The Cure: Revolutionizing the Business of Healthcare in Africa
The Cure is a deep-dive podcast exploring what it takes to revolutionize the business of healthcare in Africa. Hosted by Temitope Coker, each episode features candid conversations with the people shaping the continent’s health systems, including visionary founders, investors, researchers, policymakers, and reformers.
We go beyond surface-level insights to unpack the real-world challenges, innovations, and investment strategies transforming care delivery across Africa. At the same time, we aim to infuse hope into the narrative by spotlighting the momentum and progress already unfolding across the continent.
From financing and infrastructure to research, technology, and policy, The Cure is the place for serious thinkers and doers who care about the future of African health.
The show is powered by TC Health, a platform providing healthcare and pharmaceutical insights in Sub-Saharan Africa.
The Cure: Revolutionizing the Business of Healthcare in Africa
When the System Is Missing, Build It: Scaling Diagnostics by Creating the Infrastructure - Part 2 | A Conversation With Soga Oni
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Soga Oni, CEO and Co-founder of MDaaS Global, joins us to break down what it really takes to scale diagnostics in Africa from infrastructure to access to impact.
Because without strong diagnostic systems, healthcare simply doesn’t work.
Season 2 is about Building the Rails and this is a critical piece.
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#TheCurePodcast #AfricanHealthcare #Diagnostics #HealthSystems #HealthcareAfrica #TCHealth
Hello, healthcare enthusiasts, and welcome back to The Cure. This is the podcast where we're revolutionizing the business of healthcare in Africa one conversation at a time. I'm your host, Tim Topekuka. In each episode, I sit down with the people shaping the future of healthcare in Africa. From founders to investors to policymakers and beyond, our goal is to infuse hope back into the narrative by spotlighting the momentum and progress already unfolding across the continent. At the heart of every episode is one key question: What does it take to revolutionize the African healthcare business model? All our insights are powered by TC Health, your trusted source for healthcare and pharmaceutical insights in sub-Saharan Africa. This is part two of our conversation with Shoga Oni, the CEO and co-founder of MDAS Global. Our conversation is spanning all things diagnostic care in Nigeria and what it takes to really build the rails in this industry. So let's dive right back into this conversation.
SPEAKER_00The distribution is the goal. Yeah. So, so yeah.
SPEAKER_01I have so many follow-ups. I have two main follow-ups, and I'm trying to decide if I ask both of them or if I ask one of the things. Go for it. So I'll ask both, and then you tell me where you want to go. My first follow-up question is this idea of how you've expanded and your steering framework, almost decentralizing Lagos, if I may say. What do you think other innovators in healthcare, health tech in Nigeria can learn from that type of model? Because I think a lot of people operate from a Lagos first mentality. And then if it works in Lagos, we expand elsewhere. But you flipped the script and you were like, is work somewhere else? Let's see if it works in Lagos. Um, so that's one of my follow-up questions. How what can I do?
SPEAKER_00I can just take that. Yeah, yeah, yeah. Yeah. So I think that when it's because this is one of the questions that actually came up when we were discussing um, you know, when we were discussing actually the Ibadan location, should we do Ibadan or should we do Lagos?
SPEAKER_04Yeah.
SPEAKER_00And one of the things I just said was, uh, is that like Lagos is just 10% of the population of Nigeria. You know, Lagos is not Nigeria. There's higher incomes here compared to the rest of the country. Um, and I don't know if you've been to a general switch in Lagos compared to a general switch outside Lagos, like it deep, deep in the country. It's light and day. It's like it's it's like I feel like Lagos people sometimes uh they are spoiled for choice, but they don't even know it.
SPEAKER_04Yeah, yeah.
SPEAKER_00Like compared to the rest of the country, right? So for us, it was like, you know, Nigeria is 220 to 30 million people, and 20 to 30 million of those people live around Lagos. Yeah, the bulk of the the price is actually outside Lagos.
SPEAKER_04Yeah.
SPEAKER_00But when I've seen folks who have scaled diagnostics even, like, you know, um I I see that everybody either have a Lagos strategy or an Abuja strategy.
SPEAKER_04Yeah.
SPEAKER_00Right? And I think the reason why they're able to scale past like we have done is because once you get used to that, the things that make you successful here would actively work against you in those places.
SPEAKER_04Yeah, yeah, yeah.
SPEAKER_00Right? The kind of things you do there that makes you in Lagos that makes you successful. When you go to those places, you realize that oh my god, this is so different, and I need to be so so I think it's important. Yeah, and and yeah, so that's that's my point. And I always advise my ed tech friends, which we share together, that Lagos is not Nigeria. Like oftentimes Lagos, you are better off testing piloting outside Lagos, yeah. And and if you know, if it doesn't work, you can try in Lagos, too. If it works, you can come to Lagos or keep staying where there's so many places you can go to across the country and be successful.
SPEAKER_01Yeah. Um, and then my second follow-up question was about the the scale of your expansion. You mentioned, you know, if we if you're on our list and we have a property there, then I have the money. And you have the money, yeah. The very, very important requirement. But talk us through the operational side, like maybe even like we say you're building brick and mortar. Are you putting the bricks down or are you seeing the bricks and we're listening? We're listening, yeah, yeah.
SPEAKER_00We listen it, but we still have to do our centers look quite similar, yes across the across the the the country. So we have template ways of how we design our centers. So we literally have a brand book for it. Okay. Where if you see this sort of building, this is the kind of center you would do. If you see this sort of building, this is the kind of layout you have. If you see this sort of, you know, we have all of that now, right? So so but the idea is because for us, once we decide to do a center and we'll find a property to do it, in three months, we want that center to be operational.
SPEAKER_04Yeah, yeah.
SPEAKER_00Right. So it's about how do we they get there quick quickly. Yeah. If you're building from ground up, laying brakes and bricks, it takes you two years or a year at least. Uh, but if you can just lease a space, we know how much space we need. You can go in and do our thing. In six months, we're operational. In three to six months, we're operational.
SPEAKER_01Yeah.
SPEAKER_00In the last six months we've broken ever.
SPEAKER_01Yeah.
SPEAKER_00Then we hunt to the next center.
SPEAKER_01Yeah. This is gonna sound really strange, but it it just came as in my mind, this is like a McDonald's model. You know how in the US there's like a thousand McDonald's locations, and they uh they come in different shapes and sizes, but you you can't you know it's a McDonald's. Even when McDonald's, because they've tried to revamp to be looking more like modern and whatever, but every McDonald's location is the McDonald's look.
SPEAKER_00Exactly. That's what it is, very much. It's like retail. And even we share a lot of similarities in the sort of locations we want um with with retail, really. Um, we want to be on the main road, a lot of traffic, um, hopefully around where other hospitals are that we will target for our referrals. Yeah, and so so it's like really standardizing um or the risking, or the what is the risking that investment into that place by picking a great location and making sure that you have the high balls to see your operations and and whatnot.
SPEAKER_01Yeah, yeah, interesting. Um, and so one more piece on part one before we go to part two and three. In November 2024, you opened Beacon Health Pasture Healthcare in Douala, Cameroon. Um, I read a tech report, a tech cabal like article that reported at the time that the move was partly a hedge against denira volatility by giving MDAS exposure to the um Central African CFA franc. So for our listeners that may be unfamiliar with the term, the CFA franc is like the currency used in Cameroon and a bunch of other francophone countries, um African countries, and it's permanently fixed to the Euro at a rate that doesn't move. And that fixed link to the Euro means a business earning in the CFA franc effectively earns in a stable, hard currency while the Naira has fallen from like 360 to well over 1500 against the dollar in like the past three years. Talk us through those, the decision to expand into Cameroon. Was it, as Tekaba reported, a hedge against the Naira? Or was there something you saw specifically in Douala in Cameroon that felt like there was the a demand that you needed to fill?
