· Noor Medical recently progressed through the world’s largest social impact business accelerator, the Hult Business Accelerator and was one of the top six finalists chosen to present at the United Nations for the Hult prize of one million dollars.
· 17 million people die every year because of infections due to unsafe surgery. Health clinics that lack electricity entirely or suffer from frequent disruption cannot rely on conventional solutions to sterilise medical instruments because they’re reliant on large amounts of electricity.
· In addition to a lack of or inconsistent access to electricity, sub-par or expensive solutions are contributing to inadequate sterilisation of medical equipment across the developing world.
· Noor Medical has developed hybrid solar-thermal autoclaves that can be powered through a variety of easily accessible means, offering medical clinics affordable and reliable access to effective sterilisation.
· If you really want your [social] impact extended and sustainable then you want to be investing in social impact ventures that are for-profit. You want investors to know that that money is going to be continually working and producing results over a certain timeframe. Philanthropic capital can have a great impact that grows over time with that initial investment. People in [the philanthropy] space should be looking at social enterprises with a lot of interest to see how it can happen, their impact through scale.
Gina: Today’s guest on No Ordinary Business is Andrew Bonneau, the Co-Founder and COO of Noor Medical, a startup based in Freiburg, Germany dedicated to developing market-based ecosystems of care for safe surgery. Noor’s working to improve access to healthcare in areas not connected to the electricity grid.
Welcome Andrew, to No Ordinary Business, thanks so much for taking the time to speak with me today!
Andrew: Hi Gina, thank you, a pleasure to be here.
Gina: Before we get into Noor Medical, can you share a little bit about your own story and how you came to be where you are today?
Andrew: I’ve been involved in a number of different social enterprises. It began when I was an undergraduate at Pennsylvania State University. I had the opportunity to travel to Nyeri, Kenya, which is in the highlands. We worked with youth at a centre for disadvantaged children, street youth to help to get these kids to want an education. These opportunities often times involved agriculture or other youth enterprises. This was my foray into seeing how businesses could be run and some of the education behind it, that but it was mostly from the facilitation standpoint.
I then taught for two years in Philadelphia through the Teach for America Programme and during this time, I worked with youth developing sustainability ideas and social entrepreneurship for the communities. It was through this work that I discovered a city in Germany called Freiburg. Freiburg is one of the green capitals of the world. It has very progressive environmental policies developed over the last 50 years.
I decided to come here to study for my graduate programme. That’s when the world of entrepreneurship took more of a business focus. I participated in Climate-KIC. Climate-KIC is an incredible organisation funded through the European Innovation and Technology Fund and is focused on developing enterprises that are sustainable financially with a focus on fighting climate change. I worked with a number of different people there and different start-ups that went through accelerator programmes with preliminary funding, but they didn’t pan out as I hoped. As you go through these processes, you continually build your own network of other likeminded individuals who see business as a force for change.
One day I sat down for lunch with a few other students in my graduate programme. We were discussing the bureaucratic hurdles of registering a business in Germany. During our conversation we realised we shared similar aspiration to create social impact through business and operating in Sub-Saharan Africa because we all had experience there. This is where Noor Medical started forming.
Gina: So through this casual meeting you discovered that there were synergies and shared values that inspired the collaboration and the idea of Noor Medical?
Andrew: Yes. We each had unique and complimentary competencies. I’ve dealt a lot with organisational operations, with teachers and meetings with other stakeholders in the community and so forth. Federico Castillejo had a lot of experience with finance, especially in developing countries. Laila Berning also had experience working in businesses and had a wide network in developing areas. Through our individual endeavours, we realised that there were certain ingredients missing in the typical start up. It’s very important to have a strong team from the very beginning and we saw potential there to then collaborate together.
Gina: How did you decide to target health care?
Andrew: I’d say the biggest reason why we chose the healthcare field, in particular, dealing with sanitation issues and sterilisation of medical instruments is because Saji Zagha had worked with Adventist Health International and constructed health clinics in very rural areas in Chad so he’s quite attuned to the difficulties there. We identified this as a significant challenge and a significant opportunity. When we combined our networks together we realised maybe we could develop something here. In addition to the founders, our team includes engineers from the local areas we work and here in Germany.
