How Innovation in Emerging Markets Is Transforming the Health Care Landscape at Lightning Speed
As the only Arab woman in the Middle East running a VC fund and the first woman to lead an IPO in the region, Noor Sweid (pictured below), founder of Dubai-based growth-focused venture capital firm Global Ventures, is a force to be reckoned. With a focus on enterprise technology investments, her first $50 million fund has backed founders of innovative and disruptive companies in emerging markets with the ability to scale. And since the COVID-19 pandemic began, Global Ventures has begun investing heavily in health tech.
Q: I’ve read that a lot of VC firms are pivoting a bit into the health care tech space, especially due to COVID. So, I wanted to get your take on what the landscape looks like for these new companies that are emerging in that space right now. What are you seeing? Are you seeing a lot of great ideas or is it a bit more of a rocky landscape?
A: I’ll speak from our side of the world, and I’ll speak more globally about what we’re seeing. So, from our side of the world, we’re seeing elements of the usual split between emulation and innovation. There has been emulation on let’s build telehealth platforms, let’s build diagnostic platforms, the stuff that’s already been tried and done elsewhere. Let’s do that, that’s easy, low-risk, low-hanging fruit, we did that.
On the innovation side, we’re just closing an investment in an augmented reality (AR) company for operating rooms, for hospitals, for surgeries and they have now expanded into the UK. The company is working with the NHS, it has signed contracts with J&J and medical device companies. But that originally started as working on cleft lips and palates for children in war zones. So that’s really innovation—necessity is the mother of creation. And that’s where that came from, and that happened in emerging markets, and then it went on to other markets. Then we’re seeing a lot of the telehealth stuff, which is just emulation.
But even on the emulation, there’s no legacy platforms, and so they’re able to leapfrog, akin to what happened with fintech. So, it’s the same thing.
That makes sense. How does AR in an operating room work?
It is very impressive. So, there’s two parts to it. The first part is it’s live streaming with a specialist surgeon to help the practicing surgeon through a surgery, because they don’t have the specialist expertise. And the reason hospitals want to do that is because the biggest mortality rates in certain surgeries are actually between the East Coast and the Midwest, rather than between Uganda and the UK. So, it’s literally about the surgeons that don’t have the specialist expertise that need to do something. So you stream in the specialist surgeon, and then you take the imaging that you’ve done on the patient pre-surgery and just superimpose that onto a screen, and then there’s a glove that may or may not be worn, depending on the type of surgery, that the practicing surgeon can wear, that superimposes where their hand is onto the images and allows the specialist surgeon to walk them through it.
So, then you can imagine that for medical device companies that are now launching more medical devices than ever before, and that have to have at least a certain number of hours per surgeon of training, you can actually train people through this platform. Because of COVID, they’ve picked up massively because surgeons don’t have to travel anymore, and you can see where the whole thing is going. That is the way innovation in emerging markets is going worldwide now.
And then you have the emulation, that’s what we made two months ago, which is an EMR platform in Africa. But because you’re not building off legacy issues, you can actually leapfrog. So, what he has done is said, “It’s really nice that the hospital and the regulator want to know who showed up and what happened to them, but the patient should also have that information.” So whereas Epic, which is the U.S. multimillion-dollar company that does hospital EMRs—the electronic medical record management systems—does only the hospital side, and so Salesforce had to come in a year ago and say, “OK, we’re going to build an API where the patient can also access their information.” But as the patient, you still need to log into the hospital’s website, and this is all the legacy, clunky stuff.
Whereas what Helium Health has done in Nigeria is say, as the patient, when you leave, they’ll check you out, and then on the app, you immediately have which doctor you saw, what they said, your prescription, everything you need. And by the way, if you cannot afford the treatment, you can apply for a micro loan using the platform. Because it’s in the insurance company and your employer and the government’s best interest for you to get better, faster, rather than you can’t afford the treatment and so you get sicker and sicker and sicker, making you less productive and making your ultimate treatment much more expensive. And so, you can do micro loans and fintech now through the health tech platform. So, it’s emulation, but it’s solving real pain points along the way that make it innovation at the same time.
That’s awesome. I mean, I have dealt with so many clunky apps from my doctors and stuff; I once had to log into four different portals just to figure out what my blood pressure was to tell a different doctor.
Indeed. It makes no sense. With this one, you can go from doctor to doctor and it keeps building up your own medical record, so when you go to a doctor, they no longer ask you for your medical history.
As a company that scales, are there a lot of regulatory hurdles that you have to go through? I imagine a company moving—say, if you were to bring Helium Health to the U.S—you’d have to deal with insurance hurdles and the like. So, how does it work when you’re scaling a company like that?
