Sustainable Healthcare for the Base-of-the-Pyramid by Chetan Shivarama

www.io.tudelft.nl/BoP Phone: +31 (0) 15 278 3034 Fax: +31 (0) 15 278 1839 E-mail: p.v.kandachar@tudelft.nl

Sustainable Healthcare for the Base-of-the-Pyramid: Research and Design (2008-2010)

Delft University of Technology Faculty of Industrial Design Engineering Landbergstraat 15, 2628 CE, Delft, The Netherlands.

Sustainable Healthcare for the Base-of-the-Pyramid Research and Design (2008 - 2010)

Prof. Dr. Prabhu Kandachar Dr. Jan Carel Diehl Dr. Vikram Parmar Ir. Chetan Kaanadka Shivarama

Editors: Prof. Dr. Prabhu Kandachar Dr. Jan Carel Diehl Dr. Vikram Parmar Ir. Chetan Kaanadka Shivarama Cover design: Chetan Kaanadka Shivarama Sustainable Healthcare for the Base-of-the-Pyramid (BoP): Research and Design Overview Report (2008 - 2010) Edition: April 2011 ISBN 978-90-5155-074-0 ÂŠ 2011 Delft University of Technology All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronically or mechanical, including photocopying, recording or by any other information storage and retrieval system without explicit written permission from the authors. Delft University of Technology Faculty of Industrial Design Engineering Landbergstraat 15, 2628 CE, Delft, The Netherlands. www.io.tudelft.nl/BoP Phone: +31 (0) 15 278 3034 Fax: +31 (0) 15 278 1839 E-mail: p.v.kandachar@tudelft.nl

CONTENTS Photo: PerformImpact

CONTENTS

PREFACE 4 1. INTRODUCTION 1.1 Base-of-the-Pyramid 1.2 BoP activities at TU Delft - IDE 1.3 Proposed research 1.4 Planning, costs and management 1.5 Research proposal â&#x20AC;&#x201C; Strategic

7 8 8 8 9 10

2. RATIONALE 2.1 Introduction 2.2 The importance of good healthcare 2.3 Millennium Development Goals 2.4 Global disease burden 2.5 Root causes of disease burden 2.6 Financial risks 2.7 Healthcare infrastructure 2.8 Proposed research and development strategy 2.9 Execution

13 14 14 15 16 17 17 18 18 19

3. RESEARCH - PROGRESS REPORT

4. EDUCATION 4.1 M.Sc. Graduation projects

37 38

5. VALORIZATION 5.1 Introduction 5.2 Industry partnerships 5.3 University partnerships 5.4. Research programs

41 42 42 43 46

55 56 56 56 58 58 58 58 58 59 59

7. OUTPUT 7.1 Published Research Papers 7.2 Sustainability Challenges and Solutions at the Base of the Pyramid: Business, Technology and the Poor 7.3 Impact of BoP Ventures – International Conference, 2009

61 62 82 83

8. FINANCIAL REPORT

129

9. PEOPLE

133

CONTENTS

6. PLANS 6.1 Proposal for “Design for Emerging markets (DEM)” master track of IPD 6.2 Objectives of DEM master track 6.3 Education program 6.4 Course objectives for DEM students 6.5 Benefits of DEM master track 6.6 Competitive advantages over other design schools 6.7 Human resource requirements 6.8 Financial requirements 6.9 Proposed starting date/schedule 6.10 Team

PREFACE PREFACE

This report summarizes the findings on running and completed research and related projects in the area of Sustainable Healthcare for the Base of the Pyramid. Base of the Pyramid (or Bottom of the Pyramid, as it is sometimes termed) refers to the 4-billion plus poor mostly in non-western countries in Asia, Latin America, and Africa, living on incomes less than $3260 per year1 (2009). Some parts of these geographical regions, such as Brazil, Russia, India, China (named as BRIC countries in 2003 by Goldman Sachs), have markets experiencing phenomenal economic growth not unnoticed by the affluent west. In 2005 Goldman Sachs mooted the BRIC successors, otherwise known as the Next-11 (N11). This grouping comprises of Bangladesh, Egypt, Indonesia, Iran, South Korea, Mexico, Nigeria, Pakistan, the Philippines, Turkey and Vietnam. These “Emerging Economies” share the characteristics of rapidly growing populations combined with significant industrial capacity or potential. They also house a large percentage world’s poor.

Around the turn of the millennium it had become strikingly evident that development aid, charity or ‘global business-as-usual’ would not deliver solutions to poverty as had been expected. Despite the expectations, the gap between wealthy and poor kept widening. Today, there is little dispute that poverty is one of the most pressing global problems calling for innovative solutions. ___________________ 1. Monica Touesnard, http://www.bopnetwork.org/ 2. C.K.Prahalad and S. Hart, The Fortune at the Bottom of the Pyramid, Strategy+business, issue 26, First quarter 2002, p. 1- 14 (Booz Allen Hamiliton) 3. The Fortune at the Bottom of the Pyramid: Eradicating Poverty Through Profits, ISBN-10: 0-13-146750-6; ISBN13: 978-0-13-146750-7 (Published 2004) Pages: 432.

Prahalad & Hart2 came up with a BoP strategy offering perspectives to the poor world majority to escape from the poverty and at the same time promising fortune for entrepreneurs. This caught public attention and unleashed an extensive response from academics, businesses, NGOs and others. In his book3, Prahalad went further to propose a framework for the active engagement of the private sector and suggesting a basis for a profitable winwin engagement, between businesses and the poor. This vision of untapped great wealth in the world waiting to be explored & exploited by human ingenuity, by designing products and services to meet the needs of the world’s poor, and then efficiently manufacturing & distributing by the capabilities of the modern corporation, Prahalad contended, needs innovations. This BoP strategy has attracted the attention of scientists and entrepreneurs worldwide, although the scientific publications in this area are often from management sciences, often extending the concepts of corporate social responsibility, sustainability, etc. The extensive response to these ideas is likely due to the limited success of developmental assistance to alleviate poverty in the past 50 years. For more than 50 years, the World Bank, donor nations, various aid agencies, national governments, and civil society organizations Millennium Development Goals

have all fought the good fight, but have not been able to eradicate poverty yet. The adoption of the Millennium Development Goals (MDG) by the United Nations only underscores that reality. About 25,000 people die every day of hunger or hunger-related causes, according to the United Nations. This is one person every three and a half seconds. Unfortunately, it is children who die most often. Poverty has remained one of the world’s most daunting problems even as we enter the 21st Century. The BoP issue is a new knowledge area, and there is a need of broadening the knowledge base. Contributions to BoP knowledge domain is needed not only in general terms but particularly as regards the needs of the users as a starting point for BoP product and innovations. The faculty of Industrial Design Engineering (IDE) at Delft University of Technology unites technology with business, with a human centered approach, while the human needs form the central driving force. This faculty has decades of experience in the practice of designing products and services to meet the human needs. When BoP activity started around the turn of the millennium, the students of IDE showed great interest and enthusiasm to design products and services to meet the needs of the citizens of the BoP. Secondly, the concept of BoP started attracting the attention of many Dutch and some European entrepreneurs, leading to several assignments for IDE students to work them out, often in collaboration with the people living in the BoP. Thirdly, the supervising staff of IDE became equally active in supporting such initiatives. Fourthly some Non-Governmental Organizations (NGOs) both in the Netherlands and in some BoP countries started opening up their doors to such trials. In the meanwhile, several projects in association with business enterprises, NGOs, etc, have been and are being executed by the students and researchers at IDE. These projects cover a wide range of human needs: education, healthcare, food and nutrition, water, energy,

housing, materials, connectivity, designing and tools, and entrepreneurship. Impressed with these developments the Governing Board of Delft University of Technology provided an extra impulse in 2007 by financing a 2-year focused research project on healthcare. This report describes the results of this impulse. Additionally, other spin-offs, both in research and education have resulted, which are also reported here. These include new PhD-research projects, research grants from Dutch Science Council (NWO) etc. Finally, new plans have been developed and reported here towards establishing a focused research activity and educational tracks in the field of product design and innovations for BoP, part of which - the so called Emerging Markets - are in the meanwhile showing rapid economic growth, increasingly attracting the attention of business enterprises, scientists, technologists, policy makers and educationists. A large number of people at IDE continues to contribute to the growth of domain knowledge on BoP. I would specifically like to thank Prof. J.P.L. Schoormans, Prof. P.J. Stappers, Dr. A. Freudenthal, Dr. J.C. Diehl, Dr. V.S. Parmar, D.P. Peck, Dr. Sivakumar Alur, Dr. Santosh Jagtap, Ir. Annemiek G.C. van Boeijen, Mr. Jiehui Jiang and Mrs. Ir. Cs. Buiting-Csikós, whose contributions have made this report possible. I also would like to thank the editors: Dr. Jan Carel Diehl, Dr. Vikram Parmar, Ir. Chetan K. Shivarama. Last but not least, my sincere thanks go to the Management Team of the faculty of Industrial Design Engineering, as well as the Governing Board of Delft University of Technology.

Prof. Dr. Prabhu Kandachar Faculty of Industrial Design Engineering Delft University of Technology March 2011

Photo: Chetan Shivarama

1. INTRODUCTION 1. INTRODUCTION

This section briefly introduces the proposal made for the research program – ‘Sustainable Healthcare for the Base-of-the-Pyramid (BoP)’. It also gives a brief insight into the BoP related activities carried out at Delft university of Technology. - Prof. Dr. Prabhu Kandachar

INTRODUCTION 8

Sustainable Healthcare for the Baseof-the-Pyramid (BoP): Research and Design 1.1 Base-of-the-Pyramid

Base-of-the-Pyramid (BoP) refers to two thirds of the world’s population subsisting on less than four dollars a day. These four thousand million people have real and multiple needs. BoP is also a term used to refer to a business strategy, which, introduced few years back, advocates the involvement of entrepreneurs to assist the world’s poor to escape from poverty. For instance, emerging markets such as China, India, and Brazil and low-income populations in home markets represent huge growth opportunities that are still largely untapped. Serving these markets profitably requires companies to rethink many aspects of their strategy and operations. The BoP-strategy argues that all that is motivating business to design products and services to meet the needs of the world’s poor, and then efficiently manufacturing and distributing them is human ingenuity - innovation1. At the same time the new economic geography is illustrating that China and India, where a large part of the BoP population live, are fast growing economies and are key contributors to large global environmental impact. While the economic welfare for people in the BoP-world cannot be denied, there is also a need to work towards global sustainability. This requires a large scale effort at multiple fronts requiring large investments in developing appropriate science and technology as well as active interventions of local and (inter)national policy makers. ____________________ 1. C.K.Prahalad and S. Hart, The Fortune at the Bottom of the Pyramid, Strategy+business, issue 26, First quarter 2002, P. 1-15.

The BoP topic has unleashed an extensive and generally enthusiastic response from academics, businesses, NGOs and governments all over the world. Yet the BoP issue is a new knowledge area, still in the stage of infancy, and very much fragmented. There is a need of broadening the knowledge base. Currently very few industrial enterprises or academics are using the principles of design to solve the problems of the poor. Worldwide very few companies start with the individuals and build systems from their perspective, followed by examining if they can scale.

1.2 BoP activities at TU Delft - IDE

The School of Industrial Design Engineering (IDE) at Delft University of Technology is an expert in human-centered, need-based approach in the field of designing products and services. Applying this expertise several BoP healthcare projects in association with business enterprises, NGOs, etc, have been and are being, executed (see Fig. 1.1). These projects clearly emphasize the relevance of social sustainability and, being user as well as design driven, also have the potential of environmental and economic sustainability albeit on a small scale.

1.3 Proposed research

Until now the BoP projects in the faculty of Industrial Design Engineering (IDE) have been executed on student level. These projects indicate that a number of factors influence the ultimate success of healthcare products specially designed for the BoP market. These factors include the cultural habitat, in which the products are used, affordability issues of the very poor potential users, and technological factors. All these factors need to be taken into account while designing products & services to meet their healthcare needs. It is of utmost relevance for the success of future healthcare products for the BoP that much more knowledge about the influence of these factors is collected. The objective of this research programme “Sustainable Healthcare for the Base-of-the-

INTRODUCTION

Fig. 1.1: BoP Projects at Delft University of Technology Pyramid (BoP): Research and Designâ&#x20AC;? was to study these factors on an elaborate scientific level and consequently use this knowledge to design (prototypes of) new healthcare products for the BoP. Based on the factors mentioned, three research topics as listed in the table below were proposed. Potential partners outside the faculty of IDE are shown in the parentheses.

No.

To p i c

1.4 Planning, costs and management

Two post-docs and one PhD candidate were hired to execute these research topics, during the period 2008 2010. Scientific co-ordination & management of all topics were in the hands of Prof. Prabhu Kandachar. The costs covered (a) Two post-docs for a period of 2 years, (b) A PhD candidate for a period of 4 years (c) Lab equipment and (d) Travel. These were financed by the Board of Directors of The Delft University of Technology.

Partners

Tr a n s l a t i o n a n d m a n a g e m e n t o f B o P s o c i o - c u l t u r a l I D ( C A D , U v A ) context research data into solutions

Product service system and business propositions for PIM (EUR) BoP context.

C o n s t r u c t i o n o f t e c h n o l o g y a n d d e s i g n p l a t f o r m s f o r D E ( B K , E W I , T N W, e t c . ) BoP

INTRODUCTION

1.5 Research proposal â&#x20AC;&#x201C; Strategic

This proposal was developed taking into consideration the following: 1. Currently TU Delft / IDE is perhaps the only institute specializing in designing products & services for BoP, and as such has the potential to become a premiere institute. The current proposal is a step in reaching that position. 2. The strategic research directions currently being adopted within IDE. Within the new research portfolio a distinct position is claimed for research that is directly applied in the application area Health Care and Well-being. 3. External analysis by means of a macro-evaluation of current international activity on BoP-Research and Practice, relating BoP with innovations and sustainability. 4. Need for technological, social and innovations to realize the objectives.

business

5. External analysis by means of a meso-evaluation of current design related activity on BoP, in Asia, Africa, North and South America [This activity is supported by CvB Funding in 2006] 6. Internal inventory of current design related activity on BoP at TU Delft/IDE [This activity is supported by CvB Funding in 2006] 7. Availability of expertise with IDE and its research partners in the Netherlands.

INTRODUCTION

Photo: Chetan Shivarama

2 . R AT I O N A L E 2. RATIONALE

This section of the document addresses the rationale behind the research focus in the domain of Healthcare for/in Developing Countries by means of following Baseof-the-Pyramid strategy, which involves businesses developing innovative concepts for low-income markets with an objective of contributing to poverty alleviation by providing access to knowledge and technology in an economically profitable way. - Prof. Dr. Prabhu Kandachar

R AT I O N A L E

2.1 Introduction

This section of the document addresses the rationale behind the research focus in the domain of healthcare for/in Developing Countries by means of following Baseof-the-Pyramid strategy1, which involves businesses developing innovative concepts for low-income markets with an objective of contributing to poverty alleviation by providing access to knowledge and technology in an economically profitable way. TU Delft/Faculty of Industrial Design Engineering (IDE) is also very active in this field since 2002 in several areas: healthcare, food and nutrition, water, energy, housing, materials, connectivity, designing and tools, and entrepreneurship2. See http:// www.io.tudelft.nl/bop for more information. These projects – about 70 in the meanwhile - have been mainly executed by students supervised by IDE-academic staff. This large hands-on experience has led to initiate a focussed research effort on one topic: Healthcare. This document provides a background on healthcare needs of developing countries.

2.2 The importance of good healthcare

Differences in health standards between rich & poor countries are very high. Life expectancy varies between 85 and 36 years. A child born in the rich country receives vaccinations, adequate nutrition and good schooling. When a girl becomes a mother she will benefit from highquality maternity care. Growing older, she may eventually develop chronic diseases, but excellent treatment and rehabilitation services will be available. On the other hand, a child born in a poor country has little chance of receiving immunizations and a high probability of being underweight throughout childhood. She will probably marry early and give birth to many children without the assistance of a trained birth attendant. One or more of her babies will die in infancy, and she herself will be at high risk of death during childbirth. If she survives middle age she, too, will develop chronic diseases but, without

access to adequate treatment, she will die prematurely. This illustrates what medicine and public health can achieve, and about unmet needs in a world of vast and growing health inequalities. The key task of the global health community is therefore to close the gap between such contrasting lives. Real progress in health depends vitally on stronger health systems based on primary healthcare. Attention is needed across all levels of the healthcare system to integrate health promotion and disease prevention on the one hand and treatment for acute illness and chronic care on the other. Experiences in the past decades show that there are no easy solutions to the challenge of providing access to sustainable healthcare in developing countries. Poverty is the single biggest barrier to improving healthcare in the developing world. In many countries people do not have enough food or access to a clean water supply, no hospital or clinic in which to receive treatment and few healthcare professionals to care for them. Often the governments of these countries simply do not have the resources needed to address the healthcare needs of their people. The World Bank estimates that an annual healthcare expenditure of $14 per person is the minimum needed to provide the most fundamental services. Yet the average expenditure in sub-Saharan Africa, for example, is currently only $6.

____________________ 1. Prahalad, C.K., 2005. “Fortune at the Bottom of the Pyramid, The: Eradicating Poverty Through Profits” (Publisher: Wharton School Publishing, ISBN-10: 0-13187729-1, ISBN-13: 978-0-13-187729-0, Pages: 304). 2. Kandachar, P.V. and Halme, M., 2007. Introduction, in GMI Theme Issue: An Exploratory Journey towards the Research and Practice of the Base of the Pyramid, Ed. Prabhu Kandachar, issue 51, p.3-17.

The plight of developing countries regarding, amongst others, healthcare has not gone unnoticed by the world leaders. At the Millennium Summit in September 2000 the largest gathering of world leaders in history adopted the UN Millennium Declaration, committing their nations to

a new global partnership to reduce extreme poverty and setting out a series of time-bound targets, with a deadline of 2015 that have become known as the Millennium Development Goals3 Three out of eight goals (goals 4, 5 & 6) are about healthcare. Even though these objectives are laudable, the progress halfway is disappointing.

R AT I O N A L E

2.3 Millennium Development Goals

Fig. 2. 2: Progress made in MDG till 2007

Fig. 2.1: Millennium Development Goals

____________________ 3. http://www.un.org/millenniumgoals

R AT I O N A L E

2.4 Global disease burden

The World Health Organization (WHO) assesses the health of the worldâ&#x20AC;&#x2122;s population regularly, based on detailed global and regional estimates of premature mortality, disability and loss of health for 135 causes by age and sex, drawing on extensive WHO databases and on information provided by Member States. This WHO global burden of disease (GBD) measures burden of disease using the disability-adjusted life year (DALY). This time-based measure combines years of life lost due to premature mortality and years of life lost due to time lived in states of

16 Fig. 2.3: Child mortality rates by cause and region, 2004

less than full health. The DALY metric was developed in the original GBD 1990 study to assess the burden of disease consistently across diseases, risk factors and regions.4 For instance, more children die in poorer regions than in the richer parts of the world (Fig. 2.3). The global disease burden can be classified as shown in Fig. 2.4. A study from Ala Lopez et al (2006) shows that, the major future burden is expected to be generated from non-communicable diseases (Group 2).

Fig. 2.4: Deaths due to different causes (2001 data) 5

____________________ 4. http://www.who.int/topics/global_burden_of_disease/en/ 5. Global Burden of Disease and Risk Factors, by Alan Lopez. et al. 2006. Freely downloadable at: http://www.ncbi.nlm. nih.gov/books/bv.fcgi?rid=gbd

Environmental factors are a root cause of a significant disease burden, particularly in developing countries. An estimated 25% of death and disease globally, and nearly 35% in regions such as sub-Saharan Africa, is linked to environmental hazards. Some key areas of risk include the following: •

Unsafe water, poor sanitation and hygiene kill an estimated 1.7 million people annually, particularly as a result of diarrhoeal disease.

•

Indoor smoke from solid fuels kills an estimated 1.6 million people annually due to respiratory diseases.

•

Malaria kills over 1.2 million people annually, mostly African children under the age of five. Poorly designed irrigation and water systems, inadequate housing, poor waste disposal and water storage, deforestation and loss of biodiversity, all may be contributing factors to the most common vector-borne diseases including malaria, dengue and leishmaniasis.

•

Urban air pollution generated by vehicles, industries and energy production kills approximately 800,000 people annually.

•

Unintentional acute poisonings kill 355,000 people globally each year. In developing countries, where two-thirds of these deaths occur, such poisonings are associated strongly with excessive exposure to, and inappropriate use of, toxic chemicals and pesticides present in occupational and/or domestic environments.

•

Climate change impacts including more extreme weather events, changed patterns of disease and effects on agricultural production, are estimated to cause over 150,000 deaths annually.

2.6 Financial risks

The economic burden due to disease burden can also be enormous as shown in Fig. 2.5.

R AT I O N A L E

2.5 Root causes of disease burden

Fig. 2.5: Financial risks for developing countries due to chronic diseases 6

____________________ 6. http://www.who.int/chp/chronic_disease_report/ contents/en/

R AT I O N A L E

2.7 Healthcare infrastructure

This enormous problem requires adequate infrastructure in developing countries. Do they have adequate infrastructure?7 The answer is a clear no, see Fig. 2.6.

2.8 Proposed research and development strategy

While the healthcare needs are enormous, the infrastructure to meet such needs in developing countries is awesomely poor. Even if the rich country model of “Bringing People to Care- BPC” by providing adequate healthcare infrastructure (such as hospitals, hospital beds, equipment, medical specialists, nurses, etc) is strived at to address this issue, such a strategy requires (a) large scale investment and (b) long time to educate and train sufficient

number of medical specialists, nurses, etc. Therefore it is recommended to investigate the alternative strategy of “Bringing Care to People-BCP”. This would mean many diseases should be detected during the early stages of onset and should be detected at places where poor people live (homes, communities, villages). This Decentralized Healthcare System would also help the poor to continue to attend to their livelihood generation and do not have to spend money and time to meet the doctors who are often located in hospitals which are at quiet far distance away from where the poor live and work. This “prevention is better than cure” approach would also reduce the strain on the poor infrastructure in developing countries. Studying point-of-care (POC) diagnostics as termed and used in USA would be beneficial to learn from the extensive experience gained so far.9 Point of care testing (POCT)

Fig. 2.6: Public healthcare infrastructure in several regions of the world 8 ____________________ 7. http://knowledge.wharton.upenn.edu/india/article.cfm?articleid=4277 8. Healthcare in India PriceWaterhouseCoopers 2007 9. Paul Yager, et.al., Point-of-Care Diagnostics for Global Health, Annu. Rev. Biomed. Eng. 2008. 10:107–44

2.9 Execution

A group of professors, post-docs, PhD students, etc have been entrusted with the execution of Research & Development in Healthcare for the developing countries. The group consists of: Prof. Prabhu Kandachar (BoP - program coordinator, professor on behalf of the DE

department), Prof. Pieter Jan Stappers (professor on behalf of ID department), Prof. Jan Schoormans (professor on behalf of PIM department), Dr. Santosh Jagtap (postdoc in DE department), Ir. Annemiek van Boeijen (Assistant professor, PhD Candidate in ID department), Dr. Sivakumar Alur (post-doc in PIM department). During the execution period other researchers also joined this group. They are Mr. Jiehui Jang (PhD Candidate, in DE department), Dr. Ir. Richard Goossens (Associate professor, Research coordinator of the domain Healthcare), Mr. David Peck (Design Engineering), Dr. Vikram Parmar (PhD in ID department) and Mr. Gil Nachmany (student assistant to Prabhu Kandachar).

R AT I O N A L E

refers to any hospital or clinic employee performing any type of laboratory test outside of the central laboratory. POCT has revolutionized the continuum of patient care process in rich countries by providing laboratory results efficiently at the patients bedside. POCT may be used as either a screening and/or diagnostic tool by primary care providers to enhance the quality of care offered.

