Purpose

 of  the  Document  

Context  
This  document  is  a  study  designed  to  obtain  a  sense  of  the  poten5al  market  for  assis5ve  aids  /  
devices  (rehabilita5on  and  mobility)  for  people  with  locomotor  disability  in  India.  The  study  is  
intended  to  support  ICRC’s  Enable  Make-­‐a-­‐thon  and  Corporate  Engagement.  

1  
Interna4onal  Commi7ee  of  the  Red  Cross:  Enable  Make-­‐
a-­‐thon  and  Corporate  Engagement  
Market  Size  Assessment    

Dalberg  Global  Development  Advisors  |  July  2015  

Scope  of  the  Study  
Objec4ves  
As  part  of  this  market  landscaping  exercise,  we  aimed  to:  
•  Es5mate  the  number  of  people  with  locomotor  disability  (PwLD)  in  India  in  2015  
•  Arrive  at  a  dollar  figure  for  assis5ve  aids  /  devices  (rehabilita5on  and  mobility),  for  the  PwLD  
market  in  India  
•  Provide  quan5ta5ve  and  qualita5ve  insights  on  the  market,  including:  
–  Rela5ve  size  of  the  rural  vs.  urban  market  
–  Market  segmenta5on  &  leading  suppliers  in  each  segment  
–  Current  supply  chain  analysis  
–  Technology  innova5on  in  the  space  
•  Es5mate  a  broad  global  projec5on  for  the  market  for  assis5ve  aids/devices  based  on  the  
Indian  market  

Methodology  
 
Our  methodology  for  the  study  included:  
•  Looking  at  the  issue  through  the  prism  of  the  eight  challenges  iden5fied  by  ICRC  
•  Mixed  methods  analysis,  including  secondary  research,  telephone  interviews  with  
stakeholders  and  quan5ta5ve/qualita5ve  analysis  

3  
Execu4ve  Summary  
PwD  (people  with  disability)  (total  and  locomotor)  has  widely  varying  es5mates    
We  es5mate  a  disability  prevalence  rate  of  7-­‐10%  of  the  total  popula5on    
Within  this,    we  es5mate  a  locomotor  disability  prevalence  rate  of  close  to  40%  of  the  popula5on  
with  disability  
 
The  current  market  for  assis5ve  aids/devices  is  small  (US$  41.7m)  and  primarily    driven  by  free  
distribu5on  
There  is  a  large  unmet  market  es5mated  at  US$  316m  for  assis5ve  aids/devices  
 
The  BoP  space  is  mainly  fed  by  government-­‐affiliated  ins5tu5ons,  in  which  ALIMCO  is  a  major  player.  
ALIMCO  manufactures  aids  and  conducts  camps  across  India  for  distribu5on.  State  governments,  
other  government-­‐affiliated  ins5tutes,  and  most  NGOs  procure  aids  from  ALIMCO  and  conduct  camps  
for  distribu5on.      
 
The  challenge  does  not  appear  to  be  ability  to  pay,  given  the  extent  of  free  government  distribu5on  
and  CSR  support  
 
CONCLUSION  
There  is  space  for  innova5ve  products  that  can  deliver  high-­‐quality  solu5ons  at  fairly  low  costs.  
Sa5sfying  such  criteria  opens  up  both  Indian  and  global  markets  for  manufacturers  and  providers  

4  
Learnings  &  Recommenda4ons:  Low  cost/high  quality  products  are  a  clear  
area  of  focus    

Large  players  by  cost  and  quality1  

Cost  
High  
Private  cos.  
(O7obock,   Small  market,  
Endolite  India,   mostly  imported  
Ostrich  Mobility,   players  
VISSCO,  etc.)  

Government-­‐ ALIMCO,  State   Jaipur  Foot   Whitespace  

led,  issues  of  fit   governments,     (BMVSS),   available  to  
and  longevity   ins4tutes,  other   Mo4va4on,   innovate  
NGOs   Mobility  India  
Low  

Low   High  
Quality  
Innova5on  in  the  low  cost,  high  quality  space  has  overcome  affordability/
price  barriers  in  the  past.  An  opportunity  exists  both  to  create  new  
innova5on  and  bring  exis5ng  innova5ons  to  scale.  Microinsurance  as  a  
payment  mechanism  may  be  one  op5on  
5  
1Dalberg  interviews  
Market  sizing  approach  
We  broke  our  analysis  down  into  the  following  stages:  

Prevalence  of  Disability   Type  of  disability   Access  to  care   Type  of  assis4ve  aid  