SPEAKER_00No, I think it was mostly like a hedge. Obviously, not just it was not just that's not the entire decision. The idea is that we, you know, we knew that we wanted to scale past Nigeria. Yeah. Right? We always have that and we still do one, two. Um and but at the time, you know, the currency fell from I think 400 to 780, and then in a few months we went from 780 to I think one five at the time, and now it's dropped to 1350. Um, and so it was just a lot of things going on, and we felt like if there was any time to do to go set up a different place so that if the currency keeps going up and up, there's also like another place that we can potentially grow in. Um, so we actually visited a few African countries. We were in Ivory Coast, we were in Togo, we were in Ghana. And Cameroon felt very familiar. Um felt very familiar. Um, and it's not really as developed as Nigeria, as Lagos, but we also felt like there was a need there.
SPEAKER_04Yeah.
SPEAKER_00And so we we we were able to set up quickly there. And then the regulatory, one thing about Edcare is regulatory is huge in Earthcare. And so we were able to figure out the regulatory. It still took us quite a bit of time, to be honest, but we were able to figure out eventually in a way that would have been much, much, much, much difficult in say a Ivory Coast or say a Sanegal.
SPEAKER_04Yeah.
SPEAKER_00So because we felt like, you know, we had the contacts on the ground to help us do that, that helped us make that decision. But to be honest, like, you know, things are hard everywhere too. So right now, because we kind of like with the stabilization of everything now in Nigeria, we focus on a lot of our good efforts in Nigeria right now. Um but I think we would still love to go back there and scale the same way we've scaled in Nigeria.
SPEAKER_04Yeah.
SPEAKER_00Um, but right now we're back to kind of like building mostly in Nigeria Um because we felt like we the distribution, we're still at sub-scale levels. Uh and not just us, everybody, every diagnostic provider in Nigeria is at subscale levels.
SPEAKER_04Yeah, yeah.
SPEAKER_00And we feel like to win the market in in Nigeria, you need to be at scale.
SPEAKER_04Yeah.
SPEAKER_00And so what skill looks for us is at least, you know, 100 locations. You know, and maybe if you want to do do maybe 60 locations, but for me, because I said I stand up to myself, what skills look like to me in Nigeria, it's 100 locations. And in because we have the people, we have the demand, yeah, but we historically we just not had the capital to scale this sort of business this way. And so we want to be the first to get to 100 locations. Yeah. Um, and so that now we mostly focused back here. Um, and why the business kind of I guess run in Cameroon kind of run by itself. And yeah. So yeah. But the tech that runs it, the our center in Cameroon looks exactly like brand identity. Um the software they use, we can't start our um our software to French.
SPEAKER_04Yeah.
SPEAKER_00And so that they still use the same software, which is why we we know that like our capital our technology stack is so powerful that eventually it might be a product that we can use to partner with other people in other countries where um, and that's probably how we'll think about scaling in other African countries where we go in, we have an undergrad partner um that is in the clinical space already. Yeah, we will bring in the technology know-how, maybe some of the financing to do it, and then it will be a joint partnership.
SPEAKER_03Yeah.
SPEAKER_00So that's we how we'll probably see Pan-African expansion going forward. But in Cameroon, we actually own it. Yeah, we didn't do like a JP in that way.
SPEAKER_01Yeah, yeah. Interesting. We've touched on part one of MDAS strategy, which is building the physical rails, the physical infrastructure, the centers. Part two is the technology that turns those rails into more of a coordinated network. In your words, diagnostics sits at the nexus of healthcare delivery. So an operator at this scale is actually quite uniquely positioned to address the digital fragmentation that runs through almost every patient journey in Nigeria. You go to one center, they're using one health tech platform, then you go to another center, they're using something else. Um, once the centers were running, MDAS started building software and products and even partnerships around them. So, like we've already discussed, some of it was operational, the tools needed to actually run a clinic well, like within MDAS. Some of it was commercial, so products that let companies and HMOs um use the network. Some of it was logistical, some of it emerged because maybe some of the partners on the ground or your founder team and your internal team asked for it. So we have things like um beacon OS, we have um Oliwork.
SPEAKER_00Oliwork, yeah.
SPEAKER_01Yeah, it's it's I just wanted to make sure I I I pronounce that well.
SPEAKER_00It's Oliwork.
SPEAKER_01Um you have Beam, you have Medverse, um, which is more on the logistics side. Yeah, and then you have Lucent AI and Hazel AI. Yeah, am I missing something? Sentinel X.
SPEAKER_00Sentinel does a piss in Porter.
SPEAKER_01Yes.
SPEAKER_00So I want you to talk us through So I know it sounds a lot conf confusing, but really what we have is like we built like an operating system called Bicode Bacon OS. Okay, it's a single backend that every other application sits on. So um when um so become this is beacon OS, then you have the center application called Olework. Okay. Sits on on top of it. And um, so when your result is ready, we also have a another application called Centinor X, where that's where you get your results. So your results is ready. You know, the center application, they fill in your results, send it to BCon OS, it sits there. But the center application has access to your results, so they can print it for you, but you can also have a it's different software Sentinel X to access your results. But if you're saying an HMO customer um or a corporate customer um coming from a corporate, and for some reason maybe the HR department needs to access your results too, then there's a portal for the corporate and HMOs to also access the results of everybody they send to us. So it's easy. And then we have Lucent AI because we do a lot of reporting.
SPEAKER_04Yeah.
SPEAKER_00It's a central reporting portal where uh some a lot of our doctors sit reporting doctors sit in Lagos actually. Yeah, but they report across the network. So every annual screening that you do with us is reported by a doctor, yeah. Sit in Lagos, so we also built a portal for them to be able to pull in all of the results from all of the sick all centers and report from one single point, so it's really, really fast. Yeah. Um, or if you say like a radiologist needs to read your reports, um, you know, they can the center send it to the radiologist, the radiologist writes a report for you and send it back. They they use um Lucent AI to do that. And Azuai is our primary care um application we're building for for primary care doctors because we we're doing RD on a primary care product right now. Uh and so that's the software to run that. Yeah, um, a way to make it faster to do primary care.
SPEAKER_04Yeah.
SPEAKER_00So we've built all of this software as we need.
SPEAKER_04Yeah.
SPEAKER_00You know, as you know, something becomes a pain point, we'll build something to make it faster. And I think it's so important to be able to do that because oftentimes with um businesses like ours, there's really no bespoke software that is really that really matches your workflows.
SPEAKER_04Yeah.
SPEAKER_00So you have to look at your workflows and build for it, and which is what we've done. That it was going to be really difficult for us to say, go to get like a out off-the-shelf EMR system to use, yeah. Because it wouldn't have some of the things we do or all we need to do.
SPEAKER_04Yeah.
SPEAKER_00And if we won't really work with our workflow. So the fact that we built ours makes it life much, much easier for us. And we've built in such a way that if we need to talk to folks, um, so we can give APIs to folks. So if you have an EMR and you want to be able to send results to me or send requests to me, you can do that. Um, so and we have a few digital health businesses who are who have already connected our their own systems with our own system. So they can request, they can make a request digitally to our systems and they can get their results digitally to you. Yeah. And this is something we can provide for any HMO that wants it. In fact, we've pitched this to so many HMOs, but nobody wants to do integrations. You know, people want to work the old way. We think the integrations is faster.
SPEAKER_01Yeah.
SPEAKER_00Um, but but yeah, but yeah.
SPEAKER_01Interesting. And I I see your background as a software engineer playing a big role here. Um, I I had a question about as we move from part one, part two, part three, and just the big picture, where do you see the tech playing a role? Right now, it's a lot to support your internal operations. But like you said, you've started shipping to even external partners. Where do you see that evolving? And what do you think the inflection point is to reach that scale, especially on the tech side? Because you just mentioned HMOs are hard to convince to take on some new tech. What do you think it would take to convince them? And where does that play a role?