Fig. 2.7: Proposed R&D Strategy at TU Delft/IDE- BoP Healthcare Research Group

Photo: Anand Purohit

3. RESEARCH - PROGRESS REPORT 3. RESEARCH - PROGRESS REPORT This section provides an overview of the research activities carried out by PhD and Post-Doc candidates of the faculty of Industrial Design Engineering at Delft University of Technology, within the framework of Sustainable Healthcare for the Base of the Pyramid.

RESEARCH PROGRESS REPORT 22

Research Title: Retailing of Healthcare Products and Services in BoP context Researcher: Dr. Alur Sivakumar Introduction The BoP markets in most emerging economies faces four major challenges namely Affordability, Accessibility, Awareness and Acceptability. Affordability can be tackled through innovative financing schemes or subsidies. Awareness and Acceptability can be tackled through information, communication, education and training. The most challenging among the constraints is Access. Physical access to healthcare is impacted on account of the large distances, the remoteness of the rural areas where a large number of the BoP market resides and also low population density to support sustainable healthcare provision. This key obstacle needs to be surmounted in order to ensure easy reach to healthcare.

Objectives The sub project on Retailing within the broad BoP project is aimed at providing the solution to lack of healthcare access in rural BoP markets in emerging economies like India. Most of primary healthcare in BoP markets is doctor-focused and hospital-centric. Building a large number of hospitals with huge government investments is not easily feasible. Educating a large number of people to become doctors and other paramedical staff cannot be done quickly or easily to match with the requirements. Thus, the key problem or objective of the sub project is to secure healthcare access in innovative ways. As a BoP project housed in the faculty of Industrial Design Engineering (IDE), the aim is to facilitate design of products and services in an innovative way to increase access.

Approach and results The sub project was approached from two perspectives

â&#x20AC;&#x201C; the product and the service perspective. In the product perspective, the idea was to look at Point of care (POC) devices as tools to provide access. Point of care devices can be used for diagnosis, treatment, monitoring and delivery of healthcare. In the absence of any form of healthcare, point of care devices can first serve as diagnostic devices. Some of the key aspects that have been highlighted as part of the literature review that relate to the POC devices are the cognitive engineering dimension of the lay user as well as the medical device regulations that impact the design, development and marketing of the product. In the services perspective, provision of healthcare services without the help of the doctor and specially trained paramedical staff was the target. Social Franchising with help of existing individuals and non-governmental organizational network serving the welfare of the BoP population was seen as the solution. Social franchising is a relatively new form of organizational expansion where donors, government, social franchisor with knowledge and a willing franchisee all need to coordinate to help the spread of healthcare. A key function in effective social franchising is identification or selection of the right franchisee and the sustainability of the social franchisee entities.

Interim conclusions Field survey was carried out in India to understand the response to social franchising as a concept and the mode of social franchisee selection. The study involved interviewing potential franchisees and franchisors in person. The concept of social franchising appealed to a large number of organizations as a method of extending the reach of their organizational activities in new geographical areas. However, the key constraints were the availability of personnel to work in rural area along with nongovernment organizations with a low pay. This specially applies to those fields where specialized knowledge, for example, training on dealing with differently able people.

Dr. A Sivakumar during his two year post-doc research has produced two journal publications and presented papers in five international conferences. •

Alur, S. (2010), Can Similar Technology work for US Homecare and Emerging Market Rural Healthcare International Journal of Biomedical Engineering and Technology, Corrected Proof (In Press).

•

Alur, S. (2010), Organizational Ergonomics in Medical Device Design Standards Journal of Medical Marketing 10(4), 312-322.

•

Alur, S. (2010), Evolution of Sustainable Design An Analysis of Sustainable Design Awards In: LeNS Conference 2010 - Sustainability in Design: Now Challenges and Opportunities for Design Research Education and Practice in the 21st century. Fabrizio Ceschin, Carlo Vezzoli and Jun Zhang (eds.). Indian Institute of Science Bangalore India Greenleaf Publishing Ltd Sheffield UK pp. 1371-1376.

•

Alur, S. (2010), Sustainable Design by Habit - The case of BoP Market designers In: ERSCP - EMSU Conference Delft The Netherlands TU Delft Netherlands pp. 1-9.

•

Alur, S. (2009), Cognitive Engineering in Medical Device Design for the Bottom of the Pyramid - (BoP) market – the case of the Point of Care (POC) Malaria Detection Kit. In: PDMA India IVth Annual International Conference - New Product Development Challenges in Meltdown times N. Siva Prasad, L.S. Ganesh, Shankar Krishna Pillai and Arshinder Kaur (eds.). IIT Madras Chennai IIT Madras pp. 244-249.

•

Alur, S. (2009), Retailing Of Health Care Services – The Role of Point Of Care Devices for Base of the Pyramid Market. In: International Base of Pyramid Conference. Johannesburg South Africa.

•

Alur, S., Schoormans, J.P.L. (2009), Franchisee Selection and Health Services Impact – Social Franchising In BoP Context. In: International Conference on Impact of Base of the Pyramid Ventures. Prabhu Kandachar, Ilona de Jongh and Minna Halme (eds.). Delft The Netherlands TU Delft Netherlands pp. 279-288.

International and national network built Dr. Sivakumar has established contact with several NGOs as well as Professors especially in the USA working in the area of Point of care devices and social franchising. Among them, Dr Jeffery Blander from the Harvard Medical School was invited for a special talk on the work of his foundation as well as his research in the area of health systems and policy. Dr. Dominic Montagu of the global health group of University of California San Francisco has also been contacted and involved during this research project. Dr Montagu has been working in the area of social franchising and has developed a compendium on the social franchising efforts across the world. Many more franchisors have been contacted based on the information available in the compendium to build further the network.

RESEARCH PROGRESS REPORT

Output

Future work Further work includes understanding franchisor and franchisee orientations to social franchising, the influence of the donor in the social franchising process and the different forms of social franchising. The major effort would be to analyze social franchising in the broader context of franchising literature using inputs from several international and national NGOs. The other part of the work would relate to understanding the designing of medical devices. Post market issues of point of care medical devices will be analyzed using data from CDRH database in the USA. This would help to infer the nature of learning required for designers in future medical device design projects.

RESEARCH PROGRESS REPORT

Research Title: Design for the Base of the Pyramid (BoP)

compared these issues and strategies with those identified in the study called â&#x20AC;&#x2DC;Growing Inclusive Marketsâ&#x20AC;&#x2122; conducted by the United Nations Development Programme (UNDP).

Researcher: Dr. Santosh Jagtap

In order to understand the role of disruptive technologies in the BoP, we synthesized the reviewed literature on:

Introduction The four billion people at the base of the income pyramid, generally called the Base of the Pyramid (BoP), typically earn less than four dollars a day. These poor people face different problems such as: hunger, deprivation, powerlessness, violation of dignity, social isolation, state corruption, rudeness of service providers, unemployment, poor health, lack of shelter and education, gender inequality, etc. Over the past several years, business approaches are being explored to satisfy unmet or underserved needs of the poor and to gain profits. However, the BoP domain has been relatively unexplored by design researchers. The decisions that are made during the design process have a significant effect on the cost and quality of a product but these decisions cost very little. It is therefore important to undertake design research in the BoP domain.

Objectives 24

This research aims at: (1) identifying different issues in the design of products for BoP markets; (2) identifying different strategies used by businesses to address these issues; (3) developing an understanding of the role of disruptive technologies for BoP markets. Furthermore, this research aims at exploring systems approach in the design of products for these markets. The main emphasis of this research is on the healthcare sector in the BoP.

Approach and results To identify different issues in the design of products for BoP markets and different strategies used by businesses to address these issues, we pulled together these issues and strategies in the BoP from the reviewed literature. We then

1. Issues in designing, marketing, distributing products and services in BoP markets. 2. Disruptive technologies. Regarding systems approach in the design for the BoP, we developed a causality model for socio-technical systems by adapting a causality-model of technical systems. We then illustrated this developed model by using case studies drawn from the BoP.

Interim conclusions The initial findings of our research, regarding issues and strategies in the design of products for the BoP, suggest that the prominent issues in designing products and services for these markets are: gaining market information; under-developed regulatory frameworks; poor physical infrastructure; lack of knowledge and skills of BoP customers; and BoP customersâ&#x20AC;&#x2122; poor access to financial services. Some of the strategies used by businesses to address these issues are: adapting products and processes; combining resources and capabilities; engaging in policy dialogue with governments; etc. Regarding the role of disruptive technologies in BoP markets, some of the initial findings of our research are as follows. Businesses can gain several types of benefits by tapping BoP markets; and employing disruptive technologies in these markets can provide additional benefits. Rather than reactively rejecting disruptive technologies, businesses can harness these technologies in new markets. Businesses need to explore BoP customers needs that can be satisfied with the available disruptive

Our study on development of a causality-model for sociotechnical systems, systematically explains the importance of: •

Gaining an in-depth understanding of the existing BoP system to bring about desired changes of state and actions;

•

Including different stakeholders from the BoP in the design and development process;

•

Appropriately modifying existing BoP system before implementing the final intervention.

Output •

•

agtap, S., Kandachar P.V. (2010), Adapting a causality model of technical systems to represent sociotechnical systems: Case studies from the BoP, In International Symposium on Tools and Methods of Competitive Engineering, TMCE 2010 Ancona, Italy (Accepted).

•

Jagtap, S., Kandachar P.V., Designing products and services for the Base of the Pyramid: Issues and Solutions, Journal of Cleaner Production (Under Review).

•

Jagtap, S., Kandachar P.V., The Base of the Pyramid and Disruptive Innovations: A Systematic Review, International Journal of Innovation and Sustainable Development (Under Review).

International and national network built Participating in the following conferences helped the researcher to develop international and national network: 1. ‘The Future of Sustainable Products and Services’ at Essen, Germany; 2. ‘From Research to Improved Practice & Policy in International Health’ at Utrecht, Netherlands; and 3. International Conference on Engineering Design at Stanford, California.

Future work The future work consists of the following: 1. Rigorously identifying the need and usefulness of systems approach in the design for the BoP; 2. Developing suggestions, methods, or tools to support designers in applying systems approach in the design for BoP markets.

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technologies.

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Research Title: Supporting designers to cope with culture Researcher: Annemiek van Boeijen

techniques that help to bridge the cultural gap during their design process in order to end up with appropriate products (affordable, accessible, reliable, sustainable and acceptable). *For the definition of culture we follow the definition of Geert Hofstede (2005).

Introduction

Approach and results

In 2008 Annemiek started to explore need for research in the field of BoP Sustainable Healthcare. This resulted in a paper: van Boeijen, A.G.C., Stappers P.J. (2008), How can designers better incorporate cultural aspects in their designs for the Base of the Pyramid (BoP)…and why should they? Paper presented at the DesignEd Asia Conference 2008, Hong Kong, China.

Objectives Starting point for the research is the proposition that product (service system) designers coming from a very different culture* than they are designing for, have difficulties to create and co-create products that will be accepted by the intended users and used in the intended way. One of the factors that play a role in the acceptance of products in a society is the link of these products with the cultural context. The main question in this research is: How does culture play a role in the product design process in general and in the BoP Sustainable Healthcare in particular? Our final aim is to offer designers tools and

The research follows a qualitative approach. Design and research are combined in the process of generating new insights and artifacts and is named Design Inclusive Research (Horváth, 2007). This approach can also be characterized as ‘research through design’. (1) Literature research about theories and models from cultural anthropologist has been studied and this study will be continued parallel to other activities. (2) A number of BoP design projects executed by design graduates have been evaluated (report reviews as well as semi-structured interviews). (3) The ‘Crossing Cultural Chasms card set has been developed in order to (a) support designers doing a BoP (or other design project where a cultural chasm needs to be crossed) and (b) to use the set as a research tool; a mean to gain insights from professional designers and experts. (4) New (student) design projects are being initiated that are being monitored and evaluated.

Interim conclusions 1. The concept of culture is difficult for ‘BoP designers’:

Five students redesigned the in the 70ies developed (and still distributed) van Hemel Baby Incubator for rural areas. Their target context was in Kenya. The redesign is lighter, has more functions, and is more aesthetical pleasing for the same price. Culture did not play an important role in the determination of the manifestation of the product. Though it did play a role in the interaction with intended users in Kenya in order to understand the context of use and the design of the manual. See figure below: left the existing design and in the middle the proposed redesign and right the instruction manual.

2. Designers first have to understand preferences based on universal principles of behavior. If we focus too much on culture we may miss opportunities for designing real good products that may transcend a specific culture. 3. Culture is not a static phenomenon: Though culture is (according to the definition) deeply embedded in people and cannot easily be changed, a culture can change. Designers do not only want to know the practices and values that are now present in a specific culture, but also what people prefer/desire for their future. Designers can contribute to this changing process through their intervention, not only physically or socially but also culturally. 4. Design students, designing for ‘alien’ cultures have drawn in a lot of questions and information. A tool that supports structuring their information seems to be of utmost importance for designers.

contextmapping techniques) have to be adjusted and if so, how? We are now in the process of learning from students, applying these methods in BoP projects.

Output •

•

Parmar, V. and van Boeijen A.G.C. (2009), Educated naïve in rural areas of the BoP domain, , In proceedings Designing for, with, and from user experiences, Delft.

•

Arik, D., van Boeijen A.G.C., Kandachar P.V. (2009), Persuasion for a Healthier Life: Persuasive Technology Design Guidelines from the Precious Project for Indian Diabetics. In proceedings of IASDR.

•

Akil, M., van Boeijen, A.G.C., Boess, S. (2009), Sharing migrant stories: inclusion through facilitation of storytelling, In Proceedings of Include 2009.

•

van Boeijen, A.G.C. et al. (2010), Delft Design Guide: theory, methods and competence in design, faculty of Industrial Design Engineering, Delft. Thieme, J.C. and van Boeijen, A.G.C. (expected in 2011), Some students are more different than others, Special Issue on Design Education in Journal of Design Research.

•

van Boeijen, A.G.C. (expected in 2011), How can Western designers use Contextmapping techniques in non-Western situations? E&PDE conference, London, 8-9 September 2011, London, UK.

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van Boeijen, A.G.C. (expected 2011), Serving the under-served: What can designers learn from Rural Appraisal Techniques? IASDR, Delft.

5. Models from cultural anthropologists can be used in different stages in a design process and for different purposes. 6. Design students who want to do local research are wondering if their design methods (e.g.

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(a) it covers a broad area without clear borders; within a country there are often several sub-cultures or ethnic groups and we can distinguish many different cultures on many different levels (sub-cultures) and their manifestations (in behavior, artefacts, values, symbols etc.) are manifold, (b) cultures can cross several country boundaries, (c) there can be a large difference in individual behavior and the way of thinking and feeling and expression amongst people belonging to the same culture; personal practices are often intertwined with practices of a group and practices based on universal principles.

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Contribution of student projects to the research

Industrial Design Engineering, Delft.

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Introduction International Master Students (2009, 2010), An introduction workshop that aims to make cultural differences between design schools debatable.

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Dinh, L., Koers, W., van Lier, H., van Rooijen, V. and van Schie, P. (2009), Redesign of the van Hemel Incubator, Integrated Product Design project for HEBI foundation and faculty of Industrial Design Engineering, Delft.

•

Lysen W., Louwman J., Tolhuijs B., van Ginhoven, S. and Korthals M. (2010), Product and Business concept for the Peepoo sanitation bag for slums, Integrated Product Design project for Peepoo in Sweden and faculty of Industrial Design Engineering, Delft.

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Bunk H., Lotgering S., Molenaar N., Talsma L. and Verhoef M. (2010), Mobile learning centre device for Kenya, Integrated Product Design project for the Better Life Foundation and faculty of Industrial Design Engineering, Delft.

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Martens, J. R. J. (2010), Design of a user centered Solar Refrigerator, master thesis faculty of Industrial Design Engineering, Delft.

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Lectures and tutorials for the master elective Food Design & Culture (February-April 2010).

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Lecture for the bachelor elective Cultural Impact (2010).

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Tijs, R. (2010), Design that improves the process of humanitarian land mine clearance, master thesis for Lectron BV and faculty of Industrial Design Engineering, Delft.

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Dinh, L., Koers, W. (2010), Vision and Guidelines for the production of a mobility aid for children in Ghana, Internship for company Mak-D and faculty of Industrial Design Engineering, Delft. Gehem, S., van Goudoever F., Greijdanus A., van der Werf J. (2010), Skoon Lappie – Female Hygiene - South Africa, Integrated Product Design project for MKI foundation and faculty of Industrial Design Engineering, Delft.

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Driel, J. (2009), Cultural aspects in BoP graduation projects, master thesis, faculty of Industrial Design Engineering, Delft.

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Van Toorenburg H. (2010), Creating a business with craft in Haiti for Stichting Turtle Tree, master thesis for Turtle Tree Foundation, faculty of Industrial Design Engineering, Delft.

International and national network built •

Contribution to the BoP exhibition at ‘Impact of Base of the Pyramid Ventures, International Conference’ at the Delft University of Technology, 2009.

•

Van Wissen, S. (2010), Creating a Social Cohesive Product Service System in a Slum Community, master thesis, faculty of Industrial Design Engineering, Delft.

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Lecture for the conference Appropriate Technology in tropical pediatrics, Zeist (2010).

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Kyungeun Sung (2010), Needs assessment of BoP customers in Southern Sudan on health, water and sanitation, master thesis for Basic Building for People Foundation (BB4P) and BB-con and faculty of

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Lecture and research for the International Design Opportunity in Hong Kong (2010).

•

Lecture for 30 product designers in Shanghai (2010).

Researcher: Jiehui Jiang Introduction According to the Prahalad (2002), there are 4 billion people living on an income less than US$3 per day and 1 billion living less than even US$1 per day. This part of the population is often called “Base-of-the-Pyramid” (BoP). Most of BoP is living in developing countries including India, China and Brazil, and so on. BoP is a special consumer target group in product design. Prahalad and Hart’s (2002) work about BOP suggests that there is a fortune to be made for entrepreneurs in BoP initiatives, while offering great opportunities for the world’s poor to escape from poverty. Our previous empirical research (Jiang and Kandachar, 2009) based on student design projects showed that the state of the art in design for BoP always covers a lot of design knowledge including emerging market management (London and Hart, 2004), technology transfer (Simanis and Hart, 2008) and disruptive innovation driven approaches. (Christensen, 2006) Kandachar (Kandachar and Helme, 2008) proposed and validated a “User Centered Design (UCD)” strategy for BoP: it states that; 1) The needs of the users should be considered as a starting point for BoP product and innovations, 2) Several innovation methods could be considered for an effective approach to serve the unmet needs of the BoP-community. On user side ethnographic tools, cultural probes; Business innovations such as hybrid

business models, corporate responsibility; Technological innovations like disruptive innovations, open source designs, etc. Information and Communication technology (ICT) based products and services are considered as important solutions to solve historical health problems in rural China. (Dummer etc, 2006)

Objectives Literatures (Kandachar and Helme, 2008) and own experiences (Jiang and Kandachar, 2009) showed that Product-Service combined Design (PSD) for Base of the pyramid (BoP) in health care domains is a complex issue (wicked problem). Designers often meet difficulties in several design aspects such as information collection and user involvement. Thus, the aim of this PhD project is to develop a design framework and guide for designers. To address this issue, we limited the contexts within “ICT supported in rural China”.

Approach and results

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Research Title: Development of an early conceptual framework of health ICT design in developing countries Emerging lessons from studies for rural China

As a PhD project, several different methodologies such as case studies and design inclusive research are being used. The whole process of framework development will be conducted in three periods: 1. Literature review and case study: This period explored constraints for designers in Product-Design for BoP health care. 2. Contents development: In this period detail knowledge was developed that is useful for designers, e.g, design culture of China is studied through interview, design factors and methodologies are explored through concrete design cases. 3. Framework development: The last period will result in a systemic knowledge framework for designers about ICT supported healthcare design in rural China.

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Fig. 3.1: An early conceptual framework of ICT healthcare design in rural China (version 1.0)

Step 1: After literature review and observation of existing projects, we found that designers often face three major design constraints: Lack of investigations of designer-context cultural difference (Here, designer-context cultural difference means designers’ background culture-A will influence their design concepts and decisions for users in culture-B.); Lack of investigations about design factors; and Lack of adaptation of suitable Design methodologies (methods and tools). These gaps resulted in risks of improper BoP healthcare design in the past.

Existing User Centred Design Methodologies such as Roozenburg and Eekels (1995), Romaswamy (1996), Hekkert and van Dijk (2001) can be adapted into BoP healthcare design. A new framework in this issue ‘four domain model’ has been proposed in this part and further validated in the concrete design case “exploring design opportunities in rural Chongming”.

Step 3: A framework has been proposed in figure 3.1.

Output •

•

J.Jiang, A. Freudenthal and P.V.Kandachar(2010), Exploring the influence of design culture on ICT healthcare product and service design for rural China, Knowledge Collaboration & Learning for Sustainable Innovation ERSCP-EMSU conference , Delft, 2010.

•

J.Jiang, A. Freudenthal and P.V.Kandachar (2010), A framework To develop support for ProductService combinations for Base of the Pyramid --- ICT supported healthcare in rural China, Design Research in the Netherlands 2010 symposium, Eindhoven, 2010.

Step 2: Based on existing models such as Hofstede’s onion model, the framework of Mohammad and Mariano and Julier’s discourse, the authors propose four dimensions that are relevant: 1) Education and skills of the designer 2) Consumption of design 3) Manufacturing of design 4) Design activities’ management and organization. After two rounds of interviews with Chinese design professors and students, 15 factors within these four dimensions were finally identified. The results show that the unconscious impact of design culture on design can be better controlled and even altered if designers and management are aware of these factors. Two studies are carried out to achieve the new checklist of design factors. In the first study, 14 general factors of Design for Base of the Pyramid are conducted through 24 BoP case studies in three categories: user aspect, economic aspect, and product aspects. In the second study, 12 design factors and 29 elements are proposed through a case “A Mobile Monitoring System of Blood Pressure for Under-served in China by Information and Communication Technology Service”. By combining two studies, the author suggests a new checklist with twenty four design factors.

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J.Jiang, A. Freudenthal and P.V.Kandachar (2009), Exploring insight of user needs, the first stage of Biomedical Engineering design, Chapter 4 in book “Advanced Biomedicine” (Editor Carlos.A.B) In-Teh publishing, ISBN 968-953-307-013-1.

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J.Jiang and P.V.Kandachar (2009), Four domain model: a new possible innovation model for Design for Base

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Interim conclusions

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of the Pyramid (DfBoP), ICED 2009, Standford, USA. •

J.Jiang and P.V.Kandachar (2009), Some indications from research on user involvement in Design for Base of the Pyramid (DfBoP), ICED 2009, Standford, USA.

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J.Jiang and P.V.Kandachar (2009), Roadmap research of process in Design for Base of the Pyramid (DfBoP) Proceedings of IAENG International Conference on Industrial Engineering, (ICINDE’09), Hong Kong, 18-20 March, 2009.

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J.Jiang and P.V.Kandachar (2009), What kind of decision factors will affect Design for Base of the Pyramid (DfBoP)? – An analysis research based on 24 case study in DUT/IO, Proceedings of IAENG International Conference on Industrial Engineering, (ICINDE’09), Hong Kong, 18-20 March, 2009.

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J.Jiang, A. Freudenthal and P.V.Kandachar (2009), Research of User-Centered Design on Healthcare at Base of the Pyramid, poster for Conference of Impact of BoP, Delft, 2009.

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J.Jiang (2008), Healthcare Product Design for Rural

China, IPID-UNESCO ‘Academia meets Practice‘, United Nations Educational, Scientific and Cultural Organization, Paris, France. •

J.Jiang and P.V.Kandachar (2008), New Market, New Challenge, New Opportunity (1) -Overview of China rural healthcare & Design methodology, Proceedings of 30th Annual International IEEE Engineering in medicine and biology Conference, Vancouver, British Columbia, Canada, pp 1579-1582.

