A Workshop Report – Frugal Digital Technology for Healthcare Delivery

Frugal innovations aim to ensure ‘good-enough’ quality, with simplicity and affordability in an environment where necessity reigns and resources are limited. The need for frugal innovations has been felt the most in the healthcare sector globally, particularly since the onset of the pandemic. Although discussions on frugality have existed for a long time, the Covid-19 pandemic taught us the value of frugality more than ever. A significant lack of access to healthcare emerged as a fundamental challenge during the Covid-19 pandemic, forcing people to rethink and reimagine ways and measures to maximize access to healthcare not only in the global south, but also in the advanced industrialised countries. Frugality or frugal philosophy, emerged as a significant vantage point. To discuss these ideas, a workshop was organized by the Department of Design, Indian Institute of Technology, Roorkee, on March 9 and 10, 2023.

The primary objective of this workshop was to propagate the philosophy of frugality and frugal innovations. It was also aimed at developing a roadmap for frugality studies. The workshop was designed as a dialogue that brought together Indian scholars from diverse academic disciplines such as science, technology, and law. Participants threw in various perspectives from their respective academic fields, which were debated and discussed acutely.

In the inaugural address, A.K. Sharma referred to frugality as a “revolutionary idea” capable of changing society’s complexion. He added that there is a need for a multidisciplinary outlook and a community approach where ordinary people can contribute effectively. Currently, the designers mainly focus on only big or significant tech industries, as per Inderdeep Singh. Therefore, the word frugality gains importance.

Suchit Ahuja, the keynote speaker of the event, spoke on “Frugal Digital Innovation: Delivering Health Services in Constraints and Voids.” His presentation’s main thrust was understanding what frugal digital technology means; how it connects to healthcare, especially in India and rural areas; and the conceptual evolution of frugality. In his perspective, frugal innovation is a “combination of business innovation, technology innovation, and social innovation” that minimizes “a firm’s resource usage by redesigning its processes, products/services, business model, and to make them more affordable, sustainable, and/or accessible than existing/competing solutions.” He problematized digitalization by saying it is resource-intensive, exclusionary, and consumption-driven. Frugality rescued the digital, making it more sensible, affordable, and impactful. Frugal digital innovation is a platform through which competitive advantage is built by overcoming resource constraints and voids. The platform itself then becomes a resource. A fallout of absence or weakness of institutional regulation is called Institutional void. These voids can be filled by reconceptualizing and framing the problem, aggregating resources, and networking with actors outside the industry. He viewed voids as problem-sensing tools that can help diagnose conditions that must be addressed. However, he cautioned that frugal innovations should not be air-dropped elsewhere. Context-specificity is an integral part of frugality.

Saradindu Bhaduri flagged specific points after the presentation. He emphasised the need for distinguishing frugal digital technologies from non-frugal ones.  While digital technologies may remove some social biases, algorithms too have their own biases and can disempower people involved with healthcare delivery through technological innovation. He agreed with the speaker that the question of scale needs to be problematised correctly, if one has to understand the context specificity of frugal innovations. Thirdly, he pointed out that the evolutionary understanding of frugality is understood in light of experiences in the global north. He inquired whether a separate and similar evolutionary account of frugality could be made in the south. Fourthly, he questioned the idea of the institutional void because the institutional frameworks consists of both formal as well as informal institutions, and several studies have shown that informal institutions continue to guide human decision-making and behaviour, even when formal institutions are either absent or weakly implemented. He, therefore, suggested that we can either do away with the concept of void or reframe it differently. Bhaskar Bhowmick suggested that to scale up the reach and access of frugal innovations, digitalization should be part of frugal solutions from the beginning when the problem is being defined.

 In response to Bhaskar Bhowmick, Suchit Ahuja gave examples and said that if you embed digital from day one, it can lead to low infrastructural costs and you are already making design developments that will prove helpful. He agreed with Saradindu Bhaduri on the evolution of frugality in the global south. He was keen on studying and exploring the nature of frugal innovations in the global south. On the question of algorithms, he expressed his agreement by saying that algorithms in a particular technology are trained and designed by people keeping in view one specific context. Hence, its application in other contexts may not work. Instead, it may be harmful. He further addressed the question of the institutional void by saying that it is an imposed notion from the west and is often seen as having a negative connotation. He asserted that this perception needs to change and be addressed as institutional interfaces rather than institutional voids.

Masfick Hazarika addressed the powering challenges of rural healthcare by focusing on clean energy solutions. His presentation mainly dealt with the Energy Programme of the World Research Institute (WRI), India, which seeks to ensure energy access, transition, and efficiency in remote and rural areas. This program is focused on powering loads in the case of energy access in rural areas which can catalyze socio-economic development in these areas. This is because electricity access has been limited to households and not to sectors such as hospitals, schools, sanitation, and so on.