Visual   Prosthe4c  devices  

Advised  and  acquired    
Ar4ficial  Limbs  
Hearing   aids  /  devices  
With  
disability   Ortho4c  devices  
Advised  and  not  acquired  
Locomotor   aids  /  devices   Calipers  

Splints  
Total   Speech   Did  not  receive    
Popula5on   medical  advice   Spinal  Braces  

Developmental   Personal    
mobility  aids  
Without   Crutches  
disability  
Wheelchairs  

Tricycles  

6  
Global  indicators:  Total  disability  

Global  es4mates  of  total  disability  

prevalence  rates  (WHO)  

+50%   Most  recent  global  es5mates  indicate  that  more  

than  one  billion  people  have  some  form  of  disability  
15%    
 
This  es5mate  is  rising  due  to  ageing  popula5ons,  an  
increase  in  chronic  condi5ons  (diabetes,  stroke,  
10%   cancer),  and  improvements  in  measurement  of  
disability  
 
 
50%  of  people  with  disabili5es  cannot  afford  health  
care    
 
 
About  80%  of  people  with  disabili5es  live  in  
developing  countries  

1970s   2011  

Sources:  World  Health  Organiza5on  (2011),  “World  Report  on  Disablity”;  United  Na5ons  Factsheet  on  Persons  with  Disabili5es   7  
Icons  from  www.thenounproject.com  
Global  indicators:  Total  &  locomotor  disability  
  Locomotor  disability  prevalence  in  other  middle  
Compara4ve  data  on  total  disability  prevalence  rates1   income  countries1  
(Millions  of  people,  %  of  total  popula5on)   (Millions  of  people,  %  of  total  popula5on)  
 

46   13  

9  
23.9%   7%  
4  
83   24  
12.3%  
6.3%   7.5%   1.8%  

Turkey   China   Brazil   South     China   Brazil  

2002   2006   20102   Africa   2006   2010  
2011  

 Total  disability  prevalence  rates  vary  widely  across  countries;  locomotor  

disability  prevalence  in  comparable  countries  ranges  from  about  2%  —  7%  
of  total  popula5on  

1Turkey  Disability  Survey  (2002),  Communique  On  Major  Sta5s5cs  Of  the  Second  China  Na5onal  Sample  Survey  on  Disability  (2008),  Ins5tuto  Brasileiro  de  

Geografia  e  Estans5ca  (2010),  Sta5s5cs  South  Africa  (2014)  “Census  2011:  Profile  of  persons  with  disability  in  South  Africa”  
2Disability  prevalence  increased  from  1-­‐2%  (1991)  to  14.5%  (2001)  aoer  Brazil  adopted  the  Interna5onal  Classifica5on  of  Func5oning,  Disability  and  Heath   8  
(ICF)  framework.  ICF  is  the  WHO  framework  for  measuring  health  and  disability,  in  which  ques5ons  address  func5onal  capaci5es.  
India  trends:  Total  disability  
Compara4ve  es4mates  for  total  disability  prevalence  in  India  
(Millions  of  people,  %  of  total  popula5on)  

Ø  Es5mates  for  total  disability  prevalence   55-­‐90   8%  

in  India  vary  depending  on  defini4on   Upper    
and  measurement  methods   bound  
55-­‐66  
6%  
Ø  Government  figures  are  likely  to  be   5%  
5%   Lower    
underes4mated1:  
§  Since  data  is  collected  by  non-­‐ bound  
medical  inves5gators,  ques5ons  may   22   29  
19  
not  have  been  asked  in  a  uniform  
manner     2.1%   1.8%   2.2%  
§  Social  s4gma  aqached  to  disability  
deters  respondents  from  iden5fying  
as  ‘disabled’   Census   NSS   Census   Eleventh   World  Bank  
2001   20022   2011   5-­‐Year  Plan     20094  
2007-­‐123  
Government  es5mates   Third  party  sources  

Based  on  triangula5on  of  data,  and  aoer  consulta5ons  with  NGOs  and  
senior  ac5vists  we  es5mate  a  range  of  5  –  8%  for  total  disability  
prevalence  in  India  
1Expert  interviews,  Report  of  the  Technical  Advisory  Commiqee  on  Disability  Sta5s5cs  (2007)  and  Ministry  of  Sta5s5cs  and  Programme  Implementa5on,GoI  

(2012)  “Manual  on  Disability  Sta5s5cs”;  2Na5onal  Sample  Survey,  58th  round  (2002);  3Planning  Commission,  GoI  (2008)  “Eleventh  Five  Year  Plan:  Volume  I”;  
4World  Bank  (2009),  “People  with  Disabili5es  in  India:  From  Commitments  to  Outcomes”  