International and national network built This PhD project involves several local universities in China such as Tsinghua University, Jiangnan University, and Shanghai University. Cooperative activities between them and us like building up design projects, applying cooperative funding, writing journal papers have happened in the past.

Future work The framework is still under developed until now. In next year this framework will be further updated and the thesis of this PhD project will be written out.

Researcher: Dr. Vikram Parmar Introduction Information poverty cannot be addressed by simply giving away computers and installing internet connections in rural areas. What is really needed is to offer rural users relevant, personalized information that enables them to make positive changes in their daily lives, rather than give them the type of information that is typically available via public internet sites. ICT should be viewed as a tool, and not as the solution to building knowledge-based societies. Several innovative projects have attempted to use ICT to enable rural users to access relevant information services with a view to ultimately reducing information poverty. Here information poverty can be understood as a lack of knowledge to make decisions to improve wellbeing in terms of economic and social development. Reducing information poverty through the use of ICT to improve user wellbeing is a major challenge for governmental and non-governmental organizations alike. Several new media ICT interventions such as Telecenters that offer e-services in domains such as agriculture, healthcare, and education have recently been deployed in India. Despite huge investment in recent efforts to address information poverty via new media ICT interventions, the results still do not make a convincing case for solving the information poverty problem. Consequently, there is still an information gap between rural users and the information offered via ICT interventions.

Objectives The aim of this PhD research was to propose a design framework for developing ICT products and services for rural development. Furthermore, validate this framework by developing an ICT intervention for healthcare in the rural context. The main objective of the research was to answer the following research question about designing ICT products which improve information transfer and thereby stimulate ICT adoption: How to design and develop ICT interventions maximizing information dissemination, thereby stimulating user-adoption of ICT interventions and improving user wellbeing? This research thesis illustrates the critical role design can play in addressing the above research challenge by following a user-centered design approach towards improving information dissemination via ICT based interventions. This thesis is based on the research through design approach. The research through design approach embeds â&#x20AC;&#x153;designâ&#x20AC;? as a research means to develop an ICT intervention. In this project, a case of maternal health for rural women in India was selected because; improving maternal health in developing countries is one of the Millennium Development Goals of The United Nations.

Approach and results The proposed design framework has three phasesExploratory research, Creative design research, and evaluative research. In addition, the framework amalgamates theories from multiple disciplines, such as social sciences, computer science, industrial design, and marketing research and involves different stakeholders to support the main stages in the user-centred development process. An exploratory research was conducted in Gujarat, India, to identify the existing knowledge level (baseline study) and identify the social beliefs and practices of

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Research Title: Design Framework for Developing ICT Products and Services for Rural Development: A case of Persuasive Health Information System for Rural Women

RESEARCH PROGRESS REPORT 34

rural women related to menses and maternal health. The study also focused on stakeholder identification and design requirements for the proposed ICT intervention – the Persuasive Health Information System (PHIS). The findings from this phase lead to generating the design requirements for the proposed PHIS. The creative design research phase of the design framework involved design and evaluation of the two concepts. The design process for Concept 1 integrated theories from multiple disciplines such as social cues from persuasive technology (Fogg 2003) and the theory of planned behavior (Ajzen 1985) for shaping social beliefs and health practices of rural women. Two comparative studies were conducted to evaluate PHIS with the local NGO-run health information system (HIS) and also against product innovation attributes (Rogers 1995). The design process of concept 2 explored the use of traditional metaphors as a design strategy to develop a Mobile Persuasive Health Information System (MPHIS) with Tangible User Interface (TUI) to increase social interaction among rural women, while accessing menses and maternal health related information. An evaluative study was conducted to investigate the role of the TUI as a design strategy towards increasing social interaction. Finally, in the evaluative research phase of the design framework a longitudinal study was conducted to measure the changes in knowledge level among the women participants relating to maternal health and menstruation between the village in which the women received no intervention (baseline group) and the village in which the women received the PHIS intervention (intervention group).

Conclusions The comparative study between PHIS and NGO’s run health information system indicated that PHIS with personalized health content was more engaging then

the HIS. The results from the MPHIS evaluative study illustrated increased social interaction as a result of enhanced product engagement, product attachment, and increased community decision-making. The reflection of traditional metaphors on design reduced the technology barrier prevalent among rural women, and therefore increased their engagement when interacting with the MPHIS. Thus, it was concluded that by adapting traditional metaphors to design the Tangible User Interface (TUI), a personalized relationship between the interactive system and the user can be developed. This allows even those users with limited exposure to technology to access the relevant information independently. The results from the longitudinal study indicated that the PHIS intervention had a positive impact on improving the knowledge level of rural women and brought about positive changes in their health practices. The followup observation conducted by the PHIS operators and community health workers revealed positive changes in the daily health practices of rural women. These changes were mainly observed in the disposal of menstrual cloths, maintaining personal hygiene, nutritional habits and delivery practices. It was concluded that the necessary information relating to personal health that is consistently reinforced and is in compliance with existing social beliefs and practices may lead to a change in health-related behavior. Disseminating information specifically designed for women, and through an intervention that engages them to interact in groups to discuss their personal health issues, may lead to positive changes in their health practices. Additionally, it was concluded that information that directly adds value to the participant’s daily life may have a positive influence on the rate of adoption of ICT intervention.

Output •

Parmar, V., D. Keyson and C. de Bont (2009), “Persuasive Technology to Shape Social Beliefs: A Case

•

Parmar, V. (2009), “A Multidisciplinary Approach to ICT Development.” Journal of Information Technology and International Development 5 (4): xx-xx (Accepted for HCI4D Special issue).

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Parmar, V. (2010), Disseminating maternal health information to rural women: Longitudinal study from the Field deployment. American Medical Information Association (AMIA), Washington DC, Nov 2010.

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Parmar, V., G. Groeneveld, Jalote-Parmar, A. and D. Keyson (2009), “Tangible user interface for increasing social interaction among rural women.” Tangible and embedded interaction, TEI’09 Cambridge, United Kingdom, ACM, New York, NY, USA: 139-145.

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Parmar, V., D. Keyson, and C. de Bont (2008), “Persuasive Technology for Shaping Social Beliefs of Rural Women in India: An Approach Based on the Theory of Planned Behaviour”. PERSUASIVE 2008. H. Oinas-Kukkonen, P. Hasle, M. Harjumaa, K. Segerstahl and P. Ohrstrom. Oulu, Finland, Springer 5033: 104115.

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Parmar. V. (2008), Persuasive technology for shaping social beliefs of rural women: Development of group based health information kiosk. In AISB convention’08 (Communication, Interaction, and Social Intelligence), University of Aberdeen, Scotland.

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Parmar, V., D. Keyson, and C. de Bont (2007), Shaping social beliefs: A community sensitive health information system for rural India, In IFIP International Federation for Information Processing, Home Informatics and Telematics: ICT for the Next Billion. A. Venkatesh, T. Gonzalves, A. Monk and K.

Buckner (Eds). IIT Madras, Chennai, Boston- Springer 241: 133-143.

International and national network built This PhD project involved various local health organizations and NGOs in India such as CHETNA (a local NGO), Gram Seva Trust and Deepak foundation. These organizations have been instrumental in providing necessary organizational support to conduct the field studies, organizing focus groups and selecting participants. Other international networks were built by participating in several conferences in India, UK, USA, Finland and Sweden.

Future work As a spin-off from this research, Design Initiatief, an organization funded by the Ministry of Economic Affairs, has approved a project named “Savera”. The aim of the “Savera” project is to improve the health system in India by developing a case and possibly a demonstrator for ICT-based products and services to communicate health information effectively in the rural Indian context. Proposal for an “Emerging Market Design Research Lab” A proposal is being made to have a dedicated lab for designing and developing products and services for emerging markets. Considering the role of design in building sustainable products and services, the faculty of Industrial Design Engineering (IDE) at Delft university of Technology could become a pioneer by setting up the Emerging Market Design Research Lab. This lab would focus on educating designers to develop products and services and create end-to-end solutions for emerging markets. This lab would aim to create scientific knowledge in developing design tools and techniques, in particular design methodology for designing product or services in emerging markets.

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of Persuasive Health Information Systems for Rural Women in India.” Communications of the Association for Information Systems 24: 427-454.

Photo: Bastiaan Tolhuijs

4 . E D U C AT I O N 4. EDUCATION This section provides the list of the M.Sc. graduation projects that are directly or indirectly related to Healthcare in Base of the Pyramid context, carried out between 2008 and 2010. The scope of these graduation projects range from designing of products, interface, services, system or environment, and business strategies with respect to health, nutrition and hygiene.

E D U C AT I O N

4.1 M.Sc. Graduation projects

The faculty of Industrial Design Engineering (IDE) at Delft University of Technology is widely known for its expertise in human-centered, need-based approach in the field of designing products and services. Since 2008, several master students have applied this expertise in their graduation project to carry out BoP Healthcare

PROJECT TITLE

projects in association with business enterprises, NGOs, etc. Around 20 graduation projects carried out in the past 2 years are directly or indirectly related to healthcare in BoP context. The scope of these graduation projects range from designing of products, interface, services, system or environment, and business strategies with respect to health, nutrition and hygiene.

STUDENT

SUPERVISORS

D AT E

IndiaMoves;“Creating Business Opportunities to Improve the Quality of Life of Physically Disabled Poor in the Mumbai Context ”

E. Bongers

D r. P.V. K a n d a c h a r, D r. J . C . D i e h l

23-05-2008

A Product Service System for B u s h P r o o f ’s D r i n k i n g W a t e r Products in Madagascar

S.A. Henness

D r. J . C . D i e h l ,

23-09-2008

Pro-portion

L. Pijpers

D r. H . J . H u l t i n k ,

D r. S . C . M o o i j 24-10-2008

D r. J . C . D i e h l , . 4 5

Personal Digital Healthcare Assistant for Pre-diabetics in India

D. Arik

D r. P.V. K a n d a c h a r,

Insect Repellent Lamp for the I n d i a n M a r ket

I. van de Wo u w

D r. P.V. K a n d a c h a r,

Shaping social beliefs, a community health information system for women in rural India

G. Groeneveld

D r. D .V. K e y s o n ,

03-12-2008

I r. A . G . C B o e i j e n 08-12-2008

D r. J . F. M . Molenbroek 12-12-2008

D r. V. P a r m a r

Opportunity Identification for D .V. D . v a n new Solution Development in the Oene field of Maternal Healthcare in Rural India

D r. P.V. K a n d a c h a r,

Opportunity Identification for New Solution Development in the field of Child Healthcare in Rural India

E.J. Kingma

D r. P.V. K a n d a c h a r,

Low-cost Universal connector between cell phones and light microscopes in rural clinics of Uganda

R.A. Limmeren, van

D r. P.V. K a n d a c h a r,

India Moves Project - Mobilizing Disabled Poor

A. Bhaskar

D r. P.V. K a n d a c h a r,

23-12-2008

D r. J . C . D i e h l 23-12-2008

D r. J . C . D i e h l 20-02-2009

D r. P. E . E s s e r

I r. A . G . C . B o e i j e n

16-03-2009

PROJECT TITLE

STUDENT

SUPERVISORS

Research Strategy for Intel in the J.S. Field of Healthcare and Lifestyle Lambert Management

D r. P.V. K a n d a c h a r,

Research Strategy for Intel in the G.C.M. van Field of Healthcare and Lifestyle Leeuwen Management

D r. J . C . D i e h l ,

D AT E 18-03-2009

D r. F. E . H . M . Smulders 24-04-2009

I r. H . K u i p e r s

Te l e c o m m u n i c a t i o n f o r d e a f i n South Africa

K. D r. A . F r e u d e n t h a l , Looijesteijn D r. H . H . C . M . Christiaans

28-04-2009

On the spot water filtration for turbid water

M. Houten, van

D r. J . C . D i e h l .

24-08-2009

Design for the Mobile OR, a mobile operation room which provides medical aid in Africa and Europe

E.J. Salters

D r. R . H . M . Goossens,

A low cost solar refrigeration system for developing countries

L. Schurg

D r. J . C . B r e z e t

D r. M . R . M . C r u l 27-11-2009

I r. J .W. D e K r u i f 28-01-2010

D r. H . H . C . M . Christiaans

Design of a mobile user interface and user interaction fo r co m m u n i t y h e a l t h wo r ke rs i n rural India

C . M . L a n d r e D r. P.V. K a n d a c h a r,

Needs identification of south Sudan BOP customers in health, water and sanitation

K.E. Sung

Wate r p u r i f i cat i o n i n t h e wate r stressed areas of emerging m a r ket s

N . Vo o r ze e

D r. P.V. K a n d a c h a r,

Design a Solar Refrigeration System for Emerging Economies

J.R.J. Martens

D r. M . R . M . C r u l , I r. A . G . C . B o e i j e n

E D U C AT I O N

39 25-02-2010

D r. V. P a r m a r D r. P.V. K a n d a c h a r,

30-03-2010

I r. A . G . C . B o e i j e n 12-07-2010

D. Peck 25-11-2010

Photo: Chetan Shivarama

5 . VA L O R I Z AT I O N 5. VALORIZATION

This section of the report gives a brief overview of how the BoP Healthcare research program has helped Delft University of Technology to develop new industry and university partnerships, launch new research programs both in Netherlands and outside and develop new research and academic curriculum proposals. - Dr. Vikram Parmar, Dr. Jan Carel Diehl

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5.1 Introduction

BoP research initiative at Delft University of Technology (DUT) took its first baby steps in form of M.Sc. graduation projects. In response to the growing interest from both academics and businesses in the emerging markets, the faculty of Industrial Design Engineering, Delft University of Technology took up a solid initiative with this regard by starting a BoP Healthcare Research program. This research program was funded by the Board of Directors of The Delft University of Technology. The funding was used to start two post doctoral research and one PhD research project. The research program opened the doors of opportunity for DUT to establish contact with both national and international organizations and institutes who were willing to participate, collaborate and help scale up the research initiative. As a result seven more PhD research programs have commenced in Netherlands and outside and one PhD research proposal is currently in the pipeline. Apart from the new PhD research programs; there have been a number of other activities like university and industry collaboration initiatives, international conferences and workshops that are either direct or indirect result of the BoP Healthcare program at Delft University of Technology .

5.2 Industry partnerships 5.2.1 Design Intiatief Design Intiatief (DI) is an organization funded by the Ministry of Economic Affairs. It is a publicly supported organization with participants from large and small companies and institutions. They cooperate together to discover new and interesting business opportunities. Base of the pyramid is one of their core themes. In this theme, Design Intiatief is interested in assisting small

SME’s and business houses in developing a business case that could be up scaled in the developing countries and bring business for Dutch industries. Design Initiatief has approved the project “Savera” from Delft University of Technology. The aim of the “Savera” project is to improve the health system in India by developing a case and possibly a demonstrator for ICTbased products and services to communicate health information effectively in the rural Indian context. Project “Savera” will follow a three phase design framework and expects to draw some general lessons from this experience.

5.2.2 Design to change the world (Exhibition) – Japan The Japan Industrial Design Promotion Organization (JIDPO) had organized a design event called “Design to Change the World Exhibition” in May 2010. This was the first ever exhibition related to BoP business to be organized in Japan. It was declared a huge success with more than 20,000 visitors and participants. The aim of the exhibition event was to showcase the compilation of design projects from around the world, targeted to improve the living standards and create a life with self respect for people from the BoP segment. Numerous educational, business institutions and other various organizations who are actively engaged in projects in developing countries, participated in the exhibition, conference and workshops. Examples of their projects, especially from design aspect, were demonstrated. Valuable experiences and stories from project development and design process, including ongoing projects, were presented and shared and the future challenges on the role of the designers were also discussed. The faculty of industrial Design Engineering at Delft University of Technology has established its own method based on its experiences and plays a leading role in

Keynote speech: Potential for designing in emerging markets:

Speaker: Dr. Jan Carel Diehl, Assistant professor, IDE, Delft university of Technology. Summary: J.C. Diehl in his conference talk, spoke about creating designs by working closely with local people from developing countries and empowering them. He stressed on the need for designing for emerging markets by sharing a case study of kamworks, an energy company in Cambodia and his other design experiences in Africa. Design workshop: Practical design to reduce poverty – design to create mutual benefits to social, economic and environmental aspects Facilitators: Dr. Jan Carel Diehl, Dr. Vikram Parmar Summary: This workshop introduced the integrated innovation process of product development through consumer needs, the creation of new value, conception and the settlements of business models and market definition based on the following case studies. • Case study of healthcare in India • Case study of renewable energy in Cambodia This workshop provided an opportunity to understand

the challenges in developing countries and to think about utilizing technologies, operations and materials used in developed countries in order to solve problems and to create sustainable designs in developing countries.

5.2.3 Japan SME’s workshop, IDE-TU Delft As a follow up of the “Design to Change the World Exhibition” in May 2010, a delegation from Japan industries visited Delft University of Technology in September 2010. Jan Carel Diehl gave a Talk on examples and approaches on BoP in the field to sensitize the participants about the BoP context. The talk was followed by workshops, specifically for the Japanese delegation on healthcare and energy to brainstorm about new directions that their industries could follow. The delegation was split into two separate groups. Vikram Parmar facilitated the workshop on ICT and Healthcare for one group while J.C. Diehl facilitated the workshop on Energy and Light for the other group. Since the delegation consisted mainly of people in managerial positions, the workshop focused mainly on the business aspects of the system. The workshop focused on developing business plan, implementation plan and overview of stakeholders.

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activities for developing countries among European nations. IDE has experience working with industry giants like Philips and other organizations in many projects and also in hosting workshops and seminars around the world. Dr. Jan Carel Diehl and Dr. Vikram Parmar were invited by JIDPO to represent Delft University of Technology and to give key note speech during this design event in Japan. They were also requested to conduct a workshop in the area of healthcare and energy. Some thoughts and examples of “designing for Emerging markets” were compiled and presented by Jan Carel Diehl and Vikram Parmar during the conference and workshops of this exhibition event.

5.3 University partnerships 5.3.1 LeNS Conference, Bangalore - Challenges and opportunities for design research, education and practice in the 21st Century The LenS, Learning Network on Sustainability, is an AsianEuropean multi-polar network for curricula development on design for sustainability focused on Product-Service System innovations. It is a 3 years project (Dec/2007 Dec/2010) funded by the European Commission (Asia Link Programme, EuropAid), involving 7 design schools in Europe and Asia. Delft University of Technology is one of the partners for this Asian-European multi-polar network. The Design for Sustainability (DfS) department

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at the faculty of Industrial Design Engineering (IDE) is the active partner and representative for Delft University of Technology. The LeNS Conference was held in Bangalore, India from September 29 to October 1, 2010. The conference was a platform for sharing the latest knowledge and experiences in product, service and system design, to promote sustainable systems thinking in design education, research and practice communities. The scope of the conference was to make a significant contribution to catalyze the learning and dissemination process of an emergent design knowledge-base, theory and practice, on design for sustainability, within the design community. The objective of LeNS conference was the creation of a new ethos, within such a community, enabling all possible synergies and fruitful processes of knowledge and know-how osmosis and cross-fertilization. Prof. Prabhu Kandachar, Prof. Han Brezet, Dr. Marcel Crul and Dr. Jan Carel Diehl from Delft University of Technology were part of the Advisory board of this LeNs conference held in Bangalore in 2010. Prof. Prabhu Kandachar was one of the keynote speakers at the LeNS conference. His speech touched upon several opportunities and challenges that designers encounter while designing for global sustainable solutions. He stressed on the role of designers in todayâ&#x20AC;&#x2122;s context, which extends beyond simply designing and developing more environmentally benign products and processes The proceedings of the conference are published (with ISBN). The best paper from the conference proceedings will be published in the International Journal of Sustainability in Higher Education (IJSHE) and in the Journal of Design Research. Dr. Jan Carel Diehl, Prof. Prabhu Kandachar and Dr. Santosh Jagtap from Delft University of Technology presented their papers during the conference. Dr. Jan Carel Diehl in his paper discussed how participatory context research and co-design can help in designing

and market implementation of products for low income households. He took the case of the participatory development and market implementation of the so-called â&#x20AC;&#x2DC;MoonLightâ&#x20AC;&#x2122; a solar energy powered and locally produced light for rural Cambodia. Light is one of the basic needs required for education, improving the social security and increasing productivity. In Cambodia 90% of the population does not have access to electricity from the public grid and rely on costly and low-grade lighting sources such as candles, kerosene lanterns and car batteries to provide light at night Prof. Prabhu Kandachar and Dr. Santosh Jagtap in their conference paper tried to investigate how businesses bring about systemic changes in BoP markets. Many authors suggest a systems approach to design and develop products and services (i.e. interventions) for BoP markets, a little work has been carried out in this area. Furthermore, a framework to represent interventions in the BoP (i.e. socio-technical systems) and the resulting changes of state is not available. In this study a framework called IASTS model was developed by modifying a causality model of technical systems. IASTS model was developed to represent interventions in a socio-technical system. This paper further explains the IASTS model by analyzing a case study drawn from the BoP. The findings of this paper can be useful for businesses, governments, and aid agencies that intend to operate in the BoP.

5.3.2 Aalto School of Economics, Helsinki Business opportunities through sustainable and user-driven innovations in emerging markets Aalto University is hosting a new project aiming at creating new wealth and reducing poverty through innovative business enterprise together with the lowincome individuals and communities in emerging markets. The aim of this project is to create a user-driven network promoting innovative and sustainable business enterprise at the BoP market. The main objectives of the project are:

Various Finnish actors are already involved in this multistakeholder project including Finnish Funding Agency for Technology and Innovation (Tekes), Ministry of Employment and Economy, Ministry for Foreign Affairs, Confederation of Finnish Industries (EK), Finpro, private companies and wider civil society. Potential partner countries include India, Vietnam, China, South Africa, Kenya, Mozambique, Tanzania, Ethiopia, Brazil and Peru. The activities of the project will be based on the needs of the various stakeholders and are not limited to these countries only.

Exploring the BoP - An interactive workshop (17th & 18th January, 2011) The first inter-active workshop of the sustainable and user-driven innovations at the BoP-markets – project was held on 17th and 18th of January, 2011, at Aalto School of Economics in Helsinki. Aalto University invited various actors from the private sector, civil society, research organizations and public sector both in Finland and partner countries to jointly create innovative business models aiming at reducing poverty related problems in emerging markets and developing countries. The goals of the interactive workshop were to define for each new project: •

What is the demand or problem that the business model aims to tackle?

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What kind of support does the business model need, and from where will these resources be attained?

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What are the next steps and roles of different stakeholders after the workshop?

The two day workshop commenced with the keynote speech by Prof. Prabhu Kandachar on the topic “Sustainable and inclusive innovations – Challenges and Opportunities”. This was followed by a panel discussion on ‘Roles and expectations of Strategic partners’, led by Mikko Koria, Development director, International design business Management program, Aalto University. The discussion panel had representatives from partner countries like India, Vietnam, Sri Lanka and representative from Confederation of Finnish industries and Finnish funding agency for technology and innovation. Vikram Parmar, Director of Centre of Design Innovations and Entrepreneurship represented India during this panel discussion.

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1. To create a new user-driven network promoting innovative and sustainable business enterprise. 2. To develop generic tools for entrepreneurial coinnovation.

The second day of the workshop commenced with the speech from Prof. Minna Halme, on the topic ‘Towards Radical Market Innovation at the BoP’. The later part of the day was dedicated for the pilot projects. Five different pilot projects were presented to the participants then followed by group work. The day ended with five groups presenting their main results and innovative business model for their respective pilot project.