SPEAKER_00Yeah, so for me, I think that's you can convince them to do tech if they're not gonna make money off of the tech. If it's gonna be a cost center for that.
SPEAKER_04Yeah.
SPEAKER_00I think that's the big thing with technology in Edcare. Most people that try to sell tech to um to doctors or hospital systems or HMOs, they they most of their techs are going to be cost centers. Right? If you don't have a tech that is like can actively generate revenue for folks, then nobody would buy it. Because the margins in health care for us is thin already as is. So the little margins you have, someone wants to be collecting a part of it every month from you.
SPEAKER_04Yeah.
SPEAKER_00In the name of tech. When paper worked. My the other thing about tech in headcare is that like people, particularly, you know, there was a time where everybody was every time they canary was building an EMR. Like in the 50s and 60s, there were great hospital systems running on paper in Europe, in the US, whatnot, um, and it worked fine.
SPEAKER_04Yeah.
SPEAKER_00You know, so paper is a two, but an EMR is also a two, right? And so you think about it that way. So for me, we will keep growing our tech stock.
SPEAKER_03Yeah.
SPEAKER_00Um, if people want to integrate, great. If people don't want to integrate with it, also I'm okay with it because it's providing a lot of benefit for me. There's no way I would be able to run a 100 facility network without tech. Right? I wouldn't be able to run a 200 person um 200 facility network without tech.
SPEAKER_02Yeah.
SPEAKER_00Um, so IDH um who runs one of the biggest networks in Africa have a network of, I think, 700 clinics. Right? They can't run that without tech.
SPEAKER_02Yeah, right. Yeah.
SPEAKER_00So that's the role of tech is to help you synthesize your operation. I think the big thing I see with the tech when I look to the future is the ability to generate insights from the data that we have.
SPEAKER_04Yeah.
SPEAKER_00Uh, because we hold a lot of data already, a lot of useful data that I feel like we can we should be writing more papers, to be honest.
SPEAKER_03Yeah.
SPEAKER_00Um, from what we're saying. Um, because we can track diseases across different locations already today. Like anytime, you know, like the time where they had like the cholera outbreak, we're able to track that in our data sets to know, okay, where are people requesting school MCS? Yeah, because that's one of the primary ways to diagnose that. And we see that there was an uptick in the key areas in the in the country that had the outbreak.
SPEAKER_02Yeah.
SPEAKER_00Right. So there's a lot we could do with the data. Um, and there's a lot of partnership we'll probably need to have with like, you know, clinical research organizations, maybe in helping them recruit folks for clinical trials. Yeah. Um, I think that's the important part of the work that we should be doing, that we're currently doing right now.
SPEAKER_03Yeah.
SPEAKER_00But I think we we are still like, you know, we're still cooking. Yeah. So I think but I think that those are the kind of opportunities that having the data gets you to having in the future. It's like We were buying options on this for the future. So yeah.
SPEAKER_01Interesting because I feel like a lot of people talk about wanting to do more clinical trials in Africa. Because I think it's like le the number is like less than one percent or two to three percent of clinical trials are actually done on this continent. Yet we use all these drugs that haven't really been studied.
SPEAKER_03Study in the population, yeah.
SPEAKER_01There's a lot of momentum right now, in tandem with the momentum for local manufacturers to do more clinical trials. And people are always saying, Well, we need more centers of excellence. And yes, you can get the centers of excellence down, but you also need the way to recruit.
SPEAKER_00You need to go to recruit people.
SPEAKER_01Like if you've read an inclusion criteria for, especially with precision medicine trials, cancer, with all the biomarker testing. If you read the list of inclusion criteria, half of them require diagnostics.
SPEAKER_00Diagnostics, yeah, yeah, absolutely. Absolutely. Yeah. And that's something that we are uniquely positioned to do because of the volumes that we see.
SPEAKER_04Yeah.
SPEAKER_00Um, so so yeah, it's I think for us it's an opportunity for the future for sure. Um, but we know that there's a few folks working on this problem already.
SPEAKER_04Yeah.
SPEAKER_00So it's one part of that ecosystem that we cannot just go into ourselves. We need actually a partnership on the other side.
SPEAKER_01Yeah, yeah, yeah. And partnerships are clearly a big part of this story. I think I'm curious to hear what your overall partnership philosophy is because I look across some of the partnerships that I saw when I was researching MDAS, like Clafea, Aid Medical, Health Tracker, and there's others on your network. How did some of these important partnerships come about? And and what is your philosophy when it comes to partnerships?
SPEAKER_00Yeah, I have a very simple philosophy when it comes to partnership. One plus one must be equal to three. Right? So you must create value. Yeah. Um, and and you must have, you know, be able to capture value. You know, oftentimes with partnership, oftentimes when value is not being created, obviously, then the partnership just dies in natural debt because the two partners will just rather be doing their daily, day-to-day job and working together. So for me, with partnership is that I must see that we can coming together helps us create a clear value, right? That can be captured and shared between the both partners in an equitable way.
SPEAKER_04Yeah.
SPEAKER_00Um, I think edkare partnerships are hard. We've done a few partnerships that have worked out, done a few that's not worked out. Oftentimes about alignment. Is this person looking at things the way I'm looking at? Is this person willing to build for the future? Oftentimes people want to share, they want to kill the goose that lays the golden hag before it's, you know. Yeah. But uh sometimes, you know, we're 10 years in the game, like we are very patient.
SPEAKER_04Yeah.
SPEAKER_00Uh and for me, I'm one of those people who I told myself that I'm not one of the lucky ones. I'm one of the ones that need to work hard for things to happen to them, right? So for me, and I'm willing to do the work. And so I know that there's no silver bullet anywhere. Yeah. That we need to be patient. In Earthcare, you actually need to be patient. So if we find partners who have the same mentality about this, we're I'm always excited to work with that.
SPEAKER_01Yeah. And we're both part of um a digital health nigeria community, um, founded by um Dr. Neto and Ayobami, and I believe there's another founder of DHN. But it's it's more than just a massive WhatsApp community, but it is a massive WhatsApp community. Um, there's a lot of, I was discussing with Nato, like really lofty goals of what we can do as a community. I'm curious within the the, because there's a lot of founders in the community. Are there any adjacent companies that you, you know, would like to partner with, or do you see any peers that are doing things that you would like to kind of align with um as you think about building MDAS? Yeah.
SPEAKER_00Any shout-outs, basically. Yeah, we we yeah, I for example, I work with Neto um really closely and actually on multiple projects. Um, there's a few folks where we've done a lot of partnership where it's um Ed Tracker. Yeah. Um even though they're you know we're competitors in some of the space, we also work together um in in some other space. Um so we work very closely with Ed Tracker, It's Medical. Yeah, so we work. In fact, I feel like you know, for a good chunk of folks um there we are their back diagnostic back end when they need it. Right. Also because I'm accessible, right? In a way that's they can't just give um Synlab a call or they can just call me out of randomly and make sure that people get what they need um from us. Yeah, so so yeah, so I think that um it's it's good to have communities like that, to be honest, because iron chapinette iron, that's what they say, right? So there are folks um that I um maybe we're not in partnership with, but we have a lot of conversations together about the future. Um, Simpa is one of them, Dr. Simpa. Um, where you know he's been building in the space for almost 20 years now. Yeah. And now I'm 10 years in the game. And so we both have like, you know, we we we talk about our faces and we kind of like try to see like which ideas can we improve our ideas together. Yeah. And so those kind of conversations, I find them priceless because um they help me. For me, I'm not just building as the wind blows. Yeah, I'm building the specific verses. Yeah. That means I need to keep revisiting it to make sure that testing it to make sure that it's the right versus.
SPEAKER_01Yeah.
SPEAKER_00And that sort of conversations helped me test it.
