社会企业

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Approximately 100 words left (800 characters). I have no agricultural, food security and health issues background and if these capacities are added to what I have I will be able to address all the issues related to the well being of youths especially youth caregivers and their siblings. This will sustain my programs as I will be working with healthy beneficiaries and that will be an added value too to my product.

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With regards to farming, establishing human-nature harmony and the wellness and vitality of our farming communities, the added capacity would enable the expanse of our work, such that our scope increases. It would also increase the quality of our work through the enabling of expertise and/or technologies. Greater capacity in the dimension of full nourishment foods would enable the development of such food products (through AgriFoods), which in turn impacts on the wellness and vitality of our customers.

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Access to information is the main problem that we propose to solve. Low-income populations have too much trouble finding information and guidelines that meet their needs. Our purpose is to facilitate access and guide people in what they need.

The search engine for health resources we created aims to facilitate access to health resources, bringing the result to the user in 3 simple steps. First, you search the name of the service you need (drug, vaccine, consultation, exam, materials, equipment, health facilities). In the second step, we ask in which city, region or district you want to find it. And the third step already brings the results of the geo locations and guidelines necessary to obtain the demanded service/resource.

Our vision is to be the primary means of access to health resources for the population. We have an universe of over 140 million people who do not have health insurance in Brazil and need to use the resources available in the SUS (the Brazilian public health system). Our goal is to inform and guide an increasingly larger number of people through various platforms: Internet, telephone, in person.

Aware, guide and facilitate access to health resources for the population.

Companies with employees who do not have the benefit of the health plan, and individuals in general.

We approach our clients stating that, through the correct guidelines and access to quality resources, individuals' well being will be optimized and they will have a better performance at work and in their personal life.

Educating the population about their health rights and how to get them through the search service on the Internet, and by nurses on the phone.

Today's competitors focus on health information, instead of access information. These competitors could hinder our growth if they begin to offer the same kind of guidance to access that Saútil does. But as the market is very big and we have been pioneers, our main concern is to provide quality service to people.

One challenge we have is the cultural barrier of low-income people, especially elderlies who do not have much access to technology. That's the reason why we provide the same kind of guidance by phone, so it is accessible to all.
We also have the challenge of showing the public that despite the difficulties in accessing, SUS also has positives points. Today the population has a widespread view that the SUS does not work. We can change that perception with the help from SUS itself and through partnership with government, which we do not have yet.

Our growth strategy is based on the expansion of facilities and access platforms. We know that in Brazil we have approximately 55 million users of the classes C and D (low/medium classes). On the other hand, we have more than 200 million enabled telephone lines.

To have all the access information compiled for research made ​​by our representatives, and also by the users through the search engine.

Build a high performance service structure, scalable, to meet both an increasingly larger number of people, and also increasingly systematic research information.

In the short term this year, we might have 50 thousand people served by Saútil. In the long term - 3 years - 1 million people.

In the next 12 months, we will define success relative to the efficacy of our pilot programs. Specifically, our ability to design, plan, and carry out the programs.

After obtaining the vehicle, we have set out specific goals. At the end of year 1 of operations (2 years from now), we should have completed 52,000 total food desert transactions, served 4,000 food desert residents, implemented a 10% subsidy for EBT users. At the end of year 2 (3 years from now), we should have added a second bus, completed 120,000 total food desert transactions, served 8,000 food desert residents, implemented a 15% subsidy for EBT users.

We will measure success in terms of the number of food desert transactions, food desert residents served, and the amount of EBT sales we are able to subsidize. Though corporate sales are part of our model, the true focus of our venture is to improve access to food in these chronic low access areas.

We have strong relationship with the undergraduate community at Washington University in St. Louis and the medical student community at St. Louis University. We will recruit members from these populations. Furthermore, we hope to excite community members as well and plan to draw volunteers and members from here as well

While the venture is young, we will draw new leaders from existing volunteers and supporters. This will allow continuity of mission and vision. Due to our affiliation with both St. Louis University and Washington University in St. Louis, we will have a renewing pool of students to recruit to the venture.

As the venture matures, it is likely that the scale will require full time employees with significant management experience. As we approach this stage, we will work closely with our board to determine potential leaders.

Our blend of corporate memberships, high-income memberships, and low-income memberships will enable the venture to remain financially sustainable following the front end capital. This is demonstrated in our financial projections.

East Meets West's mission is to find innovative solutions to challenging development problems. We attempt to address the severe lack of appropriate medical technology built for the developing world. These are devices that are low-cost, durable (resisting heat and humidity), use little to no consumables, have manuals in the local language, readily available technical assistance, local training for medical practitioners to properly operate the devices, and appropriate monitoring to evaluate impact.

