health

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.

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.

“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

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

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.

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.

Acumen Fund is excited to announce two new investments, both in the field of eye care. PVRI (Pushpagiri Vitreo Retina Institute) based outside Hyderabad, India, and UHEAL (Upper Hill Eye and Laster Centre), in Kenya, both focus on specific forms of preventable ocular damage.  With similar business models and parallel aims, through our investment in these complementary enterprises, Acumen Fund seeks to identify and and share best practices across continents, while building an effective model for delivering eye care to the poor.

Loss of eye sight has a tremendous economic and social impact on low-income families, eliminating the ability of at least one member to earn an income, and often requiring substantial assistance from at least one other family member. Its prevalence is in large measure a symptom of underlying challenges related to poor nutrition, lack of access to timely diagnostic screening, and the unavailability of appropriate treatment.

Using its flagship hospital in Secunderabad (near Hyderabad) as a hub, PVRI has provided outreach clinics, mobile screening units, and treatment camps in rural areas throughout the region, as well as in-house care to thousands. With the investment by the Acumen Fund, PVRI will be building two additional hospitals and corresponding expansion of outreach units. Gori Hari, CEO of PVRI, notes that the the expansion will allow PVRI to treat “450,000 patients through surgeries or procedures and screen a million patients over 10 years, as well as conduct 1800 camps to screen an additional 450,000 patients.”

Founded by Dr. Kibata Githeko, an opthalmologist specializing in pediatrics and retina care, UHEAL has operated mobile eye units throughout the region to counter long waits endemic in eye care. With Acumen Fund’s investment it will now be able to expand, operating fifteen camps a year, specifically to screen for diabetic retinopathy and to provide non-invasive and laser-based treatments, general eye examinations, as well as some follow-up care.

UHEAL and Acumen will experiment with different pricing models to find the right balance between financial sustainability and social impact, while PVRI will subsidize eye care to low-income communities by charging higher margins to high-income consumers.

The parallel investments will provide added value in the form of shared learnings. As Varun Sahni, the India Director for Acumen Fund has recently noted, “Having two investments with similar models for delivering advanced eye care to the poor creates a unique opportunity for collaboration, and we look forward to sharing best practices across geographies as we work to bring these solutions to scale.”

Does the vision of serving the low income segment of society extend beyond the investors and CEO of a social enterprise?

In my opinion, only an affirmative answer to this question will ensure that the vision of serving the poor is fulfilled (however long it may take…).  Watch what the team of doctors running AyurSEVA Hospitals has to say about their vision and motivation to work for this organization.

A tiny bead of sweat ran down the ridge of my nose.  It reached the end, teetered for a split second, then dropped quietly onto the doctor’s desk.  I sat behind the desk, inside the Vijay Nagar Women of India clinic, which is tucked into a government-built housing project in the Bandra East area of Mumbai.  As the sweat hit the desk, it made a soft splat, and little Natra’s eyes followed it down.  About 3 years old, he seemed pretty interested in the inability of this strange white man to deal with the Mumbai heat – not surprising, all things considered.

Natra and his mother, Surekha, had agreed to take a survey about healthcare administered by Acumen Fund Fellow Joanna Harries and her colleague, Rubina Dsouza.  Joanna and Rubina work for Dial 1298 for Ambulance, a professionally-run, high quality ambulance service run in Mumbai (51 ambulances) and Kerala (30 ambulances). You dial 1298 to get a fully-equipped ambulance with doctor and medical equipment on-board.  1298 is affiliated with the Ambulance Access for All Foundation, whose mission is to provide high-quality service for all Indians, regardless of income. 

But will poor Indians call an ambulance?  That’s what Joanna and Rubina are working to find out.  Service for all is not only a noble goal, it’s good business as well – after all, some 40 to 60 percent of Mumbaikers live below the poverty line, in slums.  If you fail to serve this customer segment, you miss a huge number of calls – and your ambulances can run below capacity.

Effectively serving this market begins with listening, and that’s what Joanna and Rubina are doing.  They have been spending time visiting various Women of India clinics, all of which are located in slum areas, and asking a simple, 5-question survey: what do you do when you get sick?; how do you get to the hospital?; which (if any) ambulances do you call?; why wouldn’t you call an ambulance?; who helps you when you get sick?

Joanna and Rubina and I did eight surveys today, just the tip of the iceberg.  What is interesting is that 1298 takes its commitment to the low-income segments seriously – both in terms of social impact and in terms of business sense.  The company is marketing in a number of innovative ways – tying up with schools, hospitals, train stations, and more.  Slum outreach is an element of their business plan.  Regardless of income level, growing 1298’s customer base is an awareness game – call it marketing, brand management, outreach, whatever – you have to have potential customers know about your service before you earn their business.

‘India is merely a geographical expression. It is no more a single country than the equator’- Winston Churchill

Had I read this quote five months ago, I would have not understood what it meant. But after living, traveling and working in India for exactly that long, I can say that Winston Churchill was exactly right. In India, like in any other large country as the US or Mexico, I expected to find some regional differences in people’s tastes for food or music, their accent, dress code, etc. In my mind, these differences give countries their character and do not have major consequences for business other than the opportunity to bring in some variety to the portfolio of products or services. In India, however, regional differences go FAR beyond the ones I just described. For this reason many authors to talk not about one country but “the many Indias”.

