Shifa International Hospitals Board Seat (Pakistan)

WDI’s Senior Director of Healthcare Delivery, Ioan Cleaton-Jones, is an independent director on the board of Shifa International Hospitals (Shifa), which is publicly listed on the Pakistan Stock Exchange. He was nominated to the board by the International Finance Corporation, which owns 12% of Shifa. Shifa’s flagship operation is the 550-bed Shifa International Hospital, an advanced teaching hospital treating complex medical conditions, located in Islamabad. This hospital is one of only four in Pakistan that are quality accredited by Joint Commission International (JCI), the international arm of the US Joint Commission which does quality assurance in US hospitals. It also serves as the teaching hospital for the private, nonprofit Shifa Tameer-e-Millat University, which has colleges of medicine, nursing, pharmacy, dentistry, medical technology and other healthcare-related disciplines. Additionally, Shifa has a second hospital in the city of Faisalabad, with another under construction in the same city. It also has outpatient medical centers, medical labs and pharmacies.

2024 Global Health Commercialization Competition

The William Davidson Institute at the University of Michigan is excited to announce the call for applications for the 2024 Global Health Commercialization Competition. This innovative competition serves as a dynamic platform for U-M faculty visionaries based on the Ann Arbor, Flint, and Dearborn campuses, who wish to contribute their scientific and technological solutions to the most pressing global health challenges of our time.

Co-hosted by the U-M Center for Global Health Equity (CGHE) and the William Davidson Institute (WDI), the competition showcases U-M’s commitment to global health equity, with a unique market-driven approach. The competition relies on interdisciplinary collaboration to create sustainable and impactful innovations, aiming to improve healthcare in low- and middle-income countries around the world.

Competition participants will present their business case within a 15-minute timeframe to a panel of industry experts, followed by an informative 10-minute Q&A session. The winning team will be awarded substantial funding of $30,000, provided jointly by the CGHE and the WDI. Additionally, the winning team will be eligible for further consultative services provided by MBA students from our Ross School of Business, as a part of the Multidisciplinary Action Projects (MAP) Program.

The competition also provides extensive proposal review, guidance, and mentorship to all its participants, increasing their likelihood of success. Each shortlisted team is also entitled to a one-on-one consultation session with a member of the Fast Forward Medical Innovation (FFMI) team, who will review the project and provide constructive recommendations to enhance its prospects.

Proposals are due by April 5, 2024, providing an opportunity for team participants to fine-tune their pitches and maximize their chances of success. Application forms, template presentations, and more information about the event is available on our website.

Read more about last year’s competition

 

The Global Fund works closely with countries to help them achieve long-term sustainability of health programs so they can maintain progress and continue to expand services after Global Fund support ends. WDI provided ad hoc support to Global Fund teams working with countries. Examples of this support include estimating the costs of providing specific types of services and developing frameworks that countries can use as they prepare to transition away from donor support.

ICL has been operating a successful lab in Ethiopia since 2004. In partnership with Cerba Lancet Africa and ICL, this project evaluated the feasibility of setting up a manufacturing hub and supply hub in Addis Ababa Ethiopia for diagnostics laboratories located throughout the continent.

 

OVERVIEW:

Just over the border with Yuma, Arizona is the town of San Luis Río Colorado in Sonora, Mexico. Like many border communities, agricultural jobs dominate the local economy. In this community of around 200,000, Grupo OSME is a privately run medical clinic business, founded by Dr. Raúl Payán, focused on serving the health needs of agricultural workers and their families. Despite the success of the business, Payán explains that securing the necessary financing to expand OSME into a hospital has been a major challenge. But in early 2023, the North American Development Bank (NADB) and Grupo OSME signed a US$14.2 million loan agreement to finance construction of the medical complex. The deal was completed after WDI conducted due diligence on OSME’s expansion and business plans, which gave NADB the expert advice it needed to proceed with financing. The project includes the design, construction and operation of a private hospital with space for 67 beds, an emergency room, operating rooms, intensive care unit, medical imaging and laboratory, along with a medical specialties center. As the following video feature explains, at the time of this project, WDI was also developing a Healthcare Delivery Management Training program, following a request from the World Bank Group’s International Finance Corporation. Following a positive experience of the due diligence process, OSME requested training for its management team from WDI. As a result, OSME and a Ghanaian hospital were the first two businesses to participate in the course.