Due to market failures, the "bottom of the pyramid" has been an untapped market for locally appropriate medical devices, and we feel that our suite of BOL equipment has and will continue to prosper in that niche.

Breath of Life's solution to the lack of healthcare in emerging markets is to provide custom-designed, low-cost equipment to hospitals, and targeted training to medical personnel, to save the lives of infants suffering from common newborn pathologies. To ensure sustainability, BOL works to strengthen linkages with local health authorities to involve them in integrating these technologies into the larger health system.

When EMW provides a hospital in the developing world with the full range of Breath of Life equipment, this complex of innovative technologies constitutes a cost-effective, durable, low-maintenance NICU, or Neonatal Intensive Care Unit to effectively treat premature infants and other newborns with life-threatening health conditions.

While global under-five child mortality rates have been decreasing in recent decades, the rate of neonatal mortality has been on the rise. Annually, 43% of all child deaths occur in the first four weeks of life, the crucial neonatal period. Yet typically, newborn care is the branch of medicine with the least investment, research and innovation.

The Breath of Life program aims is to equip and empower medical institutions at all levels to provide appropriate, responsive newborn care, from national hospitals to regional facilities and clinics throughout the developing world. The strategy starts with the provision of equipment and training at the highest, most centralized level, then expanding out to train staff and supply facilities in more remote areas.

East Meets West's Breath of Life (BOL) program develops customized, clinical solutions to significantly reduce neonatal mortality and morbidity in developing countries. Our value proposition is as follows:

Locally manufactured by MTTS (Medical Techology Transfer Service)
Instructions, controls, and manuals in local language
Replacement parts easily obtained
Accessible technical support and maintenance
Tested in conditions of actual use and appropriately adapted
Durable and low maintenance
Low-cost
Not reliant on expensive consumables
Warrantied (3 years, no questions asked)
Scalable for each country, hospital, clinic conditions

Public and private neonatal hospitals and clinics in the developing world with high level of births, mortality and morbidity rates. Ministries of health, local and provincial governments.

Contact with local doctors to become advocates of the BOL program. The appeal of the BOL suite of medical devices that are functional and incorporated with technical assistance and monitoring
CPAP to address respiratory distress syndrome (RDS)
LED phototherapy machine to treat neonatal jaundice
Infant resuscitation station
Portable “bilibed” to provide both phototherapy treatment and heat
Pulse oximeters to measure oxygen levels in the blood
Hand sanitizers

Breath of Life concentrates its resources on designing and distributing equipment solely for the critical newborn period, because by supplying the basic package of equipment and providing first-rate training for the medical personnel who will use it, many lives can be saved.

BOL distributes equipment designed and produced by EMW technical partner MTTS (Medical Technology Transfer Services), which conducts its research and development in the field. Machines based on globally developed designs are designed for local conditions, tested in real clinics and hospitals, then adjusted. Local manufacture means manuals and controls in local languages and easy access to parts and technical help. BOL machines are durable, easy to use, and don't use expensive consumables— ensures sustainability.

As EMW and BOL continues to grow, we expect that other medical device manufacturers will see the potential of addressing the urgent need of locally appropriate medical technology. We see this as encouraging, in that the BOL program model is flexible to work with other devices as appropriate. EMW's area of strength is our ability to identify market failures in the medical infrastructure, and make linkages to partners, funders and manufacturers to develop an impactful and sustainable health delivery system for newborn babies.

As with many NGOs, our challenge is to further scale our work with the limited resources (financial, human) available. We address this constraint by constantly looking for local partnerships that are aligned and mutually beneficial, where ever we choose to expand.

Our strategy is continue to identify markets that have a large potential for growth and impact (Myanmar, for example).

We continue to develop MTTS as a enterprise focused on effective and innovative solutions to medical device manufacturing and distribution.

Our BOL staff are actively looking to expand in other countries as appropriate, leveraging our experience and expertise in implementing BOL in eight countries to date.

-number of BOL devices installed
-use and maintenance of devices in hospitals and clinics
-number of new countries to expand

Short term (2 years): Expansion and establishment of BOL program to another region, such as West Africa, with local manufacturing and technical assistance.

Long term (5 years): Along with partnerships with private enterprise/local government/medical institutions, have a global presence in emerging markets to distribute, install and implement the BOL model.

