Tech-enabled distance rural primary care services
Tech-enabled distance rural primary care services
Business Model Description
Scale-up software solutions that allow for remote medical consultation and telemedicine, sold to consumers through a dynamic, per-user SaaS pricing model
Expected Impact
Include rural and remote populations into the healthcare system
How is this information gathered?
Investment opportunities with potential to contribute to sustainable development are based on country-level SDG Investor Maps.
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Country & Regions
- Brazil: Pará
- Brazil: Amazonas
Sector Classification
Health Care
Development need
Healthcare deficiencies are cited as Brazil's largest development need by nearly half of the population. Some of the main challenges mentioned are a lack of resources, both human and technical, and lack of productivity, leading to extensive delays in healthcare delivery (2) Brazil has scored 76.9 on SDG 3 (Good Health and Well-being) (1)
Policy priority
The new administration is addressing the healthcare system's main challenges, by vowing to increase efficiency in the system by digitizing medical records and removing restrictions for health professionals to serve both the public and private health care systems; proposing legislation to simplify the transfer process for foreign doctors who wish to work in Brazil (5)
Gender inequalities and marginalization issues
Health-related issues, such as non-communicable diseases, lack of access to family planning services, and maternal health complications, greatly impede women’s ability to engage in the workforce. (6)
Investment opportunities introduction
High potential revenues by providing affordable healthcare to the uninsured population with high targeted returns ranging between 15 and 20%.(16)
Key bottlenecks introduction
Lack of resources and productivity leading to extensive delays
Health Care Providers
Development need
Brazil's new administration has cut healthcare expenditure by over US$ 2 billion in 2019, down to US$ 31 billion (4) putting a strain on the system which is characterized by poor quality factors. Patients in the public health system are twice as likely to die from infections than patients in the private health system (10) (13)
Policy priority
Public sector has repeatedly stressed the objective of making the public healthcare system more efficient and allow professionals to by allowing public and give flexibility to professionals to work in both public and private health care provision
Gender inequalities and marginalization issues
Maternal mortality rates in Brazil are five to ten times higher than countries of comparable economic status. Two of the greatest challenges are the high prevalence of cesarean section (c-section) and unsafe abortions. (6)
Investment opportunities introduction
Since 2015, nearly 3M people have lost private health plan coverage, driven by the economic crisis (8), putting additional pressure on the public healthcare system, but also increasing the opportunity for non-plan coverage models (e.g., pay-as-you-go)
Health Care Delivery
Pipeline Opportunity
Tech-enabled distance rural primary care services
Scale-up software solutions that allow for remote medical consultation and telemedicine, sold to consumers through a dynamic, per-user SaaS pricing model
Business Case
Market Size and Environment
6 million people unattended in Pará and Amazonas
The unattended population in Pará and Amazonas is over 6 million people (9)
Indicative Return
20% - 25%
Benchmark investors consulted in this vertical have target returns of 18-25% (8)
Investment Timeframe
Short Term (0–5 years)
Technology is readily available and medical suppliers are already providing online services, which is expected to lead to cash generation in the short term, based on conducted research
Ticket Size
USD 1 million - USD 10 million
Market Risks & Scale Obstacles
Business - Business Model Unproven
Business - Supply Chain Constraints
Market - Highly Regulated
Impact Case
Sustainable Development Need
Brazil showcases high inequality in healthcare coverage across regions and between urban and rural settings: 56% of Brazil's rural population does not have access to health insurance, vs. 22% in urban Brazil (7)
Inequitable health coverage leads to 10% of children in the North of Brazil not making it through their first year of life, vs. the 3.1% national average (7)
Gender & Marginalisation
Maternal mortality rates in Brazil are five to ten times higher than countries of comparable economic status. Two of the greatest challenges are the high prevalence of cesarean section (c-section) and unsafe abortions. (6)
Expected Development Outcome
Provide critical preventive, primary and secondary health care services to patients in parts of the country that are either remote and / or not covered by the public healthcare system (10)
Reduce costs of access to primary healthcare, including waiting time and transport costs (10)
Gender & Marginalisation
Increase women's access to affordable healthcare services, reducing maternal mortality ratios
Resolving health-related issues, such as non-communicable diseases, lack of access to family planning services, and maternal health complications, which greatly impede women’s ability to engage in the workforce
Primary SDGs addressed
3.4.1 Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease
3.8.1 Coverage of essential health services
3.8.2 Proportion of population with large household expenditures on health as a share of total household expenditure or income
Probability attributed to diseases: female 13.5%, male 20%, both 16.6% (2016) (16)
Universal health coverage 79% (2018) (16)
25.56% (2008) (16)
N/A
N/A
N/A
Secondary SDGs addressed
Directly impacted stakeholders
People
Indirectly impacted stakeholders
Public sector
Outcome Risks
Due to its impersonal nature, online healthcare delivery may reduce accountability between doctor and patient and lower the overall quality of healthcare delivery
Impact Risks
Execution risk: reduced accountability and quality of healthcare delivery due to the impersonal nature of online healthcare.
