Interview with Dr Joshua Kibera, CEO and co-founder of The Pathology Network (TPN).
Who is The Pathology Network (TPN)?
TPN is a Kenyan registered company that brings together pathologists into a working group and uses a membership-like business model to recruit hospitals that need pathology services – which is basically all hospitals. The pathology network recruits hospitals into its network as members, and uses a very unique business system to allow these hospitals to access our network of pathologists.
The field of pathology is confusing to many, with some associating it only with autopsies. Can you help us demystify the field of pathology?
Pathology is a branch in medical practice, just like surgery, gynaecology, or paediatrics. It is specific to the identification of disease in the living and in the dead. In the dead, forensic pathology focuses on the identification of disease that caused death – the cause of death is a disease process, and sometimes it’s trauma or something else. But a lot of pathology, actually, focuses on the identification of disease in the living.
“Pathology is a branch in medical practice, just like surgery, gynaecology, or pediatrics… [that] is specific to the identification of disease.”
There are pathologists who look at diseases of the blood (hematopathologists), those who look at chemical changes in the blood (clinical pathologists), and there are pathologists like me who look at tissue pathology, which includes solid diseases like cancers and tumors, growths, etc. (anatomical pathologists). These are all different branches of pathology, and each of them is a specialization on its own. It usually takes four or five years after graduating as a doctor to specialize in any one of them.
Does TPN focus on any particular one of these branches, or does it cover the whole spectrum?
I started TPN to basically address the challenges that we faced in our branch of pathology, anatomical pathology. A tumor is any growth in the body and it can be cancerous or non-cancerous. You can have something like tuberculosis that can cause a growth, or find that some fat accumulation in the body looks like a growth, which oftentimes can be worrisome. So how do you differentiate that from cancer? I think those of us who practice anatomical pathology are less than 100 in Kenya. How do you distribute all the work across the country equally among these 100 people? This is the problem we were trying to address, and so we brought some of these pathologists on board into TPN so that we could distribute the work within the community in the network (our members). We then realized that the network that we’ve created can be used to solve the problems other branches of pathology face but, at the moment, we haven’t optimized it for those branches yet. We wanted to make it work for anatomical pathology first.
“We are opting to look at quality first before looking at scale.”
What would it take to optimize TPN for other types of pathology?
It will take quite a bit of funding. Pathology is a very scientific discipline which needs vigorous testing, sometimes expensive equipment, and time to test systems to make sure that we are providing results of adequate quality. It’s not something that you can move quickly into without first having identified the right people who have the right skills, and systems to make sure that they will deliver appropriate quality at scale. You also have to ensure that there is a mechanism for detecting when this quality begins to fall below standards so that you maintain those adequate standards. If we say that somebody has cancer, and they don’t have it, that would be a very big blow to The Pathology Network. These are some of the reasons why we are opting to look at quality first before looking at scale.
What is the role of pathology generally in healthcare?
Pathology is the foundation of healthcare. Pathology is like your Excel program in finance – it helps you to make sense of the numbers that you’re seeing. We’re the ones who work in the background to make sure all those calculations are correct. If it was in the automotive industry, pathology would be the engine. It’s hidden away in a compartment but is the thing that is able to help the car move.
In the medical profession, nothing can happen without a lab diagnosis. Without a properly functioning lab in the background there is no way of practicing good medicine, because you won’t know what you’re treating. Without pathology, a doctor can’t make sense of what the patient is suffering from.
“Pathology is the foundation of healthcare… Without a properly functioning lab in the background there is no way of practicing good medicine, because you won’t know what you’re treating.”
What challenges in pathology is TPN trying to address, and how severe are they?
The unavailability of a pathologist delays access to treatment. Where it used to take a month to process a sample and deliver results, TPN has reduced that to 7 days (a 75% reduction in turnaround time). This then allows for discussions on treatment between patients and doctors to begin. Delays in diagnosis are very costly for patients. By the time a biopsy is collected, the patient was already unwell. As the patient is waiting for results, the tumor continues to grow. Delay in treatment increases the burden of cancer and death due to late treatment. It also makes treatment more expensive.
Why is digital pathology important? Who is likely going to benefit the most from this solution? What outcome do you want to achieve with this solution?
In the ‘80s and ‘90s, Kenya trained very few pathologists and the practice did not develop at par with other medical disciplines. As a result, there is currently a shortage of pathologists. Digital pathology addresses this problem. Through our system, 30 full-time pathologists could serve the whole of East Africa. Digital pathology allows for pathology to be practiced remotely while removing the need for a microscope. In some countries like the US and in Europe, digital pathology has been exclusively practiced for the last three years.