5.3.3 Cairo University, Egypt Egypt suffers a high rate of non-communicable diseases (NCDs) such as hypertension, diabetes and high blood cholesterol, which affects the general health of the nation. There is a need to communicate directly with sufferers to collect disease demographics, follow progress and issue useful health tips and advice, and to occasionally respond to individual cases. From this perspective the Cairo Curative Organization has initiated the National Egyptian Initiative for the Prevention and Control of NonCommunicable diseases. Cairo University Innovation Support Office approached the faculty of Industrial Design Engineering (IDE) at Delft University of Technology to jointly start an ICT and healthcare project to develop a mobile (ICT) solution

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to support prevention and control non-communicable diseases (NCDs). In response to this an Integral Design Project (IDP) has been launched with a group of design students at the faculty of IDE in February 2011.

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Faculty of Industrial Design Engineering (IDE, TU Delft)

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Faculty of Technology, Policy & Management (TPM, TU Delft)

The goal of this IDP project is to develop a high usability and high utility mobile information system to aid national healthcare strategy formulation and NCD control. The project will focus on Cairo and surrounding rural areas. The student team will get access to patients and national healthcare resources. The outcome of the project is to be supportive of national healthcare (CCO), but since it is underlined by mobile telephone technologies, there could be commercial interest from service providers and handset manufacturers.

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3TU Centre for Ethics and Technology (3TU-Ethics, in which the Department of Philosophy, Faculty of TPM, participates).

The IDP Project is being supervised by; • Dr. Ir. Jan Carel Diehl, Delft University of Technology • Ir. Henk Kuipers, Delft University of Technology • Prof. Dr. G.H. Galal, Cairo University Innovation Support Office • Prof. Dr. Medhat M. El-Refaee, Cairo Curative Organization (CCO)

5.4. Research programs 46

5.4.1 ‘Technology and Human Development - A Capability Approach’ A research project which aims at applying the capability approach of Martha Nussbaum and Amartya Sen to technology, engineering and design has taken flight as a result of the joint efforts of 3TU-Ethics along with faculty of Industrial Design Engineering, Delft University of Technology and Centre for Sustainable Technologies, Indian Institute of Science. . In this project, researchers from IDE and 3TU-Ethics closely collaborate with researchers from the Indian Institute of Science (IISc, www.iisc.in). Within the Netherlands, the project is embedded in:

This project has been funded with a grant of 550.000 euro by the Netherlands Organization for Scientific Research (NWO), as part of their grant program called ‘Responsible Innovation’. This research project investigates how the capability approach can be utilized in (thinking about) technological innovation and engineering design. The context of application for this project is innovation for the so-called ‘Base of the Pyramid’ (BoP) or the poor in developing countries. Case studies are taken from three engineering areas: ICTs, healthcare/medical technology and sustainable human settlements.

Principal researchers Prof. Dr. Jeroen van den Hoven Department of Philosophy Faculty of Technology, Policy and Management (TPM) Delft University of Technology (TU Delft) P.O. Box 5015 2600 GA Delft M.J.vandenHoven@tudelft.nl Prof. Dr. Prabhu Kandachar Department of Design Engineering Faculty of Industrial Design Engineering (IDE) Delft University of Technology (TU Delft) Landbergstraat 15 2628 CE Delft P.V.Kandachar@tudelft.nl

E.T. Oosterlaken, M.Sc. Department of Philosophy Faculty of Technology, Policy and Management (TPM) Delft University of Technology (TU Delft) P.O. Box 5015 2600 GA Delft E.T.Oosterlaken@tudelft.nl Annemarie Mink, M.Sc. Department of Design Engineering Faculty of Industrial Design Engineering (IDE) Delft University of Technology (TU Delft) Landbergstraat 15 2628 CE Delft A.Mink@tudelft.nl

Research questions The central research questions are: • How can the capability approach (CA) be applied to technology and innovation - especially in developing countries, with the purpose of improving the situation of the poor? A) How should the interrelations between technology and human capabilities be understood and explicated? B) How can the CA be utilized in methods and practices of engineering design, in view of technology for development? C) How can the CA be utilized in the methods and practices of assessment and evaluation of technology / innovation projects for development? •

How and in which sense would sound answers to A),

B), C) lead to improvement of our thinking and best practices of technology and development, compared to other approaches which are currently in use? Three PhD projects correspond to these three research questions. Project A is mainly of a theoretical / philosophical nature. Projects B and C are methodological projects in the area of engineering design and innovation. They are embedded in concrete case studies that will provide invaluable input for answering the research questions.

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Dr. Monto Mani Centre for Sustainable Technologies Indian Institute of Science Bangalore 560 012 India monto@astra.iisc.ernet.in

Description of three PhD projects Project-A - Theory: technology and human capabilities PhD Student: Ilse Oosterlaken Promoter: Jeroen van den Hoven (Technology, Policy and Management) Daily Supervisor: Sabine Roeser (Technology, Policy and Management) Project A will address several more theoretical and philosophical issues, including: • Conceptual analysis and comparison of discourses (terms, concepts and background views) within a) the capability approach (CA) and b) technological innovation and engineering design. •

Applied ontology of the CA (human capabilities and functioning) in relation to the ontology of engineering.

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Critical reflection on the interaction between technology and human capabilities.

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Tenability of claims of non-paternalism and neutrality towards the good life in the CA, considering the fact that many capabilities would not be possible without technology; within the philosophy of technology and within science and technology studies (STS) people have argued that technology is not neutral with respect to the good life.

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Project-B - Design application: ‘capability sensitive design’ PhD Student: Annemarie Mink Promoter: Prof. Dr. Prabhu Kandachar Daily Supervisor: Dr. Vikram Parmar If we conceive of technologies in terms of their effect on the capabilities of people, the capability approach (CA) needs to be made an integral part of engineering design, both in terms of methodologies and general awareness. This project includes: •

The appropriateness - from the perspective of the CA of existing design theory, methods and practice, value sensitive design, universal design and participatory design.

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Special attention for participatory design, considering the ‘inherent’ link between the CA and participatory methods and the added value that the CA is expected to have here.

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The development and testing of improved design methodologies, based on the CA - with special emphasis on developing countries / the global poor.

Project-C - Policy application: capability-technology assessment & evaluation PhD Student: Pramod Khadilkar Research Guide: Dr. Monto Mani First attempts have already been made to apply the capability approach (CA) to the assessment and evaluation of projects concerning technology/innovation. This part of the project builds on that work and includes: •

Articulation of criteria for “appropriateness” – from the perspective of the CA - of existing methods and practices.

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Special attention for participation.

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The development and testing of improved or new assessment and evaluation methodologies, based on the CA - with special emphasis on developing countries / the global poor.

Cohesion between the three PhD projects The three PhD projects benefit from each other’s findings and results in several ways, e.g.: For project A the other two projects offer the opportunity to get feedback from professionals and stakeholders on philosophical ideas and dilemmas. Project B, in attempts to come up with suitable ‘capability sensitive design’ methods, can benefit from the applied ontological work done in project A (functional decomposition being an important method in engineering). And since projects B and C both aim for the development of appropriate participatory methodologies in their field, they may benefit from sharing their information, ideas and results.

International orientation and collaboration Firstly, the content of the research project itself is thoroughly internationally oriented, with its focus on developing countries. Secondly, the project is a joint effort of Delft University of Technology and the Indian Institute of Science and all three PhD students are scheduled to spend some time abroad. Thirdly, the project has an internationally oriented valorization panel. Finally, the applicant’s scientific network allows the project to draw upon internationally recognized experts in relevant areas. For example, the following researchers have expressed their interest in being involved in discussions concerning this project: •

Dr. Ir. Richard Goossens, Medisign (Product Development & Research in Health Care), Faculty of Industrial Design Engineering, Delft University of Technology, the Netherlands (www.io.tudelft.nl/ medisign)

Prof. Dr. B. Gurumoorthy, CPDM (Centre for Product Design & Manufacturing), Indian Institute of Science, India (http://cpdm.iisc.ernet.in/)

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Prof. Harishchandra Hebbar, Director ‘Manipal Centre for Information Science’ & BoP Chair, India (http:// www.grassrootinnovations.org/BoP_engagements/ harishchandra_hebbar.htm)

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Prof. Dr. Melissa Leach, STEPS Centre (Social, Technological & Environmental Pathways to Sustainability), Institute of Development Studies, University of Sussex, UK (http://www.stepscentre. org/index.html)

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Dr. Evan Selinger, Department of Philosophy, Rochester Institute of Technology, USA (https:// people.rit.edu/emsgsh/)

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Dr. Randy Spence, OPHI (Oxford Poverty & Human Development Initiative), University of Oxford, UK (www.ophi.org.uk)

5.4.2 Development of an early conceptual framework of health ICT design in developing countries - Emerging lessons from studies for rural China PhD Student: Jie-Hui Jiang Promoter: Prof. Dr. Prabhu Kandachar Daily supervisor: Dr. Ir. Adinda Freudenthal Jie-Hui Jiang is currently pursuing his PhD degree in Design Engineering department of faculty of Industrial Design Engineering, Delft University of Technology, Netherlands. His research interests focus on designing low cost Information and Communication Technology healthcare solutions for Chinese markets. As a PhD researcher in

the BoP research group, his contributions are focused on investigations of design culture, factors and methodologies about BoP healthcare in developing countries (rural China). This research project is primarily funded by the Chinese Government and further supplemented by the funds from the Department of Design Engineering of Delft University of Technology. Kandachar (Kandachar and Helme, 2008) proposed and validated a “User Centered Design (UCD)” strategy for BoP: it states that;

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1. The needs of the users should be considered as a starting point for BoP product and innovations. 2. Several innovation methods could be considered for an effective approach to serve the unmet needs of the BoP community. Information and Communication technology (ICT) based products and services are considered as important solutions to solve historical health problems in rural China (Dummer etc, 2006). Literatures (Kandachar and Helme, 2008) and own experiences (Jiang and Kandachar, 2009) showed that Product-Service combined Design (PSD) for Base of the pyramid (BoP) in healthcare domains is a complex issue (wicked problem). Designers often meet difficulties in several design aspects such as information collection and user involvement. Thus, the final aim of his PhD project is to develop a design framework and guide for designers to help them overcome the difficulties in several design aspects such as information collection and user involvement. To address this issue, the context has been limited to “ICT supported healthcare in rural China”.

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5.4.3 Open Innovation with the Base of the Pyramid – A PhD project at Universiteit Antwerpen PhD Student: Ann De Keersmaecker Promoter: Prof. Dr. Prabhu Kandachar, Delft University of Technology Daily supervisor: Mia Cornelis, Artesis Hogeschool Antwerpen Ann De Keersmaecker is currently pursuing her PhD at Universiteit Antwerpen on the research topic “Open Innovation with the Base of the Pyramid”. The PhD is supervised by Prof. Prabhu Kandachar (Delft University of Technology) and supervised by Mia Cornelis (Artesis Hogeschool Antwerpen). Her research interest focuses on ways of alleviating poverty by creating a new environment, in which the BoP market cooperates with the surrounding network of relationships to create an innovative wideness. For example, an innovative design cooperation and exchange such as working in partnership with local organizations that know the context can offer unique design solutions. The aim of this PhD research is to explore different approaches in opening innovation barriers. It aims to answer various questions that arise when thinking about cooperation and open innovation.

5.4.4 Emergent Agency – A PhD project at DfS (TU Delft) PhD Student: Ana Laura Rodrigues Santos Promoter: Prof. Dr. Brezet and Prof. Dr. Goossens Daily supervisor: Dr. L Wauben and Dr. J.C. Diehl Emergent Agency is a project funded by the Portuguese Foundation for Science and Technology (FCT) and integrates proficient staff from the field of societal

and environmental sustainability (TU Delft) and from material engineering (UMINHO) in the coordination of student teams responsible for field research and product development. TU Delft, Faculty of Industrial Design Engineering • Prof. Dr. Brezet (Research Director and head of the Design for Sustainability Department) • Prof. Dr. Goossens (Head of Medisign research program) • Ana Laura Rodrigues Santos (PhD candidate and main researcher) UMINHO, Engineering Faculty • Prof. Dr. Olga Carneiro (Head of the Polymer Engineering Department) • Dr. Luís Rocha (Researcher and assistant professor at the Department of Electrical and Computer Engineering) Emergent Agency is a project dedicated to emergency surgical care in extreme contexts. The main idea is to create a network of people that can share information and contribute to the improvement of the working conditions of surgical care givers in resource-poor contexts such as regions affected by natural disasters and conflicts where infrastructures and reliable electricity are scarce. Specialized surgical products are generally conceived to be used in advanced operating rooms (OR). These have special characteristics which cannot properly function if the same controlled environment does not exist. Peripheral surgery has less opportunity of formulating problems and delivering briefings in the same codes as the ones presented in OR contexts. The extreme character of the work performed by voluntary groups such as Médecins sans Frontières and Expedicionários da Saúde is characterized by less time to operate, long lines of urgent case patients, children and adults, most frequently with common pathologies, less workforce and bad conditions

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Fig. 5.1: Project Emergent Agency

of local equipment. At the same time this scenario strengthens the creativity of doctors as they perform surgery with few or improvised equipment and poor information. In its simplest form, surgery can significantly reduce death or disability.

5.4.5 Extramural maternal care for rural women: A medical device for providing diagnostic care, preventative information, pre referral services and personal digital health identity

The proposed project aims at the elaboration of briefings for product design from the field observation and participative research made with volunteer surgeons. Further on these projects must be technically developed into more adequate surgical equipment, focused on performance and efficiency, stronger assembly, lighter transportation, easier training of non specialized people.

Principal Investigator: Dr. Vikram Parmar Research fellow: Dr. Ashis Jalote-Parmar

Aim of the proposal call The aim of the call for proposals is to stimulate sustainable Indo-Dutch research collaboration by funding joint research projects on the topic medical devices that have

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the explicit goal to reduce the costs of healthcare either in India or in the Netherlands. An additional goal is to stimulate the Dutch and Indian research field of medical devices on five topics: (1) Minimally invasive techniques, (2) Medical optics and acoustics, (3) Medical image processing, (4) High precision instrumentation, (5) Safe extramural care.

Summary The concept of home based health care is gaining ground in rural as well as in developed nations due to many fallacies linked with modern hospital-technology based healthcare system such as lack of trained manpower, and the cost of equipment, infrastructure, and transportation. The demographic shift towards aging population in developed nations and rapidly growing economically deprived population i.e., pregnant mother and child in developed countries has created a situation where it has become necessary to provide them affordable quality care at their door step. There is an urgent need to innovate affordable & accessible preventive, diagnostic & therapeutic medical technology that can fulfill the unmet needs of population belonging to both developed and developing countries. At the same time we need to ensure patient safety as one of our major concerns while keeping in mind the diagnostic and therapeutic efficacy of such evolving home based affordable medical devices. This proposal focuses on maternal health in India as an application case which also serves as the UN millennium development goals about reducing child mortality and improving maternal health. On a global scale, every fifth woman who dies in childbirth as a result of poor medical care is from India. The delivery of relevant personal health information and medical treatment is still recognized as a considerable challenge for government and private sectors in rural India. The government healthcare outreach programs in India have not been able to keep up with the growing

healthcare demands in villages. The partial success of government healthcare systems could be attributed to large geographical distances between urban and rural areas, limited medical staff, and poor infrastructure. Needs associated with pregnancy, delivery, and early infancy remain neglected, in part because information available to the midwife is inadequate for supporting home-based services for maternal care. The healthcare community workers and local GPs try to bridge this gap by visiting patient at home but because of limited infrastructure only a few patient revive this benefits. Over the past decade there has been considerable international discussion about the potential of Information Communication Technology (ICT) in providing affordable healthcare and development of medical devices. If we need to translate the benefits of medical devices to providing high quality affordable extramural care for rural patients, then an essential next step is to focus on integrating the design and development of medical devices in such a way that there are no more isolated silos of technical devices but â&#x20AC;?integrated solutionsâ&#x20AC;?. But which consider the technical and social environment in which they are required to function and should improve at a systemic level the working patterns of healthcare professionals, individual patients and communities. In a summary device made from the perspective of the end patients/communities to improve the existing healthcare infrastructure and not just a mere technological implantation in an expensive hospital. This project aims at development of an integrated mobile medical device which could play an instrumental role in improving and making maternal healthcare accessible, safe and affordable at home for the rural women in India. The proposed device is mobile and will enable the local health provider (GPs) community health worker to reach patient at home and deliver heath care services effectively. The health issues that the device development aims to tackle are (a) Home and early

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Designing sustainable services and products

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Introducing sustainable consumption practices

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Connecting to the lifestyles of local users when introducing new products, services and infrastructures while making possible learning processes to enhance sustainable lifestyles and patterns of consumption.

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diagnosis of issues such as diabetes, hemoglobin level, blood pressure, ultrasound monitoring (b) Pre-referrals (diagnosis/ referrals) with doctors in hospitals based on collected data (c) Dissemination of preventative health information in relation to maternal health and child care. The preventative information dissemination will avoid major fatal situation in the rural context, as patients will take necessary precaution in early stage and (d) Creating digital health identity and immunization card of pregnant women and children. This device will reduce the cost of healthcare both at a user and at government level in India. This proposal will try to integrate some of the existing technology solution and open source platforms to create a “usable and affordable solution focused at the end user”. Several of the components and facilities of this medical device can be also applicable to promote maternal and elder care in the Netherlands. Scientific knowledge generated from this project would be useful to industries in Netherlands, India and across the globe involved in medical device development.

5.4.6 Research proposal in pipeline Developing a design framework to promote sustainable consumption at the Base of the Pyramid: The case of India In the Base of the Pyramid (BoP), people are climbing out of poverty and form a large new middle class society. The consumption patterns of these people and the related environmental pressures are growing fast due to the combined effect of increase in disposable income and accessibility of everyday life goods and services. The proposed research project aims to investigate and to generate knowledge related to existing lifestyles of middle class at BoP, and propose a design framework to design products to steer consumption practices into a more sustainable direction. Product designers could contribute to the furthering of sustainable consumption at the base of the pyramid by;

Photo: Wietske Koers

6. PLANS 6. PLANS

This chapter of the report provides an over view of the proposed plan for starting a two year Master track called â&#x20AC;&#x153;Design for Emerging Marketâ&#x20AC;? (DEM). The main purpose of this proposal is to create a multidisciplinary research environment in the faculty of Industrial Design Engineering, which will facilitate the master students to design and develop solutions for emerging markets. - Dr. Jan Carel Diehl, Dr. Vikram Parmar

PLANS

6.1 Proposal for “Design for Emerging markets (DEM)” master track of IPD

Developing products and services for emerging markets is a multifaceted design challenge as it requires expertise from multiple disciplines such as engineering, technology, management, social sciences, computer science and industrial design. In order to facilitate multidisciplinary research environment in IDE to design and develop solutions for emerging markets, we would like to propose a two year Master track called “Design for Emerging Market” (DEM). Design for Emerging Markets represents:

•

Low income household in ‘developing countries’ (also known as BoP).

•

Middle class markets in emerging economies as China, Brazil, India and other growing markets.

The proposed master track will provide a structured outlook to our existing Base of the Pyramid (BOP) efforts to the outside world, thereby increase IDE visibility and attract funding from corporate and government organizations. DEM would offer flexibility to the design students to develop their design skills focused on emerging markets and simultaneously pursue courses in interaction design, integrated product design, and strategic product management. This will offer an opportunity to utilize the existing infrastructure of DFI, IDP, and SPD master programme. In addition to education, DEM master track would also offer a possibility to pursue research projects with industries and a platform for valorization. We strongly feel, valorization is an important component because knowledge generated through education and design research activities needs to be transferred to the emerging markets. We also foresee that information and experiences gathered through working in emerging market context could be useful in promoting novel design

trends in the developed countries.

6.2 Objectives of DEM master track

1. To create opportunity for students and industries to conduct fundamental and applied research in the domain of Industrial Design, Design Engineering, and Product Innovation Management. 2. Create scientific knowledge in developing design tools and techniques, in particular design methodology for designing product/services in emerging markets. 3. Create platform for transferring scientific knowledge to corporate, small-medium enterprises, government organization in developed and emerging markets. 4. Contribute in existing ICT efforts of Design Engineering by conducting design inclusive research to design and develop new ICT product/services for emerging markets. 5. Create a platform to aggregate knowledge relevant to industry through DEM research and education curriculum. 6. To structure existing efforts of “designing products for emerging markets” in the department of Design Engineering, Delft University of Technology.

6.3 Education program

The education program of DEM has been designed in such a way that a large part of the DEM track can take place within existing courses offered within the three IDE master programs. It is proposed to introduce two new elective courses which also can be joined by non DEM track students. The setup is similar to Medesign, however with more opportunity to apply DEM in compulsory and elective courses. Some course already offers to focus on DEM, for example IDP (every semester 2-4 projects

The IDE MSc program consists of four semesters each offering 30 ECTS and the student can start it twice a year. In order to specialize in DEM students will have to do at least one project worth at least 9 (i.e. IDP or PAP) ECTS and the thesis project (30 ECTS) with an explicit focus on DEM. Additionally the student needs to select at least 9 (or 12) ECTS from the DEM electives list. Taking other projects and courses with a DEM focus at other faculties is optional. In conclusion, the main requirements for the students are: 1. Graduation thesis with focus on DEM 2. One ‘ large project’ with focus on DEM (>= 9ECTS) 3. 9-12 ECTS elective courses related to DEM 4. Apply DEM as much as possible in other compulsory courses. The options provided to the students will be: 1. Projects of 9 ECTS or more suitable for DEM • Integral Design Project (12 ETCS) • Project Advanced Products (9ECTS) 2. Elective DEM courses (9-12 ECTS) Current elective courses within IDE: • ID 5561 Product Service Systems (3 ECTS): (special DEM teams will be made) • ID 5502 (6-9 ECTS): research (dedicated to DEM)

3. New proposed DEM electives: (for DEM students but also open as elective for other IDE students): •

ID DEMx - Capita Selecta DEM (3ECTS): Monthly meetings at which design challenges and research topics in the DEM field are presented and discussed. The main objective is to generate interaction between DEM students, DEM professors, DEM PhDs and DEM professionals.

•

ID DEMxx - DEM in practice (3 ECTS): This course prepares the students for DEM in practice. One third of the course is dedicated to DEM ethnographic research, one third to DEM relevant technologies and one third to DEM business plans.

4. Elective courses from Technology in Sustainable Development (TiSPD) • CT 5420 Public Hygiene and Epidemiology • IE 3320 Introduction to Renewable Energy Systems • EPA 1431 Cross Cultural Management • WM 0903 Technology and Global Development • WM 0904 Special Topics in Sustainable Technology Development 5. Potential application of DEM in current compulsory courses: Current courses of the master program which could be dedicated to DEM: • ID 4215 Context and Conceptualization (DFI) • ID 4220 Integrative Technology Design (DFI) • ID 4310 Brand Strategy (SPD) • ID 4350 Design Strategy Project (SPD)

PLANS

in DEM context) as well as PAP. The proposed outline of the DEM track will attract students who want to study Design for Emerging Markets (DEM) as a master variant or specialization participate in the master Integrated Product design (IPD), Design for Interaction (DFI) or Strategic Product Design(SPD) (all three masters can participate).

PLANS

6.4 Course objectives for DEM students

1. Offer knowledge of emerging market context, opportunity, and constraints. 2. Develop low-cost business models for sustaining proposed design solutions. 3. Develop creative skills to visualize and design product and services for emerging markets. 4. Conduct field studies and experiments in urban and rural context of emerging markets. 5. Develop design and research methods for emerging markets. 6. Develop scientific research skills to pursue PhD research in relevant areas.

6.5 Benefits of DEM master track

The â&#x20AC;&#x153;Emerging Markets trackâ&#x20AC;? will benefit existing research and education efforts in IDE for designing products and services for emerging markets in a following ways: 1. Teach design tools and techniques to IDE students by offering hands-on experience.

2. Projects in DEM will offer knowledge on industrial material and process relevant in the context of emerging markets to IDE students. 3. Faculty and PhDs will supervise student graduation projects and offer opportunity to deploy their projects in real-world setting. 4. Collaboration with design schools and NGOâ&#x20AC;&#x2122;s of the emerging countries to provide students with real world issues.