The problem is that our nation does not understand and treat addiction like any other chronic disease. This is at the root of our nation’s most destructive health, social, and safety problems and a tremendous economic drain on the private and public sectors. More than 22 million Americans suffer from addiction, which represents nearly 10% of people ages 12 and up. Yet, nearly 90% of those who need help don’t receive treatment in a given year, and about 75% will never get help in their lifetimes. The failures are inextricably linked to the way health care is delivered and paid for in America. The current “acute” model of care is due in large part to decades of regulations and public policy that created a payment system based on volumes instead of outcomes.

Our solution is focused on systemic and sustainable change that disrupts the status quo by attacking the underlying shortcomings of the public and social service sector approaches to addiction. Our solution is scaled community-by-community via a network of affiliates. We essentially work with multiple community sectors to create a recovery-oriented system of care. Although we have learned a tremendous amount since our first affiliate started in 2009, we have no cookie cutter model for scaling. Rather, we work with community leaders to tailor the Face It TOGETHER model to meet the specific needs and circumstances of each respective community. The conceptual essence of our model is the affiliate’s mission: to initiate and sustain addiction recovery for dramatically more people.

We marry social mission with innovation and business discipline to fundamentally transform the way our nation deals with this addiction. Our bold vision is a nation that understands and treats addiction the same as any other chronic disease. The mission is to empower communities with innovative, proven, and sustainable tools to attract millions of Americans to recovery from addiction. The mission of the affiliate complements that of Face It TOGETHER: to dramatically increase both the number of individuals and families in recovery and the quality and accessibility of services by creating a recovery-oriented system of care. Affiliate leaders must be social entrepreneurs.

Inputs: Include community leaders, entrepreneurs, available Face It TOGETHER products and tools, recover volunteers
Activities: Health care provider partnerships, employer partnerships, awareness program, advocacy activities, recovery support services, evaluation
Outputs: More people initiating and sustaining recovery, better access to peer-based quality services, more "recovery capital" in a community, cost avoidance and savings by those with a financial stake in addiction
Outcomes:Elimination of addiction as a major public health problem, cultural change, educated and informed public, improved public health and safety, quality of life, and economic development

Adopters of our model are communities. Community leaders spearhead adoption. We lead a community through four-phase community adoption process. We are about social change in all private and public sectors of a community. The current and projected demand for societal change around addiction is enormous. So ultimately, the customers are people suffering from addiction. In addition, about one-in-four children under the age of 18 will at some point live with a parent with an addiction problem. These children are at substantially greater risk of school failure, mental health and behavior problems and addiction. Moreover, addiction among parents is a contributing factor for between one- and two-thirds of maltreated children in the child welfare system.

With respect to scaling the model to create a national network of affiliates, we are pursuing multiple approaches simultaneously. One is through partnerships with integrated health providers. Strategic business planning is underway with Sanford Health, an integrated health care provider with facilities in North and South Dakota, Minnesota, Iowa, and Nebraska. We are piloting with Sanford in Thief River Falls, MN, and currently defining the terms of the partnership. We are also exploring scaling to communities via community leader relationships, and via large, multi-state employers. . Through it all, there is one mandatory and indisputable principle: no matter the means of proliferation, people with an entrepreneurial spirit must embrace and lead the efforts.

Primary activities are 1) continual improvement of the first affiliate (the beta site), 2) scaling the model, and 3) development and building capacity. With respect to the first activity, the first affiliate has six lines of business: 1) health provider initiative, a partnership between our affiliate and local health care provider in the build out of the recovery oriented system of care; 2) Employer Initiative to extend the recovery community into the workplace, adding value to the private sector through reduced absenteeism, attrition, higher quality, and improved safety; 3) Awareness Program designed to reduce fear and stigma; 4) Advocacy for addiction chronic care with other community sectors; 5) peer-based recovery support services; and 6) evaluation program.

We perceive no direct peers or competitors for Face It TOGETHER®, nor do we anticipate problems from them. There simply is no other team of social entrepreneurs articulating the big problems and meaningful and sustainable solutions relating to addiction. Notwithstanding the above, it is likely that organizations within one or more of these fields may view us as competition. Arguably, the most likely source of that confusion will come from the emerging field of recovery community organizations (www.facesandvoicesofrecovery.org). Overall, these organizations contribute to the fragmented nature of our nation’s addiction treatment and recovery infrastructure. Most track progress through conventional measures of success, and are guided by researchers and payors.

The primary need is growth capital. So during 2012, we began executing a comprehensive and cohesive plan focusing on organizations that fund venture philanthropy and social entrepreneurs. At the same time, we continue to seek funds from donors at the local and regional level. While it states the obvious, our greatest "internal" risk is an inability to attract and retain the human and financial capital needed to execute our mission and proliferate our model. Close behind this is curse of the entrepreneur's DNA to underestimate the magnitude of the challenges an early stage enterprise faces in addressing an issue of this scope while upheaval is occurring all around the issue. To help overcome this, we partner closely with those organizations that have a financial stake in solutions.

