Mr Rajinda with his old prosthetic leg (black), wearing his new JaipurKnee. Mr. Rajinda and his wife have three children and live in the Delhi area. He is 39 and is an electrician and a tabla player.

ReMotion JaipurKnee

The second version of the ReMotion JaipurKnee as part of a prosthetic leg system. The first version of the knee is being worn by more than 3,500 amputees in India and five other countries.


Purnima lost her leg in a 2011 car accident that also resulted in the death of her younger brother. She was 18 years old and on track to become an engineer. After being fit with her JaipurKnee, she intended to go back to school and complete her degree.


Vishambar was one of the first patient’s to be fit with the JaipurKnee and has been wearing the same one since 2008. One of the unique features of the JaipurKnee is how much range the knee has, recognizing users will sit cross-legged, squat, and bend deeply in daily life. Like Purnima, he is a regular teenager, sensitive to the same social aspects of friends and family as teenagers in the U.S.


The reality in many hospitals in low-resource areas--like this urban public one in India--is that existing phototherapy devices are ineffective. Bulbs burn out and are either not replaced or are replaced by ineffective white bulbs. Tube lights like the ones shown here last four to six months before requiring replacement, and cost anywhere from $6 to $65 to replace. D-Rev’s Brilliance uses LEDs which last up to five years before needing replacement.


A nurse adjusts the eye protection for a newborn at a public hospital in Tamil Nadu, India. Compared to other devices that meet American Academy of Pediatrics (AAP) standards and cost more than $3,000--Brilliance meets AAP standards and will cost approximately $400.


"Baby Hope" was the first newborn treated with Brilliance in an urban public hospital in Nigeria. He was 2.8 pounds and his jaundice was so severe that he needed an exchange transfusion--a process by which his blood is circulated and filtered twice--to prevent brain damage or death.


D-Rev assisted colleagues at University of Minnesota and Stanford evaluate filtered sunlight as an option for low-cost phototherapy. While it is a promising approach, the ambient temperature needed to be close to the baby’s core temperature, there are only 12 hours of sunlight per day (treatment often is required for 48 to 72 hours)--and mothers were generally uncomfortable with their babies sitting outside in a courtyard.



How To Create Products For People Living On Less Than $4 Per Day

You probably haven’t heard of D-Rev, but its products—including a revolutionary new prosthetic knee—are making a huge splash in the rest of the world.

Think your organization is productive? We’d like to direct your attention to D-Rev, a nonprofit technology design firm that aims to improve the health of people around the world living on under $4 per day. It’s a big mission, but the organization is already in the process of pushing out two innovations to the developing world, with a handful of others on the back burner. Oh, and D-Rev is currently operating out of a house (a temporary situation).

All of this productivity has happened fairly recently: In 2009, when current CEO Krista Donaldson joined the organization, D-Rev had a lot of good ideas that weren’t going anywhere. Now the organization is working hard to bridge the "valley of death"—that place between prototyping and bringing products to market. Here’s how they’re doing it.

D-Rev’s innovations are all driven by people on the ground in the countries where they work, instead of by people in other countries who think they know what the developing world needs. For example, Brilliance (an inexpensive phototherapy device for treating infant jaundice) came about when a doctor approached a D-Rev staff member. The ReMotion Knee, an affordable prosthetic leg system, sprung out of a Stanford University class—but the Jaipur Foot Clinic in India (an organization that provides limbs, crutches, and other devices to the disabled for free) had first approached the class and said "We need a better knee."

"We have these other criteria that I put into place when I came onboard where we evaluate [projects]. It would be things like, does it meet our mission [to help people living on less than $4 per day]?" says Donaldson. "So if it’s going to help someone who is more in the $10 to $15 range, it doesn’t really meet our criteria. And then it also has to be something that will hit a million people, so not a localized problem in one community."

Once D-Rev knows that a project meets its criteria, it performs a due diligence phase—finding out about the price point for the market, whether the product will be economically sustainable, whether distribution channels exist and if D-Rev can work with partners on the project, etc. At the same time, D-Rev works on the technical design process. Next comes the planning phase for manufacturing and distribution.

D-Rev is just getting started with the launch phase—its first commercial product, the ReMotion JaipurKnee, is being used in two clinics in India, where about 3,600 knees have already been fitted. That has all happened through a no-cost license with the Jaipur Foot Clinic. Now D-Rev has modified the design and is looking to go into mass production next year.

It’s easy to see why the ReMotion knee is superior to what’s currently available. During my visit to D-Rev’s temporary headquarters, I had the chance to check out both the ReMotion knee and a knee distributed by the Red Cross. The Red Cross knee moved along a single axis, like a door hinge. The ReMotion knee, in comparison, has a 165-degree range of motion. The problem, of course, is that the Red Cross is a giant organization with a global distribution network.

Next up for D-Rev is Brilliance, a phototherapy device for neonatal jaundice that costs about $400, compared to the average price of $3,000 for devices used in the U.S. (not to mention the cost of regularly replacing CFL bulbs). D-Rev’s solution: using LED bulbs and a more efficient design. Donaldson has high hopes that Brilliance will scale quickly—D-Rev hasn’t done a big publicity push for the device, but already the organization is receiving plenty of inquiries.

It’s also constantly working on improvements, since LED technology is changing by the month. When I visited D-Rev, a pair of employees were working in the prototyping room to optimize lighting on the Brilliance device.

D-Rev’s latest challenge is figuring out distribution models—a surprisingly difficult task. The organization has two interns in Kenya, for example, who are focused on understanding distribution channels for medical devices in East Africa. "It’s stuff like, do we have to pay tariffs, who do our distributors need to be, how well do things work? "Is corruption an issue, and how much will the price point get changed? Is there a market for it?" explains Donaldson. "One of the things I told our interns was, if there’s no need for the product, don’t give me a plan for distribution."

Ultimately, Donaldson hopes that D-Rev can launch a new product every year to a year and a half. It’s an ambitious goal, but the developing world could certainly use the innovation coming out of D-Rev sooner rather than later.

Add New Comment


  • HM

    D-Rev should consider using partnerships with other last-mile organizations or BoP products organizations (d.light, VisionSpring) to help with distribution.

  • mkwrk2

    A value of money differs round countries.
    While charity starts
    at home, Dr-Rev might be very welcomed to Australia, of which Melbourne
    daily transport Myki Pass is $4.02.

    Michael Kerjman