5. DEM master track research and design themes will involve areas such as healthcare and education (we should start with a focused area, later new areas could be added). 6. DEM master track will offer a platform to amalgamate disciplines such as sociology, public health, computer science (Persuasive technology), design engineering (ICT), and marketing research (diffusion theory).

6.6 Competitive advantages over other design schools 1. None of the design schools have dedicated lab for designing and developing products for emerging markets. IDE, Delft University of Technology could become a leader in this area.

2. With DEM master track, IDE will have an advantage over existing BOP lab in Tilburg and Cornell University, because we will build products and create end to end solutions for emerging markets (Rather than only proposing business strategies).

6.7 Human resource requirements

We expect professors from all the three departments Design engineering, Industrial design, and Product innovation management to play an important role in DEM related education and research. Additionally, PhDs from IDE that are working in the emerging market domain will be involved in education and research activities through a research or graduation assignments. Industries involved in the DEM would be invited to present industrial case studies to the DEM students.

6.8 Financial requirements

To a large extend the DEM master track can start up with limited additional financial input. The courses provided by the DEM master track fall underneath the ongoing

6.10 Team

Likewise other student projects within IDE, companies and organizations will be asked to financially support projects. These projects (i.e. IDP and Graduation Projects) will be focussed on their interest and demand. The fee will depend on the size and financial capability of the company. The goal is to execute 2-4 projects, every semester for social enterprises and NGO’s, without charging them any fee.

Support

Core Team • • • • •

• •

Prof. Dr. P.V. Kandachar (Delft) Prof. Dr. J.C. Brezet (Delft) Dr. J.C. Diehl (Delft) Dr. V. Parmar (Ahmedabad / Delft) Dr. M.R.M. Crul (Delft)

PLANS

Master tracks and as such will create revenue based upon its educational output (amount of students, amount of ECTS per course as well as amount of MSc. Certificates delivered). The initial investments will be mainly to purchase products and book to provide students with hands-on experience as well as the state of the art of literature. Expected investments will be around 5000€.

MSc. Annemarie Mink MSc. Ana Laura Dos Santos

Other faculties involved • •

Architecture Technology, Policy & Management (TPM)

In addition we also look for structural funding to set up exchange of students (and staff) between Delft University Technology and Ahmedabad University, the two main hubs of this DEM Master track.

6.9 Proposed starting date/schedule Curriculum 2010-2011 Three courses are in progress; • DEM Joint Master Project • DEM Graduation Project • DEM Research Project

Curriculum 2011-2012 • • •

Acceptance of official DEM Master Track. Official Start date - September 2011 or February 2012. Begin exchange program with Ahmedabad University.

Curriculum 2012-2013 •

Consolidated DEM Master Track as well as Collaboration with Ahmedabad University

Photo: Bastiaan Tolhuijs

7. OUTPUT 7. OUTPUT The two year journey (2008 to 2010) of the BoP Healthcare research programme has been marked by many events, achievements and landmarks in the history of the faculty of Industrial Design Engineering (IDE), Delft University of Technology. This section provides an overview of all the academic achievements and outputs which hold direct or remote relevance within the framework of Sustainable healthcare for the BoP.

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7.1 Published Research Papers

The funding from the BoP healthcare research program supports one PhD researchers and two post-doc researchers working on various issues related to designing product service system for healthcare, specifically in BoP markets. Offshoot of this research program is another PhD project at the faculty of Industrial Design Engineering (IDE), started with focus on Chinese rural health care. Each of these researchers has approached the aspect of designing for BoP healthcare market with separate issues in focus. The focus areas of the ongoing and completed research works touches upon various issues like cultural, human, information, technical, systems approach, distribution and other related business aspects. The post-doc researchers have looked into the technical and business related issues for designing product service system for BoP healthcare. On the technical side, an attempt has been made to explore and understand the role of systems approach and disruptive technologies for BoP markets. From the business strategy point of view, the researchers have tried to identify different strategies used by businesses to tackle the design issues. A much focused research has been carried out regarding accessibility to healthcare in BoP contexts with specific interest on retailing dimension of healthcare.

One of the PhD researcher is exploring, how culture plays a role in the product design process and while the other PhD researcher is investigating on culture, factors and methodologies to be adopted for BoP healthcare in developing countries with an aim to develop a design framework which will help and guide the designers to overcome the difficulties related to information collection and user involvement. This section includes a brief introduction to the research areas of each of the researchers working in the related areas of BoP healthcare at the faculty of IDE, followed by the list of their publications and their abstract.

Dr. Alur Sivakumar is a post-doc researcher in the BoP-research-group. The BoP markets in most emerging economies faces four major challenges namely Affordability, Accessibility, Awareness and Acceptability. However, the most challenging among the constraints is accessibility when it comes to healthcare. Physical access to healthcare is impacted on account of the large distances, the remoteness of the rural areas where a large number of the BoP market resides and also low population density to support sustainable healthcare provision. Thus, his research is mainly focused around the aspect of accessibility to helathcare in BoP contexts.

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7.1.1 Dr. Alur Sivakumar

His role as a post-doc researcher in the BoP research project was to look at the retailing dimension of healthcare. Retailing is the last link between the company and the consumer. This is the point where the products and services interact to produce positive or negative results. Point of care Devices and Social Franchising are two areas that relate to access for healthcare among the BoP consumers. Dr. A Sivakumar during his two year post-doc research has produced two journal publications and presented papers in five international conferences.

Journal Publications • •

Alur, S. (2010), Can Similar Technology work for US Homecare and Emerging Market Rural Healthcare? In: International Journal of Biomedical Engineering and Technology, Corrected Proof (In Press). Alur, S. (2010), Organizational Ergonomics in Medical Device Design Standards. In: Journal of Medical Marketing 10(4), 312-322.

Conference Proceedings •

• •

Alur, S. (2010), Evolution of Sustainable Design - An Analysis of Sustainable Design Awards. In: LeNS Conference 2010 - Sustainability in Design: Now - Challenges and Opportunities for Design Research Education and Practice in the 21st century. Fabrizio Ceschin, Carlo Vezzoli and Jun Zhang (eds.). Indian Institute of Science Bangalore India Greenleaf Publishing Ltd Sheffield UK pp. 1371-1376. Alur, S. (2010), Sustainable Design by Habit - The case of BoP Market designers In: ERSCP - EMSU Conference Delft The Netherlands TU Delft Netherlands pp. 1-9. Alur, S. (2009), Cognitive Engineering in Medical Device Design for the Bottom of the Pyramid - (BoP) market – the case of the Point of Care (POC) Malaria Detection Kit. In: PDMA India IVth Annual International Conference - New Product Development Challenges in Meltdown times N. Siva Prasad, L.S. Ganesh, Shankar Krishna Pillai and Arshinder Kaur (eds.). IIT Madras Chennai IIT Madras pp. 244-249. Alur, S. (2009), Retailing Of Health Care Services – The Role of Point Of Care Devices for Base of the Pyramid Market. In: International Base of Pyramid Conference. Johannesburg South Africa. Alur, S., Schoormans, J.P.L. (2009), Franchisee Selection and Health Services Impact – Social Franchising In BoP Context. In: International Conference on Impact of Base of the Pyramid Ventures. Prabhu Kandachar, Ilona de Jongh and Minna Halme (eds.). Delft The Netherlands TU Delft Netherlands pp. 279-288.

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The abstracts of the above mentioned published paper are available below;

Can Similar Technology work for US Homecare and Emerging Market Rural Healthcare? A. Sivakumar The US Home healthcare industry is developing with the need for reducing hospital stay and the increasing desire among elderly for home care. Home healthcare has resulted in the development of several portable and simple pointof-care devices. Such devices have relevance in entirely different setting namely rural areas of emerging markets. Rural contexts in many emerging countries like India present a challenge for healthcare services delivery. The dominant model of doctor-focused and hospital-centric healthcare is not available to the majority of rural citizens. Rural residents spend a huge amount of money and time travelling to the nearest town for availing healthcare services. Moreover, suspect healthcare quality in the nearest town requires an alternative for rural healthcare. Home healthcare devices can be a useful tool in such a scenario for disease detection, treatment, monitoring, and control. However, device makers cannot directly transfer them to emerging markets. This paper aims to detail medical device makers about the enormous opportunity in emerging markets highlighting the commonalities with developed markets. At the same time it cautions the (mainly US based) home healthcare device marketers on challenges they could face in this endeavor.

Organizational Ergonomics in Medical Device Design Standards A. Sivakumar

Human Factors standards for medical devices design are integral part of new product development. These standards have gained in importance recently. This is due to increased realization that medical errors, deaths and unsafe events in healthcare are attributable to human errors. Human Factors standards at present mainly relate to human device interface, physical environment and cognitive aspects of device users. The organizational setting in itself plays a crucial role in medical device operation. Medical devices mediate healthcare interventions. Organizational settings typically dominate healthcare offering. An interaction between these aspects means that organizational factors in medical design standards become significant. This paper analyses organizational factors that need consideration in medical device design standards and standards development organizations.

A. Sivakumar Sustainable design evolution mirrors development of priorities in sustainability in society and in design profession. Design researchers chronicle evolution mainly through scholarly writing as published in peer reviewed journals. A different method of tracing evolution is to trace the importance attached to a new concept within the profession. Design profession embraced the concept of sustainable design relatively recently in its evolution. Any new area within a profession, like sustainable design within the design profession, gets recognition when government or professional bodies constitute awards specific to this new emerging area. At present, the design profession across several countries promotes and incentivize development of sustainable design through specific awards directed at designers creating sustainable products/designs/services. These awards evolve over time reflecting changing societal interests and professional goals. In addition to monetary reward, prestige and recognition ensures that designers want to compete and win these awards. Prestigious awards announcement is a culmination of several processes that ensure prestige of the award. Composition of committee to decide on awards, award categories, criteria for eligibility, short-listing and final selection, profile of individuals/ organizations selected as winners, kind of products/designs/services selected together illustrate the nature of professionâ&#x20AC;&#x2122;s evolution. This is true of sustainable design awards too. This paper attempts to analyze three major sustainable design award competitions across three continents in the world. The paper will use various dimensions (mentioned above) to analyze awards. The goal is to trace sustainable design evolution across categories over the recent past. This analysis also can throw light on differential emphasis (if any) on components of sustainable design across continents

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Evolution of Sustainable Design - An Analysis of Sustainable Design Awards

Sustainable Design by Habit - The Case of BoP Market Designers A. Sivakumar Sustainable design rests on the three pillars of economic, social and environmental sustainability. The need for sustainable design arose, as there has been a global awareness or sensitivity to these aspects in its impact through design. Sustainable product designers work towards developing designs that measure up to requirements of three dimensions. Base of the Pyramid (BoP) markets are markets that face severe constraints on financial, social and environmental resources. BoP market designers, design products or produce innovations that developed countries embrace as sustainably designed products. Concepts of frugal engineering and blowback innovation trace their origin to efforts of BoP market based designers. The argument in this paper is that BoP market designers incorporate sustainable design by habit in their thinking unlike developed country designers. This is because of their subconscious treatment of measures of sustainable design while living through economic social and environmental constraints. This paper will illustrate the argument with selected of prize winning entries at the National Innovation Foundation database in India that represents a BoP market. The detailed entries provide profiles of designers too, that form the basis of substantiating the argument. These products have a universal appeal and therefore even developed countries can utilize them. Developed country designers need to understand the context of sustainable design before they involve themselves in design. This process of understanding makes it less efficient compared to designing sustainable products by habit

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Cognitive Engineering in Medical Device Design for the Bottom of the Pyramid - (BoP) market â&#x20AC;&#x201C; The Case of the Point of Care (POC) Malaria Detection Kit A. Sivakumar A portable malaria detection kit addresses the need to detect malaria effectively in remote geographical areas where healthcare access can be minimal. The use of a large number of devices also helps quickly cover a large geographical area in any country simultaneously to take steps for mitigation of risks due to advance stages of malarial infection and effectively stops the spread of infection. A multinational company based abroad sponsored the study described in the paper in India. The objective of the study was to obtain design inputs for development of a portable malaria detection kit. Two major methods of cognitive engineering mainly applied cognitive task analysis and ethnographic analysis was used in the study. The study is descriptive in nature and acts as a case study for illustrating the use of these techniques for the design phase of a new Point of care medical device.

Franchisee Selection and Health Services Impact â&#x20AC;&#x201C; Social Franchising in BoP Context A. Sivakumar & J.P.L. Schoormans

Geographical isolation, non-availability of healthcare professionals and a lack of sufficient investments by governments in healthcare severely constrain access to health services in the BoP market especially the rural areas. In addition to access, affordability, and awareness about healthcare are also key issues that hinder progress in provision of healthcare services. Social franchising as a concept combines commercial franchising principles with social marketing to offer a sustainable business model for expanding social initiatives. Social franchising in healthcare services broadly offer commodity franchising as well as clinical alternatives. Clinical social franchising is crucial in providing medical services to inaccessible rural areas. There are several opportunities and challenges in this new area of study. In this paper, we put forth an argument for considering franchisee selection as a key ingredient for making a success of clinical healthcare franchising. Success of a social franchising venture in healthcare sector means a greater impact in the BoP context. We present the significant factors affecting franchisee selection and emphasize on the consideration of the personality related factors. A quick exploratory study in India on social franchising among social enterprises and its results are also presented

A. Sivakumar Healthcare is one of the key dimensions of the BoP market. Next to Food clothing and shelter which represent basic needs, solutions targeted at healthcare for the BoP market have attracted the attention of those who work for the betterment of the BoP consumers. A combination of healthcare products and services ensure good healthcare for the BoP patients. Pharmaceutical products and medical equipment or devices come under the ambit of products. The provision of diagnostic preventive and curative healthcare services represents the services. However, it is difficult to distinguish products and services distinctly. Therefore, the whole product service system caters to healthcare services provision. Retailing of healthcare services is a crucial issue in BoP markets because Access is a major constraint. Geographical distance, non-availability, and unwillingness of urban-based doctors, bulkiness of medical equipment, spurious drugs, and fake doctors create barriers to Access to healthcare services in rural BoP markets of emerging economies. Retailing as a concept provides place utility for the consumer. Thus in the retailing of healthcare services, Point of Care devices would play a major role in the future. In this conceptual paper, argument would be to establish Point of care devices as the key link to the provision of healthcare services in the rural areas where a majority of the BoP consumers live in the merging markets. Point of care devices can perform several functions like diagnosis, drug delivery and monitoring of a patientâ&#x20AC;&#x2122;s health. However, diagnosis is an important aspect of the provision of healthcare service, in limiting progress of diseases that does not present either symptoms early or where they resemble normal illnesses. A particular emphasis therefore in this paper would be made of the use of Point of Care diagnostic devices that would have significant impact on the detection of diseases. I would highlight the contribution of design in developing point of care devices for the BoP markets. This is the significant contribution of the paper in that I would like to suggest major attributes that designers need to take into consideration while designing Point of care medical devices for the BoP markets. This I believe would help future designers in treating these attributes as a benchmark in designing Point of Care devices. It would also help in avoiding pitfalls in the design process.

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Retailing of Healthcare Services â&#x20AC;&#x201C; Role of POC Devices for BOP Market

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7.1.2 Dr. Santosh Jagtap Santosh Jagtap joined the faculty of Industrial Design Engineering in November 2008 as a post-doc researcher in the BoP-research-group. His research explores different issues in designing products for BoP markets and different strategies used by businesses to address these issues. In addition, his research explores systems approach in the design of products for the BoP. This research aims at: (1) identifying different issues in the design of products for BoP markets; (2) identifying different strategies used by businesses to address these issues; (3) developing an understanding of the role of disruptive technologies for BoP markets. Furthermore, this research aims at exploring systems approach in the design of products for these markets. The main emphasis of this research is on the healthcare sector in the BoP. Santosh Jagtap has successfully published a journal paper and presented his research papers in three international conferences during the year 2009-2010.

Journal Publications •

Jagtap, S., Kandachar P.V., Designing products and services for the Base of the Pyramid: Issues and Solutions, Journal of Cleaner Production.

Conference Proceedings • • •

Jagtap, S., Kandachar P.V. (2009), Towards Linking Disruptive Innovations and BoP Markets, In International Conference on Engineering Design, ICED-09. Stanford, California. Jagtap, S., Kandachar P.V. (2009), Issues and Solutions in Designing Products and Services for the Base of the Pyramid, In International Base of the Pyramid Conference. Johannesburg, South Africa. Jagtap, S., Kandachar P.V. (2010), Adapting a causality model of technical systems to represent socio-technical systems: Case studies from the BoP, In International Symposium on Tools and Methods of Competitive Engineering, TMCE 2010 Ancona, Italy.

The abstracts of the above mentioned published paper are available below;

Design for the Base of the Pyramid: Issues and Solution-ingredients Santosh Jagtap and Prabhu Kandachar The base of the world economic pyramid consists of four billion people typically earning less than $4 per day. The BoP markets offer profitable opportunities for businesses, and the research in this area is relatively new. To successfully design and develop products and services for the BoP markets, it is crucial to understand issues in these markets. This paper aims at identifying these issues and existing attempted ingredients of solutions addressing these issues. It is hoped that this knowledge regarding issues and solution-ingredients can better help businesses to design, develop and commercialize products and services in the BoP. To address these aims, we pulled together the issues and solutioningredients in the BoP from the reviewed literature, and compared these with a large study found in this literature. In addition, we analyzed the data available in this large study to extract some quantitative findings and to identify relationships between issues and solution-ingredients in the BoP. Our study adds to the growing body of literature on the BoP, and can be useful not only for businesses intending to tap BoP markets, but also for governments, aid agencies,

Towards Linking Disruptive Innovations and BoP Markets Santosh Jagtap and Prabhu Kandachar The base of the world economic pyramid consists of four billion people typically earning less than $4 per day. Much research on BoP markets focuses on motivating companies to enter these markets to create a win-win situation such that companies can gain benefits and BoP customers can satisfy their unmet or under-served needs. The reviewed literature suggests the need of innovations to successfully deploy products and services in these BoP markets. The reviewed research on disruptive innovations suggests that these innovations provide a good opportunity in new markets in contrast to companiesâ&#x20AC;&#x2122; mainstream markets. This paper presents the findings of the initial phase of our research, and attempts to demonstrate that BoP can present a potential new market for companies to successfully employ disruptive innovations. This is shown by synthesizing the reviewed literature on: (1) design, development, marketing, and distribution of products and services in BoP markets; and (2) disruptive innovations.

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and practitioners.

Issues and Solutions in Designing Products and Services for the Base of the Pyramid Santosh Jagtap and Prabhu Kandachar The base of the world economic pyramid consists of four billion people typically earning less than $4 per day. The BoP markets offer profitable opportunities for businesses. To successfully design and develop products and services for these markets, it is crucial to understand issues in these markets that need to be considered in the design of these products and services. This paper aims at identifying these issues and existing attempted solutions addressing these issues. It is hoped that this knowledge regarding issues and solutions can better help businesses to design, develop and commercialize products and services in the BoP. To address these aims, we pulled together the issues and solutions in the BoP from the reviewed literature, and compared these with a large study found in this literature. In addition, we analyzed the data available in this large study to extract some quantitative findings and to identify relationships between issues and ingredients of solutions in the BoP. Our study adds to the growing body of literature on the BoP, and can be useful not only for businesses intending to tap BoP markets, but also for governments, aid agencies, and practitioners.

Adapting a Causality Model of Technical Systems to Represent Socio-Technical Systems: Case Studies from the BoP Santosh Jagtap and Prabhu Kandachar Addressing issues in the design and development of products and services for the base of the pyramid (BoP) markets requires bringing about systemic changes in these markets. This study explains how businesses bring about systemic changes in these markets through the design and development process. In order to explain these systemic changes, the study first describes the development of a causality-model for socio-technical systems by adapting a causality-model of technical systems. It then explains the developed causality model for the BoP. Lastly, it illustrates this model by an indepth investigation of two case studies from the BoP.

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7.1.3 Annemiek van Boeijen Annemiek van Boeijen has been exploring the need for research in the field of BoP Sustainable Healthcare. Her research focuses on the question how specifically culture plays a role in the product design process in general and in the domain of BoP Sustainable Healthcare in particular and how we can support (learning) designers to take into account these cultural aspects; crossing cultural chasms. Starting point for the research is the proposition that product (service system) designers coming from a very different culture than they are designing for have difficulties to create and co-create products that will be accepted by the intended users and used in the intended way. The main question in this research is: How does culture play a role in the product design process in general and in the BoP Sustainble Healthcare in particular? The research follows a qualitative approach. Design and research are combined in the process of generating new insights and artefacts and is named Design Inclusive Research. As a part of this ongoing research, a number of BoP design projects executed by design graduates have been evaluated and many new student design projects are being initiated that are being monitored and evaluated. This research programme has so far resulted in four published conference papers which hold relevance to BoP (in general) and BoP healthcare research program.

Conference Proceedings •

• • •

van Boeijen, A.G.C., Stappers P.J. (2008), How can designers better incorporate cultural aspects in their designs for the Base of the Pyramid (BoP)…and why should they? Paper presented at the DesignEd Asia Conference 2008, Hong Kong, China. Parmar, V. and van Boeijen A.G.C. (2009), Educated naïve in rural areas of the BoP domain, In proceedings Designing for, with, and from user experiences, Delft. van Boeijen, A.G.C. (expected in 2011), How can Western designers use Contextmapping techniques in non-Western situations? E&PDE conference, London, 8-9 September 2011, London, UK. van Boeijen, A.G.C. (expected 2011), Serving the under-served: What can designers learn from Rural Appraisal Techniques? IASDR, Delft.

The abstracts of the above mentioned published paper are available below;

How can designers better incorporate cultural aspects in their designs for the Base of the Pyramid (BoP)…and why should they? Annemiek van Boeijen, Pieter Jan Stappers This paper presents a first research step on cultural aspects of BOP student projects that should lead to answers on three questions: (1) How does culture plays a role in product designs in the BOP domain?, (2) For which questions do designers need answers, where and when? and (3) Which tools and techniques can support designers doing these BOP projects? For a first review of BOP projects we used four elements of the theory of Hofstede (2005), viz., (i) Definition of culture:

These elements appear to be useful but not sufficient and accessible enough for designers yet. Students often do not take into account cultural aspects for several reasons: they focus on other aspects, there is a mismatch or gap between interested parties and there may be a lack of competencies of the student/designer. However the theories, and other, not yet evaluated, cases and the highly motivated students give us enough points of departure for further research.

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learned values, beliefs etc. shared by a group, (ii) Different levels of culture, (iii) Culture as a multi-layered manifestation and (iv) A multidimensional approach to compare cultures.

Persuasion for a Healthier Life: Persuasive Technology Design Guidelines from the Precious Project for Indian diabetics Deniz Arık, Annemiek van Boeijen, Prabhu Kandachar Health behavior change is a key issue in India and especially for reducing diabetes related risks. But the issue is confined neither to diabetes nor to India. After the proliferation of personal digital devices and widespread internet access, persuasion for behavior change has taken new forms. In this paper we propose 8 design guidelines for future persuasive technology designers who will work in similar domains. These guidelines are formulated based on experience acquired during a design research project leading to the degree of M.Sc. They are presented with references to their theoretical foundations, with findings from the field research conducted in India or personal experience acquired during the design process. The guidelines are further explained with the result of our project, Precious, as an example. We believe most of the guidelines can also be applied to health related persuasive technology design projects that fall outside diabetes domain as well as outside India.

‘Educated Naïve’ in Rural Areas of the BoP Domain Annemiek van Boeijen and Vikram Parmar Understanding the context in rural areas in the Base of the Pyramid domain (BoP) is a difficult task. Designers have to bridge a cultural gap (van Boeijen, 2008) and probe local contextual factors that drive the acceptability of any product or service in rural context (Parmar et al, 2009). In particular, understand ‘the system of shared beliefs, values, customs, behaviors and artefacts that the members of a society use to cope with their world with one another, and that is transmitted from generation to generation through learning’ (Hofstede, 2005). In two hours, three sessions with ten experienced designers working as entrepreneurs, researchers and a cultural anthropologist were conducted. The aim of the workshop was to identify new design tools and approaches for contextmapping in the BoP context.