We are committed to a national model to transform nearly everything about addiction in communities across the country. We are working to achieve this through the creation of a national network of affiliates. But we must scale deep, by continually improving our first affiliate--the beta site. We scale out by partnering with health care providers, large employers, and others.

Experiences and measurements by our first affiliate demonstrate model effectiveness. We have developed a suite of products and tools for use by affiliates. Experiences from early-stage rollouts into other communities, show that the strongest advocates are those who see the disease everyday, such as employers, criminal justice officials, health care providers, and higher ed officials.

Overall, the primary growth objective is millions of individuals who have entered and are staying in addiction recovery. Success also is dozens of communities operating our model. This will provide tremendous benefits to our communities: saved lives, healthier and more stable families, reduced crime, lower business costs, and a better quality of life.

We are in the middle of several strategic and exciting discussions with health providers and community leader. The distribution plan is to rollout the model:
--in 2013, to two SD communities in partnership with the State of SD, and one MN community in partnership with Sanford Health.
--in 2014, three ND communities in partnership with Sanford Health.
--in 2015, Kansas City, Minneapolis/St. Paul, and a community TBD; each will be in partnership with a large regional or national distribution partner.
This plan is conservative, and shows only the communities in which scaling is underway and is highly likely in 2014 and 2015. Ongoing discussions could yield a far more aggressive plan.

The two biggest barriers preventing the blind from getting treatment are awareness and affordability.

Indonesia has 9100 primary care clinics but the clinics’ role is passive, treat only patients who come. Many blind patients don’t go to clinics, believing it is not treatable, doubtful over the quality or the treatment is not affordable.

The cost of cataract surgery is USD450/eye at public hospital, too prohibitive for the 120 million Indonesians (50% of the population) who earn less than USD2 a day* (*source: The Jakarta Post, Beyond Statistics of Poverty, Iin P. Handayani, February 13 2012)

Thus, surgery output is very low (averaging less than 10 cataract surgeries/hospital/week), making Indonesia the country with one of the lowest Cataract Surgical Rate in the world.

Solution: break the awareness and affordability barriers.

Awareness:
* Regular training to grass roots resources (Babinsa, village chiefs etc.)
*Use media to help improve public awareness on avoidable blindness.
* Increase accessibility to treatment by providing transportation to the hospital.
*Improve the surgery quality by training and incentivising medical and hospital staff.

Affordability:
* Make available high quality and affordable community eye hospitals.
* Targeted free (charity) cataract surgery to ensure the unreached is reached.
* Document surgery output and outcome; share this data with the public and policy makers. This is useful in advocating eye health to policy makers.

Our vision is a world where no one is blind needlessly.

Technology and accessible treatment are available for 80% of blindness (cataracts and refractive errors; source: Vision2020, International Agency for Prevention of Blindness).

No one should remain blind simply because of lack of awareness or inability to pay.

Utilize our international and local network to mobilize local community to take part in ending avoidable blindness.

ANV is a young organization with little resources but we have made good impact in local community and we are well known for high volume and high quality cataract surgeries. We are on the right track to take the work to the next level – drive the building of sustainable community eye hospitals.

We can collaborate with non-traditional partners (Babinsa and private social enterprise). We also collaborate with large INGOs - The Fred Hollows Foundation (www.hollows.org.au) to share knowledge and compliment each other’s work.

Our customers are:
1. Paying patients
2. Non-paying patients

Profits made from paying patients are used to fund subsidized or free treatment to the unreached.

The quality of treatment is the same for both paid and free patients. Only the level of comfort in service differentiates the two categories of patients.

Community education – basic eye health training for Babinsa, village chiefs, local women associations, religious and community leaders.

Publicity – media (radio), stage play, flyers, banners.

Making accessibility easy – provide scheduled and regular transportation to the hospitals.

Referral by shareholders – members of the private social enterprise and local ophthalmologists association are likely to refer customers to this hospital.

Word of mouth – high quality yet affordable treatment with good service experienced by patients will be invaluable referral for future patients.

- Community education on basic eye health.

- Build the capacity of local medical team by funding intensive quality training on cataract surgery.

- Equip trained local medical team with mobile equipment and encourage them to actively take part in community work including charity surgery events held by other NGOs.

- Drive private social enterprise to start the building of sustainable community eye hospitals.

