NB Health Care

March 3

Jugal Parekh

Lessons Learned Building Locally-Sourced Wheelchairs

A couple of years ago, a startup solar lantern business introduced their product to various villages in India. The lantern could be charged through the day using sunlight, then used at night to provide light, with enough power to charge small electronics like mobile phones. The startup managers’ noble intention was to sell the lanterns by convincing the villagers of the obvious benefits of light in the dark, including education and health.

However, they were worried about the solar lantern’s list price, as they assumed that they would be unable to convince a typical villager who makes around U.S. $2 a day to pay in the region of $80 to $100. Weren’t they wrong! Their entire first shipment was sold out within a few days, and they had to double their next production lot to meet the demand.

As it turns out, the lanterns sold out because of a tangible benefit that no one at the startup imagined. Electricity grids at the initially targeted villages were not well developed; that’s one of the reasons why those villages were selected as the test cases for solar lanterns. However, what the team did not understand was that mobile phones had penetrated deep into those communities. Along with mobile phones comes the daily need to charge those phones, which the villagers could only get done at a select few locations (at the more privileged households; not at legitimate centers of businesses), which charged around U.S. 10 cents per mobile phone. Families did quick calculations and bought the solar lanterns – primarily to charge their phones, and unintentionally bringing light for education and health.

Usability and context are often overlooked when designing for the “next billion,” and that, in turn, has a major impact on the ultimate effectiveness of the project. Following are some of the lessons learned at JJD Innovations (which I  co-founded), where we are currently in the prototype stage of a project designed to enable workers in an Indian village to build wheelchairs with locally-sourced materials.


Lesson 1: Field realities

A designer’s knowledge base on usability reflects his own understanding or textbook logic; however, there’s sometimes a gap between a designer’s knowledge and reality. This is often experienced when designing a new medical device (software or hardware) for health care professionals. An engineer or designer builds the product design specifications independently, or sometimes with a small batch of users. However, when put into trial use, we often find that the actual users have found a workaround or unintended use which makes a lot more contextual sense than the intended purpose.

finished prototype

JJD Innovations made this customized wheelchair, utilizing seven local small businesses and tradesmen, for just under U.S. $50. Photos courtesy of JJD Innovations

For example, a hospital electronic medical record system might record all the medications prescribed in alphabetical order. However, when a doctor has only two minutes with each patient, he might find it easier to scan through the records if they are sorted according to the medicines’ subcategories. This example is especially useful when designing a product or service for massive health camps. Workers are either volunteers or low-paid and have to deal with the stress of handling a crowd of individuals who don’t know what to expect. Apart from the job of benefitting the individuals, workers have to manage fear, anxiety and apprehension of the procedures.

It is important for designers to understand not only the benefit they are providing with their product or service but also how the user might behave pre- and post-utilization. Imagine convincing an unaware individual at a health camp to take an HIV test using rapid in vitro diagnostic products, and the anxiety that individual might experience after receiving the results – especially since the scope of the health camp was just to conduct the tests and provide informative leaflets. Mapping the bigger picture will improve safety and effectiveness, and create a lasting impact.

Cultural differences between developed and developing nations (a large topic in itself), and the reasons for these differences, can be a game-changer in design. Understanding these reasons and including provisions for them in the design are early-assessment techniques for a successful innovation.


Lesson 2: Iterations

With improvements in technology, and the addition of tools such as 3D printing and modeling software, it is easier to prototype, test, fail and rebuild quickly. That should be the motto when a project is initiated in the developing world. It is not uncommon to go through many versions of a design specification document and prototypes should be structured into the design process early on. Prototypes should be frugal, and possibly not be made to the required standard – but remember, they do not need to be. They are meant to verify the feasibility of the project, quickly, for your next version.

With our wheelchair project, we had to reiterate the engineering multiple times based on the availability of the materials, and reiterate again when the material was available but the processing skill was hard to find locally – especially when the building process was more expensive than conventionally believed in the Western world: U.S. $1.50 (or 100 Indian rupees). That would not be a consideration for a developed country but, remember, that is almost equal to a daily wage in an Indian village. The wheelchairs that we design will be custom-made for each individual to allow for more efficiency and comfort, at a target cost of less than U.S. $50.


Lesson 3: Community impact

Wheelchairs can lift individuals and their families out of desperate situations by empowering sole bread-winners with mobility. There are many charities and not-for-profit organizations that supply wonderful wheelchairs to people around the world who otherwise would not be able to afford them. However, the impact is often limited by the reach of these organizations, and also by a lack of awareness in the communities that need them. And, disturbingly, wheelchairs donated by organizations might be sold by middlemen for profit and never reach the intended families. We are therefore trying to empower local artisans like welders with basic skills needed to build “mobility solutions” that are customized to the end-user, while also creating a virtually endless supply of these products and services. Utilizing locally sourced materials and skills impacts the end-user and the business community simultaneously, and that is how we intend to reach the next billion.

Innovating for the developing world is not a textbook process or something that can be learned from afar. Each – and I highlight “each” – case study has a lesson. Sources like this website, getting on the ground with prototypes and assessing the community, are the only ways to truly, safely and effectively reach the next billion. 


Jugal Parekh

Health Care
entrepreneurship, global health, health care, product design, scale, sustainability