Business Models In
Developed and
Emerging Markets
Vidar Jorgensen
President, Grameen America and Grameen Research
Advisor, Grameen Trust and Grameen Health Trust
Chairman, World Health Care Congress
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Dr. Charles Merieux (19072001)
What seemed essential to me
was to bring scientific
discoveries made within the
secret confines of laboratories
within the reach of everyone.
And I do mean EVERYONE.”
“
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Introduction:
Grameen Microfinance Markets
Sample Grameen microfinance direct implementation
presence in key markets
 Bangladesh: 8.4 million members
 Mexico: 18,000 members
 Guatemala: 60,000 members
 Columbia: 12,000 members
 Costa Rica: 10,000 members
 USA: 11,000 members
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What made Grameen successful?
The Grameen Method
 The Grameen Method focuses on solving the needs of
the poor with economically sustainable programs and
can be found at www.grameen.com
 Grameen has successfully established a replicable and
scalable microfinance model that resulted in more than
97% repayment rates and successfully lifted the poor
out of poverty
 The Grameen Method drove the success of Grameen
lending and has driven the development 54 primary
care clinics that provide high-quality health care paid by
the poor with 80% sustainability in Bangladesh.
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The Grameen Bank's Method
of Action :
1. Start with the problem rather than the solution: a credit system must be
based on a survey of the social background rather than on a preestablished banking technique.
2. Adopt a progressive attitude: development is a long-term process which
depends on the aspirations and commitment of the economic operators.
3. Make sure that the credit system serves the poor, and not vice-versa:
credit officers visit the villages, enabling them to get to know the
borrowers.
4. Establish priorities for action vis-a-vis to the the target population: serve
the most poverty-stricken people needing investment resources, who
have no access to credit.
5. At the beginning, restrict credit to income-generating production
operations, freely selected by the borrower. Make it possible for the
borrower to be able to repay the loan.
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The Grameen Bank's Method
of Action (continued)
6.
Lean on solidarity groups: small informal groups consisting of coopted members coming from the same background and trusting
each other.
7.
Associate savings with credit without it being necessarily a
prerequisite.
8.
Combine close monitoring of borrowers with procedures which
are simple and standardized as possible.
9.
Do everything possible to ensure the system's financial balance.
10. Invest in human resources: training leaders will provide them with
real development ethics based on rigor, creativity, understanding
and respect for the rural environment.
Source: http://www.grameeninfo.org/index.php?option=com_content&task=view&id=33&Itemid=1
07
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How to begin? Determine low-hanging-fruit health outcome
interventions based on current health status in Bangladesh
•
Most people are under 25 years of age
•
•
Source: http://www.worldlifeexpectancy.com/country‐health‐profile/bangladesh
27% of deaths (2,4,5,6) could be addressed through improved primary care
26% of deaths (coronary and stroke) could be addressed through risk screening and monitoring
6% of deaths (pediatric) could be addressed through pediatric/newborn care
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How to Get From 80% to 100%
Sustainability
 Use community health worker -based health promotion activities
supported by cutting-edge, leapfrog technologies.
 Combine a mobile health (mHealth) platform (ClickMedix and
others) point of service and lab base diagnostics and continuously
improving algorithms .
 Pioneer breakthrough changes in health care provisioning for
underserved communities, including shared decision making.
 Shift the health care paradigm from late “diagnostics and
treatment” to “predict and prevent”.
 This is centered on health promotion, disease prevention and
early detection, while improving access and quality of care to low
income populations.
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Intervention: Develop Existing Grameen Health
services to improve care delivery and training
Demonstrate measurable improvement in health outcomes among Grameen Health
beneficiaries, enhance nurse skills training to care for more patients, lower operational
costs, and increase utilization of available resources.

Grameen Kalyan Clinics and Eye Hospitals:
 Improve cost-effectiveness of operations
 Increase patient reach and lower cost per patient
 Improved patient health metrics

Grameen Caledonian College of Nursing:
 Demonstrate measurable improvements in nurse skills training






Enhance clinical skills and diagnostics skills
Enhance skills in using mobile and computing tools to facilitate provision of care
Increase number of patients under care by each nurse
Increase the extent of care provisioned by nurses
Increase enrollment of new students
Parallel Grameen Health Innovation in the US and Bangladesh will drive innovation
and quality in both countries.
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Use mobile phone “connected health platform” (ClickMedix) to enable
point-of-care training, diagnostics, telemedicine, shared decision
making and monitoring to provide end-to-end health care
College of
Nursing
GC Eye
Hospital
GC Eye
Hospital
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ClickMedix mobile connected health platform
packages data from diagnostics devices and
shares them with patients and health providers
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Examples of Diagnostics Devices
Digital stethoscope: records
audio sounds sent to remote
doctor for diagnosis
Point-of-Care TSH test for
iodine deficiency diagnosis
and complete blood count
(CBC) test
Handheld ultrasound: send
images/video to remote
doctors for diagnosis
EKG test for heart issues
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Point-of-Care Telemedicine Kit: health
care any where including Bangaldesh
and the US
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Mobile phones can enable continuous hands-on training & improved
point-of-care skills of health workers and nurses
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Health workers and nurses can use smartphones with ClickMedix
platform to capture diagnostics and symptoms information to expedite
treatment
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Scale-Up and Sustainability Plan
Home-visit health assessment
Revenue:
New subscribers
Point-of-care diagnostics
Telemedicine: access to remote doctors for
Revenue:
diagnosis and treatment advice
Fee for service,
e.g. $1 for audioRevenue:
Training
recording of baby’s
Fee for service for
heart beat and
doctor’s opinion
interpretation of
Revenue:
baby’s health
Training fees for
condition
nursing school
students and health
workers
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Sustainability Projection (US data)
Break-Even in 2014 with
$5/per person/month service subscription
$12,000,000
$10,000,000
$8,000,000
$6,000,000
$4,000,000
$2,000,000
$Revenue
Expenses (Overhead + Health Program)
OVERHEAD
2012 (pilot)
$280,000
$1,350,450
$1,001,250
2013
$1,576,800
$2,214,210
$1,001,250
2014
$4,277,680
$4,333,074
$1,001,250
2015
$6,507,600
$6,038,020
$1,001,250
2016
$8,360,000
$7,450,900
$1,001,250
2017
$10,212,400
$8,872,070
$1,001,250
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everyone. And I do mean
EVERYONE”
 Coca-Cola can do it
 The cell phone industry can do it
 The mass entertainment industry can do it
 The health care industry can also do it
 We have within our reach all the key pieces we need to
dramatically improve access to high quality and
economically sustainable health promotion and care for all
 Please join with Grameen Health in Bangladesh, New York
City, and the world beyond
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Thank you!
Vidar Jorgensen
President, Grameen America and Grameen Research
Advisor, Grameen Trust and Grameen Health Trust
Chairman, World Health Care Congress
Email: vidar@wchnet.com
Websites:
www.grameen.com
www.grameenamerica.org
www.grameenhealth.org
www.grameenresearch.org
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