Posts Tagged ‘health’

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Seeking the Balance of Mission and Margin

Monday, July 12th, 2010
Gynocare Fistula Center

Gynocare Fistula Center

In March, I had the opportunity to make a two-day field visit to Kenya’s second largest health sector hub – Eldoret – with my friend and colleague, Rob Katz. The purpose of our visit was simple – to map out the local healthcare provider landscape: identifying key players and the systemic issues in developing models to serve the poor. Of course, we hoped to uncover another entrepreneur or two brave enough to tackle these issues in a way that reflected our Acumen Fund mission – delivering services to the poor with integrity, dignity, and quality.

In theory, investing in sustainable and scalable enterprises as a means of delivering social impact seems straightforward enough. However, the reality of Acumen’s mission for the past 9 years – learned over countless due diligence trips and new field visits like this one – is that finding these pioneering enterprises within our parameters is a challenge. Furthermore, there are so many ways to approach these challenges, and Acumen Fund cannot support them all. Along the journey, we often find opportunities that don’t quite fit our investment criteria, but are ones we wish we could help because of their noble missions and the leaders behind them. In Eldoret, we came across one such opportunity in the form of Dr. Hillary Mabeya and the Gynocare Fistula Center.

After starting his medical career in Nairobi as an obstetrician and gynecologist, Dr. Mabeya first began visiting rural regions of the country as a member of AMREF’s Flying Doctor program. During these missions, he became increasingly aware of the plight of gynecologic fistula patients. These patients were often either young female victims of sexual abuse or obstructed labor survivors, who now faced daily physical difficulties in the most routine of tasks. In addition, once victimized, they could not marry and faced social ostracization, as well as the economic challenges of supporting themselves. Soon, Dr. Mabeya began increasing his tours of the region to serve these patients specifically – all operations and services were voluntary and free of charge.

Ultimately, Dr. Mabeya moved his family from Nairobi to Eldoret to be closer to these regions, to set up a higher quality, affordable facility – the Gynocare Fistula Center. In addition to all surgical and gynecological services offered at his clinic, there is also counseling, education, trainings, and other programs to support socio-economic development of women. Though currently a standalone clinic with limited facilities, he hoped to be able grow and eventually, expand across the region.

Dr. Mabeya had the character of all that we hope for in our entrepreneurs. He was extremely intelligent, compassionate, and dedicated to delivering help to those who needed it the most. Most importantly, he was invested in creating a better quality of life for them, beyond just a one-time operation. His commitment could not have been clearer. In the post-election violence of 2008 – he was one of the few doctors to remain open and operational, often conducting surgeries free of charge despite threats to his own life. He teared up as he told us that as a father of three daughters, he just wanted to ensure daughters like his own were taken care of, and given a means to support themselves to thrive and be economically independent.

Through his clinic, Dr. Mabeya is trying to make a scalable, and sustainable social impact. But in the time since he has opened the center, he has been struggling to cover his costs. His staff is often paid through his supplementary salary at the government teaching hospital, and the counselor at the center is actually an unpaid Mrs. Mabeya. With low price points, he is serving the poorest of the poor, but future projections don’t look promising, and surgeries are often done free of charge. Despite knowing his business is bleeding, he is committed to trying to make it work by stretching his personal finances as far as possible.

So while the Gynocare Center had the right mission, it had neither the margin nor as yet, as a small standalone private enterprise, the mandate for an Acumen investment.

This is the messy reality and challenge of investing in social enterprises. There are a committed few, those who seek to serve the greatest needs and beyond. But doing so in a financially-viable and sustainable manner is the hurdle. So while we may not be able to support Dr. Mabeya and his Gynocare Center as an investment, we wholeheartedly support his mission, and everything that he represents.

Manasa Tanuku just finished an internship for Acumen’s East Africa office, working specifically on the Health Portfolio. Prior to Acumen, Manasa was in M&A investing banking and holds a BSc in Finance and International Business from New York University’s Stern School of Business.