SPEAKER_01Yeah, yeah. And I also think just the community aspect of DHN, like the it was this week where someone had shared an article around how even us, the people that work in the healthcare space, don't take care of our health or forget to do annual screenings. And very quickly, I think you like um rally together like a package for like annual screenings for members of the community just to really be like, this is available.
SPEAKER_00Yeah, go do an annual screening. Yeah, so doctors too are very notorious about that. They don't take care of themselves, they take care of everybody else but themselves. Yeah, um, so so that's one of the things that we need to be more cognizant of. Um, for me, I get a lot of screenings because when I travel, I like to test other diagnostic centers. So I do get a lot of screenings, um, and I don't mind needles, like some people. Yeah, uh, so I get tested a lot, you know, but that's also helped me be more conscious of my health because like I do love my basic and I've been able to find things I won't find out otherwise because of that. Um so so yeah, it's very important to screen. So if you're watching this, please go get your screened.
SPEAKER_01Yes, ideally at a vegan health diagnostic center, wink wink. Um but I I want to talk about the broader diagnostics landscape. Most operators, well, we say at scale, but we say that they're in everyone is subscale. Subscale. In Nigeria's organized diagnostics market today are linked to these international international capital in some form, whether it's Ecolabs, whether it's Cinlab, whether it's uh Cleaner Landsat or Cyberlandsets, MDAS is in that group of you know, a smaller group of operators, smaller the number of centers, yeah, yeah, yeah.
SPEAKER_00The number of centers of like in the terms of number of centers right now, I think we probably have the most. Yeah. Um in purpose of, I know Cinlab has more sample collection points, um, but in terms of like actually having a proper lab, with 25, we have the most. Yeah. And that's an indictment on the broader ecosystem that with 25 centers, you have the you know, meanwhile in Egypt, the biggest player has 750 or thereabouts. Um same thing in South Africa, the biggest player has I think at least 500 or thereabouts.
SPEAKER_02Yeah.
SPEAKER_00So so I think it's a bigger indictment of our our sectors, our subsector that you know, the fragmentation is so so is so torrent that you know the top four or five players control less than three, four percent of the market. It's and it's I think it's quite sad.
SPEAKER_01Yeah.
SPEAKER_00So so yeah.
SPEAKER_01And I'm there's a uniquely indigenous identity that maybe I associate with with MDAS. And MDAS, you know, the company isn't is now profitable on a clinic basis across pretty much most of your clinics. I think the margins give your team enough room that I think in 2025 you opened eight centers. Um and I'm to me that's like an outpacing story. Like there is a clear outpacing happening. Um I'm curious how you keep pace or outpace in a market where most of your large competitors are have these international backers and things like that.
SPEAKER_00Funny enough, I don't comp I don't see them as competitors because that's not who I compete against. Yeah, so so for example, um so diagnostics can be split roughly into two two major subsectors, right? Yeah. Um so you have the clinical diagnostic folks and you have the occupational health, right? Um, we are the only player that does both occupational health and and clinical diagnostics at scale. Yeah. At scale. So we do a lot of screenings on the occupational health part portion where I think Medbury is the king of that. Um shout outs to Ituno. Um and um on the clinical side, which you know, the Cinlab, Cebalan, who are lab-only um networks, right? Um, I think the the the folks who we tend to compete because in many of the places I go to, those guys don't exist there, right? They're not there. I compete with primarily mom and pop diagnostic shops in those places. In Lagos, um, we have maybe a few overlaps with Cinlab. But in Lagos, I tend to do work in the with mostly occupational health in Lagos, uh, except our Shango Tedo location where we do some clinical diagnostics. But um our other centers in Lagos are mostly occupational health.
SPEAKER_04Yeah.
SPEAKER_00But outside Lagos, right, I am our centers are usually the top clinical diagnostic um lab or imaging center in in many of the cities, right? So I don't see them as competitors. We operate we we we we working with two separate places.
SPEAKER_04Yeah.
SPEAKER_00Um when you see um the strategy that each player is taking is so different. For me, uh my next few centers are going to be in Cardana, Shokoto, Maduguri, um, Kalaba, um, right? And I'm gonna by the end of this year, we're planning 10 locations. We're done to this this these two dates this year. So we run into separate playbooks. They are mostly focused on Lagos Um and teaching hospitals, working with teaching hospitals um outside Lagos. Yeah, we are trying to be the centralized diagnostic department for small and medium-sized hospitals across the country.
SPEAKER_04Yeah.
SPEAKER_00In small towns, in in smaller cities, in biggest commercial cities, in state capitals. That's what we're trying to do.
SPEAKER_04Yeah.
SPEAKER_00So maybe one day they wake up and say, hey, they want to do this too. And if they wanted to do that, we're coming to the welcome to the game. You know, I think, but I think we need more people in diagnostics because I think the more folks like Cinlab come to those places, it also raises because they bring the international profile to it. Yeah. It also raises the quality, to be fair. So they should actually try. This is a thesis they need to also do where it's not just about optimizing for the big cities or the wealthiest who can pay the most. Yeah. Also trying to optimize for the mass market. Yeah. So we sit fully in the mass market bucket. Yeah. I think the closest in the bigger place is actually union. Union is an historic, they've been around for at least 30 to 40 years. And they they we used to compete with them. We still compete with them in a few markets. And we compete really, really well. Yeah. So with them. Um, and so, and I don't know how union are doing right now, but they're the closest. I actually compete with them in more markets than the single outside of the world and the several assets of the world.
SPEAKER_04Yeah, yeah.
SPEAKER_00And and in terms of patient numbers, um, we probably do more in patient numbers. Yeah. You might not be doing more as much of them in revenue, but in terms of patient numbers, just because we're truly mass market.
SPEAKER_01Yeah, yeah. And so you said that you your main competitor is mom and pops. And you have 26 company-owned um clinics, but you also have affiliate clinics, which, from my understanding, are clinics that exist in the areas that you want to enter. Yeah, mom and pops pretty much. Yes, that you then partner with. So it turns competition into collaboration. Yeah. So talking to you.
SPEAKER_00In a way, um, we've it was a thesis we had um three, four years ago when we didn't have the spread we have right now.
SPEAKER_04Yeah.
SPEAKER_00Where we were getting a lot of requests from our partners, HMO partners, corporate partners to do work in certain places, and we didn't have a presence there.
SPEAKER_02Yeah.
SPEAKER_00So we had to go find someone who could do work on ADR. But those sort of partnerships have drawbacks, right? Yeah. Because number one, we're IP optimized. Like I shipping on my own regions, I shipping out my own equipment, I set up a lot of my own centers so it's I can do the work at a cheaper rate than many of them can do. Yeah. So oftentimes with the affiliates, they cannot honor the pricing because of the the cost base is much higher.
SPEAKER_04Yeah, yeah.
SPEAKER_00You know? And so we're kind of like right now, we're trying to, we still work with a few affiliates, but we're trying to replace with company owned stores as much as possible. Yeah. Because our our I want to be able to go to Leadway or AX and say this is the price of X chest x-ray across my network. I see. Right? Yeah. Not just in Lagos and Ibada, and then I will give you a different price in because I have an athlete there and they won't obey the pricing, I agree already. So yeah.
SPEAKER_01Interesting. Um, and I think one thing as we talk about your pricing, I think MDASIS pricing or B1 Health pricing has been positioned at the more affordable end of the market to really tap into that mass market. Does that positioning open up a meaningful public sector route? Like, are you already working with state health insurance programs or the NHIA or government referral pathways? If yes, how did that come? If no, is that on the the list on the in the plans, basically?