Gina: Would you elaborate on Noor’s mission to increase access to healthcare?
Andrew: It’s about safe surgery and there’s a product ecosystem around that beyond technology to include sharing knowledge surrounding the technology that we provide. The technology we developed is the hybriclave (hybrid solar thermal electric autoclave); this is our pioneering product. It is designed to sterilise medical instruments regardless of the operating context so there’s multiple energy inputs that can run this device.
That allows the clinics to make sure that the medical instruments are sterile and safe for surgery. Surrounding that, we are able to provide what we call a ‘safe surgery package’, including ancillary products such as pre and post sterilisation detergents and cleaners.
Gina: Would give us some information on the extent of the challenge that you’re tackling?
Andrew: Globally, one out of three patients in the developing world suffer from post operation infections and many of these are due to this unsterile instruments or improper procedure. 17 million people die every year because of infections due to unsafe surgery. Close to 200,000 clinics that have this issue across Africa, excluding South Africa. A similar operating context exists in parts of Southeast Asia, in the Middle East, in Latin America, anywhere you have health clinics that lack electricity entirely or suffer from frequent disruption. These issues prevent them from relying on the conventional solutions to sterilise medical instruments because they’re reliant on large amounts of electricity.
Gina: How does the hybrid autoclave technology overcome these challenges?
Andrew: You need temperature of 121 degrees Celsius and pressures of at least 1.5 bar; those are World Health Organisation’s standards for sterilisation. Then you want to maintain those temperatures and pressures for about 30 minutes.
You can take our pressure vessel device and power it through a solar thermal collecting dish, or place it on other thermal sources such as a cook stove. Alternatively, there are electrical inputs if electricity is available, even a car battery can be used. We’re working on the newest prototype that can use 12-volt electrical input as well. We’re trying to design a device that has the greatest flexibility here to have capacity for sterilising medical instruments.
Gina: What’s the price point?
Andrew: What’s interesting across Kenya is that roughly half of the medical clinics are private and for profit. When you look at rural Uganda, those numbers are 90%. So, a large part of our customer segment actually has greater financial flexibility and autonomy when making important medical equipment purchase decisions. These are the most rapidly expanding health clinic networks in Sub-Saharan Africa. Because they’re privately operated, they are able to, in many instances, run very efficiently, they’re able to pull in funding from a variety of sources. That being said, our price point for our hybrid autoclave device including the solar thermal collecting dish is 750 USD, which has not been a problem for any of the clinics that we’ve reached out to thus far.
Gina: Is there a trend to privatise medical clinics across the developing world?
Andrew: This is an interesting question. We have the most robust data for Sub-Saharan Africa. When you look at places like Tanzania, Kenya, even Uganda, this is certainly the case. The private healthcare facilities are spreading quite rapidly. There are new models of franchising clinics and where a private operator takes over existing clinics, and brings them into their network, which increases efficiency. It’s a very interesting thing that’s happened.
Gina: What are the other solutions that are currently available?
Andrew: The first is what we call a tabletop autoclave. This is powered by electricity and is what you would find in a German hospital or a hospital in The United States. They might require somewhere between 1,200 – 1,500 watts of electricity.
The other option is you have your classic, like thermal pressure-cooking type of device. The problem here is that some of these are just simply not rated for the temperatures and pressures that are required for medical sterilisation. In other cases, what’s available right now in many places is simply subpar. Sometimes they just include a pressure gauge, it’s not high quality and so many of the clinic networks don’t utilize some of the devices that are available to them.
Other solutions include chemical sterilisers but they’re expensive. There’s also boiling water. This is the cheapest option. It takes a long time and you’re not able to achieve the temperature and the pressure required to kill all of the bacteria that you would want to get rid of to sterilise your instruments.