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Health Checkup Camps: AyurSEVA Outreach Campaign

Wednesday, July 7th, 2010

AyurVAID Camp

AyurVAID / AyurSEVA Hospitals is a chain of Ayurveda hospitals with a reach across the four southern states in India.  Through a new health checkup camp initiative, recently launched in partnership with a Bangalore-based NGO, I interact nonverbally everyday with hundreds of people from BoP populations; almost all the people we consult with at the camps speak Kannada, Tamil, Urdu or Hindi, and I speak English and Japanese.

Every other day we go to different low-income areas and set up a camp for the day. Surrounded by a variety of aromas, noises and straying animals, the staff members of our partner NGO quietly register unorganized laborers for a small fee and give them access to bank accounts and insurance products under a scorching sun.  Registered members enjoy the immediate benefit of our health checkup screening.  Many bring self-prescribed tablets and ask doctors’ opinions for the first time.  Some bring lab results and clinical documentation, seeking  further advice.  A variety of health complaints and medical histories are assessed through detailed consultations conducted by our doctors.

AyurVAID Camp

I communicate with those patients by sharing the stories with the doctors, managing their clinical data, and observing their candid reactions to our onsite medicine sales and marketing pitch.  I hear their stories of resilience in a simple but hard life.  I see a high prevalence of tubectomy and anemia amongst the women, and undernourishment amongst the male construction workers.

Recently, we started selling medicines at the campsites in small packets containing a week-long dosage.  Although many expected the distribution of free medicine, we sell these products for a small fee as we are not solely a charitable hospital.  I see big smiles in the faces of patients, nonetheless, and the medicines are selling well.  I hear them saying, “I just wanted to try this. After all, the doctor listened to me for 10 minutes and it costs me only three cups of tea.”

AyurVAID Camp

Sometimes we can help but other times we cannot.   We categorize the patients into three risk levels and give priority to those who are at high risk.  Often, though, I feel helpless to the high-risk patients because there is still no system to support them—they are not insured and treatment costs are too high even at our AyurSEVA Hospitals.  Some take on debt to afford their treatments, but this is where I think AyurSEVA needs to develop an innovative health insurance product.  We are working hard to connect our camp activities to our hospital system for higher impact, scale and sustainability.  It takes time, though.

As for now, we are busy hearing the stories of masons, housekeepers and vendors on busy colorful alleys in Bangalore.

Satoko Okamoto is a 2010 Acumen Fellow working with AyurVAID Hospitals in Bangalore.

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When access to healthcare matters most: a personal experience of emergency medical care

Wednesday, March 10th, 2010

Yasmina Zaidman is Director of Communications at Acumen Fund. She recently returned from vacation in the Dominican Republic, where she personally experienced the importance of access to emergency medical care.

The hospital in Punta Cana, Dominican Republic, where Yasmina and her son were fortunate enough to receive treatment.

The hospital in Punta Cana, Dominican Republic, where Yasmina and her son were fortunate enough to receive treatment.

I try not to think too much about work when I’m on vacation, but when I found myself in the back of an ambulance in the Dominican Republic this past week, I couldn’t help but think about Acumen Fund’s work on improving access to emergency care. I was holding my 17-month old baby in my arms as he vomited into a bed pan, while two young medics stood ready to check his vitals. He had acquired an acute bacterial infection, we later learned, that was leading to mild dehydration. This is a problem with a very simple solution – rehydration, with the optional treatment of antibiotics. Yet this simple solution is often not available, and dehydration is the single greatest cause of infant mortality, leading to the preventable deaths of millions of children under 5 each year.

I know how very preventable these deaths are, in part because I just saw it averted for my son. At every step in the process of getting my son the help he needed I found myself asking: “what would we do if we had no money?” First, there would be no emergency transport to a hospital or clinic (though this was only needed in this case because his illness started while we were at an international airport in a foreign country). There would have been no emergency room to check into with the swipe of a credit card. There would have been no instant diagnostics to check his blood pressure, his heart rate, his white blood cell count, which told us that his infection was bacterial and not viral. And most of all, there would have been no treatment, no IV providing the perfect combination of salt and sugar to help his body absorb the fluids that would keep his 22 lb. body functioning properly.

