On July 7th, Duke University through the Social Entrepreneurship Accelerator at Duke (SEAD) program, held a “Doblin’s 10 Types of Innovation” workshop at Makerere University in Kampala.

The SEAD program works with nonprofit and for profit global health solutions addressing cost, quality and access issues for low and medium income populations in East Africa and India as part of the Higher Education Solutions Network.

The 4-hour workshop was co-hosted by Makerere’s College of Engineering Design Art and Technology (CEDAT), the Innovation Village and SEAD. The event drew 112 participants including undergraduate students from at least six of the ten major colleges at the oldest learning institution in Eastern and Central Africa as well as students from the neighboring International Health Sciences University Kampala.

The Chief Guest, CEDAT Deputy Principal Dr. Venny Nalubwama in her opening remarks, commended Duke University and the Innovation Village for “providing a learning avenue to the students.” She reiterated that Uganda was one of the most enterprising countries in the world, according to the World Bank, but new enterprises collapse within the first three months of existence. 

Facilitation and moderation of the workshop was done by three Duke University masters’ students Emmy Komada (Business Administration) James Ruggiero (Business Administration) and Caesar Lubangakene (Global Health). The students worked with the SEAD/Innovations in Healthcare team to develop, research and organize the content to facilitate the students at the workshop.

The graduate students presented the 10 Types of Innovation Framework and used their own summer internship attachment organization as models. All three graduate students are placed with East African based health innovators that are part of the SEAD program cohort and the Innovations in Healthcare network. The USAID-funded initiative aims at collaborating academic rigor and inter-disciplinary approaches to development for maximum impact. The organizations where the students are placed are: Kenya’s Jacaranda Health (Emmy), Afya Research Africa (James) and LifeNet Uganda (Caesar).

All through the workshop, the facilitators maintained an interactive session designed to encourage active engagement among the participants. There were many exciting discussions and debates around various innovation topics and ideas. The most outstanding was a long debate between divided participants whether “Rwenzori Water”- Uganda’s leading water bottling company was innovative after learning about Doblin’s 10 Types of Innovation.

The most exciting component of the event according to most participants we spoke to, was the team break-out session where groups of students selected a brand from either a shared list of local East African and global brands, picked an unlisted brand of their choice or crafted a new innovative company of their choice. The students broke out into 12 groups of student teams. The twelve brands that the student teams chose to analyze were:

• Nemo Rolex (catering services)
• Coca Cola (beverage) 
• Fresh Dairy Milk (dairy products)
• Harris International (beverage)
• Air BnB (hotel and travel)
• EcoFuel (biomass fuel)
• Total (petroleum company)
• Save for the Future (credit and savings)
• Tesla Motors (renewable energy and technology)
• Online Construction Tendering Company (construction)
• Lipa Mobile (electronic money transfer)

The student teams then applied “Doblin’s 10 Types of Innovation” to cooperatively analyze and understand the types of innovation in the selected companies within assigned teams. After which, all the groups presented their key ideas in relation to the framework to the audience in three minutes and answered questions from the audience about their chosen innovative brands. The top three brands deemed to be most innovative were then selected by the participants through a popular vote to win prizes.

The winners by the popular vote from the audience were Nemo Rolex (catering services), Coca Cola  (beverage), Air BnB (hotel and travel). The three teams each received a brand new copy of Larry Kealy’s Ten Types of Innovation: The Discipline of Building Breakthroughs book. While handing the three prizes to the winning teams, SEAD East Africa’s Regional Director, Dr. Patricia Odero implored the students to use the materials to learn more about innovation and apply them while assessing innovations in companies around the world.

In his closing observations, the University Guild President thanked the students for attending the workshop and acknowledged the organizers for availing the opportunity for the students to learn something new about innovation. He added that innovation and entrepreneurship are the most vital aspects in improving prospects of self-reliance and employment in the job market today for the young people. He also requested for more workshops of such nature for students in future through university partnerships.

This week, Investor Days: Nairobi attendees share their perspectives on what is important when reviewing global health investment opportunities. We were surprised to find that their priorities actually were not surprising – their focus on finding the right companies and the right entrepreneurs to solve huge global health challenges in East Africa echo the conversations the IC network has when reviewing companies across sectors and across geographies in the US. However, trip attendees were able to identify innovative business and investment models that they think make the right companies for these challenges and characteristics to look for to find the right entrepreneurs to build successful businesses and good investments.


Innovative global health models…
​

… Often combine healthcare delivery and technology. Healthcare delivery is complex, and our trip attendees found that technology-based business models can be effective tools for simplifying systems, streamlining delivery, and scaling health interventions. Michelle Schwartz was impressed by TotoHealth, which uses text messages to deliver critical healthcare information to new and soon-to-be parents across Kenya.

explains Schwartz. Look for technology that makes it easier, faster, or safer to provide and access healthcare.
​

… Might not look like health at first glance. Jim Davidson, IC Board chair, reminds us to look beyond the health sector to find industries and companies that have a significant impact on the health of global communities.

