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Market-Relevant Design: Making ECGs Available Across India

In the history of modern medical technology, most products have been developed in and for markets that are most able to afford them, and then modified later for distribution in other areas. From a business perspective, this seems a perfectly logical approach. But in practice it has meant that many life-saving tools and procedures have been slow to trickle through to developing economies, beyond the major medical centers.

Across large swathes of the developing world, not to mention some parts of developed countries, there is simply no economic means to equip clinics and GPs with advanced medical equipment. Poor infrastructure can impede the use of high-end medical equipment — electrical supplies are often unreliable in many areas, and poor roads or public transportation can make it difficult for people to access the care they need. Shortages of trained medical staff are also a huge problem. Skilled doctors and nurses often move to urban centers or migrate to earn a better living, leaving rural areas underserved. In India, 75 percent of medical professionals work in urban centers, leaving only 25 percent to serve three-quarters of the country’s population.

All of these factors affect how healthcare is delivered in any particular market, and they underscore the weaknesses of simply pushing developed technologies to the developing world.

At GE Healthcare, the traditional model of product development has been gradually shifting towards in-market innovation — designing entirely new products to meet the needs of a specific country or region. It is an approach that fits perfectly with GE’s Healthymagination initiative, which is dedicated to improving people’s access to quality healthcare at a lower cost, around the world. It is good business, as well.


Designing for Local Needs

GE Healthcare’s MAC line of electrocardiogram (ECG) systems is a success story of innovation in India, for India and the world. The ECG is the most widely performed cardiac test in the developed world, and GE has long been at the forefront of the industry. Since 2001, the company has manufactured high-end electrocardiogram systems in Bangalore, destined for major hospitals in urban centers in India and beyond.

But by 2005, GE’s engineers in India were eager to create a product that was designed and priced for use across the wider Indian population — an ECG machine that would reflect the economic and infrastructural realities of the country. What emerged, in 2007, was the MAC 400, an ECG machine designed to extend the capability of a traditional ECG to a largely rural and poor population. While embodying the engineering excellence that GE is known for, the MAC 400 is designed for developing market conditions. It is highly portable and can be easily carried to a patient’s home, it has an easy two-button operation that makes training faster, and it can operate on battery. Above all, the MAC 400 costs around $800, compared with other hospital-class units from GE Healthcare that range from $2,000 to $10,000.

Carrying their efforts even further, last year GE Healthcare’s Bangalore team set a new bar for low-cost ECG with the MAC India. Incorporating a smaller printer and battery-only use, the MAC India is priced at $500, potentially reducing the cost of a single ECG exam to as little as the price of a bottle of water for rural patients. Moreover, battery performance has been enhanced, enabling as many as 500 ECG readings on a single battery charge.

Another innovation followed — digitizing the entire process in consideration of the gap in skilled manpower, as well as accessibility required for use in large cardiac camps or reaching patients in inaccessible areas. The MAC 600 was developed with a built-in screen to view ECGs instantly, eliminating the need to print all ECGs and thereby saving costs and paper. The MAC 600 allows technicians and doctors to store and transfer ECGs in a universal PDF format using any multimedia phone.


Making an Impact

To date, more than 10,000 MAC units have been sold — a success for GE Healthcare and for customers and communities across India and the world. At the Mettur Diabetes Centre and AV Clinic in Salem, a small city in the southern state of Tamil Nadu, India, approximately 5-6 ECGs are conducted each day. The clinic, managed by Dr. Krishnaveni, recently purchased a MAC India system to replace a very basic machine they had used previously, and to improve the quality of their ECG readings.

Portability was an important selling point for Dr. Krishnaveni, who sometimes has to deal with acute cases that required carrying the ECG machine to the patient.

“People don’t have much to spend on their health problems, so it definitely makes a difference to have a machine that doesn’t cost too much,” Dr. Krishnaveni says. “With the MAC India, we’ve been convinced by the quality of the ECG tracings and the easy handling of the machine. It is very user-friendly.”

Offering high-quality diagnostic information, ease of use, portability and a low unit cost, the MAC India is a highly competitive product in this market.


Penetrating Rural India

According to S Anand, an area sales manager for MAC in Southern India, 90 percent of MAC customers are individual physicians, as opposed to primary healthcare centres.

It’s through direct sales efforts that GE is making strides into the rural and semi-rural markets in India, and slowly making an impact on the quality of rural health with MAC.

“At GE Healthcare we’re not focused solely on selling; we want to improve the quality of community health services, and access is the biggest issue,” Anand says. “Many thousands of people in rural areas who once may have had to travel 10–20 miles to get an ECG can now do it at a local clinic. So that is one thing we have been able to do over the past year and a half. The only hindrance so far is that we’re not as well known in the market as the competition, but our product is of high quality, and people who know GE know it stands for quality.”