Note:  The  Census  2011  sta5s5cs  for  disability  do  not  vary  significantly  from  Census  2001;  the  NSSO  58th  round  (2002)  focused  exclusively  on  disability,   9  
therefore  in  this  study  we  have  adjusted  the  NSSO  2002  figures  to  reflect  2015  projec5ons  
India  trends:  Locomotor  disability  
According  to  NSS  es4mates,  prevalence  of  locomotor  disability  
is  the  highest  in  India  
(Millions  of  people,  %  of  disabled  popula5on)  
 
Developmental   10% 11%  
Ø  Inclusion  of  dwarves  and  persons  
Speech   7% 12%   with  s4ff  neck  of  permanent  nature  
Hearing   6%
17%   in  NSS  methodology  results  in  a  much  
higher  prevalence  of  locomotor  
15%   disability  in  their  es5mates1  
49%  
Visual  
Ø  A  downward  revision  to  the  NSS  
es5mate  of  locomotor  disability  
57%   prevalence  to  ~40%  would  exclude  
(11)   dwarves  and  persons  with  s5ff  neck  
28%   of  permanent  nature  that  may  not  
Locomotor   (6)   need  assis5ve  aids/devices  
 
Census     NSS  
2001   2002  

We  es5mate  the  prevalence  of  locomotor  disability  (as  a  percentage  of  

total  disability)  in  India  at  38%*  
1From  the  Report  of  the  Technical  Advisory  Commiqee  on  Disability  (2011)  which  states  that,  “besides  sampling  errors,  inclusion  of  dwarfs  and  persons  with  

s5ff  neck,  and  inclusion  of  persons  having  mul5ple  disabili5es  under  each  category  may  be  responsible  for  the  large  varia5on  or  at  least  part  of  the  varia5on”  
between  the  Census  and  NSS  es5mates  of  locomotor  disability  prevalence  rates   10  
*Based  on  underlying  trend  analysis  of  causes  of  locomotor  disability  from  NSSO  and  Census  data    
Locomotor  disability  prevalence  in  India:  Cause  analysis  
Emerging  trends  in  causal  profile  of  locomotor  disability  

2002   Polio   29%   Predicted  to  halve  between  1990  

2015   8.8m   27%   and  20201  
Accidents     Predicted  to  double  between  1990  
28%  
and  injuries   and  20201  
47.6%  
15.5m  
Old  age   3%   Old  age  popula5on  predicted  to  
3.3m   10%   increase  to  140m  by  20212  
Non-­‐  communicable    
diseases   13%   Based  on  ICMR  research3  
3.8m   11.6%  
Other  communicable    
3%   Predicted  to  halve  between  1990  
Diseases  
0.5%   and  20201  
0.2m  
Other  reasons   23%   Adjusted  to  exclude  dwarves  and  
1.0m   3%   persons  with  s5ff  neck  of  
permanent  nature  

We  es5mate  the  number  of  persons  with  locomotor  disability  (PwLD)  at  32.5m,  assuming  7%  total  disability  
prevalence  as  men5oned  earlier  and  adjus5ng  for  recent  trends  in  underlying  causes  

Non  communicable  diseases  include  Stroke,  Arthri5s,  Cerebral  Palsy,  Cancer,  Cardio-­‐respiratory  disease;  Other  communicable  diseases  include  Tuberculosis  
and  Leprosy;  Other  reasons  includes  Medical/surgical  interven5on.  For  2002,  Other  reasons  includes  Medical/surgical  interven5on,  other  illness,  not  known.  
1World  Bank  (2009),  “People  with  Disabili5es  in  India:  From  Commitments  to  Outcomes”;  2Ministry  of  Sta5s5cs  &  Programme  Implementa5on,  GoI  (2011),   11  
“Situa5on  Analysis  of  the  Elderly  in  India”;  3Indian  Council  of  Medial  Research    (2006),  “Workshop  Report  on  Stroke  Surveillance  in  India“  
Locomotor  disability  prevalence  in  India:  Rural  –  urban  spread  by  cause  
Break-­‐up  of  PwLD  by  rural  –  urban  spread  and  cause  of  locomotor  disability  (2015)  

