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Our Journey to One Million: How impact drives innovation at Equalize Health

12 February 2021

One million patients treated by Equalize Health medical devices

At Equalize Health, we believe in a world where we all have access to world-class medical treatment, no matter where we live. To make that vision a reality, we identify the biggest gaps and opportunities in global health where tech can do the most good, and design and deliver affordable, world-class medical products that work anywhere.

So, what makes a product impactful, and how do we know? We have developed four principles to guide us. Each of them is based in lessons learned over our journey to reach one million patients:

  1. Impact requires innovation: To save lives and prevent health loss, our intervention has to be different or better than what already exists -- it has to be an improvement on the status quo.

  2. Impact is human-centered and global: Our design process and products must be user-centered from end to end. We challenge who the sector traditionally thinks of as the investor, the designer, and the inventor and are inclusive from the beginning to the end of the design process.

  3. Impact means global scale: From day one, we design products to have enough commercial and customer-driven appeal to scale through the market for years after product launch.

  4. Impact metrics are critical: We go beyond monitoring units sold. We work hard to understand and learn from our impact on health providers’ and patients’ lives.

To highlight how this commitment to impact affects our design and innovation work, we can look more closely at these lessons learned on our journey.

Almost ten years ago, Equalize Health (then D-Rev) set out to design a medical innovation that would help provide critical treatment to babies with jaundice. Each year, more than six million babies with jaundice were not receiving the treatment they needed.

One of the main reasons for this was a lack of access to affordable devices and affordable spare parts (bulbs) - to provide effective phototherapy, the standard treatment for severe jaundice.

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By introducing a high-quality phototherapy device to the global market that met local budgets, Equalize Health sought to increase the number of babies receiving treatment who otherwise would not have been treated effectively, and thereby, reduce the number of deaths and disabilities due to untreated severe jaundice and kernicterus.

*We love talking about the many innovations we designed into Brilliance, see more on our product page.

Impact requires innovation

Every intervention we develop has to add value in order to make a difference. For our Brilliance device, a key innovation was the use of blue LED lights - not common at the time, but now fairly standard in the industry. LEDs last years, not months, consume much less power, and are much less expensive over time. Not needing to change the bulbs meant hospitals weren’t struggling to procure bulbs every 3-6 months, experienced less device downtime (i.e., treated more babies), and had lower ownership costs over the life of the device.

*Fun facts: In 2014, the Nobel Prize in Physics was awarded to the inventors of the blue LED. Brilliance was the first phototherapy device to use tightly-binned LEDs that provided the most efficient breakdown of bilirubin.

Impact is global and human-centered

Despite the fact that neonatal jaundice was one of main causes of neonatal hospitalization globally, better phototherapy was not a high priority for the global health community when we began what became the Brilliance project (1). Lack of effective phototherapy was, however, a constant frustration of doctors and nurses that we and advisors surveyed in India, Guatemala and Nigeria, where we did our original need-finding (2). This user-driven demand for better technology then drove sales once our product launched. We are not just user-centered in our approach and process because we think it will lead to higher uptake; we also believe that everyone should have devices that they love and that can deliver impact in the toughest of circumstances.

*Interesting fact: Most medical devices are iterated post-market. There are three Brilliances: Brilliance Classic (v1), Brilliance Pro (v2), and Brilliance Underside, which our partner Phoenix developed with our technology to win “tightly-scoped” government tenders.

Impact is achieved at scale

This is easier said than done. The expertise that drives research and innovation is not the same that gets medical technology into the hands of doctors and nurses around the world. We identify partners from the early stages of product development that will help ensure innovations are put to use where they are needed most. For Brilliance, we achieved scale through our path-forging partnership with Phoenix Medical Systems Pvt Ltd, an India-based global medical device manufacturer and distributor. Within 8 years, we had reached patients in more than 60 countries. During most of that time, Equalize Health staff averaged about a dozen people - we never would have been able to achieve this global scale without a partner like Phoenix.

*Our partnership with Phoenix was ground-breaking at the time, in that a NGO partnered with a India-based private sector firm to manufacture, distribute, and track medical devices for global impact. See Fast Company’s article on our partnership.

Impact metrics are critical

To measure our impact, we think beyond solid distribution partnerships and even units sold. For Brilliance, that means we track three main impact indicators:

  1. the number of babies treated with Brilliance;

  2. the number of babies treated with Brilliance who otherwise would not have received effective treatment; and

  3. the number of deaths and disabilities averted through the use of Brilliance.

We calculate these numbers based not just on units sold, but on units installed and in use, using an algorithm based on machine data and assumptions drawn from and validated by fieldwork and academic research, and then sum the results to determine our total impact over time. You can see more details about how we calculate our impact in our step-by-step guide.

*We’ve iterated our impact algorithm three times based on sampled data. One reason why you should always follow your products: we learned that public sector hospitals can take months to install a device after receiving it.

As we reflect on our journey to one million, it is clear that this has been a collaborative, global journey and we are grateful to our many colleagues, partners, and supporters. We will continue to learn lessons along the way, and we look forward to collaborating with you as we strive to reach the next million, and the next million after that. Together, we can reach patients with the most need, and reduce maternal and newborn mortality and morbidity, not just in our lifetime, but today. On behalf of the first million patients (and counting), and the doctors and nurses using our products, thank you for your partnership and support.


  • (1) This was in large part because experts making recommendations relied on evidence from high-income countries to argue that mortality and morbidity associated with undertreated jaundice was rare. See Slusher, T. M., Zipursky, A., & Bhutani, V. K. (2011, June). A global need for affordable neonatal jaundice technologies. In Seminars in perinatology (Vol. 35, No. 3, pp. 185-191). WB Saunders.

  • (2) See, e.g., Cline B.K., Daly R.E., Donaldson K.M., et al. (2010). Evaluation of Phototherapy Device Efficacy in Resource-Limited Nurseries. Pediatric Academic Societies. Abstract 1496:535, 2010.