For an enterprise trying to do business across the Indian territory, it is critical to be aware of all the nuances of “the many Indias”. Allow me to illustrate what I mean by this using AyurVAID: Hospitals, the organization I am working in, as an example.

AyurVAID: Hospitals is a local business with the mission of providing high quality, affordable Ayurveda (India’s traditional system of medicine) treatment for chronic illnesses across all socio-economic segments and across India (and some day abroad). In line with this vision, AyurVAID: Hospitals opened six small to medium sized hospitals in three neighboring states: two hospitals in Kerala, three in Karnataka and one in Maharastra. The hospitals are located in urban areas and three of them in the big cities of Mumbai and Bangalore.
At first glance AyurVAID: Hospitals’ strategy of expansion seems very straightforward, but in practice things are let’s say a bit more….complicated. Here is how:

Language- At each location, all sign boards and advertising material have to be translated into at least 2 different languages (English + local language) and 4 in the case of Mumbai (high immigrant population). Our doctors need to speak 2 to 3 languages to communicate with patients, English to communicate with the management and international partners, and Malayalam, the language of Kerala, to speak with the staff.

Human resources- The roots of the Ayurveda system of medicine can be traced back to the state of Kerala. Although today Ayurvedic Medical Colleges train doctors across the country, training institutions for therapists are still highly concentrated in Kerala. Hence, hiring locally becomes a difficult task and most of the therapists have to be relocated from Kerala to other states. Then again, most people in Kerala have a strong affinity for their state and prefer not to leave it.
Systems of medicine- Whereas in other parts of the world, Allopathic or “Western Medicine” is the norm, in India, patients have many other well established options to consider like Ayurveda, Homeopathy, Allopathy and Unani. In competing with these different options, public awareness about Ayurveda is a big challenge. If we take allopathic medicine as an example, most people today know what to expect when they go to a doctor, to a hospital or understand if someone says they need a “dialysis”. On the other hand, Ayurveda means a variety of things to different people, particularly as the distance from Kerala increases. To test this last point, I decided to interview people in the streets and hotels of Kerala (to get some out of state opinions) and asked them one simple question….Observe.

[youtube=http://www.youtube.com/watch?v=34I9lLAhU94&hl=en&fs=1]

All of these factors make the business at AyurVAID: Hospitals challenging and exciting! One success factor as we continue to grow and do business in “the many Indias” will be to strike the right balance between standardization and customization of our services.

Jordan Kassalow, Chairman and co-founder of VisionSpring, was announced today as one of the Skoll Foundation’s newest grantees. The award includes a 3-year, $765,000 unrestricted grant to VisionSpring, a non-profit social enterprise that empowers local individuals to become self-sustaining entrepreneurs by selling affordable eyeglasses to the millions of people in the developing world who need them. VisionSpring is also an Acumen Fund investee (and the Skoll Foundation is an Acumen Fund Leadership Partner - it’s all in the family!)

We’re thrilled to see Jordan - and the entire VisionSpring team - recognized in such a prestigious forum. Congratulations! And we’ll see you at the Skoll World Forum next week (rather, Brian Trelstad, Ann Macdougall and Varun Sahni will…)

Acumen Fund has learned over the years that its most successful entrepreneurs listen constantly to the needs and the nuanced preferences of their customers. A killer new product will certainly fail if it is not designed around the customers’ behaviors and desires. We’ve seen it happen.

As part of Acumen Fund’s monthly breakfast series, we were joined last Friday by Richard Allan, Director of the MENTOR (Malaria Emergency Technical and Operational Response) Initiative, who spoke about a thoughtful new technology for preventing malaria: insecticide-treated wall lining (shown at left, with a customer in the foreground). Imagine a flexible wall-lining that you can unroll in long sheets and attach to the inside walls of a home. Only it is impregnated with an insecticide that kills mosquitoes (and many other pests) on contact. A new company called DART (Durable Activated Residual Textiles), a joint venture between Richard, Acumen Fund, and Vestergaard Frandsen, will produce the product for distribution throughout malaria endemic regions Asia and Africa.

We’ve seen a lot of sexy, new product designs, and we’ve decided not to invest in most of them. So why are we so excited about this new wall lining (think wallpaper)?

For starters, it combines the best features of the two most popular malaria prevention products: the long-lasting insecticide-treated bednet and indoor residual spraying (IRS - this is where the interior walls of a home are sprayed periodically with insecticide). The best nets last about 5 years without needing re-treatment, but they require you to sleep underneath a net every night, which is a significant behavior change and a challenge for any distribution scheme. Indoor spraying requires no behavior change once the walls are sprayed. Unlike with nets, a family does not have to decide to sleep under protection; the spray ensures that they are naturally protected anytime they’re inside the home. Misuse is not really possible. However, the spray’s effectiveness only lasts about 6 months and there are complicated logistics and persuasion required to do the spraying in the first place.

