FINANCIAL POST | Why this startup went to India to help solve the global diabetes epidemic
Advantages in disadvantages: Jana Care tested its device in hospitals in Bangalore within a year of start up — a feat that would have been unlikely, if not impossible, in the U.S.
This article originally appeared in the Financial Post on November 20, 2015.
TORONTO - As a graduate student at the Massachusetts Institute of Technology, Montrealer Michal Depa wasn’t satisfied with working on technology to analyze images from cutting-edge MRI machines. “The problem with something really high-end is that it doesn’t really make it to many places,” he said. “I was looking for something that has a wider application.”
Leaving behind a doctoral scholarship for MIT, the electrical engineer packed his bags and headed to Bangalore to build Jana Care, a startup that designed a small device that can be hooked up to a smartphone for diabetes testing.
In India, where 61 million people have diabetes and tens of millions more are at risk of having it, the technology has the potential to make a big impact.
The idea came to fruition in 2011 after Depa met his co-founder Sidhant Jena, then a student at Harvard Business School, at an MIT volunteer research group working on healthcare technology for developing countries using mobile phones.
The two were keen to help the poor, but decided to build a for-profit business. “Not for the reason of the profit part, but to build something actually sustainable,” Depa said. They also didn’t want to be tied down by ebbs and flows in volunteer labour or cyclical grants.
The pair toyed with the idea of designing a device for heart problems before they realized that diabetes, which can damage the heart, blood vessels, eyes, kidneys and nerves, affects a huge swathe of cardiac patients. It also presents a deeper problem, in part because many Indians can’t afford testing and millions don’t know they have it.
“In a way it is the mother of all chronic conditions because it causes a lot of them,” Depa said.
Their idea was to simplify the blood test for diabetes. What they came up with was Aina, a device that turns a smartphone into a blood analyzer. Using a drop of blood from a finger prick, the device can run five tests, including the HbA1C, which is used to diagnose diabetes and is usually done in a lab using blood drawn from a vein.
“With one mobile device, people can go through a village and actually test people’s glucose levels,” said Geoff Woolley, chief executive of Unitus Impact, a venture capital firm that invests in businesses, including Jana Care, that help the poor in Asia. “… You basically have world class technology applied with markets that really need it very badly and they can do it at very low cost.”
You basically have world class technology applied with markets that really need it very badly and they can do it at very low cost
But Depa and his colleagues worried that simply analyzing blood would help doctors more than patients, who need to manage their diabetes daily with diet, exercise and glucose checks when medical help isn’t around. “The patient needs to be empowered to … make decisions, educated decisions, while they’re not with a doctor,” Depa said.
Now, the startup, which has secured more than $2 million in funding, is pursuing a multi-pronged approach to diagnosing and treating diabetes. To reach the under-diagnosed poor, it’s selling the device with an application for smartphones and tablets that can be used in doctor’s offices, clinics and government hospitals.
Doctors also use it to test wealthier patients, but Jana Care aims to sell the device to middle class patients with diabetes or pre-diabetes for use at home alongside a subscription-based lifestyle program called Habits. Based on a successful clinical trial by the National Institutes of Health in the U.S., the program helps patients manage their diet, physical activity and other concerns related to the disease. It includes a smartphone application, an online component with a reality TV series and a weekly phone call with a lifestyle coach.
Jana Care, whose device is in use at 25 primary clinics in India, plans to be in 500 primary clinics and 50 hospitals, in addition to becoming profitable, within the next 12 months, with the help of partnerships it formed with Narayana Health — a major Indian hospital chain — and the largest chain of diabetes clinics in India. By the end of July 2016, Jana Care aims to reach 70,000 to 80,000 Indians, including 50,000 subscribers to the Habits program, which has about 7,000 subscribers now.
“Device companies, especially startups, are very fragile because someone can always come and undercut you,” Depa said. Jana Care hopes, as a value-added service centred around the device, Habits will mitigate this challenge.
Grand Challenges Canada, one of Jana Care’s main investors, projects the company could reach five million patients by 2030. That would be a great return on investment for Grand Challenges, which is funded by the Canadian government to invest in solutions for healthcare problems facing developing countries, said Andrew Taylor, vice-president, investments.
But, Jana Care must confront several challenges to hit those numbers, including low levels of literacy, customers who speak dozens of Indian languages, reaching poor patients without smartphones, and ensuring their device can be used by healthcare workers who assist the poor and may have little professional training.
Among other things, Jana Care has translated its content into several Indian languages, employed lifestyle coaches from various parts of India, and focused on designing a visual application so the device can be easily used by someone with no medical knowledge and little schooling. Because they developed the device in India, they’ve already been able to test it out on thousands of patients from different socioeconomic backgrounds.
“The cost structure to basically develop this technology and also a huge population base to test it on is a lot better economics than it would be to do the same thing in the U.S.” Woolley said.
Jana Care tested its device with patients in hospitals in Bangalore within a year of start up — a feat that would have been unlikely, if not impossible, in the U.S., where companies must pass through more hoops and pay higher fees even to run simple tests, Depa noted.
Within the next year, Jana Care plans to take its product to Southeast Asia, but it eventually wants to expand to developed countries, including Canada. It’s currently applying for regulatory approval to sell the device in Europe, a certification that would be recognized internationally.
There’s no one-size-fits-all solution to the diabetes epidemic, which affects 90-year-olds in nursing homes and young people who handle their own care, but Canadian patients could benefit from this kind of technology, said Jan Hux, chief science officer at the Canadian Diabetes Association.
“There’s lots of intelligence and creativity and innovation happening in countries less developed than us. There’s advantages built into their disadvantages,” she added.
Medical products designed in the West tend to be ill-suited for emerging markets, while those developed under harsher conditions are easier to transfer, Depa said.
“You can actually create high-end medical products in emerging markets and then swing them back, get them to work in Western markets after, which is not something people usually do. If we succeed, it would be a huge validation of that approach.”