A homegrown Kenyan innovation in orthopedics

In this GoFrugal Research Insights edition, written by Rosebella Nyumba, we spotlight a third case study of bottom-up frugal innovation in a small enterprise in Kenya to understand how frugality drives the product development process and the market creation process. This edition recounts the case of the Hip Spica Table, a homegrown Kenyan innovation in orthopedics.

It is important that proper care is taken with every medical procedure, even with something as mundane as a fracture that nearly everyone has experienced at least once in their life. A fracture that is improperly set in the first place, and therefore heals improperly, requires further unnecessary medical interventions. As Mr. Zacharia Kimengich, an orthopedic trauma technologist, and Dr. Kamau Njoroge, a surgeon at Kenyatta National Hospital in Nairobi, Kenya found, this can often be due to lack of the right equipment. For this reason, they made a conscious decision to safeguard the Kenyan future generation and founded Zakam Orthopedic Limited, with the goal of making innovative non-operative fracture equipment. Their innovation, the Hip Spica Table, is available to the remotest orthopedic facilities in Kenya and beyond.

The Hip Spica Table
Fractures are not complex injuries, and only in the severest cases do they require surgery. However, the founders of the Hip Spica Table, having both worked at the hospital for over a decade, noticed that managing fractured bones of children, especially children under 6 years old with fractures in their femur bones (thighs) or hip joints, can be rather difficult. Children cry and move up and down, meaning there is not enough stability to ensure proper management of fractures. As poor fracture management is known to cause lifelong deformities, the inventors realized the need for this innovation. The Hip Spica Table helps in proper fracture management as it reduces the movement of the children and allows them to stretch, thereby enhancing bone alignment. 

Zakam Orthopedic Limited - Hip Spica Table


 The Hip Spica Table is an equipment for positioning children when they break part of their bone; it helps doctors to put on the cast’’
- Zacharia Kimengich


On the left Mr. Zacharia and his partner Dr. Kamau on the right

The Journey of the Innovation
Zacharia states that before the innovation, many caretakers in the hospital were frustrated since there was no equipment that they could use for bone alignment, thus they had to improvise. For instance, one of the hospitals reports that “Before the innovation, we used to improvise by getting help from parents or guardians and also other medical officers to hold the children as we aligned the bones''. Others reported that they at some point even used two jerricans and wooden stools during bone alignment. One of the jerricans used to be placed on the shoulders while the other was placed under the broken leg to ensure that it was straight.

Wooden stools previously used for bone alignment

Mr. Zacharia and Dr. Kamau felt that there must be a better way to manage fractures. Their innovation journey started when Zacharia responded to a call for proposals placed by the Kenya National Innovation Agency (KENIA) in 2017 urging innovators to apply. After being shortlisted, he trained for two weeks in London at the Royal School of Engineering and got the first award when he was given a chance to pitch the idea. He pitched alone since KENIA only required one innovator per innovation to do so. Together with Dr. Kamau, Zacharia used the funds they received to make five Hip Spica Tables which they donated to four public hospitals: the Mbagathi County Hospital, Mama Lucy Kibaki Hospital, Thika Level 5 Hospital, and Kenyatta National Hospital.

The innovation has been commended for its unique nature. The innovator and the users express that there is no similar innovation in Kenya. However, the Spica table is an improvement on one found in the United States (US). The innovators added the following notable features to the one in the US. The first Hip Spica Table was a single traction table which was improved to a double traction table that helps to manage both legs in case both legs are broken. If not, then it provides a place where the child can rest one leg while the other one is being aligned. Later on, the innovators added other features like chest straps, a headrest, and a sponge to make the table comfortable for children. The material used for the innovation has also changed from stained steel to stainless steel due to its flexibility, strength, and resistance to corrosion. Other than the Hip-Spica Table, the innovators focus on developing other fracture management equipment. 

The First Hip Spica Table

The Hip Spica table with double traction made of stainless steel and straps


The Benefits of the Hip Spica Table
The Hip Spica Table has had a positive impact on the health and welfare of all its users. For one, it is beneficial to patients, as once the alignment is done properly, they can be discharged and do not have to come back for further monitoring. It also reduces the amount of pain the patients suffer because alignment takes less time, and it eliminates any third parties who at times pull young patients in different directions. The patients and parents also save money on admission costs and can sooner return for their economic activities. Furthermore, the innovation helps the hospital overall as well. Because of the immediate discharge, more space is available to other patients. With the Table, more patients can be served in a day and one orthopedic technician is enough to attend to one patient as it does not require a lot of labor. Furthermore, orthopedic technicians no longer have to bend when carrying out bone alignment resulting in chronic backaches. Finally, the local aspect of the production of the Hip Spica is a great advantage to local medical facilities. In Kenya, most medical equipment is imported. Therefore, while the Hip Spica table produced locally retails at Kshs. 70,000 (625 Euros), the one from the United States is sold at Kshs. 500,000 (4,464 Euros).

The Way Forward
As of now, eleven hospitals have bought the equipment (among them, one private hospital). At the same time, Zachariah intends to sell other medical equipment alongside the Spica table. The core value proposition of the business derives from the fact that there is no other affordable equipment that can be used to manage fractures, with less manpower and energy.  The innovation was developed to ease fracture management and is not mainly focused on profit-making. Out of the Kshs. 70,000 (625 Euros), the cost of production is Kshs 50,000 (446 Euros) and the remainder is used for transportation costs. Currently, Zacharia is turning part of his office into a workshop; this way he can stop outsourcing the production process which will eventually reduce the cost of production. This next step will help to make the innovation even more affordable.

The Innovators’ office slowly turning into a workshop

Mr. Zacheria and Dr. Kamau’s story is an example of bottom-up frugal innovation. As an orthopedic surgeon and technician respectively, they understood the problem from a first-hand point of view and developed a frugal solution that is easy to use, easily available, and offers an affordable and reliable alternative that can be used anywhere. 


Innovation Histories
Orthopedic Limited and the Hip Spica Table innovation is just one example of frugal innovation. The Innovation Histories research project of the CFIA documents in-depth information on the product conception/invention, commercialization, adoption, and impacts. The focus lies on collecting micro-level data of all relevant aspects of the innovation: its characteristics, the inventor/innovator, the context in which it is developed and used, innovation processes, different actors involved in the development, financing, commercialization, and use of the product, and the impacts at household and societal level. The main objective of collecting this data is to understand how frugal innovations are developed bottom-up, and how frugality drives the product development process and the market creation process. It also evaluates the role of frugality in legitimizing innovation at the household, community, and societal levels. 




Read more about the Frugal Innovation Histories project and the case studies in the Knowledge File

More information
Frugal Innovation Histories Project