Davidson shares. Jibu, which uses a franchise model to make clean drinking water affordable in East African slums, excites Jim in terms of impact and investing. He adds, “They’re operating well and hitting their targets, so at scale they could positively affect health across Africa and that would make a great investment.” Look into water, agriculture, and energy as additional sectors where impact investing can improve health around the world.


… Innovate on investment models as well. Healthcare delivery via health clinics was a core focus for Investor Days: Nairobi, and we found many exciting examples of clinics that bring quality healthcare to Kenyan communities. However, concerns emerged about the exit potential for clinic models: What is scale? How big do clinic networks need to grow? Are there prospective acquirers? A visit with Jacaranda Health, a network of maternal and child hospitals in peri-urban areas, inspired Stephanie Wilson to bring her US medical real estate background into her global health impact investing strategy. “Good investments are not all about equity. Jacaranda has a strong model, superior care, and the potential to grow. Obtaining and outfitting their facilities is a huge challenge, so structuring this investment around real estate could help them where they need it most and create an interesting risk/return profile for an investor as well,” says Wilson. Look beyond traditional notions of equity and debt to real estate and revenue-based financing as appropriate capital solutions for compelling global health enterprises.


Compelling global health entrepreneurs…


… Are internationally savvy. Global health entrepreneurship is a tall order: companies need to understand healthcare delivery, how to grow a sustainable business, and the emerging markets in which they operate. Our trip attendees discovered that Kenya has a growing population that has developed medical and business skills around the world and returned home to build global healthcare companies in the communities they know best. Stephanie Wilson was impressed by Jacaranda Health as a business and by its Chief Medical Officer Faith Muigai, highlighting that “she’s a Kenyan-born, US-trained doctor and business woman who is bringing 20+ years working in the US health system back to Kenya and building a management team that balances the business side of Jacaranda’s hospital system.” Look for entrepreneurs and management teams that understand both their models and their markets.
​

… Have relationship potential.

explains Luni Libes, maintaining that “trips like ours to Nairobi are much more impactful to investors than virtual meetings and standard pitch events.” Libes has the benefit of spending hundreds of hours with social enterprises through his Fledge accelerator program, including a relationship that came to life when we visited cohort company, GreenChar. GreenChar produces and sells clean charcoal briquettes, and Investor Days: Nairobi gave attendees a chance to observe Founder Tom Osborn engage with his team, customers, investors, and stakeholders. International investments are challenging because interaction is rarely face-to-face, so take advantage of limited time on the ground to get a feel for entrepreneurs as people. Look for those with the potential to build trusting relationships that can grow over time and distance.
​

IC members have found and invested in global health companies in East Africa and are calling for more impact investors to get involved. Bill Harrington shares,

Forus Health, a Bangalore-based SEAD innovator since 2014, develops and sells affordable technology to diagnose eye diseases that can be easily used by minimally trained technicians, making eye care in lower- income settings more accessible. Since 2013, Forus has installed its devices in over 1,100 locations in 25 countries. This year, Forus has set its sights on entering the U.S. market.

Forus’ flagship product, the 3nethra classic imaging device, is an affordable, robust, and portable eye-screening device that allows a health worker to screen a patient in less than 5 minutes for five major eye conditions. To date, over 2 million patients have been screened by the device, which received 510K-exempt clearance from the U.S. Federal Drug Administration (FDA) earlier this year, paving the way for Forus to market the device in the U.S. FDA clearance is important from a manufacturing and quality standpoint globally because it signifies that Forus adheres to the highest international medical device manufacturing standards. The ability to enter the US market is also important from a sales and strategic partnerships perspective.

According to Connor Larkin, who leads U.S. business development for Forus, a large underserved patient base in the U.S. still lacks affordable ophthalmic screening. For example, diabetes-induced blindness (diabetic retinopathy) afflicts over 30% of the 25 million people with diabetes in the U.S. and currently is the leading cause of working age blindness between the ages of 20 and 65. An estimated 50% or more people with diabetes in the U.S. do not receive a medically-required annual retinal screening exam due to lack of accessibility and cost. “In India, we already have around 400 devices linked to a telemedicine-enabled diabetic retinopathy screening network, and plan to replicate a similar system in the U.S. with the goal of ending this type of blindness,” Larkin said.

Since launching in the U.S. in February, Forus has already sold and installed  more than 10 devices across multiple states and Puerto Rico. “We plan to pursue multiple market segments, including optometry, opticians, general ophthalmologists, retinal specialists, and teaching hospital institutions – all of which are represented in our current client base – as well as screening at the general physician/primary care level. The goal is to eventually make this type of screening accessible at all income brackets,” Larkin said.
​
Forus is planning to launch another device, 3nethra Neo, in early 2017. This lightweight device enables clinicians to capture high quality images of neonatal infants’ eyes, and is 1/3 the cost of previous options on the market. Forus Health hopes to be able to launch several more devices in the US by 2018, and to screen  20 million patients within the next three years. 

To Michelle Schwartz, an impact investor with a background in the healthcare industry, everything about Investor Days: Nairobi was new – the landscape, the culture, the expectations, and more.

