Gradian Health Systems

Gradian Health Systems: Equipping low-resource hospitals with the capacity to perform safe surgery

Year Founded:
Organization type: 
Project Stage:
$1 million - $5 million
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Gradian is a nonprofit social enterprise that equips hospitals to deliver anaesthetia safely, enabling quality surgical care in even the least-resourced facilities. Our Universal Anaesthesia Machine is a CE-certified device that operates in settings without reliable electricity & compressed oxygen.

WHAT IF - Inspiration: Write one sentence that describes a way that your project dares to ask, "WHAT IF?"

What if every person on the planet had access safe surgery and anaesthetic care, regardless of their income and geography?
About Project

Problem: What problem is this project trying to address?

Roughly 5 billion people lack access to adequate surgical and anaesthetic care that can prevent leading causes of death/disability. More people die from surgically treatable conditions than HIV, TB & malaria combined. This unnecessary death/disability will lead to an estimated $12.3 trillion in lost productivity from 2015-30. But due to infrastructural & technological challenges, surgery remains the “neglected stepchild of global public health."

Solution: What is the proposed solution? Please be specific!

The Universal Anaesthesia Machine is a CE-certified medical device that delivers safe anaesthesia in any hospital, including those where unreliable electricity & shortages of compressed medical gases keep conventional machines from functioning. With a built-in oxygen concentrator & capacity to pull oxygen from room air when there’s no power, it can overcome the infrastructural & technological challenges of surgery in low-resource settings. Due to its innovative design, low cost, high quality, & training & maintenance support provided by Gradian, the UAM has the potential to make safe surgery possible in the most challenging contexts, averting unnecessary death & disability & helping save trillions of dollars in lost economic productivity.


2014 Tech Awards (Nokia Health Category); 2015 AidEx Innovation Challenge (Best Commercial Entry); 2016 Africa Healthcare Awards (shortlisted for both Innovation of the Year and Medical Technology Company of the Year - to be announced in February 2016)
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

A pregnant woman enters a hospital in rural Uganda with a childbirth emergency. She needs surgery to save her life, but the hospital hasn't had oxygen in 3 weeks so the anaesthesia machine can’t work. Without anaesthesia, there is no surgery, so she must walk 3 hours to the nearest facility able to perform surgery. This delay could mean death or a lifetime of disability – both of which have long-lasting effects on her family and community, which no longer benefit from her household and economic contributions. With the reliability of the UAM, she would receive timely surgical care and, barring complications, her death/disability would be averted, allowing her to continue to be a productive member of her family, community and country.

Impact: What is the impact of the work to date? Also describe the projected future impact for the coming years.

So far, 130 UAMs have been installed in 128 hospitals in 22 countries around the world. We’ve trained 600+ technicians/clinicians in how to use the machine & provide ongoing support/maintenance to all our customers. All told, the UAM has contributed to nearly 100,000 safe surgeries. As we grow, we hope to reach thousands more patients with the surgical care they need to stay healthy. An upcoming study by Johns Hopkins on the UAM’s impact in workflow & safety in Sierra Leone found that “The presence of the UAM reportedly increased the ability & confidence of anaesthetist staff to provide general anaesthesia when required.” We’ve also built a distribution network that is creating jobs across our markets. After receiving training in sales & marketing, distributors become vital links in our supply chain, many building small businesses & creating sources of income for them & their families.

Spread Strategies: Moving forward, what are the main strategies for scaling impact?

We plan to expand our operations to SE Asia, other African countries & additional hospitals in our existing countries. Every hospital with an OR is a potential customer. We estimate that there are ~9,000-9,500 "potential customers" in sub-Saharan Africa alone. As we grow, it will be crucial to identify purchasers & customers that view safe surgery as a priority. We also plan to build out our portfolio, manufacturing & sourcing other products that can be sold through our distribution networks. Within 10 years, we want to be the go-to medical device company for resource-constrained hospitals.

Financial Sustainability Plan: What is this solution’s plan to ensure financial sustainability?

We operate as a nonprofit social enterprise funded by the Nick Simons Foundation. We sell the UAM at our manufacturing cost, which allows us to keep the price low and scale production to meet market demand. We use NSF's philanthropic dollars to support the machine through training & ongoing service. As we develop other markets/products, we plan to reduce our reliance on philanthropic funds with tiered pricing & diversified revenue among products.

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

The UAM has 4 main competitive advantages. Design: It's built for infrastructure-poor hospitals, so it works when conventional machines fail. Quality: It's a CE-certified machine (Europe’s equivalent of FDA approval). Cost: It's less expensive than most machines; while there are cheaper ones, none are designed for low-resource settings & certified by a global regulatory body. Support: Our service includes training for technicians/clinicians & maintenance support for customers/users, which keep long-term costs low & machines running - offerings often unavailable for donated/for-profit devices.

Founding Story

Prof. Paul Fenton was a surgeon at Queen Elizabeth Hospital in Malawi, which faced challenges in surgical care. Without reliable inputs like electricity & oxygen needed for anaesthesia machines, Fenton was often forced to postpone/refer surgeries. So he created a UAM prototype that combined multiple delivery modes to improve the safety & functionality of anaesthesia delivery under various infrastructure failures. The Nick Simons Foundation then refined Fenton’s prototype, obtained regulatory approval & market validation & spun off a subsidiary to distribute the UAM. NSF hired Erica Frenkel & Steve Rudy to turn Gradian into a viable company that could sell & support the UAM around the world.


Gradian currently has eight full-time employees and one full-time consultant based in Europe. Of the nine full-time staff, four (including the CEO) focus primarily on market development; two are responsible for customer support and technical service; two manage logistics, administration and finance; and one manages communications and marketing. Our staff features a heavy split between MBAs and public health experts – a combination that allows us to operate sustainably within our markets while maintaining an unwavering commitment to improving health of underserved populations. Our small core team is supplemented by a network of independent contractors and distributors. Contractors include the biomedical technicians we rely on for maintaining and servicing the UAM, while the distributors are often local small business owners with a deep knowledge of the market who, in many cases, become the face of Gradian among our purchasers and users.
Please confirm how you heard about the Unilever Awards:

Changemakers Website

Please confirm your role in the initiative (eg Founder/co-Founder) and your organisational title:

Co-Founder; Vice President of Business Strategy

Which of the 8 UN Global Goals (Sustainable Development Goals) pre-selected for this competition does your solution relate most closely to? [select all that apply]

Decent Work and Economic Growth.

Leadership and the Unilever Awards
Please provide examples of any previous entrepreneurial initiatives you have pioneered.

After taking a class on neighborhood economic development as a college freshman, I founded my own computer literacy organization for low-income residents in the West Philadelphia community. I ran that organization for four years before traveling to El Salvador as a Peace Corps Volunteer where, among other projects, I raised funds and brought in an expert to train women and men from across the country in rabbit breeding as a small business opportunity. While in graduate school I wrote a business plan for an enterprise that uses mobile technology to enhance community development in Colombia. In addition to co-founding Gradian, I am also a consultant for NYC-based start-ups through Accion East microfinance.

Beyond your existing team, who else are you working with to achieve your objectives, eg partners, advisors, mentors?

We work closely with the The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care to advocate political priority for surgical care as part of the global development agenda. Within countries, we have strong relationships with anesthesia societies to build local support and capacity for safe surgery. We've also formed a partnership with Harvard Medical School’s Program in Global Surgery and Social Change to deepen the work of the landmark Lancet Commission on Global Surgery.

Finally, we've begun to forge funding collaborations with foundations that support our work. For instance, the DAK Foundation is currently subsidizing the purchase of UAMs for hospitals in Uganda.