“Find the right questions. You don'of health for mothers and children. The poorest, most...
Transcript of “Find the right questions. You don'of health for mothers and children. The poorest, most...
“Find the right questions. You don't invent the answers, you reveal the answers." -Jonas Salk
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Vision and Approach
Mission
Numbers for context
Our focus
Current scenario in India
What Sanjivani does
Under the hood
Why Sanjivani over the alternatives?
Technology deliverables
Interference test results
Next steps
Credits
Reference
Table of Contents
VISION AND APPROACH
At Blackfrog Tech, we believe in harnessing the power of Science & Technology to make the world a
safer place to live in – this is our vision. Our approach is to identify and bridge critical service delivery
gaps in the humanitarian and social impact sectors
through innovation grounded in deep, context-
driven interdisciplinary research. We prioritize
understanding the complexities of humanitarian
problems in order to be able to deal with them
responsibly, over the pursuit of engineering
gratification. That is, innovation for its own sake does
not excite us; we believe innovation must help fix
significant problems in the material world.
MISSION
Our flagship product, ‘Sanjivani’, is a concerted effort towards fighting this humanitarian crisis. With
it, our mission is:
To ensure every child in India and her subcontinent receives appropriate and efficacious
immunization against disease;
To manufacture high-quality products for our clients and healthcare partners, while creating
employment opportunities in the local business ecosystem.
Immunization Saves 2-3 million children every year
Use of frozen water packs is standard practice
NUMBERS FOR CONTEXT Vaccines keep children alive and healthy by protecting them against disease. A 2016 report from UNICEF [1] claims that approximately one-fourth of deaths among children under 5 were from pneumonia, diarrhea and measles, and could have been mostly prevented by vaccines. The Immunization Technical Support Unit (ITSU) of Health Ministry (Govt. of India) claims around 25% of all vaccines go to waste due to poor cold-chain management. Ice-based products and technologies exposing vaccines to sub-zero temperatures is potentially endemic. A recent study found that ~65% of vaccine vials showed evidence of freezing in vaccine stores and peripheral health facilities across 10 states in India [2].Low immunization coverage compromises gains in all other areas of health for mothers and children. The poorest, most vulnerable children who need immunization the most continue to be the least likely to get it.
OUR FOCUS We have identified a critical gap in the last mile cold chain vaccine delivery system. In a nutshell, the
efficacy of vaccines deployed from Healthcare Centres to be administered to patients in distant and
remote geographical areas is often compromised due to lack of temperature control in extant ice-
based systems. Since most vaccines are temperature-sensitive, and require to be maintained at
specific temperature ranges (for example, 2-8 degrees Celsius as per the Indian & European
Pharmacopeia guidelines; WHO guideline for effective vaccine storage), ice-based technologies lead
to significant amounts of wastage.
CURRENT SCENARIO IN INDIA A group of researchers from Center for Tropical Medicine
and Global Health, Oxford, UK and Mahidol-Oxford
Tropical Medicine Research Unit, Bangkok, Thailand
conducted a study on ‘Cost, health impacts and cost-
effectiveness of ice-less refrigeration in India’s vaccine
cold chain’[3]to understand the economic benefits of using
a battery-operated device as a replacement to
conventional ice-boxes. The following are the results from
the study:
The costs of wastage in the context of rural India of the ice-based cold chain system is
7,512,930 USD, as detailed in Table 1.
Table 1. Vaccine cost/dose, wastage rates, coverage and costs of wastage using ice-based delivery
*Includes $0.25 program costs per dose [4]
The incremental cost per vaccine dose delivered with an iceless, battery-powered carrier is USD
0.026. On average, a health center serves a 4,554 target population for routine vaccination for
about 18,358 doses of vaccines. The total cost of an iceless, battery-powered carrier per 5 years of
use is USD 2,375, equal to USD 475 per year (Table 2). When compared with an annual wastage of
USD 1,726 per health center, the cost-benefit ratio for an iceless, battery-powered cold chain that
avoids this wastage would be 0.28, indicating that this is cost-beneficial.