External risk: limited connectivity and digital literacy of target populations and regulations for telemedicine can limit breadth of impact
Impact Classification
What
The outcome is likely to be positive, important and intended because healthcare provision through scalable online channels could include rural and remote populations into the healthcare system
Risk
External factors such as limited connectivity and digital literacy of target populations and the fact that telemedicine is undergoing legal scrutiny may limit breadth of impact
Impact Thesis
Include rural and remote populations into the healthcare system
Enabling Environment
Policy Environment
(Federal Medicine Council (CFM)): has overruled a February bill that liberalized telemedicine. The 2002 status quo remains: telemedicine can be used for consultations, education and research but not for the prevention of diseases, injuries and health promotion (14)
Financial Environment
Financial incentives: ProFarma, a BNDES program, provides credit to health-related R&D projects
Other incentives: Programs such as Finep or Inova Saude offer credit lines for telemedicine solutions
Regulatory Environment
(Brazilian National Medicine Council (Conselho Federal de Medicina, CFM)): passed a bill in February 2019 allowing for online consultation, remote surgery and remote diagnostics (13)
(National Health Technological Innovation Policy (PNITS)): Political instrument supporting health technology development, offers some risk off-setting arrangements.
Marketplace Participants
Private Sector
Bravia, Brasil Telemedicina, Telelaudo, Ventrix, NeoMed
Government
Conselho Federal de Medicina (CFM)
Non-Profit
Rede Universitária de Telemedicina (Rute), Associação Brasileira de Hospitais Universitários (Abrahue)
Target Locations
Brazil: Pará
Brazil: Amazonas
References
- (1) Bertelsmann Stiftung, 2019, https://dashboards.sdgindex.org/#/BRA
- (2) Pardee Center, 2017, https://pardee.du.edu/sites/default/files/BRAZILReportPardeeCenter%20%281%29.pdf
- (3) Estado de São Paulo, 2019, https://politica.estadao.com.br/noticias/geral,analise-o-que-esperar-do-governo-bolsonaro-na-area-da-saude,70002662565
- (4) Núcleo de Acompanhamento de Políticas Públicas, 2019, https://fpabramo.org.br/wp-content/uploads/2019/04/napp-saude-100-dias.pdf
- (5) Poder 360, 2019, https://www.poder360.com.br/governo/cfm-pede-que-bolsonaro-crie-carreira-de-medico-de-estado/
- (6) Sarah B. Barnes & Elizabeth Wang. "Healthy Women, Healthy Economies: A Look at Brazil" https://www.wilsoncenter.org/sites/default/files/media/documents/publication/healthy_women_healthy_economies_a_look_at_brazil.pdf
- (7) Saúde Debate, 2018, http://www.scielo.br/pdf/sdeb/v42nspe1/0103-1104-sdeb-42-spe01-0302.pdf
- (8) Dalberg interviews, 2019
- (9) Saúde Debate 2018, http://www.scielo.br/pdf/sdeb/v42nspe1/0103-1104-sdeb-42-spe01-0081.pdf
- (10) Olhar Digital, 2019, https://olhardigital.com.br/noticia/cfm-regulamenta-telemedicina-no-brasil-veja-como-vai-funcionar/82291
- (11) Agência Brasília, 2019, https://agenciabrasilia.df.gov.br/2019/06/26/igesdf-inaugura-unidade-de-telemedicina-no-hospital-de-base/
- (12) IBGE ODS, 2019, https://indicadoresods.ibge.gov.br/objetivo6/indicador611
- (13) Setor Saúde, 2019, https://setorsaude.com.br/nova-regulamentacao-da-telemedicina-no-brasil-sofrera-mudancas/
- (14) Saúde Business, 2019, https://saudebusiness.com/mercado/a-nova-era-da-telemedicina-no-brasil/
- (15) BNDES, 2018, https://web.bndes.gov.br/bib/jspui/bitstream/1408/16040/3/PRLiv214078_Visao_2035_compl_P.pdf
- (16) United Nations Global SDG Database. “SDG Indicators.” https://unstats.un.org/sdgs/indicators/database/.
- (17) Consulate General of the Kingdom of the Netherlands. 2016. "Brazil eHealth – Overview, Trends & Opportunities” https://www.rvo.nl/sites/default/files/2017/01/Brazil%20Healthcare%20-%20Guilherme%20Hummel.pdf
- (18) Lemos, Manoel. “Brazil’s Healthtech Sector Is New Hot Spot.” TechCrunch (blog). https://social.techcrunch.com/2018/10/09/brazils-healthtech-sector-is-new-hot-spot/.