 

Healthcare

From left to right: Dr. Joseph Kolars Director of the Center for Global Health Equity, pitch winners Marilyn Filter and Lyn Behnke of U-M Flint, and Paul Clyde, WDI President.
Competition judges WDI Healthcare Vice President Pascale Leroueil and Dr. Lee Schroder question a competitor.
Dr. Tom Kerppola presents his concept, Psoriasis RX.
Dr. Geoffrey Siwo pitches his business called SARATANI.
Parker Martin pitches epiSLS via Zoom.
The winning team Filter and Behnke demonstrate a prototype.
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A team focused on women’s health was named the winner in the 2023 Global Health Commercialization Competition sponsored by WDI and the Center for Global Health Equity

Pressing global health concerns, from undetected cancer to untreated psoriasis, require innovation to find powerful, lasting solutions. Often, that kind of innovation comes from small teams, start-up companies, and underfunded research groups — but, for these teams to be successful, they need support.

The William Davidson Institute (WDI) and the Center for Global Health Equity (CGHE) at the University of Michigan (U-M) came together recently to assist with filling in that piece of the equation. 

“There is a lot of research happening at the University of Michigan that could lead to impactful products or services in low- and middle-income countries,” said Paul Clyde, President of WDI and professor at the Ross School of Business. “Assisting and accelerating that work, through both funding and technical assistance, is very much in line with our mission.”

To support that growth, Fast Forward Medical Innovation, a department at the U-M Medical School, offered a professional development course with a focus on key business commercialization principles, which began in January 2023. For the first time this year, WDI  and CGHE followed this course with the Global Health Commercialization Competition. The competition invited faculty innovators to share their work on technical solutions to healthcare problems in emerging markets. Responses to the request for proposals were due on April 1, 2023. Four finalists were selected from the group, and each one presented their pitches to judges on May 22. 

Ultimately, one team took home a $30,000 prize and a chance to work with MBA students at the Ross School of Business to refine their plans.

The Power of Competition

Each proposal was centered on a clearly defined, unmet need in low- and middle-income countries (LMICs) and an innovative solution to enhance the lives of people in these regions. These solutions had to be commercially viable, and teams were required to outline market timelines.

In line with similar pitch competitions, presenters had the chance to highlight the significance of their work — and their own enthusiasm for the solutions. “These pitch competitions give the proposers the opportunity to sell their idea. Sometimes, when we’re reading proposals, we’re missing some of the passion. We’re missing the background about what makes these approaches exciting and relevant,” said Dr. Joseph C. Kolars, founding director of the Center for Global Health Equity and Senior Associate Dean and Professor at the University of Michigan Medical School. 

“It’s an easier way for us to understand the ‘why’,” he explained. 

Improving the Detection System

The first of the four teams to present at the competition, Saratani, is working to improve outcomes for cancer patients in Africa and taking aim at the lack of effective diagnostics. “One of the most important tools in ensuring better cancer outcomes is ensuring early cancer detection,” said Geoffrey Siwo, Research Assistant Professor of Internal Medicine at the U-M. His team also included Robert Karanja, Co-Founder and Chief Innovation Officer at Villgro Africa, and Deogratias Mzurikwao, AI Lead at Villgro Africa.

Saratani, named after the Swahili word for cancer, aims to diversify the biological data used to create the reference genome for molecular diagnostics, which is currently designed on Caucasian genetic data. This leaves massive gaps in the data, making it ripe for problematic diagnoses in Africa. Biobanks in Africa hold the information to fill this gap, but the bridge between them and pharmaceutical companies is missing. That’s where Saratani plans to step in. It would function as a marketplace, avoiding the overhead of running a biobank and capitalizing on the potential widespread deals that could be built between small biobanks and large pharmaceutical organizations.