- Connect the private social enterprise with other INGO (eg. The Fred Hollows Foundation) for additional support.

- Advocate policy makers by presenting record and output and outcome data from our activities.

There are no real comparable peers or competitors in what we try to do. Private for-profit eye clinics/hospitals may see us as a threat and competitor but it is a misguided because there are so many patients who are currently not serviced due to lack of awareness, trust (quality) and affordability.

For the middle to upper middle class patients, their trust in the local quality of surgeries is low. Many choose to have their cataract surgeries abroad even though it costs a lot (Malaysia, Singapore)

Our challenges are For-Profit eye hospitals who are going to view low cost high quality eye hospitals as a threat to their business and they might use local ophthalmologists association to influence the authority to stop this hospital from operating.

To overcome, we encourage private social enterprise to invite local ophthalmic association to have profit shares in this hospital.

The local ophthalmic association keep their share of profits. Only share of profits owned by private social enterprise will be used to subsidize free treatment for the poor.

As a result, local ophthalmologists will also help refer patients to this hospital and help it grow.

Overtime, the market will prove that the greater the public awareness, the more patients for everyone.

The strategy is to have one sustainable community eye hospital operating by year 2014, this gives us one year to secure crowd funding, recruit and train personnel, refurbish the hospital, increase the training to the community.

Once the hospital is running, the operating model can be quickly applied to the second and third hospital in other provinces.

There are public demands and interest from social enterprises.

First three years: new regions (other provinces)

After three years: with good reputation established, the hospital can:
* Expand the scope of treatment to include other eye sub-specialties.
* Reach to customers who currently seek treatment overseas.

The growth objectives we envisage are:
* To replicate this hospital model across Indonesia’s 33 provinces.
* To influence policy makers to place greater resources on eye health and put eye health on priority health list.

Please kindly refer to answers in 3.2.a and 3.2.b above.

In Kenya 9 out of 100 children will not live to see their fifth birthday. Wealth is a major determinate of health; the poor are less likely to access preventative and life-saving treatments, to use family planning, and to know their HIV status. This leads to unnecessary suffering and death from preventable and manageable conditions.

Slum conditions exacerbate disease, where 150 families can share a latrine, just over half of homes treat their water, and registered clinics are rare. The National Health Accounts finds that 30% of Kenyans do not seek care when sick, citing cost and access as key reasons. Most health-seeking behavior at the base of the pyramid centers around waiting for conditions to exacerbate and medication is usually purchased from informal, unregulated chemists.

Access Afya is creating a chain of ultra-mini-clinics that provide standardized outpatient services targeting the extreme poor. This model lowers barriers to good health by bringing care directly to the doorstep of the people who need it the most. Through community marketing and convenient proximity, patients are encouraged to have earlier, more frequent conversations about their health.

Each clinic has a registered nurse on site, supported by electronic health systems to manage patient files, stock, and communication. There is a consultation room, mini-lab, and a dispensary to fill prescriptions right on site. The clinic is open every day for ten hours. Patients pay small fees for each service, making the model self-sustainting.

There is a massive opportunity to reach the millions in poverty with a private, affordable, social health enterprise model. Despite common perceptions, there is a willingness to pay for health services at the base of the pyramid. This is evidenced by the prevalence of informal chemists profitably peddling medications in the slums, and the early successes of organizations around the world rolling out low-cost clinic models. More evidence is coming in through the Access Afya pilot site. Technology is transforming the way medical workers and facilities diagnose diseases, manage conditions, and engage with their patients, and we use these to lower costs and improve outcomes. After its pilot, Access Afya will expand with a branded chain of mini-clinics serving poor markets in Kenya and beyond.

Our clinics are cleaner, better stocked, and more convenient options than public health centers, while being more reliable sources of information and supplies than surrounding informal chemists. Diagnoses are accurate because the clinic has registered medical staff and rapid diagnostic tests. Care is friendlier because we have quality control checks and protocols for treatment and follow-up. We link to existing community groups, making payments easier by lumping them in with school fees or savings groups. The brand Access Afya will be a name people come to trust, providing a consistent, quality, convenient experience.

The Kenyan population is 43 million with around half living in poverty. We target these base of the pyramid customers in catchment areas of around 5,000. We emphasize services for women through prenatal outreach because women are often health decision makers in the household and likely to bring their children and refer their friends. A secondary target group is youth. 43% of Kenya’s population is under 15, they are a growing force in the country, and we reach them early through talks on sexual and reproductive health. Our customers have low, irregular incomes, work in the informal sector, live in households with an average size of five, and do not have health insurance.