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Preparing Western Designers for the Use of Contextmapping Techniques in Non-Western Situations. Accepted abstract for E&PDE conference, London, September 2011. Annemiek van Boeijen and Pieter Jan Stappers The aim of this study is to determine how to prepare design students for the use of contextmapping techniques in BoP projects. We found six barriers turned into six general guidelines. To make the guidelines operational for students we linked them to the three main aspects: (1) selection of participants, (2) design of topic, materials and sessions and (3) the roles and attitude of facilitators. For each aspect operational instructions are defined that we give to students preparing their BoP project.

Serving the Under-Served: What can Designers Learn from Rural Appraisal Techniques? Abstract accepted for the IASDR 2011 conference, October 2011. Annemiek van Boeijen and Pieter Jan Stappers Current Contextmapping techniques (CMTs) (Sleeswijk Visser et al., 2005) are developed mostly in Western cultures and make use of social interactions that need substantial adaptations to work in other cultures (van Rijn et al., 2006; Siemerink et al., 2010). Designers do not know how to apply CMTs in cultures they are not familiar with. In this paper we compare CMTs with Rapid Rural Appraisal (RRA) and Participatory Rural Appraisal (PRA) (Chambers, 1994). This results into five guidelines for the design and preparation of CMTs for BoP projects. The study includes also insights from CMTs experiences for RRA and PRA. Examples from cases illustrate our findings.

Jie-Hui Jiang is currently pursuing his PhD degree in design engineering department of faculty of Industrial Design Engineering, Delft University of Technology, the Netherlands. His research interests focus on designing low cost Information and Communication Technology healthcare solutions for Chinese markets. The final aim of his PhD project is to develop a design framework and guide for designers to help them overcome the difficulties in several design aspects such as information collection and user involvement.

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7.1.4 Jie-Hui Jiang

As a PhD researcher in the BoP-research-group, his contributions are focused on investigations of design culture, factors and methodologies about BoP healthcare in developing countries (rural China). Jie-Hui Jiang has successfully published research papers in journals, authored a chapter for a book and presented papers in several international conferences during the year 2008-2010.

Journal publications •

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J Jiang, ZZ Yan, J Shi, P.V.Kandachar, A. Freudenthal (2010), A Mobile Monitoring System of Blood Pressure for Underserved in China by Information and Communication Technology Service, Information Technology in Biomedicine, IEEE Transactions on, Volume: 14 Issue:3, pp: 748 – 757. J.Jiang, A. Freudenthal and P.V.Kandachar (2009), Exploring insight of user needs, the first stage of Biomedical Engineering design, Chapter 4 in book “Advanced Biomedicine” (Editor Carlos.A.B) In-Teh publishing, ISBN 968-953307-013-1.

Conference proceedings •

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• • • • •

J. Jiang, Zhuangzhi Yan, Jun Shi, and Prabhu Kandachar (2008), Design of Wireless Mobile Monitoring of Blood Pressure for Underserved in China by Using Short Messaging Service, Proceedings of the 5th International Conference on Information Technology and Application in Biomedicine in conjunction with the 2nd International Symposium & Summer School on Biomedical and Health Engineering (ITAB 2008/IS3BHE 2008), pp 319-322. J.Jiang and P.V.Kandachar (2008), New Market, New Challenge, New Opportunity (1) -Overview of China rural healthcare & Design methodology, Proceedings of 30th Annual International IEEE Engineering in medicine and biology Conference, Vancouver, British Columbia, Canada, pp 1579-1582. J.Jiang (2008), Healthcare Product Design for Rural China, IPID-UNESCO ‘Academia meets Practice‘, United Nations Educational, Scientific and Cultural Organization, Paris, France. J.Jiang and P.V.Kandachar (2009), Four domain model: a new possible innovation model for Design for Base of the Pyramid (DfBoP), ICED 2009, Standford, USA. J.Jiang and P.V.Kandachar (2009), Some indications from research on user involvement in Design for Base of the Pyramid (DfBoP), ICED 2009, Standford, USA. J.Jiang and P.V.Kandachar (2009), Roadmap research of process in Design for Base of the Pyramid (DfBoP)Proceedings of IAENG International Conference on Industrial Engineering, (ICINDE’09), Hong Kong, 18-20 March, 2009. J.Jiang and P.V.Kandachar (2009), What kind of decision factors will affect Design for Base of the Pyramid (DfBoP)? – An analysis research based on 24 case study in DUT/IO, Proceedings of IAENG International Conference on Industrial Engineering, (ICINDE’09), Hong Kong, 18-20 March, 2009.

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J.Jiang, Zhuangzhi Yan and Prabhu Kandachar(2009), Medical Digital Assistant: what technical factors will affect it as an efficient solution for grass roots in Chinese rural healthcare?, ICBBE 2009, Beijing, China. J.Jiang, A. Freudenthal and P.V.Kandachar (2009), Research of User-Centered Design on Healthcare at Base of the Pyramid, poster for Conference of Impact of BoP, Delft, 2009. J.Jiang, A. Freudenthal and P.V.Kandachar(2010), Exploring the influence of design culture on ICT healthcare product and service design for rural China, Knowledge Collaboration & Learning for Sustainable Innovation ERSCP-EMSU conference , Delft, 2010. J.Jiang, A. Freudenthal and P.V.Kandachar (2010), A framework to develop support for Product-Service combinations for Base of the Pyramid --- ICT supported healthcare in rural China, Design Research in the Netherlands 2010 symposium, Eindhoven, 2010.

The abstracts of the above mentioned published papers are available below;

A Mobile Monitoring System of Blood Pressure for Underserved in China by Information and Communication Technology Service Jiehui Jiang, Zhuangzhi Yan, Jun Shi, Prabhu Kandachar and Adinda Freudenthal

High blood pressure (BP, hypertension) is a leading chronic condition in China and has become the main risk factor for many high risk diseases such as heart attacks. However, the platform for chronic disease measurement and management is still lacking, especially for underserved Chinese. To achieve the early diagnosis of hypertension, one BP monitoring system has been designed. The proposed design consists of three main parts: user domain, server domain and channel domain. All three units and their materialization, validation tests on reliability and usability are described in this paper, and the conclusion is that the current design concept is feasible and the system can be developed towards sufficient reliability and affordability with further optimization. This idea might also be extended into one platform for other physiological signals such as Blood Sugar and Electrocardiograph (ECG).

Design of Wireless Mobile Monitoring of Blood Pressure for Underserved in China by Using Short Messaging Service Jiehui Jiang, Zhuangzhi Yan1,Jun Shi, and Prabhu Kandachar High blood pressure (hypertension) is the leading chronic disease in China and has become the main factor for many high risk diseases such as diabetes, heart attack and cancer. At present, there are more than 100 million hypertension patients in China, but only 44% of them have been diagnosed. In some cities like Shanghai, hypertension is increasing at

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an annual rate of over 10%. For early diagnosis of hypertension and other chronic diseases, a system has been designed and presented in this paper. The proposed design consists of three main parts: a wrist Blood Pressure (BP) measurement unit, a server unit and a terminal unit. Blood Pressure is detected and the data acquired by sensors intelligently. The data is then transmitted to the remote server unit located at Community Healthcare Centers/Points (CHC/P) by using Short Messaging Service (SMS), and notification information is sent to the terminal unit to inform users if patient’s BP is abnormal.

New Market, New Challenge, New Opportunity - Overview of China Rural Healthcare & Design Methodology Jiang Jiehui and Prabhu Kandachar China has a largest population in the world (1.3Billion) and 0.9 Billion is rural population. Most of rural people earn less than US$3/day, and they are called “Base of the economic pyramid (BoP)”. Compared with high level market, BoP is a new market, which means a low individual profit, but a large population. This paper discusses the healthcare issues in rural China (BoP) and study their healthcare needs through field study and case studies. This research is carried out within the framework of “Design for Sustainability at Base-of-the-Pyramid (BoP)” programme of the School of Industrial Design Engineering at Delft University of Technology. And the aim of this research is to provide a low cost advanced healthcare product design, which will meet poor’s needs and create a business case for commercial partners.

Four Domain Model: A New Possible Innovation Model for Design for Base of the Pyramid (DfBoP) Jiehui Jian and Prabhu Kandachar The World Bank (2005) estimates that there are 4 billion people living on an income of less than US$3 per day and 1 billion living less than even US$1 per day. This part of the population is often identified as “Base-of-the-Pyramid” (BoP). Recently, some design projects have been carried out at faculty of Industrial Design Engineering, Delft University of Technology (IDE/DUT), The Netherlands. These projects are aimed at serving the unmet needs of the BoP consumers. This paper is the result of the analysis of such projects and based on empirical research, proposing an innovation model for BoP design cases: four domain model. This paper also includes testing of this model on selected design projects.

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Some Indications from Research on user Involvement in Design for Base of the Pyramid (DfBoP) Jiehui Jiang and Prabhu Kandachar According to the World Bank, there are 4 billion people living on an income less than US$3 per day and 1 billion living less than even US$1 per day. This part of the population is often called “Base-of-the-Pyramid” (BoP). BoP is a definition of user and consumer group in product design science. This paper discussed difference between BoP self design action: Grassroot Innovations Approach (GIA) and current professional Design for Base of the Pyramid (DfBoP) cases. User involvement is considered as a major way to access new innovations on design approach. The purpose of this article is to give a message to Professional Designers (PDA) who want to design for/with BoP (a) GIA is different from PDA (b) GIA is challenging, but not yet well understood and, (c) research is needed to understand GIA.

Roadmap Research on Process in Design for Base of the Pyramid (DfBoP) Jiang Jiehui and Prabhu Kandachar Base of the Pyramid (BoP) is a 4 billion design target group, which is composed of people living on an income less than US$3 per day. Design for BoP is a new research topic and design practice started from 2003 in the faculty of Industrial Design Engineering, Delft University of Technology (IDE/TU). To explore some unknown research questions about it, a research project on “Product design for BoP” had been set up. This paper is a roadmap research based on case studies from IDE/TU, and the aim is to explore the roadmap of design process in DfBoP.

What Decision Factors will Affect Design for Base of the Pyramid (DfBoP)? --- An Experience Research Based on Case Study from IDE/TU Jiang Jiehui and Prabhu Kandachar Base of the Pyramid (BoP) is a 4 billion design target group, which is composed of people living on an income less than US$3 per day. Design for BoP is a new research topic and design practice started from 2003 in the faculty of Industrial Design Engineering, Delft University of Technology (IDE/TU). To explore some unknown research questions about it, a research project on “Product design for BoP” had been set up. This paper is an analysis research based on 24 case studies from IDE/TU, and the aim is to conclude design decision factors for BoP.

Jiehui Jiang, Zhuangzhi Yan and Prabhu Kandachar China has the largest population in the world (1.3Billion) of which 0.9 Billion being the rural population. Currently, grassroot soltions for primary healthcare of rural population are becoming more and more popular Medical Digital Assistant is one of these solutions, and this paper discusses whether it is an efficient solution from a design point of view. The results show that it may be an appropriate solution once some issues about content, usability and transplantation are addressed.

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Medical Digital Assistant: A Grassroot Solution for Chinese Rural Healthcare

Exploring the Influence of Design Culture on ICT Healthcare Product and Service Design for Rural China Jiehui Jiang, Prabhu Kandachar, Adinda Freudenthal Design culture is usually considered as one of the important aspects that influence designers’ decisions and actions, especially in Design for Base of the Pyramid projects including ICT Healthcare Product Design in Rural China (IHDRC). There are two research questions in this issue: what are the cultural factors and how these factors influence designers’ cultural values. This paper investigates the first question focusing on the influence of designers’ own cultural background. Based on existing models such as Hofstede’s onion model, the framework of Mohammad and Mariano and Julier’s discourse, the authors propose four dimensions that are relevant: 1) Education and skills of the designer 2) Consumption of design 3) Manufacturing of design 4) Design activities’ management and organization. After two rounds of interviews with Chinese design professors and students, 15 factors within these four dimensions were finally identified. The results show that the unconscious impact of design culture on design can be better controlled and even altered if designers and management are aware of these factors.

77 Opportunities for Healthcare Design Interventions for Rural Migrants in Urban China Jiang Jiehui and Prabhu Kandachar As an important labor supply (more than 130 Million people) for urban areas in China, migrant workers have occupied a unique role in the development of Chinese economy. Unfortunately, they live at the forgotten corner of the Chinese urban society, earning low salary, with long working hours, with low educational level and with very limited healthcare. This paper, discusses the healthcare issues of migrant workers in urban China describing their needs as well as indicating directions for design interventions. This research is carried out within the framework of “Design for Sustainability at Base-of-the-Pyramid (BoP)” programme of the School of Industrial Design Engineering at Delft University of Technology, The Netherlands.

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7.1.5 Dr. Vikram Parmar Vikram’s expertise lies in designing socially and contextually aware interactive products and services particularly in the area of emerging markets. His work focus is geared towards improving social well-being by bridging the digital divide between urban and rural areas by developing ICT based products and services. He received his PhD in Industrial Design at the Technical University of Delft, the Netherlands on “Design Framework for Developing ICT Products and Services for Rural Development - A case of Persuasive Health Information System for Rural Women”. The aim of his PhD research was to propose a design framework for developing ICT products and services for rural development. The main objective of the research is to answer the following research question: How to design and develop ICT interventions maximizing information dissemination, thereby stimulating user-adoption of ICT interventions and improving user wellbeing?

Journal publications As a part oh his PhD Programme, he has published papers in journals such as Communication of the Association of Information System (CAIS), Information Technology and International Development (ITID). • Parmar, V., D. Keyson and C. de Bont (2009), “Persuasive Technology to Shape Social Beliefs: A Case of Persuasive Health Information Systems for Rural Women in India.” Communications of the Association for Information Systems 24: 427-454. • Parmar, V. (2009), “A Multidisciplinary Approach to ICT Development.” Journal of Information Technology and International Development 5 (4): xx-xx (Accepted for HCI4D Special issue).

Conference proceedings

Vikram has also published and presented papers in several international conferences during his PhD research program. • Parmar, V. (2010), Disseminating maternal health information to rural women: Longitudinal study from the Field deployment. American Medical Information Association (AMIA), Washington DC, Nov 2010. • Parmar, V., G. Groeneveld, Jalote-Parmar, A. and D. Keyson (2009). “Tangible user interface for increasing social interaction among rural women.” Tangible and embedded interaction, TEI’09 Cambridge, United Kingdom, ACM, New York, NY, USA: 139-145. • Parmar, V., D. Keyson, and C. de Bont (2008), “Persuasive Technology for Shaping Social Beliefs of Rural Women in India: An Approach Based on the Theory of Planned Behaviour”. PERSUASIVE 2008. H. Oinas-Kukkonen, P. Hasle, M. Harjumaa, K. Segerstahl and P. Ohrstrom. Oulu, Finland, Springer 5033: 104-115. • Parmar, V. (2008), Persuasive technology for shaping social beliefs of rural women: Development of group based health information kiosk. In AISB convention’08 (Communication, Interaction, and Social Intelligence), University of Aberdeen, Scotland. • Parmar, V., D. Keyson, and C. de Bont (2007), Shaping social beliefs: A community sensitive health information system for rural India, In IFIP International Federation for Information Processing, Home Informatics and Telematics: ICT for the Next Billion. A. Venkatesh, T. Gonzalves, A. Monk and K. Buckner (Eds). IIT Madras, Chennai, BostonSpringer 241: 133-143.

Persuasive Technology to Shape Social Beliefs: A Case of Persuasive Health Information Systems for Rural Women in India Vikram Parmar, David Keyson, and Cees deBont

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The abstracts of the above mentioned published journal and conference paper are available below;

This paper presents Persuasive Health Information systems (PHIs), which has been deployed over a period of eight months at a pilot site to improve health information dissemination among rural women in India. The design process of the PHI integrates social cues from the persuasive technology and the theory of planned behavior for shaping social beliefs and health practices of rural women. Two field studies were conducted to design and evaluate the PHIs. The results from study one revealed social beliefs and practices related to primary health that formulated the design requirements for the PHIs. On the basis of these requirements, the social beliefs were addressed by applying persuasive social cues to the design of the form, content, and interaction of the PHIs. The results from study two involved comparative engagement between PHIs and an existing health information system supported by a local nongovernmental organization. The results indicate that application of persuasive technology can persuade the rural women to change their existing social beliefs and health practices in a positive manner. This paper contributes by providing theoretical understanding of what restricts the information transfer among rural women in terms of healthcare practices and how it can be addressed by applying persuasive technology for the design of health information systems. We hope that health practitioners, ICT developers and the design community would benefit from this approach in developing information systems for healthcare, e-government, and education in a rural context.

A Multidisciplinary Approach to ICT Development Vikram Parmar Despite large-scale investment in ICT in developing countries, information poverty has not been addressed, particularly for rural users. This article analyzes the shortcomings of current ICT design and deployment approaches and attributes the failures to both poorly designed information transfer mechanisms and single disciplinary development approaches. The article calls for adopting a multidisciplinary design approach when developing ICT interventions and proposes employing a user-centered design framework as a tool to help achieve higher user acceptance and efÂŞcient information transfer.

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Disseminating Maternal Health Information to Rural Women: A User Centered Design Framework Vikram Parmar The delivery of primary health information to rural women is a considerable challenge for government and private sectors in rural India. This paper illustrates how by applying the proposed user centered framework dissemination of maternal health information to rural women can be improved. First, the paper presents baseline study to obtain existing knowledge level of women and design requirements for a Primary Health Information System (PHIS). Second, the paper presents a brief description of the PHIS system which was deployed in a village for sixteen months in rural India. Third, the paper explains longitudinal study conducted post intervention of PHIS to measure the impact of PHIS on the knowledge level and health behavior of rural women in comparison to the baseline study. The results indicate that by following the proposed user centered approach to design the PHIS, a significant improvement in knowledge level of rural women and positive changes in health practices are achieved.

Tangible User Interface for Increasing Social Interaction Among Rural Women Vikram Parmar, Gert Groeneveld, Ashis Jalote-Parmar, David Keyson The paper presents a case of tangible user interface (TUI), which has been designed using traditional metaphors to access personal health information through an ICT based health system. An evaluative study of the designed TUI was conducted with (n=175) rural women in western India. The interaction with TUI was compared with previously designed customized iconic keyboard of an existing personal health information system. The results from the study illustrate that proposed TUI increased social interaction due to enhanced product engagement, product attachment, and community decision-making. As a consequence of increased social interaction, sensitive health information has been disseminated successfully to the rural women.

Persuasive Technology for Shaping Social Beliefs of Rural Women in India: An Approach Based on the Theory of Planned Behaviour Vikram Parmar, David Keyson, and Cees deBont This paper presents the Personal Health Information system (PHI), which has been designed to influence health behaviors of rural women. The objective of the PHI is to offer health information to rural women to increase their awareness about menses and maternal health. The design and development process of the PHI is based on the theory of planned behavior and employs social cues of persuasive technology to increase perceived behaviour control of rural women. In order to measure usersâ&#x20AC;&#x2122; level of engagement, a comparative study between the PHI and conventional health information system was conducted. The results of the interactive sessions with women of different age groups and literacy levels illustrates the usefulness of PHI in motivating rural women to challenge existing social beliefs and practices, thereby persuading them to follow correct health practices. In this paper, design process of PHI, preliminary results of the initial study, and future research plans are discussed.

Vikram Parmar This paper presents, the Group Based Information Kiosk (GIK), which was designed to influence health behaviors of rural women. The objective of the kiosk is to offer health information to rural women to increase their awareness about menses and maternal health. The design and development process of a GIK followed social cues of persuasive technology to increase perceived behavior control of rural women. In order to measure userâ&#x20AC;&#x2122;s level of engagement, a comparative study between the GIK and conventional health information system was conducted. The results of the interactive sessions with women of different age group and literacy level showed that, the GIK motivated women to challenge existing social beliefs and practices, thereby motivating them to follow correct health practices. In this paper, design process of GIK, preliminary results of the initial study, and future research plans are discussed.

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Persuasive Technology for Shaping Social Beliefs of Rural Women: Development of Group Based Health Information Kiosk

Shaping Social Beliefs: A Community Sensitive Health Information System for Rural India Vikram Parmar, David V Keyson, Cees deBont This paper presents critical issues concerning the community sensitive personal health information system in rural India, from an industrial design perspective. Literature in current ICT based applications, point to the fact that, current efforts related to personal health information dissemination have gained limited acceptance at community level among rural population. This is probably due to limited understanding of community sensitive information needs, societal structure and user beliefs of the rural community. To understand the underlying social values and users beliefs related to personal health information (PHI), a preliminary study including field interviews and review of currently deployed ICT projects was conducted. This paper presents the preliminary results, indicating several social and design challenges towards the development of a PHI system. Further the paper proposes a design framework, which includes design as a primary tool to shape existing user beliefs to positively influence the technology acceptance process of PHI system.

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7.2 Sustainability Challenges and Solutions at the Base of the Pyramid: Business, Technology and the Poor

September 2008 saw the launch of the book “Sustainability Challenges and Solutions at the Base of the Pyramid: Business, Technology and the Poor” at the Sustainable Innovations at the Base of the Pyramid conference in Helsinki. The book is a rich compilation of essays contributed by a diverse set of highly qualified authors, assembled and edited by Prof. Prabhu Kandachar (Delft University of Technology) and Prof. Minna Halme (Helsinki School of Economics). This book containing rich insights from academics and practitioners from developed and developing countries is published by Greenleaf. Although the BoP concept has unleashed an extensive and generally enthusiastic response from academics, businesses, NGOs and governments, the knowledge domain around this concept is still in the early stages of development. This book addresses that need with a focus on the needs of the end-users the poor as a starting point for BoP products and innovations. The book provides a deep perspective on the immediate requirement to consider the needs of the poor while developing products and services. The book tries to address virtually all of the challenges in tackling the issue of poverty on a global scale, by not only attempting to suggest answers to the problems, but also by raising some vital questions regarding this new approach to sustainable development called the Base of the Pyramid.

Fig. 7.1: The Book - “Sustainability Challenges and Solutions at the base of the Pyramid”

The bottom-up human centred approach adopted by the book allows the readers to investigate the previously ignored market consisting of people considered to be economically disadvantaged. This book through a bottomup human centred approach has examined examples that truly engage the poor in BoP product and service development and further tries to answer the following questions; •

Do we actually know what the real needs of the poor are?

•

What types of needs assessment methodologies are indicated considering the cultural differences in BoP countries? Are the existing methodologies adequate? Do they need to be redefined and redeveloped?

It is a harsh truth that the poor are hardest hit by the adverse effects of environmental deterioration such as water shortages, climate change or the destruction of habitats. While the economic welfare of the poor is critical, the BoP approach must balance its inherent paradox of encouraging greater consumption while avoiding further pressures on environmental sustainability. This book explores various bottom-up innovations that can support BoP initiatives to alleviate poverty and stimulate economic growth without stressing the ecosystem (sustainable development). The link between the BoP approach and sustainable development is a key feature of this book. In its quest to find a balance between consumerism based economic growth and environmental sustainability, the book deals with the relationships that currently exists between development assistance and corporate responsibility with BoP, by raising the following questions; •

•

Is a BoP strategy the antithesis to development aid or can these two co-exist or even complement each other? Is BoP a new form of corporate neo-colonialism or a new form of corporate responsibility?

This unique compilation of essays contributed by both supporters and critics of the BoP approach presents an objective review on how the concept of BoP has developed, what its successes and failures have been and what promise it holds as a long-term strategy for alleviating poverty and tackling global sustainability.