Rural   Total    
53%  (17.1m)   47%  (15.4m)   32.5m  
Urban   PwLD  

70% 30% 8.8m  

Polio  

Accidents    
57% 43% 15.5m  
and  injuries  

Old  age   33% 67% 3.3m  

Non-­‐  
communicable   23%   77%   3.8m  
diseases  
Other    
communicable   2%   98% 0.2m  
diseases  
Other  reasons   13% 87% 1.0m  

Sources:  Na5onal  Sample  Survey,  58th  round  (2002);  Rural  prevalence  considered  at  68%  as  per  World  Bank  es5mates  for  2010-­‐14  
Non  communicable  diseases  include  Stroke,  Arthri5s,  Cerebral  Palsy,  Cancer,  Cardio-­‐respiratory  disease;  Other  communicable  diseases  include  Tuberculosis   12  
and  Leprosy;  Other  reasons  includes  Medical/surgical  interven5on.  
Large  unmet  demand  for  assis4ve  aids/devices  for  PwLD  

Prevalence  of  locomotor  disability  within  total  disabled   PwLDs’  inequitable  access  to  care  and  assis4ve  
popula4on   devices1  

1.2bn   1.2bn   32.5m  

5.1m  were  advised,    
16%   and  acquired  aids  
5%   1.6m  were  advised,  
but  did  not  acquire   Nearly  84%  
aids   of  PwLD  have  
not  acquired  
any  aids  or  
25.8m  did  not  receive   devices  
84.7m   79%   medical  advice  

84.7m  
7%  
32.5m  
38%  

Total     Persons  with   Persons  with   PwLD  

popula5on   disability     locomotor  
(PwD)   disability  (PwLD)  

13  
1World  Bank  (2009),  “People  with  Disabili5es  in  India:  From  Commitments  to  Outcomes”  and  Na5onal  Sample  Survey,  58th  round  (2002)  
Inability  to  afford  aids  is  the  primary  reason  why  1.6  million  PwLD    
who  were  advised  did  not  acquire  assis4ve  aids  

Reasons  for  not  acquiring  mobility  aids  

49%  

PwLD  find  assis5ve  

aids  /  devices  
unaffordable  

22%  

16%  

8%  
5%  

Not  available   Not  necessary   Not  necessary   Other   Expensive  

for  economic   for  personal  
independence   independence  

14  
Source:  Na5onal  Sample  Survey,  58th  round  (2002)  
Five  million  PwLD  were  advised  and  acquired  assis4ve  aids    

Distribu4on  of  type  of  aid  acquired  by  PwLD1  

2.4m   The  most  commonly  

acquired  aids  were  
47%   personal  mobility  aids  of  
6%   which  crutches  formed  
the  largest  component  
8%   1.4m  

27%  
0.9m   In  the  NSS  sample,  those  in  
urban  areas  were  55%  
17%   more  likely  to  have  sought  
0.4m   1%   33%   treatment,  than  those  in  
5%   rural  areas2  
7%  
11%  

In  rural  areas,  PwLD  may  

Prosthe5c  devices   Ortho5c  devices   Personal     Others   also  resort  to  fabrica5ng    
mobility  aids   D-­‐I-­‐Y  devices  to  resemble  
splints,  crutches  and  some  
Spinal  Braces   Tricycles  
other  devices  
Splints   Wheelchairs  
Calipers   Crutches  

1Na5onal  Sample  Survey,  58th  round  (2002)   15  

2World  Bank  (2009),  “People  with  Disabili5es  in  India:  From  Commitments  to  Outcomes”  
Overview  of  mobility  aids  market  
Type  of  aid   Large  players   Price  range  
Manufacturing   Distribu4on  

BMVSS  (Jaipur  Foot)  

•  US$  50  Jaipur  Foot  is  the  
Ar4ficial  Limbs  Manufacturing  Corpora4on  of  India  (ALIMCO)   standard  for  low-­‐cost  prosthe5cs  
Prosthe4c   •  ALIMCO  average  across  upper  
State  ins4tutes   and  lower  extremity  prosthe5cs:  
devices  
Other  NGOs:  Mobility   Rs.  4,800  
India   •  High-­‐end:  Rs.  0.06  –  0.2  million  
Private  cos.:  O7obock,  EndoliteIndia    

Ar4ficial  Limbs  Manufacturing  Corpora4on  of  India  (ALIMCO)   •  Calipers  

State  ins4tutes          ALIMCO:  Rs.  2,500  –  6,500    
Ortho4c   depending  on  length  (average  
devices   NGOs:  Mobility  India,   cost  ~  Rs.  4,500)  
BMVSS  
Private  cos.:  O7obock,  EndoliteIndia,  VISSCO     •  Braces/Splints:  Rs.  190  –  1,700  