The clinic markets itself partially through design and materials, which send a message about our permanence and commitment to quality. A permanent, physical structure in a dense, urban area is part of how we generate traffic for our services. Design elements include a front window where our community health worker can interact with passers-by and sell over the counter. We are open seven days a week, from 8:00am to 6:00pm.

Our core sales force is our cadre of community health workers—government appointed health volunteers who are already doing home-based care with an emphasis on HIV/AIDS. We equip these workers with information on Access Afya to facilitate referrals. The clinic team does health and outreach talks with existing community groups. We are experimenting with SMS promotions.

Access Afya is redefining each element of the health delivery value chain with rigorous attention to cost, quality, and scalability. We start with the physical space. The average plot size in the slums is 12 x 15 feet, meaning a full outpatient center needs to fit in this. We design and construct clinics, and negotiate land and lease arrangements and stock them with reliable supplies. Next, we recruit, hire, train, and support health staff. Pre-screening systems, group interviews, and mock consultations help find the right people. At the core of the model is excellent service delivery. Our staff gives consultations on common ailments, family planning, prenatal care, and perform first aid. We follow up with each patient via SMS reminding them of treatment and to check back in.

The largest competition is from informal chemists, who are unregulated but ubiquitous sellers of medication through small shacks. Competing with the unregulated drug supply chain, where up to a third of drugs are expired or stolen, we might not always win on price and must establish a reputation for quality. Chemists do not have the staff or supplies to offer our services. Quality private facilities are serving mostly upper-middle income and above. Large networks of healthcare providers could look to go down-market. These organizations have an advantage from their experience managing large healthcare organizations, but they are currently nowhere near our market. Additionally, we are tailoring our model for the urban poor, and will have an advantage in reaching this population.

Weak land rights in informal settlements is a risk to quickly expanding in number. Engaging the public sector in lease negotiations overseen by our chief to having Ministry of Health visit the site reduces this risk, and a mini-clinic model spreads the risk of any single land title across many sites. Infrastructure costs are low but concrete walls strong. A similar organization in the education space invested in a strong legal team, and we may have to do the same. The model rests on excellent staff, and rapid growth and replication. A competitive HR package and building positive organizational culture through staff meetings and training opportunities will help attract and retain staff. Our various technology systems are not integrated, and we need to invest in a seamless eHealth platform.

Following one additional pilot site in 2013, we will start to roll out the mini-clinic model in urban areas. An estimated 3 million Kenyans live in urban informal settlements, and we will start expanding within Nairobi and other urban areas. In parallel, we will pilot our rural model for bringing the same standard of care to rural communities, and use this data to craft a rural expansion plan.

In four months we have attracted 400 patients, residents of our target slum, who are paying small fees for health services. Countless more purchase supplies over the counter. Daily traffic and sales are increasing, and the market for primary care for the poor is vast. We've developed processes and protocols for operations and are ready to test these and our ability to run a mini-clinic chain.

Expansion goals are to explore variation in customer preferences in different areas, add new products and services and learn about willingness to pay for these, increase marketing and outreach, invest in protocol development and technology integration, and create a prototype for an improved clinic design. As we expand we will also explore economies of scale with resource accumulation and spreading

This year we are experimenting with new marketing and health financing strategies to increase clinic throughput, and will open one additional site. Medium term expansion will be through a cluster model, quickly opening up pods of mini-clinics in slums allowing us to leverage referral networks and relationships. We aim to be operating 15 mini-clinics in urban areas and have a rural pilot by the end of 2015.

Key milestones will be expanding traffic to 15 patients per day, increasing the core team, signing a bulk purchasing agreement with our largest supplier, obtaining the highest level of SafeCare certification illustrating our quality standards, partnering with at least one insurance provider, and signing up half of our patients for membership, packages, or health savings products.

In the absence of agents such as vaccines, effective TB control strategies in high burden endemic countries involves "reaching out" & identifying cases within communities that otherwise may go undetected and continue to spread the disease.Traditional TB diagnostics, involving visualization of TB bacilli in sputum samples under the microscope, have remained unchanged in over 100 years.This process is time-consuming and often leads to false results despite obtaining repeated samples.In addition,identification of resistant strains through cultures can take several weeks.Co-morbidities associated with TB progression include lung diseases eg asthma,pneuomnia & COPD as well as others such as diabetes.Across all these diseases,access to care,early detection & standardized treatment is lacking.