Target
population
Individuals/
center
Doses/
vaccine
Subtotal of
Doses
Cost of iceless carrier (USD)
At birth
705
3
2,116
Unit cost (5 year est. shelf
life)
2,000
In 1 year
677
4
2,708
5 year maintenance cost
375
In 5 years
2,397
5
11,983
Cost per year
475
Pregnant women
776
2
1,551
Cost per dose:
0.026
Total
4,554
18,358
Table 2. Incremental costs of vaccine delivery using iceless, battery-powered device
Vaccine Cost /dose
(USD)
Wastage
rate
Current
Coverage
Cost of avoidable vaccine
wastage (USD)
Total cost of
wastage (USD)*
BCG
0.05
25%
95%
22,1417
1,328,499
DPT
0.04
25%
100%
1,900.868
13,781,292
TT
0.02
25%
85%
237,731
11,760,383
Hepatitis B
0.05
25%
100%
233,070
1,398,420
OPV
0.06
25%
90%
1,831,964
9,465,150
Measles
0.16
25%
95%
3,087,880
7,912,693
Total
7,512,930
45,646,891
Using the current ice-based cold chain, the vaccines were cost-effective with a cost per DALY
(Disability-Adjusted Life Year) of USD 216 averted, slightly higher than prior estimates due to
the lower incidence in the current model. Switching to the iceless, battery-powered device
would avert a further 0.03 DALYs per child with cost savings of USD 0.80 per child
vaccinated. The sensitivity analysis suggested that even at a much higher incremental delivery
cost of, for instance, USD 2 per vaccinated child and with higher wastage rates in the iceless
device of up to 20% (as compared with 25% in the ice-based system) the iceless, battery-
powered cold chain would still be cost-effective.
The study conclusively shows that vaccine wastage in ice-based cold chains incurs high human
and economic costs, whereas the per-dose incremental delivery cost for an iceless, battery-
powered device to reduce or eliminate such wastage is negligible. Compared with a scenario
in which compromised vaccines are identified and replaced, the use of an iceless, battery-
powered device would result in large cost savings. Also, compared with a scenario where
compromised vaccines are administered to children, the iceless, battery-powered device
would help cut costs and provide additional health gains.
WHAT SANJIVANI DOES
Above all else, Sanjivani is a portable, battery-powered controlled refrigeration device that strictly maintains any preset temperature (error of 0.1 0C ) for up to 12 hours.
Ergonomic and weighs 3.8 kilograms Compatible for Online monitoring of live-data
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Blackfrog Tech’s portable carrier syncs with LoggFiTM dashboard online for monitoring
vital data. Beyond portability and controlled refrigeration, Sanjivani offers continuous
temperature monitoring, location tracking, battery-level indication, and real-time
communication capabilities with the healthcare facility. With these features, Sanjivani
generates valuable usage
data from the field, which
can be taken as feedback
for further calibration and
enhancements as per
necessity.
Sanjivani is adaptable for other
biological materials and for use
EXTREME COLD WEATHER
(as a controlled heater)
The device operating ambient
temperature is between -20 0 C to
43 0C
Over-ordering of vaccines is one of the leading
problem in the distribution chain, and causes the
majority of wastage. Thus vaccine wastage is an
important factor in forecasting vaccine
requirements and while placing vaccine orders.
Sanjivani provides a platform for collecting crucial
inventory-data of Vaccines.
(https://dashboard.loggfi.com/login)
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UNDER THE HOOD Sanjivani compactness and low weight owes to its solid-state cooling system. While multiple
innovation teams have, in the past, attempted to integrate solid-state cooling into a portable
solution for the transport of biological substances, they have been unsuccessful due to low
power efficiency, and insulation issues. We, at Blackfrog Tech, have overcome this challenge
with a novel design that constrains the cooling chamber to precisely the temperature-range
requirement of day-to-day delivery of vaccines.
Solid-State Refrigeration principle PID controller
A single-stage 24 W Peltier assembly with an appropriate performance curve (for micro-refrigeration) has been employed by our system. Powering the Peltier is a 200Wh Li-ion battery pack along with battery protection and safety circuits. The device is optimized to ensure that a batch of vaccines can be cooled for 8-12 hours. Quick refrigeration and efficient battery usage has been prioritized while selecting manufacturers and designing electronics to drive the Peltier. To sense the temperature of the chamber, DS18B20 is used and housed inside a weatherproof sensing probe. The accuracy of this sensor is 0.5°C in the sensing range. System Block diagram
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At the brains of the system is an Atmega2560, a microcontroller capable of controlling the whole system. The Chamber temperature is maintained digitally using a Proportional Integral Derivative (PID) algorithm on-chip which uses continuously modulated control on the Peltier to attain and maintain the set point seamlessly. The secondary function of the electronics subsystem is to provide a user interface and data logging capability. A custom Liquid Crystal Display (LCD) displays the temperature and other vitals. Using the tactile buttons on the panel the device lets the user change the setting temperature of the cooling chamber. A Global Positioning System (GPS) module embedded on-board helps with tracking the device. The temperature information and the GPS coordinates are sent to a remote server for cloud monitoring using a Global System for Mobile communication (GSM) based module connected to the internet. A small backup secondary battery is on board for continuous transmissions even after draining the primary battery.
The system works on a 12V source, and therefore, in the event of a power outage, it can be
plugged directly into an automobile (motorcycle/car/auto rickshaw) engine with the help of
an adapter that comes as part of the package. There is also potential for the device to be
charged via an external solar panel.
WHY SANJIVANI OVER THE ALTERNATIVES?
The need of the hour is an affordable, easy-to-charge, battery-operated, controlled
refrigeration device that will ensure the efficacy of vaccines through a daylong
immunization deployment, a.k.a Sanjivani.
