Organizations sometimes make the mistake of designing a solution before they have a firm understanding of the problem that they are solving.

In this excerpt from his upcoming Philanthropy University course Essentials of Nonprofit Strategy, Paul Brest, co-director of the Stanford Center on Philanthropy and Civil Society and former president of the Hewlett Foundation, speaks with the founders of the health technology organization Embrace about how they defined the problem that they were solving. This interview has been edited and condensed for clarity.

Paul Brest: Before one can begin designing – let alone implementing – a strategy you have to understand what the problem is.
I’m excited today to interview two of the founders of Embrace, Jane Chen and Rahul Panicker.

Jane is the cofounder of Embrace, she has a BA in Psychology and Economics from Pomona College, a Masters in Public Administration from Harvard, and an MBA from Stanford. While she was at Stanford she took a class in Human Centered Design that led to the innovative product that we’ll be talking about.

In addition to Jane there were three other co-founders, one of whom is Rahul Panicker who was born in Kerala, India and raised in Kuwait. He attended IIT Madras followed by Stanford University where he received a Master’s degree and a PhD in electrical engineering and participated in the same class as Jane.

The product they’re going to be describing for us grew out of that class.

So, I’d like to begin by asking what the Embrace Infant Warmer is and for whom it is intended.

Rahul Panicker: The Embrace Warmer helps a premature baby maintain body temperature. It serves the same purpose as an incubator. In the developing world there is roughly 15 million babies born premature or with low birthweight. Most of them do not have access to incubators, and so they struggle to stay warm.

[The Embrace Infant Warmer] has the ability to work with or without electricity. In the absence of electricity it can be operated with hot water. It is simple enough to be used by a nurse, or a midwife, or even a village mother. And, finally, it’s designed to be extremely low cost.

Brest: When you first began to design a product, [the Embrace Infant Warmer] is not what you had in mind. I wonder if the two of you would describe the path that took you from a course at Stanford called Design for Extreme Affordability to developing this extremely important product.

Panicker: In class we worked in small teams. A challenge was posed to us by an NGO in Nepal: incubators cost many thousands of dollars. Can you make something that is 1% of the cost of those devices?

The [Stanford] d.school being the d.school encouraged us to look at the problem afresh and travel to the countries [that use the incubators] to take a look at what the ground reality is.

What we saw was that many babies are born in rural and semi-urban areas and that’s where most of the infant mortality was happening. And these incubators actually were in city hospitals. We quickly realized that making a cheaper glass box that plugs in will reach a few extra hospitals, but it’s not going to make a quantum difference, and we had to rethink the solution. And that’s where the Embrace Infant Warmer came from.

Brest: Jane, did the realization of what the real problem was come to you in an insight [or] did it grow over time? How did that develop?

Jane Chen: Well I think it was one particular insight that led us to the solution. What happened was the team that was sent to Nepal first visited the big city hospitals in Kathmandu.

And what they noticed was there were a number of donated incubators often lying idle in these hospitals and yet dozens of babies would be in the neonatal intensive care unit in need of the incubators. So at first, we’re kind of scratching our heads wondering what’s happening here.

Then we figured out – of course, there isn’t a constant supply of electricity to power the incubators. Oftentimes medical staff are not trained on how to use them, or the instructions will be written in German. And, lastly, if a part breaks, there are usually no spare parts for replacements.

So that led us to the conclusion that even when these incubators are free, there are all sorts of systemic issues that lead to them not being viable in these settings. So then we started travelling to village settings and I think that was really where we got our “aha moment.”

My co-founder Linus travelled to a village in Nepal. [He] met a woman who had given birth to a premature baby and was advised by the village doctor to take her baby to a city hospital so the baby could be placed in an incubator. But that hospital was hours away and she did not have the means to get there. Her baby died as a result. Since then we’ve heard dozens of similar stories.

I think that led us to the conclusion that what was needed was not something that sat in a hospital, but rather something that could be placed in a village clinic, for example, or even be used at home by a mother or midwife. Something that did not require a constant supply of electricity and was easy and intuitive to use so it could work in those settings. And laying out those criteria led us to the solution.

Brest: So, it sounds like it was really important for you to get out of the classroom, out of the office, even out of the city and into the field in order to understand the need.

Chen: Absolutely, and that’s why even after the class ended we felt that it was imperative that the whole team move to India where 40% of the world’s premature babies are born to really understand the problem and the context in which it would be used.

Brest: Can tell me what the status of Embrace is today?

Chen: To date we have helped over 250,000 babies across 20 countries. We work with both government and non-profit partners over the world to distribute the baby warmers. It’s been really exciting to see that progress, but our next milestone is to try to reach a million babies with the Embrace Warmer, and ultimately to make it available to every baby who needs it.

There are about a million preterm and underweight babies born every year that are in need of the device and so we’d really love to make this accessible to all of those who need it.

To learn similar key takeaways on program design and more, take Paul Brest’s Essentials Of Nonprofit Strategy course at Philanthropy University; this course starts on [April 2nd], so enroll today!