SPEAKER_00So so it's um so we don't we get referrals from some government facilities um across the country because sometimes like one of the we just opened in Ore, right? And we are the only we're the only proper diagnostic center in Ore. They have people that have like no small shop labs, yeah, but we're the only proper diagnostic center in Oray right now. And so obviously we're gonna get a lot of referrals from the general hospital there, yeah. Because we are the only game in town. So instead of them sending people to Akura or Ondo town, the people can stay in Oray without traveling and get their diagnosis being done. Right. So so that's that's the big, big, big, big benefit of of that.
SPEAKER_01So but any plans more meaningfully to to work because I think being in the master.
SPEAKER_00So we we embedded in general hospital acudo, you know, it does didn't work out. It just didn't work out for many, many reasons.
SPEAKER_01You care to expand.
SPEAKER_00No, I think that's the this the alignment. I I would I won't obviously expand. Yeah, but there was a feeling that maybe we're making the money, we were losing money. To be honest, we were losing money there, yeah. But even though we're losing money, there was a feeling in the grind that we're making a lot of money, right? Yeah, yeah, yeah. But we did it because we also want to. I think one of the goals for us is like our work is to support hospitals. Yeah. And in many places, the government tends to have the begget house hospitals. Yeah, right. So if instead of me doing my own diagnosis center, you say, Oh, let us embed within a government hospital, yeah, and it's a win-win situation, um, that's on papers sound makes a lot of sense.
SPEAKER_04Yeah.
SPEAKER_00But in practice, when people feel like, oh, there's money being made somewhere, and we were losing we were losing quite a bit of money there, but there was just that feeling that we were making money, and so people wanted more and more and more. And at some point, I'm like, you know, it doesn't yeah, yeah, yeah, yeah.
SPEAKER_01So there's this yeah, misalignments. Misalignment of funny.
SPEAKER_00So that's one of those um misalignment issues like that we had.
SPEAKER_01No, no, makes sense. And I think we want to touch on the cure question now, because this is the question that obviously anchors every episode of this show. And it's what does revolutionizing the African healthcare business model look like? And specifically through the lens of diagnostics and through the question of what it actually costs to build? What does revolutionizing the African healthcare business model look like in a sector that is this capital intensive, this fragmented, this hard to find, hard to scale, what would need to be true for a company like MDAS to scale at the pace of the demand that's actually on the ground that's not just visible, but also invisible?
SPEAKER_00I think when I and I've said this uh publicly um time and time again, I think one of the biggest problems we have is fragmentation. Right? Fragmentation, fragmentation in the payment layer, fragmentation in the provider layer, fragmentation um, you know, everywhere.
SPEAKER_04Yeah.
SPEAKER_00So it means that everybody's opt we're optimizing for these little little shops. Yeah. Which means that when a patient needs care and they're going to a doctor for something, um, they have to pay there if they don't have an HMO, which most people don't.
SPEAKER_04Yeah.
SPEAKER_00And then when they need labs, they go to a different shop for that. Pay for something. Then when they need medication, they go to a different shop for it, pay for something.
SPEAKER_04Yeah.
SPEAKER_00Um those three folks don't talk to each other. So you're paying the maximum at each each location. There's no club subsidization, nothing like that. Yeah. And at and at the end, you know, by participating in those, if those three um players talk to each other or are part of the same network in a way, the cost of care will come down for that patient.
SPEAKER_04Yeah.
SPEAKER_00Um, but right now the patient pays the max, and so obviously, in a poor country, um, that means that we're all struggling. The HMOs are struggling, the providers are struggling, the patient is struggling.
SPEAKER_01We're all struggling. Struggle nation.
SPEAKER_00So I feel like the biggest problem we can solve is the fragmentation. And I think there's someone that that I can't remember their name now that wrote an article about oh, like we uh Ed Tech is where I know KinTech was 2013. I don't buy that. Yeah, I don't buy that. I think it's not about oh wait, it's it's about the conditions, right? You know, a single regulator that can direct the industry in a way, uh players, motivated players who can do work in certain ways, yeah, um, and who are allowed to innovate. Yeah, um, you know, obviously demand for the services. And I think in all of this, um, you know, the when you think about healthcare, even we have fragmentations in the regulatory. So you have the state regulatory folks you deal with. You have the MOH in Abuja you would deal with. And you have the NHIA that most folks also have to deal with, and that also is one of the regulators, and then you have all of the bodies and the many, many, many bodies that will regulate you. So you still have that fragmentation there where there's not a single part of power. I think the the biggest thing I see when I think about what two things either our people get um we keep paying out of pocket, 70% keep paying out of pocket, yeah. Now people just get wealthy enough for us to fund the headcare we need to build, which is obviously it's that's a lot of faith to have.
SPEAKER_04Yeah.
SPEAKER_00Um or we have like the NHA, which I think is should be that that payment layer. Yeah. I think what you need is an orchestrator, and that's what we don't really have. Yeah, we you you have different orchestrators that orchestrating their little tiny. Connors. You don't have the same orchestration like CBN for the fintech sector. Yeah. That can orchestrate like at scale for everybody and say, This is how we do this. We're going to build an exchange, and this is how we talk to each other. So that HMOs don't owe money to providers, and then so that HMOs also are priced, the HMO plans are priced right.
SPEAKER_04Yeah.
SPEAKER_00And they have enough money to have operations and have some profits.
SPEAKER_04Yeah.
SPEAKER_00So that the providers also can be okay. And so that the patients can get good care without pain out of pocket. Yeah. You know, and a lot of the orchestration now, you know, the NHIA has empowered each state to do their own version of the thing. That's even more fragmentation. Yeah, yeah, yeah. So that's all I'm saying. So the fragmentation question is what we have to do to solve for in any way.
SPEAKER_04Yeah.
SPEAKER_00The way we think about it, at least internally for diagnostics and and now for palm care, which we we've not gone far. We are still like thinking about it. Is that we need to build for what people can afford today. Um I can wait for the orchestra to happen, but what I'm praying for that to happen, I will build for what exists today.
SPEAKER_04Yeah.
SPEAKER_00And I do think in the diagnostic space, luckily, that you can build that the demand is there across the country to have to build a really, really big diagnostics business. You need obviously you need capital to build, which is something we personally struggle with. You need the capital to build at scale. And if you can do that, wait two years for things to for all of the centers to mature.
SPEAKER_04Yeah.
SPEAKER_00And you're going to be this massively profitable business in that case space. That would now have aggregated or or defragmented the diagnostic space.
SPEAKER_04Yeah.
SPEAKER_00You know, so that if any player, say AXA needs um to do diagnostics in any part of the country, they really need to come to you. They don't need to come to any other person.
SPEAKER_04Yeah, yeah, yeah.
SPEAKER_00Um, in a way, and that's what we are building for. Obviously, they offer they might say, okay, instead of going to every single person, we go to maybe these three, four players that we trust. Yeah. We trust not to defraud us, which is one of the biggest problems they have. And so when you're not thinking about fraud, you can partner more closely.
SPEAKER_04Yeah.
SPEAKER_00You know? So because I feel like a lot of the ways, the things that make care sub care pathway suboptimal, is because you have to think about oh, this provider might defraud me. So let me make it slightly tough for them. But by making it slightly tough for them to defraud you, you're also giving the patient a much, much worse experience. So it's about solving all of the things that are causing the fragmentation to happen. Um, we're lucky that in a diagnostic space, um, you know, we I think nobody is is building as many locations as we are building, yeah. And nobody is uh building in the places we are trying to build, also. Um so we think that we it's a massive blue ocean. Yeah. Um that's and which is crazy because when we started, people was like, there's so many players out there, but by being in the space and doing the work we do, right now we think that you know it's a massive blue ocean. Whoever gets to build, whoever builds the first diagnostic center network to get to a hundred locations is gonna win the mask the market massively.
SPEAKER_04Yeah, yeah.
SPEAKER_00I'm not just talking about the outside the Lagos market, it's also gonna that person is probably going to win the Lagos market also because when you have that that skill, you can walk backwards from it. Right? True, true, which is something we hope to do. Yeah.