GeneXpert is a rapid diagnostic test that diagonses TB & drug-sensitivity within 2 hours thus enabling mass identification and treatment of TB cases.The cost of the test is too prohibitive for low-income populations and this also limits the number of tests that can be supported through donors.Our solution lay in mass-screening and community outreach through which sufficient number of "suspects" can be indentified for testing.Through this advanced commitment the test manufacturer was able to reduce the upfront price of the test from USD 17 to USD 10 whilst retaining sufficient profits margins.Through donor support,we offer GeneXpert testing free-of-cost to patients thus increasing access to care for poor patients whilst our business model seeks to sustain GeneXpert testing in the long-term.

We envision to scale-up and sustain GeneXpert based TB diagnostics for the poor through a social enterprise model.Diseases associated with latent TB activation and TB progression are common within these three cities and an urgent need to provide affordable care to patients is needed.

Therefore in addition to TB, we setup mass-screening, state-of-the-art diagnostic facilities and treatment programs for these conditions to provide a source of revenue.This innovative approach acknowledges the increased risk and poor outcomes of TB among such patients and improves care through integrated disease management. All revenue generated will be reinvested into the social enterprise in order to support an extensive network of community health workers and to purchase additional GeneXpert tests.

Our value proposition involves improving healthcare access and making it affordable for the poor. This includes:

-Free of cost screening for TB, Diabetes, Asthma and COPD
-Free of cost, rapid diagnostic test for TB
-Affordable, high-quality diagnostics such as Digital X-rays
-Standardized case-mangement
-Cheaper pharmacotherapy for diabetes and other diseases
-Home based treatment support through healthworkers.

Our customers include individuals of all demographics within the cities of Karachi, Dhaka and Jakarta. Our primary target population is the "working-poor". These individuals can be described as those with some disposable income to spare on healthcare but are likely to suffer catastrophic financial losses through expenditure in the private sector for diseases such as TB, without interventions.We have also partnered with local governments, charitable hospitals and NGOs to refer patients that are too poor to pay for any form of healthcare.

Nearly three-quarters of all healthcare across Pakistan, Bangladesh and Indonesia is delivered by the private sector.

Customers are reached through mass-screening activities in the private sector which are carried out by community workers.In addition, local cable TV, radio and road-side advertisments are used to inform patients of the availability of screening and diagnostic facilites.Other innovative strategies such as the use of loyalty programs and lottery-based incetives for purchasing diagnostic services are being explored by our group.

Our activities can be broadly categorized as: screening, diagnosis and treatment.Trained community-health workers screen individuals at private Family Physician (FP) clinics and hospitals using a mobile-phone app with algorithmic decision support that identifies "Suspects".These patients are referred to our diangostic facility where appropriate tests are conducted to confirm the diagnosis.Additionally, direct walk-ins to the center can also take place.The manager of each facility assigns the patient to a Treatment Support worker and refers them back to their FP (or assigns one in case of walk-ins).The treatment supporter provides home-based drug delivery,counsceling and ensure adherece to treatment and follow-up testing in line with clinically established guidelines.

No other groups to our knowledge in the private sector are involved in screening, case detection and treatment for these diseases within these three cities at this scale.Publicily financed TB control programs are present in each of these places and are important stakeholders within our innovation.An explicit aim of this intervention is to create sustainable public-private partnerships. In particular establish referral pathways where patients that are unable to pay for our program are managed.

Our potential competitors include other private labs and diagnostic centers, including ones for large tertiary care hospitals that frequently have lab collection units across the city.Whilst our VP is distinguished through free GeneXpert testing,pricing of other tests need to be carefully devised.

Logisitcal challenges of organizing diverse teams across three different cities has been a major challenge.Political tensions and security constraints, in particular for Karachi are a continuing source of concern and have led to dealys.

Organizationally, recruitment of appropriatly qualified staff has been difficult especially given high expenditures and low-proft margins in low-income populations. Planning ahead and anticipating future requirements have been the key to success whilst maintaing electronic documentation for processes such as SOPs have been useful to share across the three locations.

We aim to replicate our existing model of harnessing the private healthsector for improved TB case detection and management to other parts of Karachi through the social enterprise model. Similar social businesses are being setup in Dhaka and Jakarta which allows for an extension of our learnings to other countries and provides a natural growth startegy in the coming years.

Initial captial investments supported through grants allow for expansion locally where as strong linkages with in-country partner organizations in Dhaka and Jakarta allow us to take the social enterprise model forward to these cities.

Our major growth objective is to reach screening targets in order to "funnel" sufficent number of TB suspects into our diagnostic center.Identification of a large number of suspects will be required to maintain the low-cost of GeneXpert tests which is based on an advanced market commitment.Similar growth will be required for the remaining diseases since TB diagnosis and treatment will be free.