7.3 Impact of BoP Ventures – International Conference, 2009 A landmark event for BoP initiative at the faculty of Industrial Design Engineering, Delft University of Technology was held during the month of November 2009. An international conference “Impact of Base of the Pyramid Ventures” was successfully organized during November 16 to November 18, 2009 at Delft University of Technology.

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•

This conference was the result of a joint effort of a number of enthusiastic EU parties, eager to contribute to the development of knowledge and experience of private sector strategies towards the BoP. It was decided to organize this international conference during the “Sustainable Innovations @ BoP” conference in Helsinki, September 2008. It was agreed that the conference could be called a success only if the organizers would at least be able to: • Focus at a specific challenge of developing BoP initiatives • Have a significant number of participants whom live and work in transition and developing economies • Create a bridge between practitioners and academics This international conference focused on the challenge of “proving and improving” BoP ventures by creating a large platform to share ideas, discuss and debate on ‘How to assess impact and to create value?’ The organizing committee of this international conference had representatives from; • Delft University of Technology • Wageningen University • Helsinki School of Economics • International Institute for Environment and Development • International Centre on Sustainable Consumption and production

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TNO, Netherlands

The organizing committee worked hard for 12 months to make this event a memorable success. They approached various global networks to obtain funds and more than 50 participants who are actively contributing towards BoP initiatives in developing economies. Several workshops,

poster exhibitions and match making events were organized to help the participants share and learn from each others experiences. The organizers successfully gathered a wide spectrum of 29 strong sponsors to help them make this conference a running success. Below are the sponsors who were the key support for this international conference.

Fig. 7.2: The Organizing committee

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Fig. 7.3: The sponsors for the ‘Impact of BoP Ventures’– International Conference, 2009

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Finally to create a bridge between practitioners and academics, the program was specially designed such that there was something for everybody. Each morning of the conference began with Keynote speakers sharing their latest views and findings on impact assessment and value creation of BoP ventures from an academic, private sector and development point of view. The afternoon sessions following the keynote lectures were split up in five parallel sessions, covering the whole field from an academic track up to a co-creation lab and allowing the participants to choose the sessions that fit them the best. The conference was a success in providing a platform to share conceptual and empirical evidences that address ways to better understand and increase the sustainability impacts of BoP ventures in terms of changes in economic, capacity, environmental and relational well-being. The conference helped to create a bridge between private and public sector, NGOs and knowledge institutes. It provided an opportunity for all the participants to gather new knowledge and experiences on value creation and impact assessment of BoP Ventures. The conference also proved to be an encouraging platform for all the attendees to increase the range of their network.

Inaugural speech by Maarten Brouwer An inspiring speech from Maarten Brouwer, Ambassador for Development Cooperation at the Dutch ministry of Foreign Affairs marked the opening of the conference. He personally believes that the biggest challenge of the Baseof-the-Pyramid is to create real sustainable impact by its ventures in terms of poverty reduction, and reach that impact at a large scale and in an effective way. He stressed on the fact that the Base-of-the-Pyramid approach has the interest of the Ministry of Foreign Affairs as it involves the private sector and businesses to alleviate poverty. He also pointed out that the policy priority his ministry is to bring about stimulating economic growth, and equity of income and opportunities.

Fig. 7.4: Inaugral Speech by Maaren Brouwer He said that the development policy of the ministry revolved around demand orientation, strengthening of local knowledge- and innovation capacities, and increasing skills and knowledge of local entrepreneurs and businesses in developing countries. He concluded by suggesting that four different types of innovations (system innovation, technological innovation, chain innovation and management innovation) needed to be pursued evenly, in order to attain the potential for success of the Base-of-thePyramid approach and to avoid the threat of the pitfalls. This can happen only by investing in understanding of local insights, co-creation and together working on innovations: thus investing in partnerships!

7.3.1 Keynote lectures Each morning of this two day conference began with Keynote lectures. Eight highly qualified Speakers with diverse background and rich experiences shared their latest views and findings on impact assessment and value creation of BoP ventures from an academic, private sector and development point of view through their keynote lectures.

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Fig. 7.5: Keynote Lectures at the conference

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Keynote speakers Ted London Ted London is a leading expert on the role and impact of marketbased strategies on poverty alleviation. He is a Senior Research Fellow at the William Davidson Institute (WDI) and on the faculty at the University of Michigan’s Ross School of Business. At WDI, he directs the Base of the Pyramid (BoP) Initiative, a program that champions innovative ways of thinking about more inclusive forms of capitalism. In leading this effort, Professor London generates ground¬breaking research and actionable recommendations that explore the unique principals, insights, and implications of the BoP perspective on poverty alleviation. His most recent work involves developing the BoP Impact Assessment Framework

Eric Lesueur

Eric Lesueur is a graduate of Ecole Polytechnique in France. He started his career in R&D and engineering for the chemical industry. He joined Veolia Environnement in 1993 as Director of a consultancy department for integrated waste management. He was later appointed Deputy Director of Veolia Environnement’s R&D and the company’s Environmental Director. In 2006, he joined Veolia Water’s Executive Team as Project Director. Particularly involved in the company’s development for a sustainable economy, he is in charge of the social business projects with Grameen Bank in Bangladesh.

Jessica Davis Pluess Topic: Measuring the impact of business on development Jessica Davis Pluess is an assistant program manager in the Development Focus Area at the World Business Council for Sustainable Development in Geneva. Over the last couple of years, her primary focus has been helping WBCSD member companies develop an approach to measuring business impact on development and explore opportunities to building inclusive business models. Before that, she worked as a supervisor of Sports Research for the Beijing Olympic Games at NBC Olympics Jessica received a Bachelor of Arts from the University of Southern California and a Master’s degree from the Fletcher School of Law and Diplomacy with a concentration in health system reform in China.

Saurav Mukherji Topic: Impact of Inclusive Ventures: Serving the Base of the Pyramid Saurav Mukherji is a representative of the “Growing Inclusive Markets” initiative from the UNDP. Building on existing research, UNDP and its partners believe that more needs to be done to generate and assemble information and analyses of the markets of the poor, to better understand inclusive business models that create value for all and to identify innovative strategies for doing business with the poor. In addition, Mr. Mukherji is also an Associate Professor and Fellow at the Indian Institute of Management, Bangalore. Consulting he does in fields like organization restructuring of a large company and analysis of processes in oil drilling companies in India with an objective of making it globally competitive.

Harry Barkema has held the DSMsponsored Chair in Innovation Management at the Rotterdam School of Management, Erasmus University, since 2007. He has (co-) authored over a dozen articles in journals as Strategic Management Journal, Academy of Management Journal and more. He is the Director of the Innovation Co-Creation Lab. Harry was the first European Associate Editor of the Academy of Management Journal and in 2007 was elected a member of the Board of Governors of the Academy of Management. Visiting research and teaching assignments were at The Royal Institute of Technology in Stockholm, The European Institute of Advanced Studies in Management in Brussels, the Simon Business School in Rochester NY, and, IESE Business School in Barcelona.

Nishant Lalwani Topic: Emerging Markets, Emerging Models - Market Based Solutions for Social Change Nishant Lalwani is a practice manager within Monitor Group in India. His focus is on private sector models for poverty alleviation, and has consulting and development experience in several continents. Nishant is team leader of the Monitor Inclusive Markets team in Mumbai, most recently completed was a foundational market-based solutions study to identify and scale up the most promising commercially viable approaches to social benefit in India. Nishant worked with the UNDP in Zambia on developing financing products for microfinance institutions. He has a Master’s

in Aeronautical Engineering and a Bachelor’s in General Engineering from Cambridge University, UK. He has also published academic papers in conjunction M.I.T.

Pieter de Baan Topic: Inclusive Business: Market-Based Solutions for Poverty Reduction

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Harry Barkema Topic: Sustainable and Scalable Business Model Innovation at the BOP: What’s the process?

Pieter de Baan has been with SNV since 2003, most recently as Senior Advisor Strategy & Policy within SNV’s Strategy Team in The Hague. He will take up the position of Regional Director for the Balkans region as of 2010. Pieter was Country Director in both Cameroon/DRC and Vietnam from 2003 to 2008. In this capacity, he has been instrumental in adapting the Inclusive Business initiative, which was developed in Latin America in collaboration with the World Business Council for Sustainable Development (WBCSD), for introduction in SNV’s Asia programmes. Before he joined SNV, Pieter worked for ARCADIS Euroconsult in Cairo (Social Fund for Development) and Jakarta (Regional Coordinator SouthEast & East Asia).

Laurent Liautaud Topic: Access to Energy for the Base of the Pyramid Laurent Liautaud is a Project Manager at Hystra. He has worked with several clients to help them identify successful models at the Base of the Pyramid and develop strategies to scale them up. Prior to Hystra, he developed BoP projects for Unilever in Mozambique and worked as a strategy consultant with Bain. Laurent is a graduate from Sciences Po Paris, London School of Economics and HEC.

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7.3.2 Workshops The workshops covering the whole field from an academic track up to a co-creation lab were organized in the afternoon sessions following the keynote lectures. The workshops were conducted in parallel sessions with different themes and focus thus allowing the participants to choose the sessions that fit them the best. Below is the list of workshops conducted during the two days of the conference.

Workshop-1: The Relationship Matrix: bringing market actors together to improve the milk market system in Bangladesh Facilitator: Abdur Rob, Practical Action Workshop-2: Exploring the Links Between International Business and Poverty Reduction: A Case Study of Unilever in Indonesia Facilitator: Oxfam GB, Novib, Unilever & Unilever Indonesia Workshop-3: Sustainable Consumption and Production (SCP) and Poverty Reduction â&#x20AC;&#x201C; Making the Link Facilitator: Martin Herrndorf, SwitchAsia

Workshop-4: MEET-BIS project; market development approach Facilitator: Nienke Stam , Triodos Facet Workshop-5: Comparing Contexts: Designing for multiple contexts within the Base of the Pyramid Facilitators: P.V. Kandachar, J.C. Diehl, Van der Kleij, A. and N. van der Vleuten

Fig. 7.6: Co-creation workshops

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Host: P.V. Kandachar, J.C. Diehl, Van der Kleij, A. and N. van der Vleuten

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Comparing Contexts: Designing for contexts within the Base of the Pyramid

Abstract The workshop shared the outcome of the research project whose objective was to gain an insight into developing and designing sustainable solutions, in the form of products and services, for different BoP markets, regardless of the differences that may exist between them. To achieve this objective it is necessary to gain an in depth understanding of specific consumer needs for the local context for multiple markets. A framework was developed during this research project. This framework facilitates the process of understanding the local context by making a structural comparison between them. This can framework can further help develop an integrated vision for the product, the service and the business which forms the basis for designing for multiple contexts. The main highlight of the workshop was the guided discussion with respect to the development, application and evaluation of the proposed framework for conducting research in and designing for multiple BoP contexts.

Fig. 7.7: Co-creation workshops

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7.3.3 Exhibitions Posters exhibition In attempt to develop a comprehensive understanding of this relatively new field, the conference welcomed both

theoretical and empirical contributions from academics and practitioners. The scientific committee made a selection from the numerous submitted abstracts and papers to be presented as posters. These posters were exhibited in Aula Foyer.

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Product exhibition The products designed and developed to meet the needs and solve the problems of the underdeveloped countries were put on display in IO basement area. These products on display were the result of the design efforts by students, entrepreneurs and academic staff of the faculty of Industrial Design Engineering (IDE), Delft university of Technology.

Each of the design project displayed in this exhibition focused on a specific design problem for an underdeveloped country. Extensive and thorough field research followed by a design process resulted in these designs as a suitable solution. These projects are a reflection of how the students, companies, NGOâ&#x20AC;&#x2122;s and professors have collaborated together to set up a base to develop a new knowledge domain full of challenges and opportunities.

Fig. 7.8: The Product Exhibition

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Fig. 7.9: The Product Exhibition

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Sponsors Exhibition Alongside the poster and products exhibition, the sponsors were also given a platform to exhibit their products and services which are centred around real life interventions in the Base-of-the-Pyramid. This exhibition was organized in the foyer of the Aula in an area of 135 square meters.

The sponsors who came forward to use this opportunity to display their product and service initiatives in the BoP ranged from private sectors to NGOâ&#x20AC;&#x2122;s and governing bodies. Some of the sponsors stall like that of Philips Lightning, the Shell Foundation, BiD Network and TNO attracted a large crowd of participants and curious viewers.

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Fig. 7.10: The Sponsors Exhibition

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Fig. 7.11: The Sponsors Exhibition

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7.3.4 Academic track - Paper presentations A call for papers was announced in preparation of this international conference. The theme for the papers revolved around the main question being addressed in this conference: How to define, measure, and optimize towards enduring value creation of BoP ventures? In attempt to develop a comprehensive understanding of this relatively new field, both theoretical and empirical contributions were welcomed and challenged to respond to the issues related to Impact Assessment (IA) and Optimization of Value Creation (VC). All the submitted papers were reviewed by an international Scientific Committee and the nominated papers were presented. Prof. Prabhu Kandachar (DUT), Ben Garside & Emma Wilson (IIED) and Dr. Minna Halme (HSE) moderated the paper presentations during the two day conference. The nominated papers were categorized under two main themes. The theme of the paper presentations on day1 was “Examining the Theories of value creation” and the theme for day-2 was “Examining the Theories of impact assessment and co-creation”. . Below is the list of nominated papers followed by their abstracts, which were presented during the international conference.

Day-1: Examining the Theories of Value Creation 1

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Challenges in Expanding the Scale of Business Ventures at the Base of the Pyramid

Taking a bop venture to scale Towards a theory for scaling up at the bottom of the pyramid

Rethinking the MNC’s Network to Serve BoP Markets

BoP market segmentation and proposing proper value proposition for the electronics industry: How to do so?

The balancing act of optimized value creation

Theoretical Perspectives on Value Creation at the Base‐of‐the Pyramid (BoP)

Looking over the fence: Finding and introducing poverty‐related indicators in management research

New Mindsets for BOP Value Creation

Day-2: Examining the Theories of Impact Assessment & Co-Creation 1. On the Delivery of Pro‐Poor Innovations: Managerial Lessons from Sanitation Activists in India 2

Innovation for the base of the pyramid: Critical perspectives from development studies on heterogeneity and participation

Evaluating Poverty Impacts of Base of the Pyramid Irrigation Technology Supply: IDE’s Rolling Baseline Approach to Household Income Impact Assessment

Franchisee Selection and Health Services Impact – Social Franchising In BoP Context

Impact of high quality vegetable seeds for smallholder farmers in South East Asia

The Importance of a Bottom Up Development: Perspective when Serving the Base of the Pyramid: Concepts, Interrelations and Usability

Pro-Portion: an approach optimizing value creation for BoP Businesses

Introducing solar products in rural Cambodia; a quest for the right marketing mix in base of pyramid markets

The abstracts of all the above nominated papers can be found in the later part of this section.

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Fig. 7.12: Academic Track - Paper Presentations

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Challenges in Expanding the Scale of Business Ventures at the Base of the Pyramid François Perrot Since Prahalad and Hart (2002) coined the term “bottom of the pyramid” (BoP), a significant part of the related literature has consisted in the collection of successful business cases that show how some firms create business and social value by targeting poor households in emerging countries. However, this literature provides little explanation on why, in some sectors, the most successful business models only serve a few thousands customers a year, while in other sectors BoP projects reach a larger scale. This article aims to contribute to understand to understand the challenges and trade-offs facing firms in taking BoP projects to scale. The article shows how the literature on the BoP, building on the Resource based view of the firm (RBV) theories, establishes that firms have to acquire new capabilities in order to succeed in creating business models for the BoP. The article focuses on the housing sector and analyses the results and challenges in terms of business and social value creation of two BoP programs, one being a Government‐led project (Lafarge CosmoCity) and the other a market based business model (Cemex Patrimonio Hoy). The article shows that in both cases, firms develop new capabilities in the form of partnership with Governments for Lafarge, and through a deep inclusion in communities for Cemex, and that the very partnership dimension of the business model appears as the main limit in both models. The article demonstrates that developing new capabilities through cross sector collaboration is a necessary condition to create value, as argued in the literature, but is not sufficient to create scalable business models. The article suggests that in order to take BoP projects to larger scales, firms should open partnerships to other organizations like financial institutions, Government and development agencies, each one owning one part of the solution to the poverty issue and of the business venture’s expansion. Such a multi stakeholder solution requires firms to act as “bridging organizations” and leverage not only on their new capabilities but also on their own and core resources.

Taking a BoP Venture to Scale Towards a Theory for Scaling Up at the Bottom of the Pyramid Michel A. Bachmann, Patrick A.M. Vermeulen, Jac L.A. Geurts and Stuart L. Hart

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To date there has been no study that systematically looked at how companies scale their BOP ventures. This is quite surprising, considering the obvious importance of the topic. The current BOP literature merely offers a few case studies on successful projects that hint at how scaling could take place but do not address the topic systematically. This paper explores how MNCs can scale their ventures at the Bottom of the Pyramid (BOP). To tackle this question, an exploratory research design was adopted to study three BOP ventures in rural India that are at different stages of the scaling process. The focus of the study was to understand the various issues that taking a BOP venture to scale involves as well as the underlying mechanisms that drive this process. A theoretical model is developed that describes scaling‐up as a three‐ dimensional process which unfolds itself in three recurring stages, each with a unique set of challenges. A comparison of the thus‐made findings with the propositions of the BOP protocol reveals that the studied firms apply top‐down thinking when scaling their ventures whereas the protocol advocates a biological growth mode in a more decentralized fashion, indicating two fundamentally different approaches to scaling a BOP venture. Implications for practice and further research are drawn.

Federica Angeli, Charmianne Lemmens and Frits van Merode BoP markets violate most assumptions applicable to Western, developed economies’ customers and challenge the traditional International Business (IB) theory explaining international competitive advantage of MNCs. This paper develops a conceptual framework through an inter‐disciplinary lens, which explains the creation of value for MNCs in BoP markets by focusing not only on across‐country but also on within‐country segmentation. It argues that MNCs can be profitable in BoP markets by striking a new balance between global efficiency and local adaptation, which leverages heavily on local capabilities through synergies on the global scale. Starting from the generation of local BoP units, we investigate the change in the MNC’s overall network by focusing both on the BoP units’ local network or organization set – in terms of variety of actors, strength of ties, and density – and on the BoP units’ global network. We particularly emphasize a new link to ToP units in the local dimension and to BoP units in other countries on the global dimension. This conceptualization is of major value to IB literature and to MNC theory in broad terms.

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Rethinking the MNC’s Network to Serve BoP Markets

BoP Market Segmentation and Proposing Proper Value Proposition for the Electronics Industry: How to do so? Katrin Talke, and Jan Carel Diehl Many global companies start developing specific solutions for the BoP market. However, success stories are still limited in number, as BoP markets still remain poorly understood. However, it is critical to understand different market segments and to propose proper value propositions, which fit the context and the resources of the different target groups. In this paper, we will use the particular case of consumer electronics firms and discuss the challenges faced when developing targeted solutions for BoP customers under the condition of non‐ or unreliable access to electricity. In 2005, 1742 million people, representing about 44% of the total BoP population, were estimated to still lack (stable) access to the electricity grid. We first discuss the challenges a consumer electronic firm faces when deciding to target BoP customers. In order to get a better understanding of the potential BoP market for consumer electronic firms, a three‐step research approach was executed. First, based upon an extensive literature study, a preliminary market segmentation method was proposed, which led to an indication of specific segments and their characteristics. Second, an applied action research and participatory rural appraisal in two subsequent field studies in Sub‐Saharan Africa was conducted to validate the market segments and to gain in‐depth insight into the life of selected customer groups. As a result, a clear picture emerged of these BoP customers’ needs, household budget and living circumstances in relation to electricity consumption and the use of electronic products. Based upon this insight, value propositions for using electricity have been developed for different target groups. In a next stage these value propositions have been translated into proposals for new product (system)s. The article closes with discussing our findings and providing implication to both research and management practice.

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The Balancing Act of Optimised Value Creation Anand Sheombar, Jakobus Smit, and Gilbert Silvius In BOP ventures the notion of “selling to the poor” has steadily been replaced by business approaches that suggest sustainable value creation. This has certain implications, in particular the development of strategies that serve triple bottom‐line goals. These include economic, social and environmental benefits, in other words, the well known goals of people‐planet‐profit. However to optimize value‐creation one ideally needs to follow a strategy that is based on some form of conceptual model that can serve as a frame of reference. This paper proposes such a conceptual model. The research was undertaken in 8 BOP projects involving multinational information and communication technology companies in Africa. ICT is relevant here because of frequently high expectations that it contributes positively to development goals. A study of the BOP literature reveals that several elements need consideration when trying to create value in developing areas. In addition it emerges that these elements are somehow interdependent. Using information found in the literature as guide a study of 8 cases was undertaken. The research approach was the case study method and the data was analyzed for emerging patterns. Primary and secondary data was collected through interviews as well as a close study of archival and other sources. The analysis revealed three high level factors that may need to be aligned in order to ensure optimized value creation of BOP ventures. These three factors are BOP strategy, partnerships, and products & services development. It is also confirmed that neither BOP strategy nor partnerships nor products/service development can be synthesized independently from the rest. There is a delicate balance and interaction between the three where all three are interdependent and mutually influence each other.

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Theoretical Perspectives on Value Creation at the Base‐of‐the Pyramid (BoP) Marijane Luistro Jonsson and Susanne Sweet As the worlds of business and development are merging, MNCs, entrepreneurs and other actors are increasingly interested in tapping the Base‐of‐the‐Pyramid (BoP) ‐ the 4 billion people living on less than $2/day. This has resulted to a new breed of value creation strategies for doing business at the BoP. This paper explores the theoretical basis of value and value creation, and relates it to empirical cases at the BoP. An integrated approach among the different theoretical perspectives is suggested to be able to fully understand current value‐creation strategies used at the BoP. Doing so bridges the gaps among the fragmented theoretical platforms within management studies, and creates an understanding that the BoP reality is a kaleidoscope of the different perspectives of the firm. A holistic approach to established perspectives which is not limited to economic dimensions is needed to understand the blurring boundaries of business at the BoP.

Martin Herrndorf Management research as published on the leading journals has been slow in taking up poverty as an issue, and introducing new variables to assess latent and unobservable constructs is one challenge that has hindered research on business and poverty. This is matched by struggles of practitioners to measure their impact on poverty in a practical but scientifically sound way. The paper supports the introduction of poverty‐related indicators in management research. It first highlights several key issues that provide a challenge to the measurement of “poverty reduction” in management research. These include the understanding of poverty as a multi‐dimensional construct in the ‘human development’ tradition, the nature of long‐term and non‐linear, dynamic development processes and the problem of attributing poverty reduction to the activities of a single actor. In a second step, the paper sketches the approaches taken to measure corporate social and sustainability performance. The paper concludes on the potential to inductively develop new measures of poverty reduction through qualitative inquiry. It also comments on existing recommendations for practitioners in new or existing businesses that want to measure and maximise poverty reduction based on a sound scientific basis.

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Looking Over the Fence: Finding and Introducing Poverty‐Related Indicators in Management Research

“If a multinational corporation identifies those earning $2 per day as its new customers, how exactly will this recognition lift them out of poverty? How will buying a television set or a new set of furniture on easy credit (the Casas Bahia story) lift a family out of poverty?” (Walsh et al. 2005: 478)

New Mindsets for BoP Value Creation Pial Islam There are many similarities between the challenges of value creation for BOP ventures and conventional businesses: economic drivers for profit, appropriate stakeholder management, need for customer service, etc. However, there are some significant mindset shifts that are required specifically for BOP ventures. These include: - Affording access rather than ownership: Assessing viability at a group level rather than individual customer level - Monetizing hidden assets: Tap local knowledge on customer needs and ability to pay residing in informal networks - Bridging the gap in public good through private enterprise: Invest in hard infrastructure, skill development and training as part of overall Capex - Scaling out rather than scaling up: Retain lean, flexible organization with high decentralization in governance and decision making by adopting local structures rather than creating unwieldy monitoring structures and layers - Governing through influence rather than authority: Align incentives to create “natural” influences; create entrepreneurs rather than employees These mindset shifts lead to a series of guiding principles specifically important for BOP ventures, and offer a framework for innovation. The guiding principles include: creating life enhancing offerings, re-configuring product supply chain,

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educating through marketing, collaborating to form non‐traditional partnerships, and unshackling the organization to adopt BOP‐specific operational models. There is one other cross‐cutting underlying principle that is required to make BOP ventures successful. While people at BOP are acutely aware of their challenges and have ideas about potential solutions, many are not able to adequately articulate what they need in a way that easily translates into new products/services. Therefore, business ventures at BOP should first understand the fundamental problem a person at BOP needs to resolve in a certain situation, and then adopt user experience modeling techniques, such as ethnographic research and persona design, to guide the development of new solutions for the BOP markets.