While Siwo acknowledged that these biomarkers are not yet widely used for detection in Africa, he encouraged support for their preemptive and proactive work. “If we wait until these biomarkers are widely used, it will be very difficult to change, and we know they are inaccurate,” he explained.

Eliminating False Positives for Allergies

Penicillin allergies riddle medical records across the U.S., but it could be that up to 90% of people with this notation have been mistakenly diagnosed. This particular allergy marker keeps patients from treatments that protect against site infections during surgeries and superbug infections during hospital stays. In LMICs, false penicillin allergies could make certain treatments totally inaccessible.

EpiSLS aims to make allergy testing simpler, from correcting those false positives to providing clear answers about food allergies. Parker Martin, an MD and MBA student at the U-M, and Cory Cooney, a 2023 U-M MBA graduate, created a novel optical sensing technology that is compact, portable, and safe for any patient who might get an in-office allergy test. For clinics in emerging markets, the tool — which is currently patent pending — could mean bringing sustainable allergy testing to regions where there has not ever been an allergy specialist. 

Through their easy-to-administer and even-easier-to-read technology, the team is set on “bringing allergy testing into the 21st century across the world.”

Equalizing Results for Global Psoriasis Patients 

Psoriasis is a chronic disease that causes psychological and physical suffering when left untreated — and, in LMICs, this is often the case. While medications can treat many symptoms of the condition, they aren’t available in emerging economies. The costs are prohibitive, the production is not available, and the administration is a challenge. The Psoriasis RX team, led by Tom Kerppola, Professor of Biological Chemistry and Biophysics at the U-M, has set its sights on changing that dynamic.

“The problem is enormous,” Kerppola explained. There are about 100 million people suffering from psoriasis at the moment, and a substantial number are not finding any relief. “Regrettably, the only drugs used in low-income countries have very low efficacy, barely better than placebos,” he said, explaining that that’s not the case in high-income countries. “It’s clear we can do better.”

His research is centered on the Keap 1 protein, which could suppress inflammatory responses in skin fibroblasts without the risks of systemic infection that often come with immunosuppressant drugs. “This is not an untreatable condition,” Kerppola said, and he’s on his way to finding a treatment that works for patients regardless of geography.

Saving Lives with a Better Women’s Health Tool 

Over 70% of women around the world have not been screened for cervical cancer, and part of the reason is access to and comfort with the current medical tools required for these screenings. At the moment, the exam for cervical cancer screening requires a vaginal speculum, an exam table with stirrups, and a person who is physically and emotionally able to handle the exam. For many around the globe, those requirements just cannot be met.

In search of a way to reach these women, Marilyn Filter, a Certified Nurse Midwife and Associate Professor at the University of Michigan – Flint, and Lyn Behnke, Board Certified Family Nurse Practitioner, Psychiatric Nurse Practitioner, and associate professor at the U-M – Flint, built a new tool. The Femscope Calm Collect system is a slim cell-collection device with a scope that would replace the speculum and swab typically used. Providers can learn to use it in under an hour, it connects to a smartphone or computer, and patients can receive the exam without an exam table.

“We have made it our mission in life to improve patient outcomes,” explained Filter. Their  accessible tool is less expensive, easier to use, and more comfortable for many patients — all traits prioritized to improve screening rates for people around the globe.

The team is on its way to completing its pilot study to ensure biopsy results are of the same caliber as a traditional exam, then the product will move to a full clinical trial and eventually head to market around the globe, Filter said.

Choosing a Winner

Judges Ioan Cleaton-Jones, Senior Director of Healthcare Delivery at WDI, Pascale Leroueil, VP of Healthcare at WDI,  Amy Conger, Managing Director for the Center for Global Health Equity, Kolars, Brad Martin, Managing Director of Fast Forward Medical Information, and Dr. Lee Schroeder, Associate Professor of Chemical Pathology at the University of Michigan, faced the difficult task of choosing a winner. They considered the presentations, asked questions of the teams, and came to a decision: The Femscope team took home the prize.