•  Crutches:  Rs.  900  –  1,800  

All  India  Limbs  Manufacturing  Company  (ALIMCO)  
•  Manual  wheelchairs/tricycles  
State  ins4tutes  
Personal          ALIMCO:  Rs.  6,000  –  7,000  
mobility   NGOs:  Mobility  India,          High  end:  >  Rs.  0.01  –  0.03  million  
aids   BMVSS,  Mo4va4on,  APD  
Private  cos.:  O7obock,  EndoliteIndia,  VISSCO,  Ostrich   •  Motorized  wheelchairs/tricycles  
Mobility,  Callidai,  Sage,  Janak,  Karma,  JSB            ALIMCO:  Rs.  0.04  –  0.65  million  
       High  end:  Rs.  0.06  -­‐  1  million  
16  
Source:  Dalberg  interviews,  company  websites,  online  resources,  ALIMCO  price  list  (2014)  
Market  segmenta4on  of  PwLD  aids:  Low  cost/high  quality  is  the  holy  grail  

Large  players  by  cost  and  quality1  

Cost  
High  
Private  cos.  
(O7obock,   Small  market,  
Endolite  India,   mostly  imported  
Ostrich  Mobility,   players  
VISSCO,  etc.)  

Government-­‐ ALIMCO,  State   Jaipur  Foot   Whitespace  

led,  issues  of  fit   governments,     (BMVSS),   available  to  
and  longevity   ins4tutes,  other   Mo4va4on,   innovate  
NGOs   Mobility  India  
Low  

Low   High  
Quality  
Innova5on  in  the  low  cost,  high  quality  space  has  overcome  affordability/
price  barriers  in  the  past.  An  opportunity  exists  both  to  create  new  
innova5on  and  bring  exis5ng  innova5ons  to  scale.  Microinsurance  as  a  
payment  mechanism  may  be  one  op5on  
17  
1Dalberg  interviews  
The  bulk  of  the  BOP  space  is  met  by  free  distribu4on  
Non  –  BoP  

End  users  have     Hospitals/doctors   End  users  purchase  

access  to  medical   perform  needs   products  directly  
care/rehabilita5on   assessment   from  market  players  

Manufacturers  aids  and  conducts  

ALIMCO   camps  for  needs  assessment  and  
distribu5on  of  aids  

State   Procure  aids  from  ALIMCO  and  

BoP  

Governments,   conduct  camps  for  needs  

Ins4tutes   assessment  and    distribu5on  of  aids  
End  users    
avail  GoI’s    
ADIP  scheme  by  
Procure  aids  (some  from  ALIMCO)  
approaching  
NGOs   and  conduct  camps  for  needs  
assessment  and  distribu5on  of  aids  

Source:  Dalberg  interviews   18  

Icons  from  www.thenounproject.com  
ALIMCO  is  the  largest  player  in  the  BoP  space  

 
ALIMCO’s  customers  as  a  percentage  of  sales1  

Na5onal  Ins5tutes  
State  Govt.                      4.46%  
Direct  Purchases  

Dealers,  Fabrica5on   7.11%  

Material  &  Others  
7.54%   Assistance  to  
35.35%  
Annual   Disabled  Persons  
Sales:   (ADIP)  scheme  
Central  Public  Sector   0.46m  
Undertakings  under     21.31%   aids2  
CSR  ac5vi5es,    
Exports,  Bilateral,  Scrap  

24.24%  

Sarva  Shiksha  
Abhiyan  –  ADIP    

Almost  60%  of  ALIMCO’s  aids  are  provided  under  

government  subsidies  through  the  ADIP  scheme  

1ALIMCO  (2013-­‐14)  41st  Annual  Report   19  

2Annual  sales  of  0.46M  aids  include  sales  of  0.1M  hearing  aids    
Key  insights  into  the  current  BoP  market:  Pricing  and  distribu4on  

Aids  are  not  covered  by  insurance  and  costs  must  be  borne  by  end  users  
 
 
 
 
However,  ability  to  pay  is  not  a  constraint  since  aids  are  mostly  distributed  for  free.  
The  primary  point  of  access  to  aids/devices  are  camps  conducted  by  ALIMCO  and  
other  organiza5ons  
 
 
 
 
ALIMCO  provides  low  cost,  low  quality  products  largely  for  free,  and  has  strong  
distribu4on  channels  that  can  be  u5lized  to  ensure  last  mile  connec5vity  
 
 
   

