[SERIES] Digital Health in South America: Venezuela, Chile, Brazil, Argentina

After a special series about digital health in Asia and Africa covered in 2019, this series giving a glimpse in healthcare in South America. A shoutout goes to Unity Stoakes and Jennifer Hankin from StartUp Health, who made introductions to the speakers in these episodes. All of the companies are StartUp Health Transformers.

F097 Digital health in South America 1/4: “Only 0.1% of the population has been sequenced so far” (Adrian Turjanski, Bitgenia, Argentina)

Most of the Argentinian population comes from Europe. It is a centralized country with most things happening in Buenos Aires, says Adrian Turjanski, Chief Science Officer at Bitgenia - Argentinian startup bringing genomics closer to society.

With no large traditional industries in the country, Argentina prides itself with the large scientific community and leading IT development, says Turjanski.

Argentina is a federal republic and the health system is decentralized, meaning public health is administered at a municipal level. Primary health care is often independently managed by each city. Every citizen has the right to public healthcare with the option to choose a private one as well. But because Argentina is a developing country, it is lagging behind in tech development on many levels. For example, says Turjanski, globally, 3% of the population has been sequenced. In South America, only 0.1% of people have been sequenced, which is an opportunity for Bitgenia. There is no local competition, however, some European companies are entering the market, says Turjanski.

The promise of genetic research for South America

Bitgenia offers gene panels, whole exome, and whole-genome sequencing. The biggest challenges for the company are to raise awareness about genetics in society, promote consumer testing, and gain government support for health insurance to cover genetic testing. With 3.3 million people with rare diseases and 80% of them identifiable with the help of genetic testings, by raising the number of population sequenced, new data analysis and findings could significantly impact health outcomes, says Turjanski.

Tune in for the full discussion:

Some questions addressed:

The speakers of the show are very often from the US and Europe. So let’s start with the description of Argentina. How do you see it/would describe it in contract to the US or Europe?

How would you compare Argentina to other South American countries?

Argentina is a federal republic and the health system is decentralized, meaning public health is administered at a municipal level. Primary health care is often independently managed by each city. Do you know - does that impact quality of care based on where you live?

You are the chief science officer at Bitgenia, a company aiming at bringing genomics closer to society. What is the current state of genomics companies in South America? Is South America an exciting market for companies coming from other continents as well?
Your goal is to sequence 1 million people in South America in the next five years. That is 0,2 % of the population in South America. Can we elaborate on the context of this chosen number? First of all, what can a 0,2 percent sample tell you?

Where are you placing your bets with genomics development in the future?
Pharmacogenomics seems promising, but to which extent is it already developed and utilized in practice?

What about other genetics related technologies, such as CRISPR?

How much of AI are you already using? Are there any hypotheses that you have regarding what you aim to discover?

F098 Digital Health in South America 2/4: Colombia: “Doctors normally have two or three jobs” (Javier Cardona, 1Doc3, Colombia)

When Googling the Colombian healthcare system, there’s mostly praise about how good it is! The World Health Organization ranked Colombia’s healthcare system as number 22 in a review of 191 countries.

The reason for such high ranking, says Javier Cardona, is that everyone in the country is covered by health insurance. But while coverage is taken care of, access and workforce numbers are an issue.

According to the World Bank, there are 1,3 nurses and midwives per 1000 people in Colombia, which is an extremely small number. For comparison, Argentina has 2,6/1000, Brazil 10,1, USA 14,5, Venezuela 0.9, France 11,5. There are 2.08 doctors per 1000 people, which again is not a lot. Argentina has 4.0, Colombia 2.2, France 3,3, USA 2,6, Venezuela 1.9.

Cardona’s company 1DOC3 addresses the issue with an AI-assisted telemedicine platform that provides affordable access to doctors in seconds; no appointment needed. “60% of the visits to the emergency department could be resolved with other means. We are working with health insurance companies to relieve the pressure on the healthcare system by preventing unnecessary visits,” says Javier Cardona.

How is 1Doc3 used?

Javier Cardona.

There are several ways an individual can access the platform: either by paying food an individual consultation, which costs around 2 dollars; some employers pay for 1DOC3 as a benefit to their employees, and the company is also working with health insurance companies. Because 30-40% of consultations require in-person visits, 1Doc3 is making partnerships with local providers.