Filter and Behnke plan to use the funds to purchase a 3D printer and fund its pilot test — the first essential steps to get the life-changing product into the market. Once there, “it will certainly save lives,” said Filter.

Healthcare

WDI turned to a well-tested private-sector practice to gain insights for a healthcare nonprofit working to develop an injectable to prevent malaria infections.

Medicines for Malaria Venture (MMV) is a nonprofit organization that works with partners to discover, develop and deliver new, effective, and affordable antimalarial drugs. One of MMV’s current projects is to develop a long-acting injectable product to protect children at risk of malaria. To ensure the product would achieve its goals, MMV needed clear guidance on what was most important to clinicians treating pediatric patients in malaria endemic countries. Getting there required understanding the business and real-world clinical side of taking a health product to market. This is familiar territory for WDI’s Healthcare team. 

Early Answers for Effective Drugs

To find the best path forward for its injectable, MMV sought answers from the drug’s final users. As it updated the injectable’s Target Product Profile (TPP)[CA1] , which is a compilation of the desired characteristics that will make up a product or device, MMV wanted to know what aspects of the new product would create the most value for clinicians administering it to children.

“When you develop a product, there are a number of elements that you can act on, and we wanted to know, from the local stakeholders, that is the people in the field, the decision-makers in the countries, what matters to them,” said Céline Audibert, Director of Market Research, Access & Product Management at MMV.

Audibert enlisted WDI’s help to better understand those elements. WDI’s Healthcare group wrote and carried out a survey in six African countries — some of the places that would benefit most from such a product. It was sent to healthcare professionals and public health officials, including those in charge of maintaining nationwide malaria-related efforts, in Cameroon, the Democratic Republic of Congo, Senegal, Ghana, Mali, and Nigeria. The survey covered a series of characteristics in an injectable product, including duration of protection, efficacy, number of injections, volume per injection, needle size, and tolerability. It laid out various options with different levels of each characteristic and asked participants which ones they would choose.

This method of choosing various combinations of parameters, rather than simply asking for a ranking, was intentional. It forced a choice, thereby providing a deeper understanding of the importance of various elements. When a large enough group of participants are pushed to make trade-offs, researchers can uncover what truly matters to the population.

Uncovering preferences for the product characteristics was the objective of the study — and key to developing an injectable that would be both adopted and effective. “In the past, there wasn’t a focus on the needs of a particular group of people, at the country or regional level,” said Pascale Leroueil, Vice President of Healthcare, who led the research. “The more we build Target Product Profiles specific to the countries where we’re introducing new products, the better.”

Pulling Private-Sector Factors into Public-Sector Work

WDI didn’t need to reinvent the wheel to develop its survey and methodology. The Institute has been gathering and analyzing data for decades to support business-centered solutions that drive economic growth and social freedom in low- and middle-income countries. In this case, it applied a well-tested system in a space where it had been rarely used.

“There are tried-and-true methods that are utilized in the private sector that we can apply to this area, and WDI does that better than most,” said Leroueil.

Leroueil and Ben Davis, WDI Senior Research Fellow, proposed the methodology to Audibert, who was familiar with it from her previous private-sector work. They both understood the core purpose behind the answers they sought. “There are reasons people want something,” explained Leroueil. Supply issues, cultural preferences, and geographic needs can drive the acceptance or denial of treatment — and no amount of after-the-fact adjustments will bring the same benefits as early-stage consideration.

The results were promising. “This research has confirmed some of the things we believe. There were characteristics where we had a lack of understanding internally and needed information from the field, so we had very clear answers on what matters and what doesn’t,” Audibert said.

The Value of Investing at the Start

The value of getting these answers at the start of the development process is broad and inclusive. Investors and donors can be sure their money is being put to effective use, drug development teams can focus their energy on the aspects of a product that matter most, and patients can get the drugs that serve them best.

Efficiencies in development matter to nonprofits like MMV. “When you have a restricted amount of money to invest, you need to know where you’re going to put that money,” said Audibert. MMV is currently working on funding for the continuation of the project, so this information will be used, in part, to demonstrate how the injectable can better meet the needs of the populations they plan to serve. 