What are some of the successes you have had so far in addressing these challenges?
We identified the obstacles on the path to diagnosis and built software that links hospitals, labs, and pathologists in response. We convert a tissue into a report that is delivered to the doctor and the patient. This is achieved through a lean workflow process and a monitoring system that can accommodate large volumes of work but still maintain good quality and short turnaround times. We are currently serving 20 facilities at 500 tests per month, but we have the capacity to absorb much more work and we can analyse pap smears and complex samples like brain tumours.
Are there any key partners that have supported the delivery of this solution?
Joining the Villgro Africa incubation program gave us a huge boost in self confidence; it said that someone believed in us. Then there was the funding, which didn’t come with noise. There was no dictation of terms to us but we got asked a lot of critical questions that helped us to think through our work. We also got sales training and investment readiness support including financial modelling. All this has brought us closer to maturity.
Are there any challenges that you have encountered in your service delivery?
Getting the business model right was tough, especially as pioneers. Keeping the company running as we iterated and pivoted was also not easy. Creating the structures for rapid scaling has been challenging (i.e. building the software systems and finding the right talent). Also, hardware is quite expensive. For instance, a scanner costs $80,000 a piece, and many investors don’t understand the space, which has made fundraising difficult.
Who are the main competitors in your space?
Any lab out there is an indirect competitor, but it could also be a partner.
What do you hope to achieve in the next 5 years?
We would like to be in 11 countries in 5 years. In 10 years, we hope to be so entrenched in the market that we become like Google in our space.
Could you share some key learnings that you have picked up in your entrepreneurial journey and what advice would you give to a fellow entrepreneur in the healthcare sector?
Entrepreneurship is not for the fainthearted. Struggles will come. There was a moment I almost closed the company and returned to employment. As an entrepreneur, you will face that pivotal moment when you will have to decide to quit or stay the course. I had to decide that I will do this until it works.
Make sure you’re solving a real problem. Stay hungry to learn more. Walk with the right people. Finding the right co-founders and staff is striking gold because you can’t go it alone. Don’t be selfish with equity and power. Develop yourself. Go for entrepreneurship training. I attended an excellent entrepreneurship course by WYLDE that really enlightened me. Read books. Built to Last is a must read. I’ve also attended excellent entrepreneurship courses from the “university” of Youtube. There is so much good content you can find there. I’ve enjoyed listening to the likes of Eric Saintz and Reid Hoffman. There is no formula for success, there are only principles.
“Entrepreneurship is not for the fainthearted. Struggles will come… Make sure you’re solving a real problem. Stay hungry to learn more. Walk with the right people… Develop yourself.”
Globally, 830 women are lost every day due to pregnancy complications, the vast majority of which are preventable and treatable. In Uganda alone, 16 mothers and 94 babies are lost daily. Maternal mortality has been highlighted as a priority by the United Nations Sustainable Development Goals, including the target of providing universal access to sexual and reproductive healthcare services by 2030.
Many expectant mothers, especially those far from healthcare facilities, go through their pregnancies with very little information on whether what they are experiencing is normal or a cause for concern. Therefore, they are often unsure of whether or not to make the effort to visit a health facility. This can result in either spending significant time and money to see a medical professional unnecessarily or waiting too long to address complications. When a healthcare visit takes place when it is not needed, it is expensive for the patient, adds to the overcrowding in maternity wards, and increases the burden on medical professionals. When complications are addressed later than they should be, this can lead to expensive emergency interventions, such as c-sections, that could have been avoided, or even loss of life.
The root of this problem is a lack of access to information. The expectant mother often does not have information about what is going on in her body and, therefore, does not know when to be alarmed and when everything is progressing as it should. Medical professionals do not have information about the mothers who come to see them, making it challenging to triage and treat patients effectively.
Stephen Tashobya, the founder of Wekebere, understands this challenge on a personal level. He says he started Wekebere out of “both pain and passion” after his own sister died during childbirth. By the time she realized she was in labour, she was not able to travel the 100 kilometres to the nearest health facility and her complications were not addressed in time. As his family searched for the reasons why his sister died, he discovered that her case was not unique and that, in fact, many expectant mothers experience very similar challenges. Stephen, who was in his fourth year of university at the time, asked himself, “How do I use the skills attained in school to build a solution that can impact the community and tackle the real problems that are affecting people on the ground level?”