Gina: I understand that you’re set up as a for-profit. Can you talk a little bit about your business model and how you are becoming sustainable as an organisation?
Andrew: There are two principal revenue streams with a third quickly emerging. The first is through the sale of the hybrid autoclave device itself. The second is more of an annuity revenue stream through the safe surgery package, which includes helping clinics coordinate with different logistics organisations in their areas to make sure that they have a reliable access to other products. The new revenue stream revolves around collecting market data on these different clinic networks. How they’re operating, what are the conditions of the clinics, how often do they have electricity, what other logistical issues are there? We naturally collect all of this information through our operations and it is of interest to other healthcare providers that want to offer other products to these clinics.
Sub-Saharan Africa is one of the fastest growing healthcare markets in the world and the surgical market alone is worth over 3 billion USD and it’s growing. This isn’t going unnoticed by other companies that have hit their peak in the developed economies and are looking for other conduits for their products.
Gina: So the data that you collect can be sold to these interested companies operating in the sector?
Andrew: Correct. Every business wants to capture more data but when it comes down to it, you have to ask what does that mean? What does that look like? How are you collecting it? How are you packaging it? How do you place value on it and connect with the stakeholders that want it? That’s something that as a company we’re looking at because one of our biggest strengths is this comprehensive network of partners that we have. I’ve mentioned earlier that many of these private networks are already collecting a lot of data and very willing to share to make their operations more efficient and more effective. So it’s emerging.
Gina: How do you plan to scale as an organisation?
Andrew: It comes down to how we are targeting customers. When you look at the healthcare clinic networks, you have an operating entity that then services major hospitals connected with the satellite of different medical facilities. When it comes to the procurement of medical equipment and supplies, it is somewhat centralised. What that does for us is to reduce the points of contact while really maximising the sales potential within that network. That’s one aspect of scaling. The more partnerships you have or the greater the number of partnerships that you have, the more you can readily scale into the number of clinics you’re serving.
The other is in terms of other organisations that are already servicing hundreds, if not thousands of clinics. For instance, you have our partnership with Lifebox. They’re doing incredible work bringing oxygen monitors to healthcare hospitals in the developing world and they’re operating in 100 countries. When you have a partnership like that, there are doors that open up. For instance, the Tanzania Private Healthcare Federation have thousands of clinics in their network and it’s one organisation that can connect you.
Gina: What’s your vision for Noor in five years?
Andrew: We are guided by the vision to increase humanity’s access to equitable healthcare. What that means is to bring products that are uniquely adapted to a setting that has been neglected. So when we developed our autoclave, what we want it to do is provide a device that could produce the types of surgical outcomes that many people are used to in Europe, in the United States, elsewhere. This is the perspective we take when we’re developing what we call our ‘safe surgery product ecosystem’ and we want to continue to expand that. We start with a very important piece of equipment to sterilise medical instruments but that’s not where we’ll stop. We are able to offer other products around that, we’re going to continue to build that up to better serve the healthcare clinics.
In terms of geographic spread, our first two phases are centred around Uganda, Chad, and Gambia. In five years, we would like to be operating in Kenya, DRC, throughout the Sub-Saharan Africa region. Other large markets where there’s a lot of potential and a lot of need include India. There are about 150,000 healthcare clinics that lack electricity so expanding is not out of the question. We’re currently initiating partnerships in that region. In five years I’d like us to have a more substantial product base that can make safe surgery be realised in these resource-poor settings and I’d also like us to be operating in many more areas.
As an interesting side story, when we were testing our prototype in Uganda, we had a farmer walk by and inquire what the device did. He borrowed it for two weeks and used it to pasteurise mushroom spores for growing. This is an agricultural application we didn’t think of. so that was he was using it for. If a farmer or a farming collective came to us and said: we’d like five of these units, we’re going to utilise them to more effectively cultivate mushrooms, of course we will provide the technology to allow them to do that.
Gina: Interesting. So there may be different use cases that you haven’t considered that may continue to arise.
Andrew: Absolutely, yes.