The research also makes a major difference for scientists, developers, and those in the business of drug delivery. Audibert expects that having these answers will help optimize the time and investment spent on drug development and support better-informed decisions. With a focus on what counts, researchers can create the best possible product for the population.

Finally, patients are more likely to accept treatments that fit their needs, and that acceptance can support healthier families, communities, and countries.

“Businesses that know how their customers will use their products usually have the edge over those that wait for feedback after a product is launched,” Leroueil said. “It’s exciting to see organizations like MMV take this approach.” 

WDI’s Healthcare Delivery sector is offering an online pilot program to equip management executives of private hospitals, clinics, and healthcare delivery enterprises in low- and middle-income countries with the skills to improve efficiency through better processes, and to allocate costs more accurately for better strategic and pricing decisions. The program includes modules on Process Analysis and Optimization and Time-Driven Activity-Based Costing. The program consists of online, asynchronous training for each of the two modules; synchronous remote class sessions via Zoom; and a team-based action learning project based on a real business challenge at the participating institutions. Participating hospitals to date include Nyaho Medical Center in Ghana and the OSME Hospital in Mexico.

WDI’s Healthcare Delivery sector is offering an online program to equip management executives of private hospitals, clinics, and healthcare delivery enterprises in low- and middle-income countries with the skills to improve efficiency through better processes, and to allocate costs more accurately for better strategic and pricing decisions. The program includes modules on Process Analysis and Optimization, Time-Driven Activity-Based Costing, and Healthcare Supply Chain. Modules on Cost Management and Control, and Due Diligence are in development. The program consists of online, asynchronous training for each of the two modules; synchronous remote class sessions via Zoom; and a team-based action learning project based on a real business challenge at the participating institutions. To date, six hospitals from Mexico, Ghana, Nigeria, Kenya, and Pakistan have participated in the courses. They are: Nyaho Medical Center, Ghana; Grupo OSME, Mexico; Evercare Hospital Lekki, Nigeria; AfyA Care, Nigeria; Avenue Healthcare, Kenya; and Evercare Hospital Lahore, Pakistan.

Improving Health Care Delivery

If a strawberry or cucumber or spinach leaf — or any number of other fruits or vegetables — was grown in the U.S., it’s likely a migrant farmworker had a hand in its journey from ground to plate. These essential workers are keeping U.S. farm systems functioning, and they require essential services — including healthcare.

Dr. Raul Payán has been answering that need for 30 years. He runs the OSME medical clinic in San Luis Río Colorado in Sonora, Mexico, a border town just south of Yuma, Arizona. He and his team provide general and urgent care, imaging, and routine medical services to the community, mostly made up of migrant workers and their families whose healthcare costs are covered by U.S. insurers and businesses.

But Dr. Payán’s clinic is not a hospital, so he and his team refer patients with more serious medical needs to hospitals, often in the city of Mexicali, an hour away, where prices for care are higher. This means the clinic is losing business it could keep if it had a hospital, insurance companies are spending more than if OSME had a hospital in San Luis Río Colorado and patients are inconvenienced by being forced to travel to receive treatment and pay higher copayments.

To provide specialist inpatient care, Dr. Payán is planning to grow the OSME clinic into a full-scale hospital, with the goal of retaining patients within the system, lowering their cost of care, and attracting new ones from the surrounding region. In response to the effects of the COVID-19 pandemic, the North American Development Bank (NADB), a border-focused developmental financing institution run jointly by U.S. and Mexican leadership, is looking to support projects that have both environmental benefits and direct positive impacts on the economy of the U.S.-Mexico border region and the health and well-being of border residents.

The bank works closely with project sponsors to create financing packages that move crucial ventures forward, either through loans or grants. Recognizing the success of OSME’s service model, NADB is considering a loan to the medical group for a portion of the funds it needs to expand. Before deciding to support OSME’s growth, though, the finance institution turned to the William Davidson Institute (WDI) to tackle some of its due diligence and provide deep industry and business analysis into the possible benefits of such support.