Teaming up with colleagues who had medical experience as well as programmers like himself, they came up with a device that allows expectant mothers to have information at their fingertips and provide better information to doctors. Their process began as any good invention should: by asking questions. They wanted to understand the root causes and what was actually needed on the ground. After visiting 27 hospitals and speaking with over 100 midwives and mothers, they realized they needed to come up with a solution that could collect and monitor physiological data from both the mother and the fetus and provide information to mothers and the necessary medical professionals.
When it comes to the medical device, they are currently on their fourth generation prototype, which can detect fetal movements, fetal heart rate, and uterine contractions. Their app, which users have already started using for knowledge sharing, is on Google Play Store. They will soon be launching a pilot study in Kawempe National Referral Hospital to ensure the efficacy and safety of their product, after which clinical trials will take place in several regions throughout Uganda.
“This innovation has the power to save so many lives, not only in Uganda, but also throughout Africa. The cost of the problem is also very high, and we believe Wekebere’s solution should help reduce it.” – Immanuel Momanyi, Senior Portfolio Manager at Villgro Africa
As Wekebere continues in the development of their innovation with the support of Villgro Africa, Stephen and his team ultimately hope that they will make an impact when it comes to tackling the root cause of the problem. They hope to reduce maternal and infant mortality as well as neonatal deaths, increase expectant mothers’ utilisation of health services, improve the speed and accuracy of health workers, and reduce healthcare expenses.
How to Do More With Less: Cost Cutting Development Strategies
On 1st July 2021, Villgro Africa held its second iteration of the Innovators Forum, a forum committed to building resilience through investment in biomedical and diagnostics innovation and manufacturing in Kenya. Titled “How To Design and Manufacture Ventilators in Kenya,” the discussion served as an accelerated case study on the development, approval and manufacturing of medical devices.
The conversation was rich, covering the many triumphs and challenges encountered by the brave souls who have ventured into the uncharted territory of medical device development — and did so in the middle of the COVID-19 pandemic, which has been marked by global supply chain upheavals. It was therefore no surprise that one of the challenges highlighted was the difficulty and cost of obtaining components and test equipment. The discussion brought to light the need for cost control, especially in the early proof-of-concept stage. Several opportunities for improvement were identified for the very new Kenyan medtech ecosystem. The following thoughts address the opportunity for cost-cutting in the prototyping stage, which could enable entrepreneurs to move faster towards their commercialization goals.
To keep the cost of developing a proof of concept low, entrepreneurs can (and definitely should) start their rapid prototyping with low-fidelity prototypes that are inexpensive and simply help communicate their ideas to users for quick feedback.
At the very beginning of a design/development process, these low-fidelity prototypes could be made out of inexpensive, easy-to-obtain materials such as wood, PVC pipes, duct tape, plastic sheets, etc. In the case of user interfaces, they can be simple PowerPoint mockups illustrating user interaction. As the user needs are better understood through feedback and observation, more functional and complete models can then be fabricated.
During the next stage, it may be that specific functionality needs to be proved out by building specific engineering models. These are often sub-systems that can be tested in isolation of the complete system. In the case of ventilators, a good example would be putting together a system to mix oxygen and medical air to test which type of valves and electronic drivers are flexible enough to meet user requirements. This level of development is very engineering heavy and although, ultimately, the functionality meets a user need, the purpose of the prototype is simply to prove technical feasibility.
At this point, things become less straight forward because, although it is not yet essential to have medical-grade components, the testing often has to be done with high-end components that will mimic the ultimate medical-grade functionality. These will often need to be imported, since the medical device supply chain is currently not fully supported locally. To reduce the cost of development, innovators can look into organizational assistance from bodies such as the Kenya Association of Manufacturers (KAM) that have access to the most current information on government subsidies and incentives for manufacturers. In the example of ventilators, KAM is able to work with innovators on duty remission for raw materials. This can result in tax savings that provide entrepreneurs additional funds for development.
Developing medical devices from initial concept to the point of bringing it to market is a long and complex process. By focusing on the larger picture and understanding the purpose of each step in the process, innovators can learn to prioritize in ways that reduce their costs without hindering their progress. By using a rapid prototyping approach and using appropriate levels of complexity in prototypes, innovators can have a more cost-effective development strategy. Additionally, government subsidies and incentives can further help by reducing the cost of expensive high-tech components.
You have completed one year as Villgro Africa’s CEO. How do you feel?