SPEAKER_01And you mentioned capital, and I would love to deep dive on what sorts of capital would be required to build that. So I I actually I think it was this morning I was scrolling on LinkedIn or something, and I saw Tekabao release, it's part of their state of the health care industry. Yeah, yeah, yeah. And there was a graphic that they posted that I saw the top-funded health tech startups or healthcare startups or companies in Nigeria, and MDAS was on that list. At the top of the list was like your helium health, obviously.
SPEAKER_00Reliance. Reliance and helium. Deforging raised more money than helium.
SPEAKER_01Well, that are still operational.
SPEAKER_00Yeah.
SPEAKER_01Um, but the top of the list was your reliance and your helium health, I think it was like 40, 50 million. And then MDAS is on that list, and it's around 6.0 million across a decade of operations. And I'm I'm curious, what does what kind of capital does it take to build what you're building? And what kind of capital are you looking for as you think of your vision from now where you are to your vision of a hundred um clinics? Because I read your kind of 2025 year in review, and you you went into some detail on the the types of capital that you're looking for. So I'm curious if you could just talk us through from a capital and investment standpoint, what kind of funding does it take to build what you're trying to build?
SPEAKER_00So ideally, for the kind of work we're doing, um, you would probably would say debt. But debt is expensive locally in Nigeria right now. Yeah. Just it as your name's truth. Um so in the absence of the sort of debt we need, what we really need is long-term patient capital. Long-term patient capital, um, mezzanine financing would be great, um, which is like a long-term debt for six for seven to nine years.
SPEAKER_02Okay.
SPEAKER_00Um type deal. That would be the optimal um way. Because if you can get that kind of debt, the centers actually pay for themselves. Because the cost of building a center just becomes a financing charge every month on the centers when they mature. Yeah. Right. So ineffectiveness, these centers will just build themselves.
SPEAKER_04Yeah.
SPEAKER_00Right? But someone needs to pony up that initial cash. Um, so that's the big problem, is that we don't um a lot of the capital we've historically we've raised the VC and VC, you know, because you know, it was such a risky business that nobody else would give us money.
SPEAKER_02Yeah.
SPEAKER_00But VC is risky capital, and we we're really grateful. We have some amazing, amazing investors who have given us over the years and supported us and our thesis. And I believe that thesis is because our thesis is not for the weak. And we've had people who believed it and who supported us with it and given us money to do it. Yeah. To do that. Um, so but we're at the stage right now where VC is probably, we're probably it's probably too expensive for us at the moment. Yeah. Um, just given that we also like you know, as founders we we've diluted, we've we've sold a good chunk of the business to the to the to investors.
SPEAKER_04Yeah.
SPEAKER_00Where right now we're looking for more, we're still open to raising capital from players, but it has to be um strategic. People that can just bring more than money to to the to the to our space, and you know, that also is are willing to be patient over the next seven to nine years. Yeah. About that. That's what we need. And if we get that capital, we can we can go crazy. Yeah. With the center build out. Because we need to build with the way uh the business model works, you pretty much need to build and wait for two years for centers to mature.
SPEAKER_04Yeah.
SPEAKER_00Right? What that means is that that means the more you build today, your growth two years from now, you have to guarantee it today.
SPEAKER_04Yeah.
SPEAKER_00Uh, so if you want to grow 100% year on year, you know the number of centers you need to build to guarantee that. And that's what we've been doing over the past two to three years. Yeah. And so the for the past six, seven years, we've been growing 100% year on year. Um and so, but that's because we plan the growth. Yeah. Um, by building the number of centers we need to build to guarantee the the continued doubling of the business. And as you get bigger, the number of centers you need to build also increases, you know. Yeah. Because you're not growing from one to two anymore. You're growing to like, you know, 500 to.
SPEAKER_01Yeah, yeah, yeah. So yeah. And that reminds me of a a term that I read in your um 2025 year in review. Um, I don't know if it was Genevieve that came up with the term, or it was you or your team, but you've written about thinking of the company in terms of being default alive first, and then now default growing.
SPEAKER_00That's that's that's Genevieve. Yeah, okay, okay.
SPEAKER_01I was right. Okay, okay. Um, so she's the mastermind behind that phrasing. I would, these aren't terms most of our listeners will have come across. So I'm I'm curious to understand what that means from your lens and how that ties into what you just described of what you need to kind of scale from now to your hundred center vision.
SPEAKER_00So, so you know, the time, you know, when it time Different Alive came into the lexicon was after the VC crash, and every investor was telling their portfolio companies that you just need to stay alive. Just try to become because you might not get funding again. Yeah. So just do whatever you need to be alive, to be able to cover your costs. Because in case if money doesn't show up, you don't the business doesn't shut down.
SPEAKER_04Yeah, yeah.
SPEAKER_00And so when we, you know, when and people were like very worried, rightfully so, because we the ecosystem just lost a lot of the easy funding that used to come in. So at first, we also bought into it and said, you know what, let's just try to to just be alive. To be alive and just slow down a little bit. But um for us, we were lucky we were able to raise a little bit of money when we raised.
SPEAKER_04Yeah.
SPEAKER_00Um, and so we're like, we don't want to just grow slowly and just wait till the money runs out. We'll we're better at you know going to build inside and guarantee our future, which is what we've done.
SPEAKER_04Yeah.
SPEAKER_00And by doing that throughout for a couple of years after that, where we've gotten to now is that even if we don't get funded, um, we are able to grow out of our cash flows, but it will be slower. But that's why, but because we want to go fast, we want to get to the under locations. Yeah, if I I'm building out of my cash flow, maybe I build two, three locations per year. But if I get funded, I can build 20 locations in a year.
SPEAKER_04Yeah.
SPEAKER_00So this year, we're building with a combination of cash flow plus a little bit of funding that we got. So, so that and we're doing 10 locations this year because of that. But the idea is to be able to do 20 locations, 13 locations in a year.
SPEAKER_01Yeah, yeah. That exponential component requires that funding.
SPEAKER_00Funding, yeah, six.
SPEAKER_01Ah, okay. So we want to conclude our discussion looking ahead at part three. So we've gone into part one, we've gone into part two. Part three is in your investor memo, you describe part three as exponential scale through partnerships and data with the ambition of becoming the largest integrated health network in Africa and cultivating the largest clinical data repository on the continent. And the benchmark that you cited, which I found quite interesting, is Quest Diagnostics in the US, which uses more than 20 billion lab results collected over a decade to support clinical trials, as we've discussed, precision medicine and new diagnostic test development. So when you want to develop a new diagnostic test, you can access the Quest Diagnostics Bank to test that. Um I would love for you to give me your 2030. Well, 2030, I keep saying 2030 in all the episodes, but 2030 is in like four years. Give me your 2036, let's use a 10-year time frame, headline for MDAS. Like what is that front page, I don't know, headline for MDAS?
SPEAKER_00Um is probably gonna be um a good one. You know, Sugar retires from the biggest diagnostic companies in Africa. Early retirement, love it. Yeah, so that would be great. Um I'll have done my time then. Um, but but some of these things that we put there as exponential, because when we came up with our investor thesis and memo, yeah, that was like 2022 actually. So it's quite four years ago.
SPEAKER_04Yeah.
SPEAKER_00That's when we wrote all of that. But we do some of those things already.
SPEAKER_04Yeah.
SPEAKER_00So we're like we partnered with an European, um, very big European equipment manufacturer right now to develop uh malaria testing because you know they developed a your AI power diagnostic to that they wanted to validate and they needed our help with that. And and so we're able to help them out with that. Um, obviously not free.
SPEAKER_04Yes, yeah.
SPEAKER_00Um and and so and we've seen a few opportunities like that has come up.
SPEAKER_04Yeah.