HEALTHCARE AS CRITICAL INFRASTRUCTURE

NADB is dedicated to supporting and financing environmental infrastructure projects along both sides of the border, which typically include water and energy infrastructure projects. Amid the massive impact of the COVID-19 crisis, however, it became clear that NADB should play a key role in working to enhance the economic recovery and the general health and welfare of U.S.-Mexico border communities while remaining cognizant of its core mission to preserve, protect and enhance the environment of the region.

The pandemic’s global impact highlighted that infrastructure includes any systems or spaces required for a community to survive, maintain its welfare, and improve its well-being — and that encompasses healthcare services and facilities.

With that in mind, the bank is beginning to offer loans to nontraditional projects that include healthcare initiatives along the border under its COVID-19 Recovery Loan Program, an imperative influx of funds that could help bring greater care and stability to the local communities. They’ve allocated $200 million for these initiatives, and the potential OSME hospital is the first such healthcare project.

REACHING THE OSME PATIENT COMMUNITY

The OSME clinic has been connected to essential migrant workers for decades, and that community is only growing. The agricultural industry needs 1.5 to 2 million workers to complete planting, harvesting, and processes tasks, and since farms across the country are struggling to find U.S. citizens and permanent residents to handle these critical responsibilities, migrant workers are filling the gap.

Although some of these workers are undocumented, many take advantage of a visa system meant specifically for this kind of work: the H-2A and H-2B visas. These visas have increased dramatically over the last few decades. By 2019, there were 257,667 jobs approved for H-2 visa positions by the U.S. government, with 204,791 visas issued. And 91% of those were claimed by Mexican citizens.

Many agricultural workers’ families live on the Mexican side of the border and use OSME and clinics like it for their medical needs, and the workers themselves return to the town from the U.S. for their care, as do some U.S. citizens and permanent residents of Mexican heritage. In fact, while just over 200,000 visas were issued to temporary agricultural workers in 2019, there were 394,564 H-2 visa admissions across the U.S. border during that same period, demonstrating the back-and-forth nature of workers in these roles.

To incentivize workers to take on these fundamental farming tasks, agricultural enterprises are now offering medical insurance and coverage to migrant workers, and that’s been to the benefit of the OSME clinic. Today, around 75% of OSME patients are covered by either U.S. insurance companies or U.S. businesses that foot the bill for health services or procedures for their employees. For the most part, Dr. Payán and his staff work directly with insurance companies to provide this care, even running the only U.S.- insurance-connected pharmacy in the region.

[OSMED Clinic has] built their business plan around capturing more of the value chain of care for their existing insured patient market while also enabling their U.S. health insurance partners to expand their market, bringing more workers and their families into the insurance net.

A BUSINESS THAT MAKES SENSE

This insurance-focused service plan is one that holds tremendous financial potential for the clinic and provides a framework for offering excellent healthcare to the community. It’s already working for routine and urgent care, and Dr. Payán is certain it can only improve with the construction of an OSME hospital.

Ioan Cleaton-Jones, Director of healthcare delivery at WDI and a seasoned healthcare finance and management consultant, agrees. He has been working closely with both Dr. Payán’s OSME team and the team at the NADB to ensure adequate due diligence while also examining the likelihood of success for both parties. He’s optimistic about the possibilities.

“This makes sense as a business,” Cleaton-Jones explains.

Not only does the OSME clinic already run at a profit, but its plans to expand are clear and full of potential. “They’ve built their business plan around capturing more of the value chain of care for their existing insured patient market,” says Cleaton-Jones, “while also enabling their U.S. health insurance partners to expand their market, bringing more workers and their families into the insurance net. Additionally, they anticipate that there will be patients and doctors who would come from Mexicali.”

The clinic has provided decades of care to essential agricultural workers, and that community of migrant workers and their families may now have access to a hospital for care it either couldn’t get before or at reduced cost. This is thanks to Dr. Payán and his team’s devoted efforts and WDI’s expert analytical support.

Cleaton-Jones hopes WDI will continue to provide this kind of analysis to support healthcare projects, and he believes the positive business model of this OSME hospital expansion is a beacon for what’s possible.

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