On the Delivery of Pro‐Poor Innovations: Managerial Lessons from Sanitation Activists in India Shyama V. Ramani, Shuan SadreGhazi and Geert Duysters There is an emerging body of literature that examines how pro‐poor innovations should be created and what business models should accompany them. However, there is little on actual implementation practises and the present paper attempts to fill this void by analyzing the findings of the literature and confronting them with the actual field practises of sanitation activists in India. It demonstrates that the common thread that unifies progressive sanitation activists is their adoption of a ‘market based approach’. Market failures stemming from the demand side are shown to be due to problems of expressions of demand and their mismatch with perceptions of the value of the innovation. It also identifies how activists go beyond the academic model of assessing need, appropriateness of technology and demand to include practises for ‘accompaniment’, ‘sustainable maintenance’ and ‘generation of knowledge, demand and innovation spillover’ in an endogenous fashion, providing an alternative to the ‘centralized platform delivery’ model’.

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Innovation for the Base of the Pyramid: Critical Perspectives from Development Studies on Heterogeneity and Participation Saurabh Arora, and Henny Romijn This article criticizes current BoP approaches for under‐appreciating two issues that play vital roles in projects targeting the poor at the BoP: heterogeneity among the poor, and the intricacies of participatory partnerships between TNCs, the non‐profit sector (NGOs) and local poor communities in the global south. Our main contention is that the extant BoP literature has a naïve view of what working with the poor really involves, which grossly underestimates adverse power relationships and disregards the hierarchies between the poor and outsiders who administer development interventions. To unpack the hidden complexities associated with heterogeneity and partnership dynamics, we draw on extensive knowledge from the field of development studies, which has accumulated key insights about working in and with poorer communities over several decades.

Giel Ton, Stuart Taylor, Joost Vlaming and Sabine Hiller In countries with a history of multiple and spatially overlapping agricultural development projects, it is difficult, if not impossible, to find proper ‘treatment’ and ‘non‐treatment’ groups and derive the ‘treatment effect’ as a proxy for attributable household income impact. In self‐selected groups of irrigation technology customers, confounding variables make income comparisons even more difficult. We present a methodology for assessing changes in household income attributable to technology adoption by smallholder farmers in Nepal. The rolling baseline survey methodology was developed to evaluate the work of IDE, a non‐profit organization that develops and promotes market‐based supply chains of low‐cost micro-irrigation equipment for households living at the bottom of the pyramid. Household income is calculated yearly by estimating the gross margins of farm and off‐farm activities, before and after technology adoption. Pre‐adoption household incomes of successive cohorts are used to construct a proxy control for exogenous factors such as price fluctuations and weather conditions. This paper describes the design and implementation of the method in Nepal and tests assumptions underlying the methodology related to inter‐cohort variation and recall bias. These tests indicated the need to adapt the initial design incorporating two additional design elements in the survey framework: a more robust exogenous factor coefficient, calculated using measured income changes in a control cohort, and a recall bias coefficient, based on test‐retest scores from cohorts reporting annual income in two measurements with changing recall periods The adapted rolling baseline methodology is suited to evaluate income changes attributable to technological innovations with impact over short periods of time.

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Evaluating Poverty Impacts of Base of the Pyramid Irrigation Technology Supply: IDE’s Rolling Baseline Approach to Household Income Impact Assessment

Franchisee Selection and Health Services Impact – Social Franchising In BoP Context A. Sivakumar and J.P.L. Schoormans Geographical isolation, non‐availability of healthcare professionals and a lack of sufficient investments by governments in healthcare severely constrain access to health services in the BoP market especially the rural areas. In addition to access, affordability, and awareness about healthcare are also key issues that hinder progress in provision of healthcare services. Social franchising as a concept combines commercial franchising principles with social marketing to offer a sustainable business model for expanding social initiatives. Social franchising in healthcare services broadly offer commodity franchising as well as clinical alternatives. Clinical social franchising is crucial in providing medical services to inaccessible rural areas. There are several opportunities and challenges in this new area of study. In this conceptual paper, we put forth an argument for considering franchisee selection as a key ingredient for making a success of clinical healthcare franchising. Success of a social franchising venture in healthcare venture means a greater impact. We present the significant factors affecting franchisee selection and emphasize on the consideration of the personality related factors.

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Impact of High Quality Vegetable Seeds for Smallholder Farmers in South East Asia Derek Eaton, Rolien C. Wiersinga, and Myrtille Danse This paper addresses the challenging issue of how to assess impacts of BoP strategies on smallholders farmers’ incomes and livelihoods. It reports on a case study involving the development of hybrid vegetable varieties and associated cultivation technology. These were developed by a seed company that saw the potential to serve the approximately 250 million smallholder farmers in tropical Asia, cultivating vegetables for domestic markets. This BoP market segment was successfully accessed due to the development of a new business model that enriched the company’s product with new services and products for smallholder farmers. The company developed suitable small‐scale product packaging formats and invested considerably in demonstration and transfer of knowledge of improved cultivation practices. A study to assess the impact of this technology, successful in terms of developing a widespread market among smallholder farmers, was confronted by a number of methodological challenges. The success of the BoP strategy meant the absence of a suitable control group and there is insufficient historical, documented data to construct a baseline. The approach involved purposive sampling of locations, the use of rapid appraisal techniques (group discussions and diagramming), and interviews of farmers to collect quantitative data. Change in farmers’ income was assessed in the interviews using a diagrammatic instrument to record farmers’ perceptions. The paper discusses this approach and contrasts it with more conventional approaches to impact assessment of agricultural technology. A number of insights, or lessons, are identified, including the opportunity to make more use of perceptions of BoP clients.

The Importance of a Bottom Up Development: Perspective When Serving the Base of the Pyramid: Concepts, Interrelations and Usability Piera Waibel

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One important factor for succeeding in finding new strategies to develop suitable services, products and business models for the Base of the Pyramid (BOP) is engaging directly with the poor and thus, choosing a bottom up approach. Local know how of the poor has to be integrated and delivers new capacities for building up new competencies. This is a completely new way of seeing the important role of the poor in a global economy. But the recognition of a bottom up approach – besides participation – is neither yet elaborated in BOP literature nor has there been made profound research on how this bottom up perspective can be manifested in the theory of serving the base of the pyramid. The “classic” development literature however, has made this mind‐shift over 20 years ago. Bottom up approaches, which give more power to the poor, are taking advance. This vast know how however, hasn’t found a systematic consideration in the concept of the Base of the Pyramid yet. Focusing on Multinational Corporations, the paper will take a closer look at bottom up development approaches and argues for the importance of integrating this know how in the Base of the Pyramid debate by highlighting the relation between the concepts. It complements therefore a missing, but for value creation very important piece in the theoretical debate on the Base of the Pyramid.

Lieke Pijpers, Thomas Schuurmans and Jan Carel Diehl This paper investigates how the ProPortion approach can improve value creation of Base of the Pyramid (BoP) businesses by encouraging organizations to think ‘out‐of‐the‐box’ and to develop ‘solution‐oriented partnerships’.

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ProPortion: An Approach Optimising Value Creation for BoP Businesses

The ProPortion approach stimulates the development of social businesses, by creatively combining the individual attempts of various organizations to create value at the BoP, ranging from multinational corporations (MNCs), small‐ and medium sized entrepreneurs (SMEs) and Non‐Governmental Organizations (NGOs) to governmental bodies. Instead of looking at a single product or service delivered by those organizations individually, the whole context‐of‐use is taken as the starting point. The approach believes that smart combinations between the local needs and the complementary strengths of private and public organizations could lead to sustainable social businesses. A case study in Vietnam on how to make milk affordable for low‐income children, illustrates how the ProPortion approach can be applied. The study was done in close cooperation with the Vietnamese subsidiary of FrieslandCampina: Dutch Lady Vietnam (DLV). DLV is currently one of the biggest players in the Vietnamese liquid milk market, but is unable to make milk affordable for low‐income families. The ProPortion approach challenged DLV to look beyond its own competencies, interest and business approaches (out‐of‐the‐box), and to combine its corporate strengths with complementary organizations to solve the affordability issue. Generative research methods revealed the attractiveness of the kindergarten context‐of use, particularly since the synergy between nutrition and education can be beneficial for multiple stakeholders. Besides DLV and the educational services in Vietnam, other parties that are interested in reaching kindergarten children could benefit from, and contribute to, the solution‐oriented partnership. As a result of collaborating via the ProPortion approach an innovative product‐ service system was developed, which could lead to a sustainable social business concept with shared investment and improved value creation at the BoP.

125 Introducing Solar Products in Rural Cambodia; A Quest for the Right Marketing Mix in Base of Pyramid Markets K.C. Rijke, J.C. Diehl, and J.P.L. Schoormans While there is a growing attention for the needs and types of innovation for BoP markets, still little is known about new product introduction and branding issues. This paper focuses on two elements. The importance of branding in BoP markets as creator of trust; and a case study of Kamworks in rural Cambodia, applying the research insights to create a market introduction strategy for affordable solar lighting products. An important conclusion of our research is that the factors that steer product introduction in BoP markets ask for a strong branding strategy. Branding is at least as important in BoP markets as it is in developed country markets. Branding is of essence, especially in BoP markets, because a brand

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creates the trust that is needed to take away experienced financial and product quality risk. The research is aimed at defining the best market strategy for introducing solar consumer products into the Cambodian rural market. The case of Kamworks is used to illustrate our findings. First, the characteristics of the target customers and their drivers to buy products are investigated. The purchase decisions of the rural Cambodians with respect to new products are represented in a model that is adapted for cultural and market reasons from the innovation adoption model of Rogers. Next to the factors found in Roger’s innovation model four extra factors are introduced. This adapted model is tested using a series of in‐depth interviews with potential consumers. Our research demonstrates that both the original factors introduced by Rogers as well as the factors that were formulated based on cultural and market specificities play a role. Price and quality of the products are found to be the most important. The data shows that the very low purchasing power of the Cambodian customers forces them to search for products with a high quality, as they cannot afford to buy low priced inferior products with a high risk of breaking down early. Based on these insights, the strategy aims at creating high brand value through a high quality and consistent product portfolio and through high quality service. Next the brand needs to aim at a consistent communication strategy through their products, packaging, sales and promotional activities. Based on this study, a general advice for the BoP‐market is to create consistent brands and brand images that support customers to distinguish high quality long‐lasting products from less favorable alternatives in the market.

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Photo: Jason Mark

8. FINANCIAL REPORT 8. FINANCIAL REPORT

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This section of the document provides an overview of the financial management for the ‘Sustainable Healthcare for the Base-of-the-Pyramid’ research program during the year 2007 - 2011. Prepared by: Ir. Cs. Buiting-Csikós

FINANCIAL REPORT

Financial Report Year 2007 2008 2009 2010 2011

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Total

Revenues (CvB)

Expenses

Balance

€ 38,400

-€ 30,800

€ 7,600

€ 245,000

-€ 45,700

€ 199,300

€ 245,000

-€ 241,600

€ 3400

€0

-€ 176,400

€0

-€ 33,900

€ 528,400

-€ 528,400

€0

The expenses in 2011, partly still to be paid, are related to the completion of the project. Costs for rounding off the research activities, preparing and printing the BoP Healthcare report and the BoP student project booklet are involved.

FINANCIAL REPORT

Realized Expenses 2007 Personnel related Travel costs + conferences Materials related Outsourcing Total

2008

2009

2010

€ 2,700

€ 17,400

€ 172,600

€ 168,300

€ 10,200

€ 9,000

€ 42,600

€ 7,300

€ 7,800

€ 4,000

€ 12,700

€ 800

€ 10,100

€ 15,300

€ 13,700

€0

€ 30,800

€ 45,700

€ 241,600

€ 176,400 131

132

Photo: Chetan Shivarama

9. PEOPLE 9. PEOPLE

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“Here is the basic rule for winning success. Let’s mark it in the mind and remember it. The rule is: Success depends on the support of other people. The only hurdle between you and what you want to be is the support of other people.” - David Joseph Schwartz

Prof. Dr. Prabhu V. Kandachar Design Engineering IDE, Delft University of Technology Email: P.V.Kandachar@tudelft.nl Telephone: 015-2785769

Educational Research Background

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Prabhu Kandachar is extensively involved in projects with students and businesses to identify opportunities as well as to design & prototype products and services for the Base-of-the-Pyramid (BoP). Issues covered include water, healthcare, energy, housing, etc., in countries like India, Indonesia, China, Brazil, Ghana, Tanzania, Honduras, Philippines, Pakistan, Madagascar, etc. He is also directing the research work on some healthcare issues of the poor in developing countries. His interests also include sustainable well being as well as ethical aspects of design. He is the co-editor of the book: Sustainability Challenges and Solutions at the Base of the Pyramid: Business, Technology and the Poor (August 2008). He was co-organizer of the recent conference on BoP with the focus on impact of BoP ventures, at Delft (Nov. 2009). He has given several keynote lectures on this topic. He recently gave a series of lectures to masters students of Aalto University at Helsinki, Finland, in a course on â&#x20AC;&#x2DC;How to Change The Worldâ&#x20AC;&#x2122; (January 2010).

Role in this project

Prabhu Kandachar is the project leader of this project, with 3 sub-projects: One on Technology (executed by Dr. Santosh Jagtap, supervised by Prof. Prabhu Kandachar), one on Design (executed by Ir. Annemiek van Boeijen, supervised by Prof. Pieter Jan Stappers) and one on Marketing (executed by Dr. Sivakumar Alur, supervised by Prof. Jan Schoormans). This project started in January 2008 and ended in December 2010, and was entirely funded by the Board of Directors of The Delft University of Technology.

Prof. Dr. Jan P.L. Schoormans

Product Innovation Management IDE, Delft University of Technology Email: J.P.L.Schoormans@tudelft.nl Telephone: 015-2784840

Educational Research Background

Jan Schoormans holds a PhD on Perceived Justice of Social Security Benefits, from Tilburg University, The Netherlands. His areas of specialization are consumer research and consumer behavior in New Product Design. He has been holding the post as professor of Consumer research at the faculty of Industrial Design Engineering, Delft University of Technology, since 2001. He has been the Head of the department Product Innovation Management form the year 2000 to 2008. He also held the post of Vice-dean of the School of Industrial Design Engineering at Delft University of Technology, during the year 2006 to 2009.

135

Role in this project

Jan Schoormans has been actively involved in the BOP Healthcare research program as a supervisor for the project executed by Dr. Sivakumar Alur. This project focused mainly on the aspect of social franchising and retailing for healthcare in BOP context.

Prof. Dr. Pieter Jan Stappers Department Industrial Design IDE, Delft University of Technology Email: P.J.Stappers@tudelft.nl Telephone: 015-2785202

Educational Research Background

Pieter Jan Stappers holds an MSc in experimental physics and a PhD on the dynamics of visual perception. His research and teaching interests include explorative contextual studies of user experience (http://www.contextmapping.com/), techniques for co-creation, and the role of design skills, especially prototyping, within research.

Role in this project 136

In this project, he has worked with Annemiek van Boeijen on identifying barriers to designing for people in other cultures, connecting the BOP Healthcare research program to other work in the User Experience programme, especially the research on user contexts, in the faculty of Industrial Design Engineering.

Dr. Ir. Adinda Freudenthal

Department Industrial Design IDE, Delft University of Technology Email: a.freudenthal@tudelft.nl Telephone: 015-2785196

Educational Research Background

Adinda Freudenthalâ&#x20AC;&#x2122;s research area is methodologies for user centred design of ICT based medical devices, systems and services. The focus of the research has primarily been on high-tech medical devices in developed world (e.g., minimally invasive surgery, and ICU). Recently a transfer project for the Deaf in South Africa was started. Through this project, codesign methodology is being developed between technology partners, industrial designers, and the end. This approach is now being extended to rural China through the PhD research project of Mr. Jiehui Jiang.

Role in this project

Adinda Freudenthal is the daily supervisor for PhD student Jiehui Jiang. The goal of this is (besides PhD guidance) to provide knowledge transfer about user centred industrial design of ICT based medical devices, systems and services.

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Dr. Ir. Jan Carel Diehl

Design Engineering IDE, Delft University of Technology Email: J.C.Diehl@tudelft.nl Telephone: 015-2782231

Educational Research Background

138

Jan Carel Diehl graduated from the school of Industrial Design of Delft University of Technology and recently defended his PhD Research on product innovation knowledge transfer to emerging economies. His ongoing research is focussed on design for the base of the pyramid and he has been involved in over 50 BoP projects. The goal of the research is to develop proper design strategies and methods for Multinational Corporations as well as for social entrepreneurs to enter the BoP markets. Next to his position at the Delft University of Technology he is consultant for UNIDO and UNEP and invited lecturer at universities in amongst others Portugal, Colombia, Mexico, Turkey, Japan and Austria. He is co-author of the UNEP Design for Sustainability manual for Developing Economies (D4S DE).

Role in this project

Within the project he has been intensively involved in the educational projects connected to the research (i.e. graduation projects and integral design projects). In addition, in collaboration with Prof. Prabhu Kandachar and Dr. Vikram Parmar he took care of the valorization of the project by means of workshops for external stakeholders as well as publications like the BoP project booklet.

Dr. Vikram S. Parmar

Design Engineering IDE, Delft University of Technology Email: V.S.Parmar@tudelft.nl Telephone: 0091-9712941911 (India)

Educational Research Background

Vikram Parmar is an Associate Professor and Joint Director of Center for Design Innovation and Entrepreneurship (CDIE), Ahmedabad, Gujarat-India. In addition to CDIE, he works as an adjunct faculty with the department of Design Engineering of Industrial Design Engineering, Delft University of Technology. His work focus is geared towards improving social wellbeing by bridging the digital divide between urban and rural areas by developing ICT based products and services. His expertise lies in designing socially and contextually aware interactive products and services particularly in the area of emerging markets. His areas of interest include healthcare, renewable energy, and agriculture.

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Role in this project

Vikram Parmar received his PhD in Industrial Design at the Technical University of Delft, the Netherlands on â&#x20AC;&#x153;Design Framework for Developing ICT Products and Services for Rural Development - A case of Persuasive Health Information System for Rural Womenâ&#x20AC;?. As a PhD researcher, he was involved in setting up a pilot in rural India and collaborating with local stakeholders at a village level. His role also involved capacity building of rural women that supported him during this research project.

Mr. David Peck

Design Engineering IDE, Delft University of Technology Email: D.P.Peck@tudelft.nl Telephone: 015-27 84 895

Educational Research Background

David Peck has had a rich and varied career in a variety of organizations, for and not for profit â&#x20AC;&#x201C; public and private. He has had a wide range of roles from project managing multi-million $ projects to teaching and research. With many years in the aerospace sector he thrives in complexity. A mechanical engineer and a Warwick MBA he has for many years found an ideal home in the world of Industrial Design Engineering. His current research interest has a focus around the risks, challenges and opportunities that the phenomena of scarce or critical materials may offer. He currently teaches on a range of sustainability and business related subjects.

140

Role in this project

It is clear that the critical materials phenomena, peak oil and a growing world population (more specifically a growing middle class in emerging economies) are totally interlinked. As the millions at the base of the pyramid begin to move away from that base and into the middle then the criticality time frame becomes even more urgent. David is keen to deploy his current research into how organizations see a variety of interdependencies to help develop risk mitigation strategies.

Ir. Annemiek G.C. van Boeijen (MSc)

Department Industrial Design, Section Design Aesthetics IDE, Delft University of Technology Email: a.g.c.vanboeijen @tudelft.nl Telephone: +31 624765213

Educational Research Background

Annemiek is educated in Delft as an industrial design engineer. She graduated in 1990 with the design of a carbon fiber racing wheelchair for handicapped people. In the nineties she worked at the DUT in cooperation with companies and universities in developing areas in countries e.g. India, Sri Lanka, Thailand, the Philippines, Tanzania in the field of product development and education (tricycles for handicapped people and eco design). From 2000 she focused on education and curriculum development within the faculty of Industrial Design Engineering in Delft in the field of concept design, design manifestation & the cultural meaning of design.

141

Role in this project

Annemiekâ&#x20AC;&#x2122;s research focuses on the question how specifically culture plays a role in the product design process in general and in the domain of BoP Sustainable Healthcare in particular and how we can support (learning) designers to take into account these cultural aspects; crossing cultural chasms. The final output should result in a doctorate.

Mr. Jiehui Jiang

Design Engineering IDE, Delft University of Technology Email: J.Jiang@tudelft.nl Telephone: 015-2785730

Educational Research Background

142

Jie-Hui Jiang was born in 1981. He received both the B.S and the M.S degrees in biomedical engineering department of the School of Communication and Information Engineering at Shanghai University, China, in 2004 and 2007. Currently, he is pursuing his PhD degree in design engineering department of faculty of Industrial Design Engineering, Delft University of Technology, the Netherlands. He is also working as the research assistant in the research group â&#x20AC;&#x153;Design for Base-of-the-Pyramidâ&#x20AC;?. His research interests focus on designing low cost Information and Communication Technology healthcare solutions for Chinese markets, which includes user needs research (user centered design approach), strict product development and setting up business model.

Role in this project

Jie-Hui Jiang is a PhD researcher in this project and his contributions are focused on investigations of design culture, factors and methodologies about BoP healthcare in developing countries (rural China).

Dr. Santosh Jagtap

Department â&#x20AC;&#x201C; Design Engineering IDE, Delft University of Technology Email: S.N.Jagtap@tudelft.nl Telephone : 0031-152784546

Educational Research Background

Santosh Jagtap joined the faculty of Industrial Design Engineering in November 2008 as a post-doc researcher. Prior to joining this position, he was a Ph.D. student at the Engineering Design Centre of the Cambridge University. His Ph.D. research aimed at understanding engineering designersâ&#x20AC;&#x2122; requirements regarding in-service information, and use of this information in the design process within the aerospace industry. He holds a masters degree in product design from Indian Institute of Science, Bangalore.

Role in this project

Santosh Jagtap is a post-doc researcher in the BoP-research-group. His research explores different issues in designing products for BoP markets and different strategies used by businesses to address these issues. In addition, his current research explores systems approach in the design of products for the BoP.

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Dr. Sivakumar Alur

Department Product Innovation Management IDE, Delft University of Technology Email: S.Alur@tudelft.nl Telephone: 015-2785552

Educational Research Background

Sivakumar Alur is a management academic and has worked at a Business School in India for the past 14 years as a teacher, researcher and consultant in the areas of marketing, retailing and agribusiness. He holds Bachelors degree in Agriculture. He has done his Masters as well as PhD work in the area of Marketing. His textbook on Retail Marketing was published in 2008. He has also served as a supervisor for over 150 graduation projects over the years in the area of marketing.

144

Role in this project

Sivakumarâ&#x20AC;&#x2122;s role in the BoP project was to look at the Retailing dimension of Healthcare. Retailing is the last link between the company and the consumer. This is the point where the products and services interact to produce positive or negative results. Point of care Devices and Social Franchising are two areas that relate to access for healthcare among the BoP consumers.

INTRODUCTION

145