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Year : 2019  |  Volume : 67  |  Issue : 4  |  Page : 447-448

“Indovation” in ophthalmology – The potential power of frugal innovations

Editor, Indian Journal of Ophthalmology, Editorial Office: Centre for Sight, Road No 2, Banjara Hills, Hyderabad - 500 034, Telangana, India

Date of Web Publication22-Mar-2019

Correspondence Address:
Dr. Santosh G Honavar
Editor, Indian Journal of Ophthalmology, Editorial Office: Centre for Sight, Road No 2, Banjara Hills, Hyderabad - 500 034, Telangana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_550_19

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How to cite this article:
Honavar SG. “Indovation” in ophthalmology – The potential power of frugal innovations. Indian J Ophthalmol 2019;67:447-8

How to cite this URL:
Honavar SG. “Indovation” in ophthalmology – The potential power of frugal innovations. Indian J Ophthalmol [serial online] 2019 [cited 2020 Sep 24];67:447-8. Available from: http://www.ijo.in/text.asp?2019/67/4/447/254724

“Human creativity is a natural, infinitely renewable resource – and it's coming up with smart, cheap solutions to people's biggest problems” – Navi Radjou

If necessity is the mother of invention, desperation is said to be the father of brilliance. Frugal innovation is a need-driven solution to a common problem that has emerged from the crucibles of simplicity, austerity, ingenuity, resilience, and desperation, resulting in a “minimum viable product.”[1],[2],[3],[4]

In 1816, Laennec encountered a challenging case of a young obese woman who needed to have her heart examined. Palpation and percussion being precluded by her obesity and direct auscultation with ear to the chest “rendered inadmissible by the age and gender of the patient,” he used a quire of paper rolled into a cylinder to auscultate the heart, which, after further refinements, lead to the invention of the first stethoscope.[5] This is a classic example of the application of native wisdom to overcome a challenge, which we now eloquently call frugal innovation. Frugal innovation encompasses heterogeneous activities providing effective functional solutions to common problems with minimal use of resources.[4] Such innovations arise in low-resource settings, when the existing solutions are too expensive or are simply not available.[4]

The modern concept of frugal innovation was mooted by Schumacher in 1973, who advocated the use of appropriate technology as an inclusive developmental approach to overcome the challenges of socioeconomic disparities in emerging countries.[6] His famous quote in the book “Small Is Beautiful” dwells on the basic concept of frugal innovation – “Any intelligent fool can make things bigger, more complex, and more violent. It takes a touch of genius, and a lot of courage to move in the opposite direction.”[6] Prahalad recognized the immense business potential of addressing the unmet needs and aspirations of four billion people worldwide who lived on less than two dollars a day – this he called the bottom of the pyramid (BoP).[7],[8] He proposed radical innovations in technology and business models to provide low-cost solutions to outstanding common problems of people at the BoP.[7]

Frugal innovation overlaps with the concepts of reverse innovation, disruptive innovation, grassroots innovation, catalytic innovation, Gandhian innovation, and “Jugaad” in Hindi.[9] Radjou et al. outline the six principles for effective innovations in their book “Jugaad Innovation” – “seek opportunity in adversity, do more with less, think and act flexibly, keep it simple, include the margin, and follow your heart.”[10] They go on to say, “Collectively these six principles of Jugaad help drive resilience, frugality, adaptability, simplicity, inclusivity, empathy, and passion, all of which are essential to compete and win in a complex world.”[10]

An innovation could be considered frugal if it meets the following relevant criteria: a substantial reduction of cost, concentration on core functionalities, and optimized performance levels.[11] Studies indicate that frugal innovations are sustainable, reverse-diffuse from emerging countries to developed countries, and need different business models.[12],[13],[14] These span across almost all the industries and various aspects of daily living. One of the major beneficiaries is the healthcare industry.

India is currently the hub of frugal innovations and has been aptly recognized as such by the new term “Indovation.”[1] India leads the way in the BoP approach to healthcare delivery. Narayana Hrudayalaya and Aravind Eye Care System are the much-studied successful models of delivering affordable medical care.[3] Both use effective and appropriate technologies to deliver high-volume and high-quality medical care to the masses and yet make enough profit to fuel their robust growth and expansion. India is only second to the United States in the number of frugal healthcare product innovations and leads as the favored first-launch market. Jaipur foot is one of the several legendary Indian frugal medical innovations.

Ophthalmology, being investment-intensive, provides a large breeding ground for frugal innovations. Ophthalmic healthcare delivery, especially at small and medium scale, is ripe for innovations. Adaptation of low-cost business tools such as no-frills service, para-skilling of healthcare workers, daycare surgeries, shared facilities, and pay-per-use equipment can bring about substantial reduction in the cost of delivery of care and help generate modest profits. Affordable electronic medical records (EMRs) are much needed to go paperless and provide for porting of data vertically across referral layers and accumulate critical follow-up data to assess the outcome. Good business models of neutral and centralized shared investigation facilities and surgical centers in urban areas can bring down the cost of initial investment and optimize the use of medical equipment. Well-equipped teleophthalmology and EMR-enabled mobile screening vehicles can meet the needs of remote rural locations where establishment of permanent infrastructure may not be feasible. Sustainable hub-and-spoke models of hospital-based surgical care can minimize the risk of complications and improve the outcome. Appropriate use of technology can bring eye care out of the realm of dependence on charity and compromised quality and make it self-sustainable standard-of-care.