You don’t need a vivid imagination to see how this situation could have played out differently, and my mind kept switching from my own circumstance, in a relatively clean room, with a nurse and blood test results in hand, to a very different one. I pictured a dirt-floored room in a crowded slum or temporary shelter, my sick child in my arms, a dirty rag to wipe his mouth, and futile attempts to provide water, perhaps itself contaminated, to a child who was not tolerating liquids. I would essentially have to watch and wait to see whether his own immune system’s ability to neutralize the infection and its symptoms would outpace the deadly effects of dehydration. And too often, children lose this battle, with the result, over and over again, of death. On the very island where we just spent our holiday, in a small country just across the border, there are 400,000 children displaced by Haiti’s earthquake. How many of them will face the same illness that my son had? How many of them will survive it?

I take the helplessness I felt as I watched my son getting stuck with needles and consider the situation of a parent who isn’t lucky enough to have access to this basic medical intervention and who can’t perform the basic duty of a parent to protect their child from a preventable catastrophe.

Today, my son is his normal bright and bounding self, picking up words here and there, and anything else he can get his hands on. I’ve never been happier to be home from a vacation in my life. Not only because of the comfort of familiarity after this experience, but also because what I come back to is this work we do at Acumen Fund. The work to bring basic, yet life-sustaining goods and services to people who can’t typically afford them. Whether it is access to emergency care from 1298 in Mumbai, or affordable maternal care in Hyderabad, or rural pharmacies in Kenya, or health insurance in Pakistan, basic healthcare for families should never be out of reach. No parent should have to watch helplessly while their child battles infection when a simple diagnosis and rehydration therapy is so simple and so effective. Getting to that point is not simple, but it is the work I come back to with great gratitude, both for my own circumstances, and for the privilege of doing my own small part to bring access to healthcare to other families.

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Posted in AF Team, On the Ground | 10 Comments

Emerging trends: Toilet parties in the Nairobi slums

Thursday, March 4th, 2010


Benje meets Ecotact CEO David Kuria

“Once you don’t have it – that’s when you realize the value”

David Kuria, founder and CEO of Ecotact

When I first journeyed to Kenya in 2004, celebrating the launch of a public toilet facility was one of the last ways I imagined spending a Monday morning – or any morning (or afternoon, or evening), for that matter. In fact, unless I had enjoyed an elephant’s dose of mango juice and was on a 5 hour safari across the Great Rift Valley, I might not have had reason to celebrate a toilet at all.

Six years later, however, armed with the realization that an estimated 2.6 billion people lack access to basic sanitation and 2.2 million die each year from water and sanitation related diseases, I now have billions of reasons to attend toilet parties, an emerging trend in the Nairobi slums thanks to David Kuria and Ecotact. So when the Acumen team received the invite to attend the launch of Ecotact’s 17th Ikotoilet facility last Monday, I practically ran for my dancing shoes.

Sitting under a small tent adjacent to the about-to-be-launched Kawangware Ikotoilet, Rob Katz and I listened eagerly with the 200-plus gatherers inside and spilling out the edges of the makeshift party hall. The crowd – a mix of residents, officials and journalists – engulfed the architecturally distinct Ikotoilet structure. It was clear that Acumen wouldn’t be dancing alone at this party.

The Minister of Public Health and Sanitation and the Chief Public Health Officer also showed up for the celebration. Given the honour of Chief Guests, they both made remarks before cutting the ribbon: this day marks the launch of a noble public-private partnership initiative, as we bring necessary services closer to the people and are no longer dependent on flying toilets.

Part of the media frenzy at the Ikotact launch event

Part of the media frenzy at the Ikotact launch event

The Kawangware facility is part of Ecotact’s newly implemented slum outreach model; it is now the second Ikotoilet in the informal communities of Kenya. And according to Kuria and the Minister, there will be more Ikotoilets in Kawangware in the near future – extremely exciting news for Acumen as a BoP investor!

Ecotact is experimenting with a school model in the slums as well. After cutting the ribbon at Kawangware – and being mobbed by reporters as she toured the facilities – Minister of Public Health and Sanitation and Kawangware MP Beth Mugo led a delegation to the Dagoretti Secondary School, about 10 minutes away from the new Ikotoilet.