Schwartz says. To that end, we went straight to our best source – IC members – to seek out their advice for investors who are considering an investment-oriented international trip.

Begin with the end in mind. Luni Libes has coached, mentored, and funded many international entrepreneurs (and even one who we met in Nairobi!) through his Fledge accelerator program, but IC Investor Days: Nairobi was Libes’ first experience in Africa. For someone going on his or her first impact investing trip, Libes suggests having an investment budget in mind before boarding the airplane.

When you focus on what you’ll invest in instead of if you’ll invest, your mindset shifts to possibility. Libes explains,

Before your trip begins, set an intention or create an investing goal.

Anticipate and appreciate cultural differences. A fascinating and fun part of the trip for Libes was to seek out the tiny but meaningful differences in how things work.

“The first of these was on the ride to the hotel from the airport, when the driver ignored the red light, and when asked, said it was just there to ‘make Nairobi pretty.’ Similar assumptions hide in plain sight across all interactions between people from different cultures, with no exceptions for business and investing,” says Libes. Understand that differences in culture transcend into business –exceptional hospitality, unhurried meetings, leisurely tea ceremonies, etc. – and appreciate that this is all part of the experience.

Start building your network on the ground. Stephanie Wilson has made international investments, traveled to East Africa twice, and serves on IC’s Global Health Advisory Board (GHAB). She started her work in Kenya by gathering introductions and building local relationships.

“I’ve learned the importance of tapping into resources in the States and establishing relationships with resources on the ground in East Africa. Before your trip, use local resources like the GHAB. Learn from them. Use them to find out who is on the ground. Then, on your first day, set up lunch and talk with those locals. Let their expertise begin your experience.” Tap your network now, and let referrals be your initial guide.

Be prepared to work together. Wilson focuses on building relationships that lead to collaborating on investments. She suggests investing with other people to better understand early-stage investing, the global health sector, and emerging international markets. Wilson says,

In February, six Investors’ Circle (IC) investor members convened at a rooftop restaurant in downtown Nairobi – four of them in Africa for the first time. Over a thousand hours, 50 meetings, eight company site visits, and one rocky rural bus ride later, the importance – and opportunity – of investing there was clear.

While impact investor interest in international investing is increasing, it’s difficult for US investors to understand the opportunities, challenges, and risks around investing in emerging markets. This Investor Days: Nairobi immersion trip was one of IC’s newest approaches to building international market and investment knowledge in East Africa’s global health landscape.

Through a partnership with Social Entrepreneurship Accelerator at Duke (SEAD), IC created this two-week immersion opportunity to overcome these investor challenges and to inform the global health impact investing ecosystem. SEAD brings together interdisciplinary partners through a coordinated effort across Duke University and leverages institutional relationships and networks to create an integrated global health social entrepreneurship hub for diverse stakeholders across the globe.

We brought six members to Nairobi with us. The agenda for Investor Days: Nairobi included attendance at the Sankalp Summit, engaging with local contacts on the ground in East Africa, and visiting with eight global health entrepreneurs over site visits. These three components of the trip sought to not only provide an immersion into the global health opportunities but also to dive deep into the landscape through education, forums, and meeting with prominent local investors and health care professionals.

The Sankalp Summit convened global inclusive development dialogues with entrepreneurs, impact investors, corporates, and governments and focused on spurring the entrepreneurship economy. It was here that IC members and staff led a sector-based conversation with over thirty attendees, participated in a sector showcase which resulted in two companies receiving IC investor interest, participated in the SEAD Report Launch Event, and attended a health panel led by Villgro Kenya, an early-stage social enterprise incubator that supports innovative healthcare businesses. The summit started conversations with entrepreneurs and investors that lasted the duration of the trip and continue today.

Two of the global health site visits were SEAD innovators, Afya Research and Jacaranda Health. Investors also met with a few later-stage companies, MicroEnsure, access.mobile, and Burn Manufacturing. These visits illustrated the potential for good health investments and allowed the investors to learn these entrepreneurs’ thoughts on the market opportunity. This range of stage was helpful for investors to experience and helped to inform their understanding of the ecosystem. Other site visits included Toto Health, Jibu, OneDegreeSolar, SunCulture, and GreenChar. When investors weren’t engaging with entrepreneurs, they were busy learning with and from locals. Attendees participated in i3N’s Capital Roundtable with seven local angel investors, had meetings with prominent local healthcare professionals, and hosted a happy hour with over 30 local investors.

You may read more IC member investor perspectives by visiting Luni Libe’s blog. There is much to learn about investing in East Africa specifically and in the global health sector broadly, and we will be using our Investor Days: Nairobi experience as the foundation for sharing and continuing these important conversations.

Stay tuned for more on the global health landscape, the challenges, the opportunities, and the potential for investment. Over the next four weeks, IC will release weekly blog posts with insights and takeaways from our travel, culminating in the official launch of our Global Health Interest Group on July 19th – all interested capital providers are welcome to join us, so please register for that webinar here. We look forward engaging with you in the coming weeks!