The year has gone by quite fast. I have settled into the new role quite well, thanks to having both Rob and Robert as my co-founders. Having a co-founding team makes life much easier compared to being a solo founder. We are very well aligned as a leadership and have built a world class team over the last few years. This is bound to improve with more female team members joining the leadership and gives me a lot of confidence. Overall, we have done quite well as an organization. Despite COVID-19, our portfolio companies’ performances have improved, with their revenues increasing by almost 30% and the funding they raised grew tremendously.
Our annual budget more than doubled within a year and we have sight of incubators we want to partner with in the Pan-African expansion plan. We have definitely overachieved in some areas so, overall, I feel good about where we are.
In your acceptance letter, you boldly declared that Villgro Africa would be at the forefront of driving the SDGs in Africa. What progress have you made towards this?
Achieving sustainable impact will require a village mentality. At the beginning of my term, Villgro Africa joined Afrilabs, a pan-African network of incubators. We also joined the Association of Startup Enablers in Kenya (ASSEK) and my co-founder Robert was elected as their chair. We are also in other member networks like the ANDE network, CHRead and Early Stage Capital Providers (ESCP). Collaborating with other actors allows you to share lessons, best practices and pipeline. Similar to a biological ecosystem where an organism can’t thrive on its own, we have learnt to rely on other ecosystem actors to work towards achieving the SGDs.
We have started testing the waters through the AI4D call, which was a Pan-African call for solutions based on artificial intelligence that attracted over 250 applications from over 20 countries across the continent. This is a testament that collaboration with other incubators in Africa is needed. We are also looking at expanding our board to make it more Pan-African. It’s more than just plugging in; we want to be more involved in the local ecosystems throughout the continent. Through our partnership with Villgro Global we have identified and started training 10 incubators within the continent using our playbook.
We had envisioned that if we could train around 10 incubators, then we might be able to build solid partnerships with some of them after training and do a joint Pan-African call for innovations. Our ethos is that when we come together, the entrepreneur wins. We are also very keen to learn from these partner incubators because they are on the ground and more anchored. It’s two-way traffic. As we partner with them, we will grow. Even our sector scope will broaden because most of them are sector agnostic.
Our current operations across East Africa are also diversifying. From the recently concluded ICIPE/BioInnovate program we selected three companies in Ethiopia for $20,000 each in grant funding. We also shortlisted 10 AI companies from 10 countries in Africa for a grant award of between $5,000 to $10,000 each. As we move further beyond East Africa, we will need local incubator partners in the new countries. AI allows the continent to leapfrog towards attaining the SGDs. It’s a sector that we can’t ignore. That’s why we have brought in Dr. Deogratias Mzurikwao to lead the AI vertical. Dr. Deo holds Ph.D. from the University of Kent on the Application of Artificial Intelligence in healthcare, under the commonwealth scholarship.
You mentioned the growth of portfolio companies. What are the lessons learnt from the growth in numbers?
We should be adaptive and willing to change operations. Pandemics and catastrophes give one an opportunity to evolve. Startups that evolved were able to increase their revenues. Some pivoted and came up with new products, like Flare. Others had to scale down their operations costs.
Listening to the customer’s needs is essential. It reached a point where patients wanted to be treated at home, so those that listened to their customers found an opportunity to start healthcare delivery services. Neopenda found an opportunity to redesign their neonatal remote monitoring wearable bands to adult bands to help monitor COVID-19 in order to reduce the risk of infections within facilities.
When COVID-19 came, it was an opportunity for us to step up and remain relevant even during this period. That is how we ended up with the call for COVID-19 innovations. For companies that rely on day-to-day sales, it made sense for them to scale down on their operation costs to extend their runway. But for us in healthcare, it was mostly a call to step on the pedal and increase our support. The pandemic cut both ways. While others were scaling down, others were scaling up.
It was also an opportunity for us to partner with other organizations so that if the clients one company was serving needed a different service, they would be able to partner with another organization that fills that need. For example, brick and mortar clinics serving walk-in clients who may desire at-home healthcare diagnosis saw an opportunity to partner with telemedicine companies that already had the platform set up.
Gender-wise, what measures have you and the leadership team put in place to help reduce the gap between female-led and male-led startups in the region?
For us to have gender balance, we need to look at where decisions are being made, as highlighted in the GALI report, which found out that entrepreneurship support organizations (ESOs) were widening the gender funding gap. To make our decision process favorable to women-led startups, we began by increasing women in our board. We have brought in Dr. Beatrice Murage and Ms. Ndeye Thiaw. We have also made some changes at the senior management level. We brought two fantastic ladies, Eng. Wambui Nyabero as the Chief Technology Officer and Franciscah Nzanga as Director of Operations.