Gina: I understand that Noor recent progressed through the world’s largest social impact business accelerator, the Hult Business Accelerator and that you were selected out of a group of 42 social enterprises along with five others to compete for the Hult prize. Congratulations! Would you share some of your experiences with the accelerator programme?
Andrew: To provide a bit more context, there were over 100,000 applicants, and out of those 100,000, you compete at 15 regional locations around the world. From those regional tournaments, 42 teams were selected to participate in the accelerator outside of London. From those 42, six teams were selected to compete at the United Nations headquarters. That process at the accelerator was extremely valuable to us as far as support. I think one of the most important things, if you’re looking at social entrepreneurship, is to build up your network of likeminded investors, partners, collaborators, and other businesses. It’s hugely important to learn from each other. To have this kind of incubative environment over six weeks was tremendously valuable for us.
Gina: Would you share some of the highlights?
Andrew: In addition to the network, there’s a lot of value to have experts and people that have decades of experience running their own businesses take a critical look at what you’re doing. To read through your business model, to critique it, to really look at how you’re pitching your idea to investors and help you better understand how to improve that. So, in addition to being connected with fantastic individuals, getting that feedback and working through and iterating the way you want to operate your business was extremely valuable for us.
There’s also a certain amount of knowledge that was made available regarding financial modelling, to some of the engineering aspects of what we were doing, so I suppose that knowledge helped propel us forward.
Gina: What’s your experience with getting the right type of support, financial and otherwise beyond the accelerator programme that is helping you to launch your solutions?
Andrew: Noor Medical has been involved in a few different accelerators at this point. One of them is ongoing now. I think this is crucial. Just getting into that network of people is very valuable. We joke sometimes that we don’t know how people started businesses when they didn’t have the Internet. Everything is at your fingertips.
Gina: For young enterprises or people with ideas, what advice do you have for them regarding getting on the right path?
Andrew: There was a professor at Ecole Polytechnic, I was in the Social Entrepreneurship Programme at the time and he said you need to know how to pick up on the weak signals. There’s opportunity all around you especially if you’re working. The biggest thing I’d have to say is learn how to pick up on those little opportunities that have huge potential. Many of them won’t pan out into anything, but you need to capitalise on the opportunities that you have all around you. Also getting in tune with networking with people and going to conferences, going to little café meet ups, having the courage to start a conversation about your idea and maybe look for partners. If you don’t do that then you’re not going to be able to move forward.
Gina: It does take a certain level of courage and vulnerability to put yourself out there, but it’s an essential component.
Andrew: Absolutely. I look at the enterprises I was engaged in before and I’ve had people straight up tell me to stop what you’re doing, it’s not worth it. Then other people said: no, keep trying what you’re doing. You have to take the good and the bad but learn from it all and get as many different perspectives as you can because everyone’s perspective is valuable to some extent.
Gina: How do you discern between what to follow and what not?
Andrew: For us, often it’s a team decision. Sometimes it’s a gut feeling, sometimes it’s ruthless prioritisation on how you want to operate and how you want to meet different milestones and what tasks you follow. You need to figure out as an organisation what’s going to have the quickest and greatest impact. For instance, I’ve been saying we’re exploring the Indian market right now, but we’re not nearly as close to having an established revenue stream as in Uganda. Of course most of our energy is going into looking and extending the opportunities we have in our existing operations.
Gina: What do you see is the principal risks to your organisation’s success?
Andrew: There are certain external risks that are inherent in our operating context. Some of those include political instability. We had to shut down our operations briefly in Uganda for a bit. We had internal risks in the beginning related to our actual competencies as the founding team. Besides Saji’s work in the healthcare field, none of us had medical experience as a doctor or a nurse. I did have experience working in hospital centre, but it was more related to hospital sustainability through my thesis work. In order to address this issue we’ve pulled together an advisory board with a lot of depth and experience in the medical field. I think this is important for organisations to look at your own competencies and the risks that your team may have because of their lack of let’s say professional experience in certain areas, you really want to complement that and address those risks by having very strong advisory board...