SPEAKER_00Like, you know, where for us is we're building for all of the optionalities, right? Um the ability to be able to be able to do clinical trials, the ability to be able to um inform public health, what happens in the public health by uh, you know, uh using our data to to help. Um, the possibility to for folks to do research with our data, because we have a massive data set.
SPEAKER_04Yeah.
SPEAKER_00Like every day now we see 700 to 8,000 people or thereabouts, you know. So it's it's um it's it's it's significant. Yeah. And we're doing not a lot, and we're also doing a lot of proper testing for folks, like you know, across multiple mod multi multiple pathologies, right? So we have something unique, and and folks like you know, Sinla probably have something similar, right? And I think there's an opportunity. Right now, we don't know the color of the opportunity yet fully, but we know that in the future, whoever has the biggest network will have this every day. You add them more to the data set.
SPEAKER_04Yeah.
SPEAKER_00Right? Every day is more information to your data set and more information you can dig into to find insights to to you know to get something to create value in one way or the other. Yeah. And so so that's and that's what we're building, really, is that some of those things we predicted in 2022 pretty much spot on. I know when I sent that to you, I read it and I was like, you know what?
SPEAKER_01Yeah, we're actually done.
SPEAKER_00Yeah, we're pretty right with this thesis. And and for me, you know, we had a multi-the thesis, but the core thesis is the same. It's never really changed. Is that like you when you build something this big, um number one, folks, and we've seen that um you get network effects from the distribution. So one of our um big things now is we want to be in every single state. That's what we that's our most aggressive target. We want to be in every single state by the end of next year. You know, 36 of them. So we we're building for it right now. And that's because we want for all of the HMOs that exist in Nigeria for them to have at least one partner that can do work for them across the country. Right? All the national HMOs should have a partner they can work with across the country.
SPEAKER_04Yeah.
SPEAKER_00Where it doesn't matter where you are, like you know, where your your beneficiaries, you can have a beneficiary in Zafara.
SPEAKER_04Yeah.
SPEAKER_00And you can say, go to the beacon of diagnostics in Zafara and get it done.
SPEAKER_04Yeah.
SPEAKER_00And then your results will come in and look exactly the same thing as your results in Lagos. And then the HMOs in in Lagos who trust that this is a quality result. I I might not have been there before in Zafara to physically vet this diagnosis center, but because it's a beacon help, we know that we're guaranteed this quality.
SPEAKER_04Yeah, yeah.
SPEAKER_00You know, and so that's what that's the race we are running right now. The race to be in every single state in the in the federation.
SPEAKER_01Yeah. And and you've alluded to this in today's episode in 2025. You opened three primary care pilots under the Live Longer brand.
SPEAKER_04We saw that one already.
SPEAKER_01Ah, okay, two under the Live Longer brand alongside your diagnostic centers, and you framed primary care as strategically as a demand generation and retention layer for diagnostics. Um it it looks like another practical step toward your your part three, your vision.
SPEAKER_00Yes.
SPEAKER_01What have you learned so far? I mean, you close one down, but two are still operational.
SPEAKER_00I learned that you would lose money in primary care. I learned the reason why it's it's tough. Primary care is tough. It's probably the toughest part of healthcare because people expect it to be free.
SPEAKER_04Yes.
SPEAKER_00Um, so it's tough. And so even when you're trying to innovate in that space, um people don't want to people are not willing to pay money to talk to a doctor.
SPEAKER_04Yeah, yeah.
SPEAKER_00They're willing to pay for diagnostics, they're willing to pay for medication, but oftentimes people are not willing to pay for it, particularly because they have like a doctor in their church, they can say, uh, got doctor alpha. Yeah, you know, I have a dick today, what should I do? You know, so and some doctors also do consultations just because they are also serving their community.
SPEAKER_04Yeah.
SPEAKER_00So it's that part is really, really tough. Um, but we I think that that's the primary care is the price of of ethcare, whoever solves the primary care layer, yeah, that's the main price. Uh but I also think that's the addest price to solve. Just because you don't have that cash flow that you tend to get from, say, pharma or diagnostics. That being said, we excited to we learned a lot of, we have a lot of key insights from operating these locations.
SPEAKER_04Yeah.
SPEAKER_00One of the reasons why we shut down the one in Alaba was because it was inside the market. Um and the market is primarily male, male and notorious for not seeking care.
SPEAKER_04Yes, yes.
SPEAKER_00Um, so when and then we because it was so deep inside the market, the day they shut down the market, we cannot operate. Um sometimes the market is shut down during the Christmas period for one month at a time. Yeah, you cannot operate anything there. So it was just like didn't fit the kittens. And we were not for opportunities like that, you need to the buying of the managers of the market.
SPEAKER_04Yeah.
SPEAKER_00And we didn't have the buying of the managers of the markets there. So so you just have to shut it down. But I think that that's something we keep learning about. Um, we hope that the two things to solve for, I think this is my key thesis in case other people are building for Prime Care, I can share. Yeah. So number one is that there probably has to be some sort of membership fee components. Um, to and then um so that people don't have to pay to see a doctor right away.
SPEAKER_04Yeah.
SPEAKER_00Which actually that's what typically happens in, you know, they just call it card money, right? But a membership fee component with it, but then you need a lot of people.
SPEAKER_04Yeah.
SPEAKER_00So so you need to figure out a way to get a lot of people. I think in each location, you need at least a thousand members to make it work.
SPEAKER_04Okay.
SPEAKER_00And we have not been able to get, I think our biggest location will probably have like a hundred members. Um and so so yeah. So that's that part is difficult. Yeah. But you know, I'm grateful for BCONELT who continues to support my passion project.
SPEAKER_01Yeah. And you have experience doing hard things.
SPEAKER_00I mean, building BCon Health in the first place was not exactly supports my passion for it's my RD I'm doing on the side. Okay. So how do you scale primary care? I've seen a lot of interesting models, particularly in Brazil, yeah, that I think could work in Nigeria because the model kind of solves for the fact that only a portion, only 10% of Nigerians have insurance. Yeah, yeah. And when you think about private insurance, um, there's only maybe two million, or there about people on private insurance, proper private insurance, not the government's updated ones.
SPEAKER_04Yeah, yeah.
SPEAKER_00Um, so so there's a massive opportunity to provide a cheaper out-of-the-pocket experience for folks um when they want to experience primary care. Um, because people are using chargebity and going to their pharmacy right now, and there must be something um better than that. And I think overall, I think the chargebities are not necessarily I think it's actually net positive, to be honest, because more people are finding out things about themselves they wouldn't otherwise find out, and they're they're talking to doctors about it. Yeah, so I don't I think AI in that case is actually a positive thing because more people will actually come because they will find out more things about it.
SPEAKER_01Yes, but the thing with AI is the data that it was trained on, how much of that was inclusive of Africans?
SPEAKER_00Yeah, but I think I can talk about it for primary care. I think it gives you enough information to say, hey, I should probably talk to a doctor about this.
SPEAKER_03Yeah, yeah.
SPEAKER_00Um, I've you know, to be fair, I have good symptoms with AI before. And oftentimes I'm like, let me call up a doctor and confirm some of these. Yeah, because this looks scary, right? Yeah, so so I think that net people more people would want to talk to a doctor, and and and so I think we need to build for that world. Yeah, we we need to build for a world where people would have gotten some information from like you know the LLMs, yeah, and that they need to confirm or want to talk to a doctor now. And yeah, and so we that's what we we that having lived longer episodes experiment on stuff like that. Yeah, and yeah, so it's very interesting. It's one of my fun it was one of my fun projects because like with my big big with Bitcoin Office, like almost like a big business, yeah. We're a big corporate now, yeah.
SPEAKER_03Of 100 people, yeah.
