hosted ex-student Patil’s attempts to design the device with Sen, though the duo had no luck the first, wait for it, 33 times. They struck gold with the 34th attempt, however, and Midha and Ingawale helped them perfect the device. In 2012, ToucHb was born — a handheld machine that can give you instant haemoglobin readings for less than ₹5 per reading, without a single pinprick.
Thanks to the cause Biosense is working for, funding has always been forthcoming, with the Centre for Innovation, Incubation and Entrepreneurship at IIM Ahmedabad providing the ₹5 lakh seed fund for the venture. Patil and his team personally invested ₹2 lakh into Biosense, and received ₹80 lakh from Global Superangels, ₹20 lakh from New York-based venture capital firm Echoing Green, ₹30 lakh from Villgro Innovations and ₹1.5 crore from the Insitor fund.
Putting it together
Solid investments and a dedicated engineering team meant that within no time, ToucHb prototypes were ready to be tested. The device, which runs on AA batteries, has several colourful avatars, apart from a classic black case. To check your haemoglobin count on ToucHb, you have to insert a finger into the probe fitted on the device and wait for the reading. LEDs fitted on one side of the probe transmit light through your nail and a photodiode on the other side processes the absorption pattern to give details of haemoglobin level, pulse and oxygen concentration. “Currently, ToucHb has 90% accuracy, but we are working on pushing that up to 98%. Since the device is still in a pre-release state, we might be able to achieve our target very soon,” says Patil.
Biosense has assembled close to 600 ToucHb prototypes and has the capacity to deliver 1,000 units per month. For the test run, Biosense has sold 200 devices at ₹30,000 apiece to more than 130 clinics, including those run by NGOs. Says Sachin Gupte, director (health), Swades Foundation, “ToucHb’s portability is a major advantage in rural areas as people there don’t have proper access to medical care, and anaemia and malnutrition are major problems.”
Swades, which received its ToucHb consignment in the first week of August, has successfully screened 300-350 patients so far. It is about to begin a major rural health camp in Chhattisgarh and has bought 10 ToucHb machines and 10 extra probes. “We use ToucHb to diagnose anaemia in rural patients and provide folic acid tablets to those with low haemoglobin count, based on its readings. And it didn’t take very long to train our personnel in using the device,” Gupte adds.
Apart from portability, ToucHb also has a cost advantage over traditional diagnostic techniques used by laboratories for blood tests. The current setup has an installation cost of ₹5 lakh and costs ₹18-20 per use, thanks to the chemicals and equipment that have to be procured repeatedly. ToucHb, on the other hand, runs each test for less than ₹5, and with a life of 10,000 tests on each set, makes up for its pre-release price of ₹30,000. For NGOs or PHCs in a remote area with very little medical infrastructure, ToucHb will be a boon to safeguard maternal health during pregnancy. With the domestic diagnostics market valued at $2.2 billion (₹13,312 crore), the opportunity is immense for Biosense.
The company sources separate parts of the device from manufacturers in Chennai, Navi Mumbai and the US and gets them assembled at its Thane office. It offers a three-year warranty on the device and a one-year warranty on the probe attached to it. Biosense is currently making minor changes to the user interface and the efficiency of the battery. Once ToucHb is commercially launched by the year-end or early next year, it may offer discounts to current users if they wish to procure the newer version. There are no plans to hike the price for the market version, which should be out early next year.
So far, Biosense has notched up ₹45 lakh revenues in FY13, but is far from break even as it continues to plough money into research and development. However, proceeds from its investors should keep the business afloat till then. Says Pinaki Bhattacharya, Villgro’s chief investment and incubation officer, “The device is quite innovative and likely the first such in the Indian market. But there is a lot of competition for such devices abroad, so we hope that Biosense will include more diagnostic features in the device before launching it in the international market.”
Next is what?
In its bid to improve the quality of healthcare provided in rural areas, Biosense has so far sold the device to NGOs and smaller clinics. It plans to approach the government with ToucHb by December 2013, once it improves upon the accuracy rate. Biosense wants to collaborate with the ministry of health and family welfare on the National Anaemia Control Programme and the Janani Suraksha Yojana (JSY), and aims to ultimately make the device available through the National Rural Health Mission (NRHM), as that would give it direct access to PHCs and government health check-up programmes.
The NRHM has a much wider reach, with nearly 12 million pregnant women benefiting from its schemes. The ministry also runs 600 targeted facilities to treat malnutrition and anaemia. “We want to start distributing ToucHb to government hospitals, as they are the biggest players in the healthcare sector. Bulk buying done by the government will make the deal financially viable for us as well,” says Patil.
But there are significant hurdles ahead. The most critical one is that the firm doesn’t have a distribution system in place at present and depends on its sales team’s efforts in reaching out to NGOs and clinics.
The focus on ToucHb doesn’t mean Biosense has shifted its attention from innovation. It recently released a free iPhone application uCheck, which gives instant results for urine tests. uCheck is pretty unique in the sense that it can help consumers regularly test their glucose levels and check for hepatitis or urinary tract infection problems at home without involving a diagnostic lab. “The home user-based screening device concept is growing rapidly in the Western markets, especially USA,” says Karan Gupta, India investment manager, Insitor Fund.
Biosense is also making its presence felt in markets such as Africa and South East Asia, which show the highest prevalence of anaemia. It is in the process of signing partnerships with distributors in West Asia and Europe and plans to begin operations there by December 2014. With the worldwide market for anaemia drugs and diagnostics valued at more than ₹60,940 crore, Biosense is more than eager to grab a share of the pie. The team has started looking for viable distributors in markets like the US and Europe so that as soon as ToucHb takes off in India, the firm can tie up with companies abroad to sell its products. To protect its interests, it has filed three provisional patents in India.
Biosense plans to sell 1,000 devices in the current fiscal. That sounds ambitious but Patil believes the founders are up to the challenge. “Since we are friends first, collaborators next, working together we can achieve a lot,” he says. Whether their camaraderie indeed manages to touch other people’s lives remains to be seen.