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The systems employed by Blackfrog Tech are tested, reliable technologies, with the added
advantage that most components are commercially available, which means manufacturing
becomes cheaper and easier.
Further, we conducted primary research in order to better understand user experience with
our device, in order to optimize its design. This involved:
1. Protocol analysis (a research method where respondents describe their thought processes
and experiences in real time, as they are performing a particular task): We shadowed primary
healthcare workers as they went about their vaccine administration job, and encouraged
them to talk us through the entire process as descriptively as possible.
2. Semi-structured interviews: Building on certain insights garnered from protocol analysis
and observation, we explored important user-experiential themes in open-ended
conversations with the healthcare workers. For example, we discussed in depth how they felt
about having to improvise and troubleshoot in the face of the variability that ice-based
cooling systems present.
3. We also asked the healthcare workers to physically examine and test our prototype in order
to get real time usage feedback, which has significantly contributed to our design process.
Ice-boxes are a century-old method of refrigeration
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Pictures from a local Vaccine-Outreach Centre where we conducted simulated trials (Kapu, Udupi district- Feb 2019)
Overall, from our research, we have gathered that Sanjivani does plug important gaps in the
cold chain immunization system. The device was
perceived by healthcare workers to be ergonomic
and efficient in its operating principle, but it also
took away the burden of improvisation and
troubleshooting from them. This latter point is
significant because improvisation often leads to the
vaccines being compromised, and blame is most
often placed on the healthcare workers, because
they represent the penultimate human link in the
immunization cold chain system. Therefore, we believe that Sanjivani is suited to cater to the
Indian last mile cold chain immunization system better than any other device in the global
marketplace.
$ 7,512,930
is the annual cost of wastage in
the context of rural India of ice-
based cold chain system.
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TECHNOLOGY DELIVERABLES Following are results from a simulated field-trial for Sanjivani against current practice of using
Ice-boxes in a Vaccine outreach programme (Routine immunization campaign) held at Kapu
RMCW (Rural Maternity & Child-Welfare) home in February 2019.
Ambient Temperature: Ranging from 27° C to 34° C
Temperature Sensor used (for both systems): Berlinger Q-tag Wireless (WHO PQS Certified)
Clearly, Sanjivani performs significantly better than the ice-based option in terms of temperature control. Our device is able to maintain a stable 4 degrees Celsius platform, with a 0.1 degrees Celsius error margin. On the other hand, the temperature within the icebox is radically variable (often freezing the samples), and this is potentially the single most serious threat to the efficacy of temperature-sensitive vaccines. Sanjivani’s stable temperature platform ensures absolute accountability for the efficacy of vaccines, and minimizes human error, thanks to the novel design that does away with repeated freeze/thaw cycles.
INTERFERENCE TEST RESULTS When vaccines are taken to the field for administering, the device is opened multiple times
to retrieve the vials. This is usually when the temperatures shoot above the recommended 8
degrees Celsius higher limit and thus degrade the efficacy. It is absolutely imperative for any
refrigeration mechanism to bring the temperature down to the safe-limits in the least
possible amount of time.
We simulated these human-interference by opening both the systems (ice-box and Sanjivani
containing same volume and density of load) for a period of 3 minutes (as per WHO PQS
guidelines for testing refrigeration). The temperatures went above the set-temperature and
they were placed back inside the respective devices for stabilization. Temperature versus
Time curves were plotted for both the systems and compared.
SANJIVANI Temperature Chart UNICEF (Blue Plastic Ice-box) Temp
Chart
Ta = 34.03 °C is the Average Ambient Temperature during Test
T0 = 4.6 °C is the Set-temperature / optimal temperature for cold-chain
Parameters Ice Box Sanjivani
Peak Temperature (T1)
9.3°C
10.4°C
Temperature change brought about by Refrigeration (dT)
4.7
5.8
Time taken to reach 4.6°C (T0) in minutes (dX)
35
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Rate of cooling R = dT/dX
0.13429 °C/min
0.26364 °C/min
Table 3. Interference test results
Improvement in rate of cooling = (Rsanjivani – Ricebox )/ Ricebox
= (0. 26364 - 0. 13429)/0. 13429 = 96.33%
Sanjivani is able to refrigerate (stabilize temperature to recommended levels) at a rate of
96.33% faster than the ice-box
NEXT STEPS We aim to conduct user-experience research in an iterative manner, until we have designed
the most viable product for the purpose. That is, we intend to incorporate our respondents’
feedback into our design, and take it back to them for more feedback, until we have checked
all the important boxes. We are almost there. An important step that remains to be taken to
test the device under extreme weather conditions. This is part of our ambition to take
Sanjivani global.
CREDITS
Agung Pandit Wiguna from Pexels
Harryarts - www.freepik.com
Hush Naidoo on Unsplash
Pasja1000 from Pixabay
REFERENCES
NOTES
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