Over 1 million individuals were screened as part of the intial two TB Reach grants in Karach and Dhakai.For the third wave beginning in 2013, we aim to screen 9 million people over the course of 3 years in all 3 cities.Other key milestones for diagnosis and treatment include:

Suspects Identified for TB: 800,000
GeneXpert tests Consumed: 120,000
TB Drug Senstive Pts Treated: 18,000
TB Drug Resitant Pts Treated: 950

How to keep people healthy and productive for a longer time?

This is a huge challenge to be overcome in a world where its population is still growing, is getting older and is developing chronic diseases earlier. In spite of population is becoming a little bit wealthy in developing countries, in comparison to some years ago, its higher "purchase power" does not means necessarily healthy lifestyle.

Lack of integration between preventive programs and primary care, unawareness on how to prevent chronic diseases and low willingness to pay from individuals and health insurers, combined with budget restrictions in government, projects a catastrophic scenario that must be addressed today by an innovative approach.

Vitalbox shows to the participant the impact of personal decisions in the their own health, allowing them to understand that and decide what should be changed. After to provide some basic information, individuals receive a health map, showing the current risks to develop chronic diseases. Alerts to control some aspects of health (e.g. glucose, cholesterol), and to see a doctor when is recommended, are issued in accordance to the Health Ministry guidelines. Then, participants may run a "what-if" analysis to verify which behaviors are accountable to increase risks, allowing them to realize what should be changed. At this moment, individuals are ready to receive personalized guidance to reach their target and obtain more healthy days.

We believe that healthcare sector will face a major shift in the following years, adopting new business models and technologies, in to adjust to the modern world. Like, for instance, bank sector had some resistence to move to internet, health providers sooner or later will open their minds and embrace technology.

Vitalbox aims to be the first choice platform provider for Preventive Services and Remote Primary Care that will become the new standard. Our business model was designed to render Vitalbox sustainable, while the company grows in term of number of users, at the same time that laws and regulations are being adjusted to the new reality of health care.

Vitalbox currently approachs the market in three different ways:
- Allowing citizens and corporations to take advantage of government incentives
- Increasing company's productivity by driving corporate wellness programs
- Helping CPG, Pharma & Healthcare brands to occupy wellness whitespace by creating an emotional connection to consumers

Our customers are the general population, in spite of the fund to finance the delivery of Vitalbox at no cost to the population comes from companies who share our vision and have social responsibility in their DNA.

We reach customers trough the internet and mobile technologies

We have 3 priorities where our focus are on:
- Product development
- Early adopters customers (sponsors)
- Fundraising

Our business model offers a very unique and confortable position in the market. Of course there are some intersections with current offers, like Chronic Disease Management Programs and providers of EHR/EMR/PHR systems. There is also a some movement on the telecom industry, trying to position new products and services to health sector.

We are about 2 years on front of any competitor, but money can make it 6 months shorter. We cannot fail in execution in order to keep our advantage. Time to market will make the difference.

Current players are not so open to new approaches on healthcare. This is always a major risk. So, we are building a strong committee, with representatives from several areas that could be an opposition to preventive programs, and we are bringing them on board to discuss all conflicting aspects and have an advanced agreement prior to deliver new solutions to the society.

Raise money is hard when you have an innovative or unproven business model. So we must to overcome the conflict "chicken and egg": we need money to prove the model, investors need a proven model to invest money. We decided to keep our main focus on prove the model, although a investor, who is really willing to take the risk, is more than welcome.

We are concentrating our efforts to have more and more participants, but keeping the operational costs at the minimum level. This is helping us to create data to make value propositions more elaborated and also provide us insights to adjust some aspects of the platform or to create new features.

We have consistently tested (and failed in several ocasions), both the platform and business model. Although the core idea remains the same since the begining, live operations has showed us aspects that wouldn't work well in a large scale. So we have carefully reviewed and redesigned all points that could represent a risk when facing high volume.

We expect to have more than 500.000 participants at the end of this year, reaching 10 million by 2016, only in Brazil. We also plan to launch a worldwide version that will expand our addressable market on 2014.

As mentioned before, time to market is king. Increase the number of users is one one the most important thinks on the short term, as well as sign contracts that will fund our operations while we grow. We expect to have sponsorship 5 quotas sold in 2013 to finance operation, at the same time we grow with the corporate subscription model, which does not scale so fast, but offers a good revenue and margin. Again, 500.000 users in 2013 and 10 million by 2016 are the targets. Once we have that, we believe the market will be ready to receive primary care at distance.