Introducing wall lining. Wall lining will remain effective at least as long as bednets and likely longer, since it will likely see less wear and tear. And, like spraying, it does not require any behavior change once the walls are lined – if you’re in the home, you are protected. In this sense it is the best of both worlds – years of protection without the struggle to change people’s behavior.

Yet, beyond these technological advantages, the product seems to appeal to the customer better (at least as evidenced in early trials). Printed in many different colors and patterns, the wall lining is designed to appeal to the desire for beauty and home improvement that exists in all of us. Who wouldn’t want beautiful blue walls instead of the drab brown of sticks or mud? In fact, this is how Richard got the idea in the first place. In Cambodia, he noticed homes lined with wallpaper for purely aesthetic reasons. Why not combine the customer’s desire for beauty and home improvement with addressing a critical health issue?

Of course, there are many challenges ahead, but in a market dominated by multilateral & NGO distribution schemes, it is rare to see a product so thoughtfully designed with the customer in mind. With ~2 million deaths per year due to malaria and 1/4 of the world population living in malaria endemic regions, we owe it to the customers to design products that work for them but at the same time are as effective as possible.

The entrepreneurs at AyurVAID: Hospitals are testing a business model that promises to overcome the scale up challenge of delivering medical care to the masses based on Ayurveda, a system of traditional medicine. According to RV Raman, Head of Marketing at AyurVAID: Hospitals, there are about 18,962 Ayurveda companies registered in India today. Most of these companies focus on offering ayurvedic products (from medicines to toothpaste!) and spa related services, however no one has been able to come up with a successful, scalable model to deliver health services. (Ironic considering that Ayurveda is a system of medicine that has been around for more than 3,000 years!) In this video Rajiv Vasudevan, CEO of AyurVAID: Hospitals, explains some of the challenges inherent to the Ayurveda “industry” and some of the strategies the team has developed to overcome these obstacles.

[youtube=http://www.youtube.com/watch?v=VT87qBfClV8&hl=en&fs=1]

Full Story can be found at http://www.dnaindia.com/report.asp?newsid=1220060

When I first read this article published yesterday on the DNA Bangalore newspaper I felt moved by Daniel’s story of resilience. Then my thoughts drifted to another character in the story, Dr. Belaku Chandu[1] from AyurVAID: Hospitals. The reason why I found myself thinking of Dr. Belaku is because the article reminded me of her reaction one of those days that Daniel heard the sound of the fire crackers.

I was sitting in the hospital’s kitchen having dinner with the staff and doctors when the noise of the firecrackers filtered the hospital building. Dr. Belaku immediately stopped eating her food, she rose from the table and went in to the hallway. She stopped for a few minutes as if waiting for something to happen and then disappeared into the first floor. Then I heard laughter.

When Dr. Belaku came back to the kitchen and I asked her what was that all about she told me Daniel’s story and how the noise of the firecrackers had affected her in the past few days. With a smile in her face she said, “The first day Daniel was very scared by the noise. She thought it was the noise of shotguns and her nerves started to jerk again. The second day she was just startled and dropped her food tray. Today, she recognized the noise and she just laughed!” She was paying attention to Daniel’s progress day and night.

Dr. Belaku’s story exemplifies the type of personal and organizational commitment that makes a social enterprise thrive. Everyday I spend at AyurVAID: Hospitals I am in awe of how devoted the caregivers and doctors are to the patients and to the organizational mission. Every single one of them believes in the healing powers of Ayurveda for treating chronic illnesses and is committed to AyurVAID: Hospitals’ mission of taking classical Kerala Ayurveda to as many people as possible in India and around the world by offering affordable, high quality services.

This article also highlighted for me the positive ripple effect of investing in a social enterprise. Acumen Fund’s investment in AyurVAID: Hospitals operation’s in India is helping reach people in Africa! Although Daniel may not belong to the low income class at the BOP that Acumen is trying to reach, there is no doubt that she was a person in need of physical and spiritual help, and that her courage in sharing her story of improvement through Ayurveda provided in the AyurVAID: way, will help this team of committed doctors and entrepreneurs communicate to all its promise to solving society’s health needs.

We at Acumen Fund are deeply saddened to learn of yesterday’s terrorist attacks in Mumbai. Our thoughts go out to the victims and their families, our Mumbai-based investees, Fellows and friends and everyone connected to people who have been affected by the attacks. Our personal connection to Mumbai makes the city a home to us, even if we don’t live there.

While watching the TV coverage, I did want to share another feeling of connection, and that was to everyone associated with Acumen-investee Dial 1298 for Ambulance, who have been on the scene and responding to the attacks since they occurred late Wednesday night, as seen in footage on CNN, IBN and other networks.

1298 operates under the ethic of “ambulance service for all.” Per its own policy, it provides free service to all accident and disaster victims - as well as to victims of terrorist attacks. Knowing that a few years ago, the city was so much less equipped to respond to such an emergency underlined the true service that 1298, now with 51 medically-equipped and professionally staffed ambulances, is making to the city where it was founded. We at Acumen Fund feel a great sense of pride, just in seeing how much can be built to change things in a constructive way and in this case, it was due to the hard work of the team at 1298. We thank everyone at the company for the work you do and the ethos of service you hold.