Dr. Abhishek Sen, Dr. Yogesh Patil, Dr. Darshan Nayak, Aman Midha and Myshkin Ingawale got together to work on a not-for-profit project to reduce mortality caused by anaemia. What started as a project ‘AnaeMedia’ turned it into a full-fledged technology startup in December 2008, when the project gained traction in the ecosystem. The team won the second place at IIT-Bombay’s Techfest in 2008 for its project and was the runner-up at the Piramal Prize (a partnership between Piramal Foundation and CIIE – Centre for Innovation, Incubation, and Entrepreneurship at Indian Institute of Management, Ahmedabad) and was awarded incubation at CIIE. This project was then transformed into Biosense Technologies (Biosense), a company that monitors anaemia, which is a problem on the rise in developing counties. “Our incubation at CIIE gave us the confidence and reassurance to do our own thing and that it was alright to be disruptive and sometimes, even fail in an otherwise traditional industry,” says Myshkin Ingawale, co-founder and chief executive officer.

The tragedy is that the cure for anaemia is relatively well known – iron tablets, folic acid and regular monitoring of haemoglobin levels. But we found that monitoring anaemia was the real problem.

Biosense received Rs. 1 crore from its promoters and angel investors. “Funding is not a problem for a startup unless you treat it like one. If you have a strong team and show commitment to your idea, then the investors who really believe in what you stand for will support you,” says Ingawale. The company got innovation grants from the Government of India in 2009 (through the Technopreneur promotion programme for Rs. 12 lakh) and in 2010 from US-based Echoing Green, a fund that encourages social innovation, to the tune of Rs. 40 lakh. In 2011, Villgro, a company that empowers rural development by identifying and incubating innovation that can be translated to market-based models, offered them support. “Since anaemia is a big problem in rural India, Villgro was interested in working with us to meet the needs of people,” says Ingawale. He adds, “It has committed Rs. 30 lakh and will provide mentorship and support from its expertise in rural innovation scale-up.”

Beating anaemia
Undiagnosed anaemia kills more than a million women and children each year globally, with a large number being from developing countries. “The tragedy is that the cure is relatively well known – iron tablets, folic acid and regular monitoring of haemoglobin level. But we found that monitoring anaemia was the real problem,” says Ingawale. In general, access to diagnostics is expensive in developing countries relative to its treatment. And the founders felt that this is a very big impact area for the future and a great place to be for a technology startup.

Biosense’s innovation, ‘ToucHb’, is an instant non-invasive, hand-held, battery operated device for monitoring anaemia. The company wants this to be the beginning of change in the way public healthcare functions. By making diagnostics affordable and accessible, it is shifting the focus to preventive medicine, rather than expensive reactive medicine. Based on the initial pilots, its pricing will be Rs. 10 per test as against Rs. 300 to Rs. 800 for a laboratory (lab) test. However, Ingawale clarifies, “As a screening tool, ToucHb will not give the accuracy that a lab test offers. And hence, we will not replace lab tests but be complimentary.” Lab tests not only give haemoglobin count results, but also offer 13 other blood analytes in the output report and are accurate. It requires expertise to come up with this result and takes about a day to turnaround. If a patient is diagnosed with anaemia through ToucHb, he/she has to undergo further investigations via lab tests to understand the depth of the problem.

With four out of the five founders working full-time, Biosense took three years to develop this product and has filed two Indian patents and one world patent for the product. The company also has five others in the team – designers, field staff and engineers. It plans to market its products through channel partners, medical distributors, pharmaceutical companies and through direct sales to healthcare chains. It earns its revenue from selling the device and through a recurring yearly maintenance fee to service the devices.

How does it work?
ToucHb is a hand-held, needle-free (non-invasive), AA battery-operated medical device that screens for anaemia. It has a small finger clip that goes on the patient’s finger and a LCD screen on a mobile phone sized body that reads the blood haemoglobin, oxygen saturation and heart rate in 10 seconds. “The closest device you might have seen to ToucHb technology-wise is the heart rate and oxygen saturation monitoring device called Pulse Oximetry in hospitals,” says Ingawale. It is a mature technology that measures oxygen in blood non-invasively, but not haemoglobin.

In high resource settings (like the urban areas), an anaemia test is done through a blood test to check the haemoglobin level at a hospital or a diagnostic pathology lab. These centres use machines called the Coulter Counter (costing US $ 20,000). In low resource settings (like in the rural areas), the existing solutions are not so effective. While pregnant women are recommended to get a haemoglobin test at least once in every trimester of their pregnancy, it is inconvenient for them to walk to the nearest primary healthcare centre (which could be more than five kilometres at times) and hence, end up skipping the tests. Even if they go, in most cases, the health worker does not have such machines for surveillance. “I have seen field workers use a device called the Sahli’s apparatus in settings where there is no access to such sophisticated equipment or technicians,” says Ingawale. “There is a lot of subjectivity, problems like breakages, lack of acceptability and more with this method, and the clinics in rural areas are crying out for a better option,” he states.

Even if the right tools are available, the population is less compliant with the idea of withdrawing blood. ToucHb, with its non-invasive nature, aims to get over this specific problem and help keep track of rural health. At this stage, ToucHb is the only commercial product from Biosense. “But we have a few aces up our sleeves in our lab,” shares Ingawale. Since the company has a non-invasive platform technology, it can do diagnostics of adjacent areas like jaundice, pneumonia and sleep apnea.

Starting small, aiming big
The company had a pilot launch early this year for its product. “This was a controlled, limited launch. We will have a full launch later this year, once we have the quality analysis in place,” says Ingawale. Biosense sells ToucHb to clinics – both public and private. “We are not planning to scale our sales too heavily for the next six months and would only sell to select clinical outfits. This is because we would like to develop the service infrastructure to scale this reliably to as many clinics as possible over the next three years,” says Ingawale.

In five years, Biosense hopes to increase its sales numbers significantly. “There is a potential to sell about 10 million devices across the world,” says Ingawale. It plans to sell its product in at least six to seven countries – those with similar healthcare related problems like Mali, Ghana and Kenya in Africa and Bangladesh – after it establishes itself in India. “At some stage, we would also enter the U.S. and European Union, which have specific regions where this technology would be very well received,” concludes Ingawale.

Concept in brief

Biosense Technologies has developed ToucHb, a non-invasive, hand-held, battery operated device for monitoring anaemia. The company wants to change the way public healthcare functions by making diagnostics of anaemia cheap, accessible and at the doorstep of the consumer.