Affordable equipment for the screening, diagnosis, and management of the major causes of preventable blindness can touch millions of lives in India and billions worldwide. Harnessing the power of mobile and connected technologies can bring about paradigm shift in diagnostics and screening. Low-cost portable diagnostic and digital documentation tools can help standardize screening and enable teleconsultation compliance, and artificial intelligence–based diagnostics. While we seem to have made significant impact in providing frugal solutions for cataract surgery (low-cost intraocular lens), we are, at best, scratching the surface in several other major areas – inexpensive scratch- and shatter-proof spectacles, low-vision devices, low-cost autorefractors, digital slit lamps, anterior segment imaging, biometry, tonometer, visual fields, retinal imaging, ultrasound B-scan, optical coherence tomography, operating microscopes, phacoemulsification and vitreous surgical systems, surgical instruments, sutures, and drugs.

Ophthalmology has the potential for better technology at a much lower price. Clinician-driven innovations have always been sparked by frustration and fueled by dire necessity. Translational gap must be bridged to bring basic scientific knowledge to the bedside and unleash radically constructive and economically sound innovations to fulfill our unmet needs. Effective use of cutting-edge science at the foundation of frugal innovations will help find inexpensive and better solutions to existing clinical challenges.[15] Ideas are aplenty, and the innovators are not scarce. However, an innovation ecosystem must cocoon the innovator to help complete the innovation cycle. Grassroots innovators can, at best, solve a local challenge, while start-up funding, design refinement, manufacturing, and marketing muscle are needed to scale up and be of some impact.

The Editorial Board of the Indian Journal of Ophthalmology recognizes the need to highlight native innovations and find space for them in the academic literature. We have initiated a new section “Innovations in Ophthalmology” in this issue of the journal.[16],[17],[18] We look forward to a flood of good publications in this section, and hope that our initiative will help catalyze “Indovations” in ophthalmology.

  References Top

Birtchnell T. Indovation: Innovation and a Global Knowledge Economy in India. London: Palgrave Macmillan UK; 2013.  Back to cited text no. 1
Lehner AC, Koldewey C, Gausemeier J. Approach for a pattern-based development of frugal innovations. Technol Innov Manage Rev 2018;8:14-27.  Back to cited text no. 2
Arshad H, Radić M, Radić D. Patterns of frugal innovation in healthcare. Technol Innov Manage Rev 2018;8:28-37.  Back to cited text no. 3
TranVT, Ravaud P. Frugal innovation in medicine for low resource settings. BMC Med 2016;14:102.  Back to cited text no. 4
Available from: https://en.wikipedia.org/wiki/Ren%C3%A9_Laennec. [Last accessed on 2019 Mar 18].  Back to cited text no. 5
Schumacher EF. Small Is Beautiful. New York: Harper & Row; 1973.  Back to cited text no. 6
Prahalad CK. Bottom of the pyramid as a source of breakthrough innovations. J Prod Innov Manage 2012;29:6-12.  Back to cited text no. 7
Prahalad CK, Mashelkar RA. Innovation's holy grail. Harvard Bus Rev 2010;88:132-41.  Back to cited text no. 8
McPhee C. Gupta DS, Hossain M. Editorial: Frugal innovation. Technol Innov Manage Rev 2018;8:3-5.  Back to cited text no. 9
Radjou N, Prabhu J, Ahuja S. Jugaad Innovation: Think Frugal, be Flexible, Generate Breakthrough Growth. San Francisco, CA: Jossey-Bass; 2012.  Back to cited text no. 10
Weyrauch T, Herstatt C. What is frugal innovation? Three defining criteria. J Frugal Innov 2016;2:1-17.  Back to cited text no. 11
Levänen J, Hossain M, Lyytinen T, HyvärinenA, Numminen S, Halme M. Implications of frugal innovations on sustainable development: Evaluating water and energy innovations. Sustainability 2016;8:1-17.  Back to cited text no. 12
Hossain M, Simula H, Halme M. Can frugal go global? Diffusion patterns of frugal innovations. Technol Soc 2016;46:132-9.  Back to cited text no. 13
Winterhalter S, Zeschky MB, Neumann L, Gassmann O. Business models for frugal innovation in emerging markets: The case of the medical device and laboratory equipment industry. Technovation 2017;66-7:3-13.  Back to cited text no. 14
Rao BC. Science is indispensable to frugal innovations. Technol Innov Manage Rev 2018;8:49-56.  Back to cited text no. 15
Chandrakanth P, Ravichandran R, Nischal NG, Subhashini M. Trash to treasure Retcam. Indian J Ophthalmol 2019;67:541-4.  Back to cited text no. 16
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Ahuja A. Commentary: Frugal innovations – Path to eye care for all. Indian J Ophthalmol 2019;67:544-5.  Back to cited text no. 17
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Akkara JD, Kuriakose A. Commentary: Tsunami of grassroot innovations from makers. Indian J Ophthalmol 2019;67:545-6.  Back to cited text no. 18
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