So emerging markets are about four or five billion people, depending on which markets you look at, and the way that we’re really thinking about it is, right now with health care inclusion, the regulators and governments are so focused on just giving primary health care access to people that they’re willing to work with the younger companies that can do that for them at a very affordable rate. And again, it’s very similar to when governments looked at financial inclusion, which it is not feasible from a pure economic perspective to cater to the middle in a lot of markets using traditional infrastructure. So how can you build digital platforms on top of that to make it cost effective, to reach these people?
They’re not replacing the hospitals. It’s like emerging markets, you’re simply giving them more reach. You’re giving more people reach that never had access to a hospital or a doctor, which is, for the emerging marketplace, very different. It really is health care inclusion to people who’ve never had access to health care. Similarly, it was the same way with financial inclusion; it’s positive that there are many banks, but they’re never going to cater to citizens who earn $5,000 a year. So how do you provide access using fintech because it’s uneconomical for banks to provide access?
When you’re looking at companies, what are you looking for in the health care space, specifically?
We look for all the same things we’re always looking for, which is the team and the founder. So, resilience, the ability to pivot, the ability to work with regulators and understand what they’re looking for, the ability to identify pain points. With Helium, identifying that financial ability to pay, that pain point is something that nobody would have really thought of, so it really has to be enclosed to the value chain and the patient’s viewpoints.
Then, within health specifically, is it regulated? So, is it biotech or health tech? Is it access to health care or is it actually something where the regulator is going to come and say, “No, you need to go through FDA approval,” or the equivalent, and therefore it’s a much longer and binary outcome, whereas access to health care is something that every regulator will tell you, “Yes, as long as you’re not infringing data rights, it’s fine.”
The other thing we’re looking at is massive scalability. It’s about what can you achieve over many markets. And a large part of that is the data play. So, we’re seeing several health data companies, so aggregating data, clinical data, and again, across non-Caucasian data, which a lot of pharmaceuticals really want now. Or access to patient populations that have not undergone multiple clinical trials before. So again, harder to find now in the U.S. and Europe, easier to find in the emerging markets, but who can give me a list of 2,000 or 50,000 people with migraines that haven’t…Again, that data has been really hard to find, because hospital visits aren’t as documented. You really have a cross evaluation of health care, health care inclusion on all aspects, a lot going on. So, we’re looking for opportunities that are massively scalable, cross market, solving real problems.
I know that since COVID the health care system, at least in the U.S., has really been on trial; everyone’s talking about all the inadequacies of the U.S. health care system. Do you think this crisis is going to change how people look at health care inclusion and the importance of access to health care?
I do. And I think it’s just like how the global financial crisis changed financial inclusion; suddenly, it really accelerated the adoption of tech into the financial industry, which then meant that fintech could play a bigger role, and the regulators were more accepting. Even when you think about blockchain over the last five years, how big banks have integrated themselves with blockchain. And so blockchain became much more acceptable to the regulators as a backend system. But if you had tried to do that before the big banks accepted it, it would have never happened.
And so similarly in health tech, because of this crisis, the big hospitals and big pharma are starting to say, “OK, let’s see what technology we can use to enable health care access, to make FDA approval faster, to accelerate the data collection,” and all these different problems that they’re facing as an industry as challenges, how can we use tech in that sense? And so, suddenly telehealth is accessible to an insurance company, whereas a year ago, most insurance providers would say, “No, it’s not a form of a consultation.” Now the response is, “No, please let that be a form of consultation.” And so, the regulator responds to the pharma companies and the insurance providers. If telehealth is a form of consultation, then so is telediagnostics. And then, you can own the patient journey as the content player. Because then if you’re sick, you go online, you look for content and you discover the same website or company can then allow me to book a doctor using telehealth, give me my prescription, which gets delivered to me, and then I feel better. And so you’ve owned the patient journey from sick patient to well patient, but you would have never been able to do that if the insurance company wasn’t happy to pay for these things, which they would’ve never been able to do if the large providers and the regulators didn’t allow that.
By allowing the regulators to see things from a different light, because they have such strong lobbies, you’re enabling the smaller players to participate more actively. And so that’s what the crisis has done—it’s enabled the larger players and the hospitals and the providers and the payers and all of them to get onboard with tech.
Hopefully five years from now, not just in America, but everywhere in the world, we’ll have much better access to health care for everyone and at much more affordable costs and much more personalized. Because the doctor can actually see your entire medical record and spot trends. AI (artificial intelligence) will help them, and they can spend five minutes with you on a teleconsultation with the enablement of AI, rather than you having to spend two and a half hours out of your life going to see them.