20  
Source:  Icons  from  www.thenounproject.com  
Key  insights  into  the  current  BoP  market:  Quality  and  innova4on  

 
Some  important  challenges  are:  
A
•  Informa4on  dissemina4on  to  the  BoP  space  to  increase  awareness  about  
assistance  schemes  and  type  of  aids/devices  available  
1
•  Scaling  up  exis5ng  distribu5on  channels  to  serve  a  larger  por5on  of  the  BoP  
•  Life  
•  While  customiza5on  is  feasible  for  high-­‐end  products,  at  the  BOP-­‐level    
customiza4on,  ensuring  fit,  and  adap4ng  aids  for  outdoor  use  is  uncommon  
 

 
Thus,  there  is  a  need  for  innova5ve  solu5ons  that  provide  the  BoP  with  assis5ve  aids/  
devices  that  are  both  durable  and  customizable.  
 
 
Examples  of  innova5ve  solu5ons  are  presented  on  the  next  slide  
   

21  
Source:  Icons  from  www.thenounproject.com  
Innova4ve,  low-­‐cost  technology  in  the  BoP  spaces:  Opportunity  set  

The  Rs.  3,000  Jaipur  Foot  is  1/100th  the  cost  of  compe5ng  devices  
and  a  comparable  limb  in  the  United  States  costs  $10,000  
 BMVSS  has  also  developed  the  Rs.  1,200  prosthe5c  knee,  in  
 partnership  with  Stanford  University1        

Mobility  
  India  has  taken  the  Jaipur  Foot  further  by  developing  
various  
  designs,  including  a  pediatric  version,  and  this  unit  is  
managed  
  by  trained  women  technicians2  
  has  also  developed  pre-­‐fabricated  components  of  ortho5c  and  
It  
prosthe5c  devices,  enabling  fabrica5on  and  fiyng  to  be  completed  
in  the  same  day,  reducing  PwLD’s  5me  and  cost  spent  on  acquiring  
devices  
 

Mo5va5on  has  developed  the  WorldMade,  a  three-­‐wheel  

wheelchair  suitable  for  rough  terrain,  for  Rs.  7,000  –  10,0003  
 
 
1hqp://jaipurfoot.org/images/BROCHURE.pdf;  2Brochures  regarding  research  and  development  conducted  by  Mobility  India  were  provided  to  us  by  the  

organiza5on;  3hqp://www.thehindu.com/todays-­‐paper/tp-­‐na5onal/tp-­‐karnataka/new-­‐model-­‐of-­‐wheelchair-­‐to-­‐help-­‐disabled-­‐persons/ar5cle3125368.ece  and   22  

hqp://www.apd-­‐india.org/productdisplay/sponsor-­‐worldmade-­‐wheelchair-­‐fund-­‐serverly-­‐disabled-­‐person  
Key  parameters  for  calcula4ng  annual  addressed  BoP  market  size    

Ortho4c  devices   Personal  mobility  aids  

Prosthe4c  
Total4  
devices   Calipers   Braces   Splints   Crutches   Wheelchairs   Tricycles  

Distribu4on  of  type  of                

aid1   7%   11%   1%   5%            33%                  8%              6%  

PwLD  acquiring  aids  

0.36   0.56   0.05   0.25   1.68   0.41   0.30   3.61  
(millions)  

Average  life  of  device  

3   5   1   1   1.5   4   4  
(years)  2  

PwLD  acquiring  aids  

0.12   0.11   0.05   0.25   1.12   0.10   0.08   1.83  
annually  (millions)  

BoP  segment  (70%)  of  

PwLD  acquiring  aids   0.08   0.08   0.04   0.18   0.78   0.07   0.05   1.28  
annually  (millions)  

Average  price  of  device  

4,787    4,464   1,028   460   1,100   6,900   6,900  
(INR)3  

1Na5onal  Sample  Survey,  58th  round  (2002);  2Average  life:  Prosthe5c  devices  (hqp://jaipurfoot.org/images/BROCHURE.pdf),  Calipers  (Oqobock  

