But that has not been enough. To make sure that end prices remain low, D-Rev has needed to find manufacturing and distribution partners willing to cap prices and forgo substantial markups. In the case of the Brilliance lighting system, D-Rev asked hospitals about reputable equipment makers and then approached Phoenix Medical Systems, a neonatal equipment distributor based in India.

D-Rev proposed a deal: Phoenix would manufacture and distribute the Brilliance lighting system and cap its price at $400, or $500 with a warranty (Western systems can run $3,500). In turn, D-Rev would structure licensing fees so that Phoenix made more money selling to poorer clinics than to wealthier ones.

But D-Rev realized early on that in India, the purchasing process wasn’t working in Brilliance’s favor. Hospital systems still sometimes chose higher-price systems because of bribery or cronyism, or because they didn’t understand Brilliance’s technical innovations, Mr. Schwemmin said. To help make Phoenix’s bids more persuasive, D-Rev realized that it needed to coach the company from the sidelines, especially in explaining technical features — say, why Brilliance doesn’t need cooling fans or filters.

Plans to expand beyond India, meanwhile, hit serious bumps. One distributor in the Philippines ordered eight units from Phoenix for $500 each but then resold them for $2,400, Mr. Schwemmin said. When D-Rev asked for the reason behind the drastic markup, the company said it needed to budget money for kickbacks, he said. Because of these and other experiences, “we feel the need to be a lot more involved in picking distributors and managing relationships, because we’re afraid of corruption,” he said.

To that end, D-Rev sent an analyst to the Philippines for eight weeks last year, to vet potential partners. It sent another associate to South America for three months to assess markets in Argentina, Brazil, Colombia and Peru. D-Rev shares its market studies with Phoenix, consults on potential new markets and stays involved as Phoenix develops new relationships with foreign distributors.

“We always expected to be a little bit involved with building markets, but it was more work than we anticipated,” Ms. Donaldson said. Fortunately, that work has paid off. Since the Brilliance lighting system hit the market a year ago, nearly 300 units have been installed in India, Malawi, Myanmar, the Philippines, Tanzania and Uganda. It has treated nearly 15,000 babies in six countries and prevented 300 deaths or disabilities, D-Rev estimates.

Though social entrepreneurship has been in vogue for many years, D-Rev’s model — nonprofit product development combined with third-party, for-profit distribution — is unusual. And it might be unfamiliar to some foundations.