Is security a huge issue with these companies and apps? I imagine data privacy is a really big deal?
It is, and that’s why we’re starting to see a lot of technology being built around that. So, trying to anonymize the data, which is one side of it, and then you’re seeing a lot of data residency platforms; governments saying, “My citizens’ data cannot leave my soil,” for example. But then the question becomes, “OK, but everyone is in cloud.” That’s impossible.
What we’re starting to see is these platforms as a service that come in and anonymize and privatize all that data, so it’s aggregated and accumulated, but by the time it gets to the cloud, it’s been highly anonymized. And so that is kind of how everyone’s addressing data privacy.
You mentioned that five years from now you think things are going to be a lot different in the health care landscape. Is five years realistic? Do you think we’re going to see a lot more health care inclusion?
I think it took 10 years in finance, and I think that the world moves faster every year. So, I would say five to seven years, we’ll see a lot of change in healthcare.
What do you think the biggest change is going to be?
I think partly it’s going to be the adoption of mobiles for being your primary physician. My children will never see a bank; they’re 11, nine and seven, and it’s unfathomable for them to walk into a bank. And I think, similarly, 10 years from now, if you ever go to a hospital, it’s because you really need surgery. And more often than not, you’ll probably see a doctor once every couple of years. Your first port of call will be your phone, especially in emerging markets; so, it will be, get on the phone, put in your symptoms, log in, here’s your medical profile, get a doctor on the phone. And it just becomes—unless the doctor then goes, “No, something is wrong, please come in”—”Oh, we can diagnose you based on your medical history which we have,” and the AI which gives us patterns of maybe even what’s happening in your community. So, we know that within a one-mile radius of you, 30 people have had these symptoms in the last week. Here’s the medicine, it gets delivered to you and you’re done. So, it becomes much more like that in a five- to seven-year process, especially for emerging markets where doctors and hospitals are actually very scarce.
I’ve been seeing a lot of stuff about these at-home COVID tests. Are we going to be doing our own swabs and blood work, basically, in the future?
Yes, but I think it will look very different. You won’t be drawing your own blood with a syringe. I just don’t think that’s how we draw blood anymore. A drop of blood will give you so much more information than anything else in the future. So, I do think maybe every home will have a little kit—akin to a first aid kit, part of it will be a diagnostics kit. But I don’t think that’s going to be the case in the next five years; I think that’s more like 10 to 15 years down the line.
Yeah. That makes sense.
But even now, with the pandemic, the barber came over to cut my childrens’ hair. We discovered my eldest child needs glasses and because he’d never had glasses before, a full eye test was required. We were able to access an ophthalmologist who had portable equipment, brought the screen with him, sat my child six feet away and did the test to diagnose him. Everything was portable. It took five minutes to diagnose him. It’s three quarters degree in one eye, half a degree in the other eye. Here’s an iPad, pick which glasses. The next day, they brought over 10 pairs of glasses for him to try. He picked one, 24 hours later, the glasses were at home. This was last week. But the way that these things have adapted because shops are closed—it was a case of, we have the ophthalmologist, we have the glasses, we have your address, let’s just do this.
My parents were laughing, suggesting it was just like the old days when the barber, ophthalmologist and doctor come over. This may be just the way that it gets done, and if you can do your full diagnostics in 10 minutes, why not? We have now the COVID tests at home here, and you have the antibody testing at home now. They do the testing, and 24 hours later, they message you on your phone the results. It’s a very interesting time, it’s really back to how it was done many, many years ago.
What excites you most about the future in terms of health care inclusion, as well as in terms of the innovations you’re seeing?
It’s similar to finance. We saw what the emerging world did, when they weren’t bogged down by legacy. M-Pesa, which is mobile minutes instead of money, used the telco platform to actually bank the unbanked in Kenya and other parts of Africa. Nobody sitting in Silicon Valley would have thought of that because they don’t actually have that problem. Or using GPS clients, so geolocation data, to do last-mile logistics, because street addresses don’t exist. So, I’m really excited to see what’s going to happen in health care. Because we don’t have hospitals and doctors, what are people going to invent and innovate so that we can actually still have access to primary care, which is suddenly very important, and regulators are onboard, and governments want to support it. But what are those innovators going to come up with? To me, that’s really, really exciting. What’s the M-PESA of health care? What does that look like? To me, that’s really, really exciting.
Do you have any advice for a founder who has a great idea startup in the health care space right now who’s searching for funding?
I think just start, prove the pain point, find one customer, one client, and then you’ll be able to find the funding. Because there’s so much coming out this space over the next six to 12 months.