Social Enterprise: CIES
Social Entrepreneur(s): Roberto Kikawa
Complement existing healthcare services with financially sustainable mobile units focused on providing free or highly affordable world-class specialized care.
The Innovation Explained:
Many countries utilize mobile health units to improve access to quality healthcare, especially in remote regions or slums where there are very few doctors per thousand inhabitants. Very few such units offer specialized care and even fewer use world-class technology and equipment. For the most part, mobile units are restricted to general check-ups or to offering one single specialty at best. Plus they have high operating costs, meaning they require perpetual subsidies.
In contrast, CIES has developed mobile health centres offering services in more than 10 medical specialties, including gastroenterology, cardiology, urology, mammography, endoscopy and more. Its health truck is billed as the world’s “biggest clinic on wheels”, incorporating exam and surgery rooms that can treat up 250 people a day with specialized care at an average cost of BRL 19 (US$ 10) each.
CIES has developed two additional models to complement the health truck. Its Health Box is a container-like structure measuring 7.5m x 2.5m, easily transportable by a tow truck, catamaran or raft to treat populations accessible only by river in places like the Upper Amazon Basin. It consists of a stand-alone mobile health system capable of addressing four to seven specialties and incorporates a 28m2 living space. Finally, its Health Van is a compact unit with equipment for digital radiology exams, ultrasounds and echocardiography that is specifically adapted for narrow streets, mountainous regions and steep terrain.
But building mobile units alone will not relieve enough pressure on the public health system. “We work in close partnership with local governments to influence public health policy,” explained Roberto Kikawa. “We deploy our units strategically, adapting the specializations on offer based on each population’s needs, and only after conducting a consultation process with many local stakeholders. Our aim is to complement primary healthcare and reduce the need for conducting diagnostic tests at small and medium-sized hospitals, freeing them up to focus on effective treatment of patients.”
In addition, to ease the strain of too few qualified specialists, CIES partners with research universities to train doctors. “A hospital will have an electrocardiogram machine, for example, but local doctors don’t know how to read it,” said Kikawa. “So we partner with university hospitals to train these doctors and provide continuous support.”
To date, CIES has treated over 120,000 patients and trained more than 5,500 health workers in 28 cities across six Brazilian states. Its model has attracted interest from 50 other cities in the country and abroad.
Why This Matters
In Brazil, 148 million people (76% of the population) depend upon the overburdened public health system. The disparity in medical service between regions is growing, putting remote populations at an increasing disadvantage. For example, in the Amazon region there is only one general practitioner per 8,000 inhabitants.
The state of specialized care in many emerging markets is even worse. Many patients must wait months or years to get specialized medical attention at public hospitals in larger cities, often at great personal cost.
Localize to replicate. Kikawa said, “The first step to replicating your model is to understand the local conditions. You need to develop knowledge about the local community’s habits, culture, social and economic conditions. Only then can you work alongside them and adapt your services.”
Ensure an alignment on vision and values with your investors and partners. “We have to make sure that potential investors are investing in us because they want to invest in a company with a social mission,” said Kikawa. “And it’s reflected in our governance. One investor came to study us, to look at our cash flow, our financial results, and asked to replicate our model in another country. Even though they said they prioritized our social mission, it quickly become clear they wanted to focus on growing the profits of the company rather than on the benefits to the community. So I said no.”