Gina: That’s active and meaningful.
Andrew: Yes, and share your values, your vision and willing to work with you. In the beginning, an advisory board, is basically pro bono work and so you really want to find that alignment. If you have it, this is such a valuable resource and something that you want to continue to expand to whatever is useful for you. We have 8 advisors that are quite active with us. And as I said, a lot of them come from medical background so it’s very valuable to us.
Gina: How do you define a social enterprise?
Andrew: Well, it’s one that through its operations is inherently double bottom line; meaning that you have the impact and the financial return, that you want to keep a business stable and growing, and at the same time, through your operations, you inherently have a positive social impact in some tangible way that should be measurable, that’s important.
Gina: What are necessities to help social enterprises succeed?
Andrew: In some respect, many social enterprises are operating in areas that can be deemed high risk. In our case, we’re operating in right now Sub-Saharan Africa and with that risk, there’s certain apprehension for investors. I think the big thing to look at is there’s also a huge amount of upside because these are the areas that are growing the fastest economically. China was seen as a place to have a tremendous amount of risk at one point but today there is so much investment there because now you have a growing middle class there.
In other cases, social enterprises that are working in countries that would be seen as less high risk, even the US, many of them might be nonprofit but I think investors need to realise that there’s a huge upside when it comes to social impact investment because of the high growth potential. Also, the perception to business is changing everywhere. When businesses can be seen as having positive social impact, especially if they are serving the millennial generation, they have a much better image and appeal to those consumers; it’s advantageous for them when they are social impact oriented.
Gina: Arguably, philanthropic capital is the ultimate risk capital. So for social enterprises, particularly those operating in risky emerging markets, there’s a tremendous opportunity for philanthropic capital to provide the risk capital to help an organisation to scale so that they can attract the less risk tolerant traditional commercial investors. Do you have any thoughts around that?
Andrew: I certainly think it’s a step in the right direction to try to connect investors that are looking for opportunity especially if they’re concerned about social impact. One of the important things to think about is that if you really want your impact extended and sustainable then you want to be investing in social impact ventures that are for-profit. You want investors to know that that money is going to be continually working and producing results over a certain timeframe. I think philanthropic capital can have a great impact and one that really grows over time with that initial investment. People in that space should be looking at social enterprises with a lot of interest to see how it can happen, their impact through scale.
Gina: What opportunities or challenges do you see for a major transformation to occur towards sustainability?
Andrew: I think it’s important to connect people with a business mindset to those that really have first hand knowledge on many of these issues that influence the progression of Sustainable Development Goals (SDGs). When you get the right people together, you identify opportunities, for high impact business ventures that are sustainable. But you need to be able to connect these different groups and knowledge, you need to get people talking and working together to create things. This is why I think the Hult Prize stood out. It’s trying to get the best and the brightest minds together to think about how you can tackle challenges in a sustainable way. But it doesn’t have to end there, this is something that any organisation that wants to have social impact should be looking at, how can we get the right people together to create a business and make sure that it grows and is sustainable.
Gina: Do you have any last thoughts that you want to share?
Andrew: One of the things I suppose that I’ve really taken away from my journey is the impact of partnerships that share a vision. I think there’s so much potential in the social impact space when you can bring together not only bright minds with a sustainable business model that can create a lot of impact organically, but also connect them with business leaders, even corporates, or investors that share a similar vision. There are some very powerful things that can happen to move the needle not only on the SDGs, but also economically in many of these regions. It’s about making those connections. I think the work that you are doing right now by interviewing different start-ups at various stages and perhaps connecting them with philanthropic capital or other interested parties is important in that process, so thank you.
Gina: Thank you. Thank you for taking the time to share information about Noor Medical.
If readers want to connect with you what’s the best way that they can reach you?
Andrew: We have all of our social media links on our website: www.noor-med.com. You can also follow us on Twitter @noor_medical and reach out to us.
Gina: I want to wish you and Noor Medical success in your endeavours and, all the best to you!
Andrew: Thank you, Gina.