Design Thinking in Action: Building a Low-Cost Incubator
February 16, 2010
by Greg Warman

Today’s post highlights the work of Embrace Global and one of its co-founders, Linus Liang.

20 million premature and low-birth-weight (LBW) babies are born every year. Of these, four million will die within the first month of life. Those that survive face severe long-term health problems like diabetes and respiratory disease.

99% of neonatal deaths occur in low to middle-income countries. Why? The proven treatment – the infant incubator – is cost-prohibitive. At $25,000 for a single unit, this life-saving device is out of reach for the world’s poorest.

The solution seems obvious – design an affordable incubator.  In 2007, Linus Liang and his team at the Stanford d. Schools were tasked with the ambitious objective of creating an incubator for 1% of the standard cost – a mere $250.

I recently shared this story with a friend who is an accomplished engineer and his immediate reaction was one of excitement. “It actually might not be that difficult,” he claimed, “incandescent bulbs, analog, combined with appropriate insulation would be a starting point.” A talented visual thinker, my friend appeared to be working up the schematics in his head.

And perhaps he’s right — it might not be that hard. However, as Linus and his team soon discovered, hard to design or not, an affordable incubator would have little impact because it solves the wrong problem.

Solving the right problem

Based in Bangalore, India, Linus’s tech start-up, Embrace, focuses on the complex operational issues associated with the design, manufacture, and distribution of a product in the developing world. 

While at Stanford’s, the team that would become Embrace took a focused course on innovation for social good, “Design for Extreme Affordability.” Linus and his team gravitated to the incubator challenge, a project sponsored by a Nepalese NGO (a country with the highest percentage of neonatal deaths per baby born in the world). As good design thinkers, the team’s first step was to observe users, specifically the healthcare workers in Nepal responsible for treating premature and LBW babies.

Linus traveled to Kathmandu and immediately started touring hospitals, speaking with doctors and nurses about the issue of premature births. As he walked around, Linus noticed something surprising — there were already a number of incubators, primarily older units, that had been donated. Even more surprising, most of the incubators sat empty.
When Linus asked why, a doctor shared that most problematic premature and LBW births occur in rural villages, up to a day of travel away. Sadly, because babies cannot regulate their body temperature, they often die en route to the hospital. This was a powerful insight, and Linus immediately recognized his team had the wrong design challenge. To develop it successfully, he needed a completely different data set.

He canceled his remaining hospital tours and arranged to visit surrounding villages, the areas where the need truly existed. He spoke with local doctors and mothers who had lost their babies. He discovered that geographic proximity to urban hospitals was only part of the problem; in many cases, families simply couldn’t afford the travel, let alone the cost of hospital care. He also unearthed several realities that would inform the design of his team’s solution: no reliable source of electricity, rudimentary local healthcare and extreme cost constraints (It became clear that $250 would be far too expensive for local adoption).

With these factors in mind, Linus’s team reframed their task. Rather than focusing on affordable incubators, they set out to “design an ultra low cost, portable way of maintaining babies’ temperatures without the use of electricity.” By shifting and narrowing the challenge, the team increased the likelihood their final solution would have an impact.

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Solving the problem well

Once back in the States, Linus’s team gathered as much information as they could on incubator technology and methods for regulating babies’ temperatures. They were fortunate to be at Stanford, where access to expertise in medicine, engineering, and materials’ science was readily available. Their research revealed, among other valuable facts, that a significant portion of the expenses associated with standard incubators had little to do with temperature regulation.

Second, focused on their revised design challenge, the team brainstormed possible solutions. Using the brainstorming principles advocated at the (including deferring judgment, building on the ideas of others, and allowing for wild ideas), they generated a large volume of potential ideas, a subset of which would ultimately influence their final solution.

Third, after synthesizing and voting on their brainstorming output, the team advanced their ideas by engaging in rapid prototyping. Using a variety of sundry items available at the, the team threw together various solutions, pushing their thinking in unique directions. In just a few weeks, the team built and broke over 100 prototypes.

The path was tortuous but necessary; the resulting solution was extraordinarily elegant. Resembling a miniature sleeping bag, the product insulated a child against the cold. A side pouch accommodated the real magic – a unique, removable heating pad. After a few minutes in boiling water, the pad releases just enough heat to maintain the perfect temperature inside the sleeping bag for over four hours. Just as importantly, the solution had no moving parts and could be built for under $25 (one-thousandth the cost of a traditional incubator).

In typical business scenarios, a prototype this polished would enter into clinical testing, production planning, and finally manufacturing and distribution. Linus’s team was determined to make sure their final product suited the intended market though. 

With the prototype in hand, the team returned to India seeking feedback. Thanks to the usable prototype, users had little difficulty reacting with suggestions for improvement.

For example, the team learned that local doctors often accompanied new mothers and their premature babies to urban hospitals. When in transit, they need to observe chest movement and monitor respiration. To facilitate this, without opening the sleeping bag and losing heat, Linus’s team added a rugged plastic window to the front of the unit.

Another modification accommodated a cultural norm. The team discovered that it is fairly common for patients to use intuition when taking medication, regardless of a doctor’s instructions. Local doctors worried that the LCD temperature strip on the exterior of the sleeping bag, showing the temperature in Celsius, would invite interpretation and result in bad decisions. Using paper mock-ups, Linus’s team quickly tested a temperature gauge with just two states: a happy face to indicate the bag was warm enough, and a sad face to signal the need for a new heating pad. This level of abstraction was received well and incorporated into the design.

Ultimately, interest in the “Embrace Infant Warmer” exceeded expectations, with healthcare systems around the world inquiring about the unit’s availability. By identifying a real problem and solving it well, Embrace is poised to do more than introduce a popular product; they will be saving lives.

Curious about how the Embrace Infant Warmer worked out in the years since we published this article? Check out Embrace Global and consider donating $20 USD to buy an infant warmer to help support Linus’ cause.