Documenta5on  Requirements),  Braces  and  Splints  (Assump5on,  discussions  with  dealers),  Crutches  (Assump5on,  discussion  with  dealers),  Wheelchairs  
(Meyra  Ortopedia  Opera5ng  Manual  for  Folding  Wheelchair)  and  Tricycles  (Assumed  same  as  average  life  of  wheelchair);  3Dalberg  interviews,  online  
resources  -­‐  Prosthe5c  devices  (Average  cost  of  upper  and  lower  extremity  devices  from  Jaipur  Foot  cost  sheet),  Calipers  and  Braces  (average  cost  from  
ALIMCO  price  list  2014),  Splints  (average  of  VISSCO  and  Tynor  products  on  Amazon.in),  Personal  Mobility  Aids  (interview  with  ALIMCO);  4Others  category  of   23  
assis5ve  aids/devices  (people  affected:  5.6M)  has  been  excluded  in  the  unaddressed  market  size  due  to  lack  of  informa5on  about  sub-­‐components.  
The  current  BoP  market  is  not  en4rely  met  by  exis4ng  large,    
organized  players  

Overview  of  BoP  space  of  the  annual  current  market  (US$  42m)1  

1.  The  annual  current  markets  for  prosthe5c  

16  
devices  and  personal  mobility  aids  such  as  
14   Crutches  
wheelchairs  and  tricycles  are  met  by  
Market  size  (US  millions)  

exis4ng  organised    players  

12  
2.  The  annual  current  market  for  ortho5c  
10   devices  such  as  calipers  is  mostly  met  by  
Wheelchairs  
exis4ng  organised  players  
8   Prosthe5c  devices  
6   3.  The  annual  current  markets  for  some  
Calipers   Tricycles   ortho5c  devices  such  as  braces  and  splints  
4   (referred  to  as  soo  goods)  and  some  
Braces     personal  mobility  aids  such  as  crutches  
2   are  met  by  unorganised  players:  a  space  
and  Splints  
exists  for  organised  players  to  enter  
0%   100%  
Level  of  satura4on  for  organized  players  

Circle  Size  =  Size  of  BoP  space  (numbers)  

 

24  
1Calculated  as  70%  of  the  total  annual  current  market  
Key  parameters  for  calcula4ng  annual  unaddressed  BoP  market  size    

Ortho4c  devices   Personal  mobility  aids  

Prosthe4c  
Total4  
devices   Calipers   Braces   Splints   Crutches   Wheelchairs   Tricycles  

Distribu4on  of  type  of                

aid  (%)1   7%   11%   1%   5%            33%                  8%              6%  

People  affected  
1.9   3.0   0.3   1.4   9.0   2.2   1.6   19.4  
(millions)  

Average  life  of  device  

3   5   1   1   1.5   4   4  
(years)2  

People  affected  
0.6   0.6   0.3   1.4   6.0   0.5   0.4   9.9  
annually    (millions)  

Average  price  of  device  

4,787    4,464   1,028   460   1,100   6,900   6,900  
(INR)3  

1Na5onal  Sample  Survey,  58th  round  (2002);  2Average  life:  Prosthe5c  devices  (hqp://jaipurfoot.org/images/BROCHURE.pdf),  Calipers  (Oqobock  

Documenta5on  Requirements),  Braces  and  Splints  (Assump5on,  discussions  with  dealers),  Crutches  (Assump5on,  discussion  with  dealers),  Wheelchairs  
(Meyra  Ortopedia  Opera5ng  Manual  for  Folding  Wheelchair)  and  Tricycles  (Assumed  same  as  average  life  of  wheelchair);  3Dalberg  interviews,  online  
resources  -­‐  Prosthe5c  devices  (Average  cost  of  upper  and  lower  extremity  devices  from  Jaipur  Foot  cost  sheet),  Calipers  and  Braces  (average  cost  from  
ALIMCO  price  list  2014),  Splints  (average  of  VISSCO  and  Tynor  products  on  Amazon.in),  Personal  Mobility  Aids  (interview  with  ALIMCO);  4Others  category  of   25  
assis5ve  aids/devices  (people  affected:  5.6M)  has  been  excluded  in  the  unaddressed  market  size  due  to  lack  of  informa5on  about  sub-­‐components.  
The  annual  unaddressed  market,  which  represents  nearly  84%    
of  PwLD,  is  es4mated  to  be  US$  316m  

US$  49m   US$  105m   US$  60m  

US$  43m   US$  45m  
US$  4.5m   US$  10m  

Prosthe4c   Calipers   Braces   Splints   Crutches   Wheelchairs   Tricycles  

devices  
People  affected                
annually  (millions)   0.6        0.6   0.3   1.4        6.0              0.5                0.4  

US$  57m  
US$  48m  

US$  30m   US$  32m  

US$  26m   US$  28m   US$  24m  
US$  24m   US$  21m  
US$  13m  
US$  2m   US$  6m  US$  4m  
US$  2m  
People  affected   Rural   Urban   Rural   Urban   Rural   Urban   Rural   Urban   Rural   Urban   Rural   Urban   Rural   Urban  
annually  (millions)   0.29m  0.31m   0.42m  0.18m   0.14m  0.16m   0.8m   0.6m   2.76m   3.24m   0.23m  0.27m   0.18m  0.22m  

