By Taslima KhanDr Sheela CN, head of the obstetrics department at St. Johns Medical College Hospital in Bengaluru, seems pleased with a new product she’s testing to detect fetal distress during childbirth."We are testing this device to see if it can help us (diagnose) high-risk problems during delivery earlier than the existing devices. That will help us intervene and prevent adverse effects on the baby," she said.Undetected fetal distress—such as when an unborn child does not receive enough oxygen— account for about 3 lakh fetal or child deaths in India every year, according to the World Health Organisation. Existing technology to detect fetal distress is too expensive and, thus, not easily accessible. It is also too complicated even for doctors.You could substitute fetal distress with another condition or ailment and the equipment with another, but the core problem of exorbitant pricing and inaccessible and difficult technology untiringly replicates itself.The solution may lie within the dozens of laboratories and workspaces where startups such as Forus Health Remidio and Sattva Medtech are developing advanced yet easy-to-use devices at lower cost.Taking on the global giants that dominate India’s medical devices industry and despite unfavourable domestic regulations, these startups promise to make lifesaving medical technology more accessible in a country where quality and affordable healthcare is scarce, especially in any place that’s not a major city.Sattva CEO Vibhav Joshi said the idea for Fetal Lite , which Sheela is testing, came from his gynaecologist mother who uses the only approved device type available in India to screen for fetal distress. It is huge, requires constant power supply and a skilled obstetrician to be present at all times to interpret the data it sprouts.Fetal Lite, Joshi says, is light and can be worn by mothers around their abdomen and be recharged via a USB port. It uses proprietary algorithm to track a foetus’s movement, measure heart beats and can send alerts to the doctor’s mobile phone in an emergency.He plans to price the device at around Rs 1 lakh, about two-thirds cheaper than devices manufactured by General Electric and Philips. Sattva has so far raised a seed round from InnAccel and a grant from BITS Charitable Trust.India’s medical devices industry is growing at about 15% annually and is expected to reach at least $25-30 billion (Rs 1.65-1.98 lakh crore) by 2025, according to a report in March by Deloitte Touche Tohmatsu India, driven by indigenous manufacturing, exports and local innovation.But the industry is fragmented, price-sensitive and faces constraints such as erratic power supply, low doctor-patient ratio and a shortage of trained personnel to handle complex devices, pain areas startups are trying to tide over to achieve market acceptance.The affordability and increased reach that these startups bring are also particularly crucial. Medical technology contributes significantly to healthcare delivery costs in India, with medical devices and diagnostics accounting for 20%-25% of the cost of medical services, according to Deloitte."We are seeing Indian medical devices startups being able to innovate and bring products to the market faster than their western counterparts at a price point that is very attractive," said Barath Shankar Subramanian, vice president at venture capital firm Accel Partners, an early backer of Forus Health, a maker of affordable eye-screening devices, and Perfint Healthcare, which works in the areas of cancer and pain care."We will continue to identify and invest in such differentiated opportunities," Subramanian said. Accel has 10 healthcare technology startups in its investment portfolio.Remidio, which makes eye-care diagnostics technology, has so far commercially launched two products — smartphone-based Fundus on Phone and Angio on Touch diagnostic imaging system.While obtaining a complete image of the retina would require a wide-field imaging camera that costs about Rs 65 lakh, Remidio’s Fundus on Phone, priced Rs 1.8 lakh, can connect to a mobile phone camera to take pictures of the central part of the retina. It is highly useful in early detection of diabetic retinopathy."This is a marathon, not a sprint," said Anand Sivaraman, CEO at Remidio, an IIT-Kharagpur alumnus who previously worked at General Electric and biotechnology firm Reametrix. His startup, has raised $1 million from UK based Welcome Trust and a group of angel investors. The startup has achieved 300 installations across hospitals and private opthalmologist clinics in the past 22 months.There are scores of startups dotting India’s medical technology sector focused on niche, marketable segments. Coeo Labs has designed a device to tackle ventilator-associated pneumonia, a major cause of death in roughly 40% of patients on breathing support in India. Wrig Nanosystems , which is backed by Flipkart founders Sachin Bansal and Binny Bansal and former Ranbaxy and Fortis promoters Malvinder Singh and Shivinder Singh, among others, has developed a mobile phone-sized device called TrueHb Hemometer to measure haemoglobin in a few minutes."There would be over 150 odd-companies at various development stages with high concentration in areas such as ECG monitoring, patient monitoring and in areas such as point-of-care screening and diagnostic tools for haemoglobin, glucose and others," said Siraj Dhanani, CEO at InnAccel, an accelerator focused on healthcare startups such as Coeo Labs. "The quality of startups is improving because the body of knowledge is expanding on what works and what doesn’t."The road has never been smooth, however, for med-tech startups in India. "There is a huge backlog with the patent office, which often stifles innovation," said Dhanani."The government should create a favourable regime for products that are designed and developed in India because these are specifically designed for the Indian market."Without that kind of local support, overseas markets become key to expanding the playing field, at least for older startups."The idea is to build a product that works in the existing market as well as opens up new markets," said K Chandrasekhar, CEO at the 2010-founded Forus Health. "There are no shortcuts," he said , pointing to the fact that while it takes more than two years to develop and test a product, it takes three-four years to build the brand.Forus’s strategy to gain market acceptance was to tweak its product to suit the working style of ophthalmologists while adding advanced features such as telemedicine.The company, which has raised upwards of $13 million from Accel Partners, IDG Ventures and other investors, is also enhancing service quality and after-sales support to win trust. "As the initial set of companies are able to gain share globally, the others will follow suit," said Subramanian of Accel Partners.