Harsha Verma presented her work on “Textiles in Uttarakhand- Craft Design Interventions and Digitalization,” wherein she highlighted the issues and challenges the handloom industry faces, such as the marketing, institutional inefficiencies, and the unorganized nature of the industry. Apart from the above, the textile industry also suffers due to technological backwardness, paucity of design novelty, inconvenient working conditions, insufficient research and training, and so on. Hence, she designed a mobile application, “ताना बाना” with a vision to revive and create awareness about Indian handicrafts, encourage artisans, provide information through a website, and decrease their dependency on selling products. The application is highly customizable and can respond to the questions of artisans. She had gone through a series of interactions and engagements with the artisans and handicraft workers to arrive at this result. Her research was mainly embedded in grassroots experiences.

Bhaskar Bhowmick first pointed out the dominant industry perspectives in healthcare technology. Healthcare infrastructure in India suffers from many defects, such as insufficient hospital beds, healthcare centers, blood banks, urgently needed vaccines, and medical colleges. He then pointed out the requirements and concerns regarding the delivery of healthcare. His presentation mainly focused on the innovation ecosystem prevalent in IIT, Kharagpur, a fusion of academics, innovation and practice, and commercialization and funding.

Laws shape our actions and determine our social, political, and economic relations. Therefore, any discussion on technology whatsoever is incomplete without reference to the legislative framework in place. Nupur Chowdhury’s insights into the “Regulatory pathways for frugal innovations in healthcare” addressed this gap. Her presentation first dealt with the definitional aspects of regulations. Among other critical insights, she pointed out that there exists an incongruent policy framework where an innovator is free to innovate. It is the manufacturer who is regulated by law. Hence, all the aspects, such as rights over data protection, market authorization (right to sell), patent protection, and research grants (incentives), are designed for manufacturers and not innovators. She briefly touched upon the Orphan/Pediatric Regulations in Europe, which create an incentive-like situation to produce medicines for rare diseases on the market. Among other things, she recommended that technology must be understood as part of freedom of expression and individuality. Further, recommendations included the creation of a class of “frugal products” through a law that will allow for accessing regulatory advice on a case-by-case basis and access funding.

A three-member panel consisting of Rajat Agarwal, Saradindu Bhaduri, and Bhaskarjit Neog was constituted to brainstorm future directions in frugal innovation. An open ended-discussion followed with all the participants. Saradindu Bhaduri defined frugal innovation as “judicious tinkering and improvisations of individuals based on their experiential learning.” According to him, “linking frugality merely with affordability and being inexpensive is a very narrow construction of the term.” The broadness of its uses gives more legitimacy to engage with a concept, further explore the values that inform frugality, and imagine an ecosystem to incentivize such actions and innovations. Based on the ongoing discussion, Saradindu Bhaduri put forth certain vital interjections regarding issues like financing of, and regulation-making for, frugal innovations. His overview of the ongoing discussion then invited other panellists to share their views.

Pushing the discussion regarding values and ethics, Bhaskarjit Neog focussed on frugality as a moral value, a belief to adhere to or fulfil in everyday life. He pointed out how the concept of frugality can also be seen in Ancient Greece, where the idea of moderation finds a place. In non-western civilizations, Buddhism too emphasized the importance of moderation. Even the Gandhian way of life, which is minimalist, follows frugal logic. Following a sensible, balanced middle way is essential in innovation and everyday life, especially amidst the record-breaking high consumption levels in the past few years. Ethics behind a product or a design is equally important. Innovations need to be sensitive to people and the people would receive them; an example of a soap dispenser in a public washroom that doesn’t work when a black puts his hand forward due to its nonrecognition of the black race was eloquently mentioned. Innovations should be reflective enough of not just being cheap, accessible, or affordable but ethical too.  In the end, it was effectively pointed out that frugality is a value that needs to be practiced not just at the individual or institutional level but within institutions but should be practiced at the collective level by the members of the institutions. The next speaker, Rajat Aggarwal, highlighting the importance of mindset in frugality, pointed out the need for more collaborations to build an ecosystem for frugal advancement. He pointed out that the existing well-crafted ecosystems involve youth, students, NGOs, etc. Technologies are being developed devoid of relentless profit-seeking. He further focussed on connections with students, supporting and empowering them in their innovations through various means, like discussions on ideas, testing, and funding to help build the appropriate ecosystem. However, there is a need for more flexibility for students to ideate and innovate.

The discussion intensified towards the end, and the ideas of frugal innovations, jugaad in common parlance, and its scientific version came to the fore. In conclusion, the discussion was put to a close by Saradindu Bhaduri, referring to the words of the author of “Against Methods,” Pual Feyerabend, where he pointed out that the messy process of innovation is often rationalised only after the innovation has been achieved. Secondly, no method is universal; improvisation is unavoidable.

Report prepared by Priya Singh. Priya is a Ph.D. Research Scholar at Centre for the Study of Law and Governance, Jawaharlal Nehru University, New Delhi.