The next level of change will be focusing on how to better target female-led enterprises. Naturally, men tend to be more aggressive and are more likely to apply for business plan competitions compared to their female counterparts. Our calls for applications attract male founded companies 80% of the time. We have to be very intentional in scouting more female led enterprises, especially in healthcare, if we want to reach more end beneficiaries. This can be underpinned by the fact that women have a better health seeking behaviour compared to men. They are likely to show up at a facility for a check up compared to men. This is more so for women with children. Therefore, a female startup founder understands the healthcare needs of other women much better.
What do you feel is the biggest strength of Villgro Africa right now?
Our biggest asset right now is the team. We have built a very talented team with multidisciplinary skill sets ranging from engineers to business analysts, healthcare researchers to AI experts, among others.
Our proven track record speaks for itself. We have a robust process of doing things. Very few incubators offer the kind of high-level support we give to our incubatees. We can use the term precision incubation to describe the process. Each founder gets specialized, customized support depending on their stage of enterprise development, their prior entrepreneurial experience, the type of innovation, etc. That’s how we are able to get 17 times the leverage on every dollar invested in our companies.
Paint a picture of where you see Villgro Africa and the startup ecosystem in the next one year.
In the next year, we see ourselves doing joint incubation programs in more than two regions, including SADC and West Africa. We have already seen Nigerian companies entering East Africa very successfully, and we want to help our companies scale across regions as a result of our expansion. For example, Ilara Health is keen to scale into Ethiopia and the SADC region. Even for companies that have graduated from our portfolio, like Turaco and others, we will be happy to help them scale in West Africa through partner incubators. I see a lot of intra-continental expansion happening as a result of the Africa Continental Free Trade Area (AfCTA) agreement that was signed recently, so it is the right time for us to scale.
We also want to scale our reach and impact. As one incubator, we have unlocked close to $20 million of follow-on funding for startups in the last 5 years. If you multiply that by 5 incubators, then we end up unlocking $100 million for African startups in the next 3-5 years through these partnerships. In terms of direct impact, we have been able to touch 2 million lives in East Africa in the last 5 years. If we work with 5 other incubators, we can increase that to 10 million lives. We will see a lot of leverage in terms of funding raised, impact, and expansion. Our incubatees should follow suit and we will be happy to help portfolio companies working with other incubators expand to new regions.
Since we don’t want to be both the goalkeeper and the referee, we are looking at external independent M&E partners who will ensure that the data we are reporting is verifiable. We do not want to just check SDG boxes but ensure that we remain very objective with our impact numbers.
As we move forward, we want to continue building on where we have come from and what we have learned along the way, while also being open to new and unexpected opportunities. We will stay committed to our vision of supporting innovators and continue to use every tool available to expand our impact and extend our reach. We remain open to partnering with organizations that want to be part of this common agenda of transforming lives throughout the continent.
Reflecting on 2021 thus far, it is impossible not to take the past 1.5 years of the COVID-19 pandemic into account. It has been filled with some of the greatest challenges our continent and world have faced, yet we also have plenty to celebrate as we reflect on our journey. Although the pandemic has been damaging to our communities and economies, it has also inspired a new commitment to innovations that have a positive impact.
Here are a few highlights from Villgro’s past year:
Of course, efforts to build an ecosystem for innovation were more challenging due to the pandemic, as the process of negotiating with stakeholders across various sectors in a virtual context proved difficult. However, we were able to establish relationships and are having ongoing conversations with relevant government bodies that are key in convening other stakeholder partners. Additionally, the Innovators Forum, a virtual event series exploring the challenges and opportunities for biomedical and diagnostic innovation and manufacturing, has been established and partnerships with other key stakeholders are taking shape.
The Villgro team is especially proud of the successful transition from Villgro Kenya to Villgro Africa. This took place to both reflect the continental expansion that was already taking place as well as to catalyse further expansion, establishing firm partnerships to extend our reach. Visibility and brand recognition across the continent has increased, which has been reflected in the wide geographic spread of media reports, incubation applications, and attention from funders and investors.
The circumstances of the past year have only reaffirmed the importance of our mission at Villgro Africa: to support startups with a global social impact focus in the African region. As we move forward, we remain committed to this mission and look forward to the partnerships and collaborations with you, our community, which are an essential feature of our success.