1Na5onal  Sample  Survey,  58th  round  (2002)  

2Dalberg  interviews,  online  resources   26  

Others  category  of  assis5ve  aids/devices  has  not  been  included  in  the  unaddressed  market  size  due  to  lack  of  informa5on  about  sub-­‐components  
Market  failure:  At  current  sales  levels,  ALIMCO  would  take  27  years  to  serve  
the  annual  unaddressed  market    

ALIMCO’s  current  sales  as  a  percentage  of  the  annual  

unaddressed  market  for  assis4ve  aids/devices  
The  challenge  lies  in  scaling  up  current  
9.9M   distribu5on  numbers  in  order  to  meet  the  
unaddressed  market  through:    
 
Ø  Innova5ons  by  the  government  to  
increase  access.  Possible  solu5ons  are  
5e  ups  with  government  hospitals,  
public  health  centres  and  local  clinics/
ALIMCO’s  current  annual   doctors  
sales  (0.36m  aids)  
represent  just  3.7%  of  the   Ø  Purchase  of  assis5ve  aids/devices  by  
total  annual  unaddressed   end  users  in  the  BoP  space  
market  of  9.9m  people  
affected  annually   Ø  A  combina5on  of  the  above  
 
Annual  unaddresed  market    
 
Innova5on  must  focus  on  distribu5on  &  financing  models  as  much  as  on  
product  innova5on    

27  
Source:  Dalberg  interviews  
Summary:  Market  Sizing  

Prevalence  of  Disability   Type  of  disability   Access  to  care   Type  of  assis4ve  aid  

Prosthe4c  devices  
0.6m  (US$  49m)  
Visual   Annual  BoP  market  :  1.3m  
Ar4ficial  Limbs  
Advised  and  acquired    
aids  /  devices   Ortho4c  devices  
Hearing  
With   2.3m  (US$  57m)  
disability  
Locomotor   Annual  BoP  market  :  9.9m  
84.7M   Calipers  
32.5M  
Advised  and  not  acquired   Splints  
aids  /  devices  
Total   Speech  
Spinal  Braces  
Popula5on  
Did  not  receive    
medical  advice   Personal    
Developmental  
mobility  aids  
6.9m  (US$  210m)  
Without  
disability   Crutches  

Wheelchairs  

Tricycles  

28  
Key  insights  to  serving  the  BoP  space  

The  poten5al  market  size  for  assis5ve  aids/devices  is  large  and  aqrac5ve;  the  current  
market  in  India  is  es5mated  to  be  US$  42m  and  the  unaddressed  market  is  es5mated  
to  be  US$  316m  
 
 
Crutches  and  wheelchairs  form  the  largest  segments  of  the  unaddressed  market  at  US
$  105M  and  US$  60m  respec5vely.    
 
 
The  overall  unaddressed  market  is  evenly  split  between  urban  and  rural  areas,  at  
approximately  US$  158m  each.    
 
 
End  users'  ability  to  pay  by    is  low,  especially  without  insurance  coverage.    
However,  robust  distribu5on  channels  exist  through  the  government,  NGOs  and  CSR  
 
 
Case  studies  exist  of  innova5ve  low-­‐cost  solu5ons    that  have  managed  to  be  
sustainable  enterprises  (Jaipur  Foot,  Mo5va5on,  Mobility  India)  
   

29  
Source:  Icons  from  www.thenounproject.com  
Global  market  for  assis4ve  aids/devices  for  PwLD  is  projected  to    
be  US$  3.89nm  

Prevalence  of  locomotor  disability  within  global   Global  projec4on  for  the  market  for  assis4ve  
disabled  popula4on   aids/devices  based  on  the  Indian  market  

7.3bn   7.3bn   US$  3.89bn  

US$  316m  

1.1bn  
1.1bn  
15%   400m  
35%2  

Global   Global     Global     India   Global  

Popula5on   PwD   PwLD  
(2015)1  

1United  Na5ons,  Department  of  Economic  and  Social  Affairs,  Popula5on  Division,  Popula5on  Es5mates  and  Projec5ons  Sec5on  (hqp://esa.un.org/unpd/wpp/

unpp/p2k0data.asp)   30  
2Global  prevalence  of  locomotor  disability  assumed  to  be  35%  
Thank  You