The company is currently operating in Mexico, Colombia, Perú, and Ecuador. While all the countries are Spanish speaking, each market provides users with local doctors that know the specific of their country’s healthcare system and are also able to refer people to the right healthcare provider.

It is normal for the doctors in the country to have two or three jobs for a decent living, which makes 1DOC3 an appealing earning opportunity.

Tune in for the full discussion:

Some questions addressed:

When Googling the Colombian healthcare system, there’s mostly praise about how good it is! The World Health Organization ranked Colombia’s healthcare system as number 22 in a review of 191 countries. From your perspective, what are the strong points and weaknesses of the system?

In your observation, how does the system take care of efficiency, given its high ranking by WHO?

Because of the Venezuela crisis, approximately 1.8 million Venezuelans have arrived in Colombia as of December 2019, according to Colombian official statistics (https://www.worldbank.org/en/country/colombia/overview). That is quite a high number. What impact does it have on healthcare, healthcare access and your solution specifically? What is required for an individual to become the user of 1Doc3?

1Doc3 has an active network of 500+ doctors in 4 countries (Mexico, Colombia, Perú & Ecuador). How would you assess the differences in culture and attitude towards healthcare? For example, if a public system is a norm, people don’t have trust issues with free services; however, if you need to pay for everything out of pocket, you might be skeptical about free services. So in that regard - what differences are you noticing from country to country, and does that influence your approach to a specific market?

When did you first start thinking about 1Doc3? What was the trigger?

From a more technical perspective: what is the availability of smartphones in Colombia? Does that influence solution design?

When talking about affordability: how much does a consultation or subscription cost? Can we put that in the perspective of the average income?

What are currently your biggest challenges?

What do you look forward to most at the moment? What is your Roadmap in terms of product development in the next five years? What direction do you wish to take?

F099 Digital health in South America 3/4: Brazil: “Our goal is to bring specialised cancer management EHR to underserved areas of the world” (Paulo, OTAWA Health)

Brazil has 209 million people. It is the fifth most populous country in the world. Since 1988 a health for all universal and comprehensive access to healthcare was established. The system is good at its core, says Paulo Fernando Buarque de Gusmão, who is the CEO of OTAWA Health. However, the public healthcare system lacks investments. "This resulted in a decrease in the number of beds in hospitals. Patients face challenges with healthcare access, access to medication, and consequently, those who can afford it, pay for private health insurance. There are 47 million people that have private health insurance," says Paulo Fernando Buarque de Gusmão.

An EHR made by medical specialists for specialists

OTAWA Health was officially founded in 2019, but in fact, the group of developers that work in the company, have been working on the product since 2007 at one of the most respected oncology clinics in Brazil - Centro de Combate ao Câncer. The team developed a comprehensive EHR for the continuum of cancer care management.

*The TNM system is the most widely used cancer staging system. Most hospitals and medical centers use the TNM system as their main method for cancer reporting.

A group of developers works closely with a multidisciplinary team of healthcare professionals: oncologists, nurses, pharmacists, nutritionists, and psychologists. Their product - OTWonco is a centralized multidisciplinary EHR combining predefined clinical pathways and protocols with TNM staging* and molecular markers for personalized decision support.

The solution efficiently helps professionals on their daily care routines. It also aggregates health information on a very rich data set for real-world evidence analysis.

The company's vision is to bring the oncology health record to underserved areas of the world, especially other parts of South America and Africa as universal healthcare cannot be universal while the huge gap between health technology assessment in use by high-income and low-income areas remains.

Some questions addressed:

Paulo, you have 20+ years of experience in IT, so you're looking at healthcare through that lens. So as a warm-up question - there is an understanding that IT people and clinicians are two different species, each with their own language. What have you learned through your experience in healthcare IT? How do you translate your thinking to clinicians?
Before we dive into cancer care's specifics and complexity, let's first describe Brazil and its healthcare. Brazil has 209 million people, it is the fifth most populous country in the world. Since 1988 a health for all' - universal and comprehensive access to healthcare was established. How does the healthcare look like from a user's perspective? How big of an issue are waiting times? Where is the system weakest and strongest, in general?
How would you assess the healthcare system in Brazil in comparison to healthcare in other SA countries? What do the differences mean for OTAWA and its solution? What kind of cultural challenges do you anticipate and needed localizations of the software?
There are over 6500 hospitals in Brazil, out of which 300 are specialized in oncology. How do they compare and where on the map is Centro de Combate ao Câncer - which OTAWA came from?
OTAWA health is a new startup; it was founded in 2019. However, the team has been working on a comprehensive EHR created by and for cancer care since 2007. Can you take us through the journey of detecting the need for a specialized EHR to the state you are in today?
We've mentioned that the team has been working on the project since 2007. In 12 years, a lot has happened in cancer research; for example, immunotherapies and gene testing have become reliable as decision support in medication prescribing. How closely are you following the pharmacological advancement of oncology? How does it affect your own development?
What moved the needle to start a separate company after 12 years of development?
Is your plan to expand to all the oncology medical centers in Brazil? Having a network with a rich pool of data count largely benefit cancer research in Brazil…?
What is your biggest challenge at the moment?
What is your current main hope/aspiration?

F100 Digital health in South America 4/4: Venezuela: “Many hospitals went from digital back to paper” (Luis Santiago, Pegasi)

Venezuela is a country in the current severe turmoil because of a political crisis that also turned into a medical crisis. At the beginning of 2019, the government refused to accept medical supplies from abroad through humanitarian organizations. By December 2019, 1.8 million people fled to Colombia.

PEGASI is an IT company specialized in digital health and the smart management of healthcare information. With a solid base in Venezuela, PEGASI is currently expanding into Chile and the Dominican Republic. In contrast to Venezuela, according to The Startup VC, Chile is perhaps one of the most attractive countries to form a startup in Latin America. CORFO offers seed money to startups from all over the world. In ten years, CORFO funded over 1,600 startups from 80 countries.

The CEO of PEGASI Luis Santiago, has been involved in the company since his teenage years because his father founded the company in 1992. While Luis pursued a different career path at first by studying journalism, he then dived into programming to be able to lead and develop the company further.

“Before the big crisis in Venezuela, in the peak time of market growth around 2014/2015 there were at least eight other IT companies that were providing solutions for healthcare. In 2016 many competitors left the country, leaving the hospital no choice but to switch back to paper,” explains Santiago. That was also the time when Pegasi started providing more institutions with services.

The impact of the crisis on society and industry

At the moment, the healthcare IT landscape in Venezuela is grim, says Luis Santiago. When the national crisis began, doctors and tech specialists were the first to leave the country. A lot of insurance companies closed down, giving people no choice but to try to get international health insurance. This is not easily affordable, since the average salary fell to 1.5 US dollars because of the devaluation. This means that many family members need to work to be able to cover basic living costs, explains Santiago, who currently leaves in Chile.

Luis Santiago moved to Chile when the company got the opportunity to take part in the Start-Up Chile program in 2019. As explained by Santiago, the Chilean market differs a lot from the Venezuelan one. The ecosystem is much more developed; the drive for development is driven by the awareness of entrepreneurs that they need to connect to each other and collaborate.

Your father launched a company in 1992, which ended up becoming one of the first and largest healthcare IT companies in Venezuela. This means you had quite a different entrepreneurial journey than most first time CEOs. You followed the company’s development for almost 20 years by now. What is the state of healthcare IT in Venezuela?
What is the level of healthcare digitization in the country in general?
Pegasi is based in Venezuela. What is the situation in Venezuela at the moment, taking that perspective in mind, topping it with COVID-19?
You are also working in Chile and the Dominican republic. How did you just these two countries as your next targets, why not Argentina or Brazil?
You reached Chile through the Startup Chile program in 2019. After a year and a half - what are your impressions of the healthcare market in Chile?
Can you compare the three countries you are present in terms of culture and development? Why didn’t you for example, expand to Brazil or Argentina (yet)?
Pegasi, in a simplified explanation, standardizes medical data to help patients, physicians, and service providers manage their information in a smart, accessible and secure manner. While doing that, data is aggregated and anonymized for real-time population health monitoring (e.g. endemic and epidemic disease tracking). Is this population health monitoring done on a country level, monitored by a national health institution?
Do patients need to consent for their data to be analyzed, even if anonymized, or is sharing mandatory?
Who are your buyers and decision-makers? Is it mostly healthcare executives or healthcare workers?
What is your biggest challenge at the moment?