Darogetti students meet Ecotact CEO David Kuria

Darogetti students meet Ecotact CEO David Kuria

The school’s 150 students currently use pit latrines. But with funding from the Solid House Foundation, Dagoretti will soon inaugurate a free-for-use Ikotoilet on site. What’s more, a biodigester will generate valuable methane gas, pumped from the toilet to the school’s kitchen.

With facilities in Nairobi’s central business district, city parks, slums and schools, Ecotact is tackling the sanitation problem here in Kenya on many fronts. As an investor and partner with Ecotact, Acumen Fund is eager to continue the celebration with Kuria and his team, as they grow from 17 facilities to a target of more than double that within the next year.

Bio:

Benje is currently a Portfolio Intern in the Agriculture and Energy portfolios in Acumen’s East Africa office. Prior to Acumen, Benje was a management consultant at TecnoServe in Kenya and at PwC in New York. He is currently starting several SMEs in the Nairobi slums, and holds a BS in Business Administration from UC Berkeley.

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Market Failure in Global Health Technologies

Thursday, February 25th, 2010

Jim Fruchterman is Founder and CEO of Benetech, a social enterprise that leverages technology for social applications. The following article argues for the transfer & application of medical technologies to the developing world. The challenge to adapt healthcare solutions to the BOP is being tackled by investees in Acumen Fund’s Health Portfolio, like A to Z Textile Mills and First Micro Insurance Agency. The article was originally posted on Benetech’s blog.

New ideas for Benetech projects come to us from interesting people all the time. The challenges that people bring are rarely technology problems: they are market problems. One repeating theme came to me during a recent and fascinating meeting with Professor Rebecca Richards-Kortum, the Director of Rice 360, the Institute for Global Health Technologies.

Rebecca was looking for help with a familiar problem. Her students at Rice University have been busy inventing new tools and equipment for global health. Many universities do similar things, but Rice goes a key step further. Their students actually go into the field, work with local medical professionals, and learn their real problems, their real pain points. They design solutions in response to these pain points, and bring them back into the field for real-world feedback.

So far, so good. But, what happens after doctors in Africa rave about how successful this or that invention are in their hospital? How do you go from ten or twenty prototype units to scale?

And that’s where things break down. The big vendors of medical gear that sell into the developed world have no practical interest in deploying products at a third, a fifth or a tenth of their current price points. The market isn’t that elastic. So, the established players rebuff such approaches as being impractical. And, through the lens of a successful company, that rebuff makes perfect financial sense.

But, Rebecca passionately explained that this means that people die in the developing world all of the time from lack of medical gear (and medicine) that we take for granted in the rich world. Or, they don’t have as successful medical outcomes that translate into poor health or disability.

I am convinced that there are many exciting social enterprises here. Ones that should make money in the long run, but may need a jump start. Clayton Christensen of Harvard in an article entitled Disruptive Innovation for Social Change has noted the need for disruptive innovations in health care. These “catalytic innovations” may not be quite as good as the status quo solutions, but are meeting an unmet need by virtue of being simpler and less costly.

There is a great deal of opportunity to help get more of these started. There are many brilliant people, both students and experienced professionals, who would love to do these kinds of products. The opportunity to transfer this kind of technology to enterprises in the developing world is also exciting, and one that I expect to see more and more. A Silicon Valley entrepreneur (or VC) can’t afford to look at a $5 million revenue opportunity, but that is probably much more attractive to a Kenya entrepreneur. We just have to marshal some capital and know-how to lower the barriers to creating and distributing these products.

I am not yet convinced that this is something Benetech should do, though. Although our social enterprise skills are strong, our specialty has been social applications of information technology. These have the benefits of being purely virtual products, without the need to have inventory or warehouses. But, seeing a gaping social need for social enterprises to bridge this gap is tempting. Someone needs to fill that gap and save a lot of lives.

Posted by Jim Fruchterman on Benetech’s blog, 15th February 2010.

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