SPEAKER_00Which it's like sometimes it's just like HR issues there, this one issues here, that one issues here, supply chain logistics and whatever. But like, you know, live longer is fun, it's like startup energy. Yeah, yeah. The start of energy you had back in twenty sixteen. Yeah, yeah, yeah. It's super fun to work on in the field.
SPEAKER_01It's also crystallizing. Um, I don't know if you're thinking about sole leadership. I'm always thinking about sole leadership. Some of the lessons that you're learning about scaling in primary healthcare, like the thesis, the the insights would be fantastic to kind of share and just put that out there broadly and kind of see what the reaction is to it, to see what other people contribute to it. Because I do think if primary healthcare is the prize, but it's the hardest prize, then as much information on what it takes and what the realities are on the ground would make that prize a bit more attainable.
SPEAKER_00Like yes, I agree with you. I I should write more.
SPEAKER_01Um, and that's one of my read a lot of your media articles.
SPEAKER_00Yeah, I used to write a lot back in the day, but when we're not deep in the we're the deeper end of the business, so yeah, yeah, yeah. It's a lot tougher right now. But that's something I want to do more of because I think it's really good. Because writing for me also helps me crystallize my ideas. So oftentimes when I'm writing, it's because I'm trying to form my own thesis about stuff. Yeah, yeah. And I think writing lets me put my ideas and then I need to run it through. Like I talk about this with Genevieve a lot, and so she puts my day through the grinder to make it come out.
SPEAKER_01She rips it to shreds and it's like, okay, this is what's left.
SPEAKER_00Yeah. So so I think that that's always um a great thing, and I think we should all do more of it. Yeah. Which is why I've enjoyed reading to see a health actually. Thank you. Because you guys put in a lot of really well-researched articles that uh it was few and far between before you guys came on. And and so, so it's great to be able to read those high-quality research products. Yes, so absolutely. Much appreciated.
SPEAKER_01So we've covered a lot today. Um, it's been an incredibly rich conversation. I mean, we've touched on everything. I mean, we set out to talk about diagnostics, but we've talked about primary healthcare, we talked about funding, we've talked about all sorts, fragmentation in the system with large. I want to close with a few rapid fire questions.
SPEAKER_02Let's go for it.
SPEAKER_01Um The idea of the rapid fire is I ask and you answer as quickly and as succinctly as possible. It's actually funny, you've answered quite a few of the rapid fire questions. Um, like one of the rapid fire questions was what's the most remote speak on health location? Um, but you already answered that earlier. Um, so we'll start with the first one. You and Genevieve welcomed your second child last year. Building MDAS with a toddler and a newborn at home, how does that actually work day to day?
SPEAKER_00It's not easy. It's not easy.
SPEAKER_01Yeah.
SPEAKER_00Because you know, you have to balance home life, work life. I think um, you know, but I think right now we've finally found a good cadence with it. And obviously, um, we're also on the ground more now, so it's it's really pretty to have the help. Um, so so yeah, but it's also like those are like and this is kind of like our first baby. Yeah. So it's like, you know.
SPEAKER_03It's three babies.
SPEAKER_00Yeah, it's three babies. So you manage all of them together, and so but it's been fun. It's been really, really fun.
SPEAKER_01Yeah. Um, one encouraging word for founders who are looking at the gap and realizing they will have to build the rails themselves.
SPEAKER_00Just do it. Yeah, I think that's for me, it's like always thinking from first principles. If you, you know, there's no point going off this tangent if you, you know, it won't work. So if you from your thesis, you realize you have to build the rails, then just do it.
SPEAKER_02Yeah.
SPEAKER_00I think my biggest advice for folks is like at least the way we try to do it at MDAS is that we always focus on the biggest risk at any single point in time.
SPEAKER_02Yeah.
SPEAKER_00And so you do, even though you need to build the rails, you don't need to build all the risks at once. Um, so when so we started, even though we build a lot of tech right now, we didn't start building by building tech because when we had two centers, tech wasn't uh the biggest risk. Yeah, you can manage two centers on so we we just Google Sheets for it to manage our clinical workflow. But when we had four or five centers, obviously, then the tech became really, really important.
SPEAKER_03Yeah.
SPEAKER_00So so and and so people because people shouldn't be defeated by the fact that they would have to build the rails. You just need to build the biggest, the the highest risk one.
SPEAKER_04Yeah.
SPEAKER_00And then when you get to the when you're done building it and you've the risk that, then you build the next one. Then you build the next one. So, for example, we only have our logistics business because you know we were using um third parties to deliver to move samples up and down, and then the third parties guys prefer to deliver chicken and blood samples. So we're like, okay, let's bring it in else to be able to do that. So you don't need to build that all at once. Oftentimes you can just build for the highest risk one and then move on to the next one. So yeah.
SPEAKER_01And since you're in diagnostics, the lifestyle disease you think Nigeria is most underprepared to diagnose at scale?
SPEAKER_00Um, or a lot of liver, liver and kidney issues that we're seeing right now. Yeah, because we drink all kinds of crazy stuff.
SPEAKER_01Yeah, yeah.
SPEAKER_00So I feel like we talk a lot about diabetes, we talk about appetition a lot. Um, I think we're not talking about all of the liver liver and kidney issues that people are developing because of the things people consume. And I think that that's that's that's really yeah, we see a lot of that.
SPEAKER_01Interesting. One government policy that would change MDAS's unit economics tomorrow.
SPEAKER_00Government policy. I've tried to build independent of government policy. Um that will change us, but for the better, if government, if we move to a single payer system and we're vetted as one of the um you know diagnostic providers for that, yeah, I'm chilling.
SPEAKER_01Yeah, yeah. N HIA, wink wink.
SPEAKER_00Yeah, so so that will change us um fundamentally because uh the we still get people coming and can afford care. So so that's the big problem.
SPEAKER_01Two more. First one, finish the sentence.
SPEAKER_00The biggest myth about built brick and mortar healthcare in Africa is dot dot dot they uh I think brick and mortar people denigrate become better businesses um in the healthcare space because they're not profitable. They think people are not they're not profitable, but we have great margins.
SPEAKER_01You have great margins, you do.
SPEAKER_00Um we do the work at a really high uh level. Those margins um happen because we built in a particular way. Like we we we are own supplier of equipment and reagents mostly, right? So that means that we make the margins on the reagents as a distributor and we also make it as a as a diagnostic provider. So so but if you build in a particular way, there's a way to have great margins with um brick and mortar. Sometimes when um some of the nonprofit folks see our margins, they were like, What?
SPEAKER_04Yeah, yeah.
SPEAKER_00But it's because we've built something really great and and and we're grateful for that.
SPEAKER_01Nice, I like that myth. Um what gives you the most hope about healthcare in Africa right now?
SPEAKER_00Um, what gives you the most hope? Um for me, I think there's this realization posts USAID cards posts that you know nobody's coming to save you.
SPEAKER_01Yes.
SPEAKER_00Self-reliant, yeah, that you need to figure out how to save yourself. Yeah, and I've always believed that. Um because when we started building, right, um the kind of people that were working in our space and had a lot of opinion about what we're building were the folks that came from the foundation background, the public health folks, who are also very disease-focused folks. They want to focus on malaria, they want to focus on tuberculosis, they want to focus on HIV. Yeah. But for us, we our own faces was around how do we support earth systems as a whole, that not just like this narrow disease vertical. Yeah. So so I think that in the end, you know, everybody will be fine.
SPEAKER_01Yeah, the the thing that was meant to strip our hope actually gives the most hope. Yeah, yeah.
SPEAKER_00So so, but I think that the fact that, you know, now everybody's like, okay, how can I make sure that I'm not dependent on certain supply chains because if they cut funding, I'm I'm really I I'm really screwed.
SPEAKER_04Yeah, yeah.
SPEAKER_00Or and to say, okay, what are the autonomous supply chains I can have? If you have, for example, a lot of our government hospitals would have like top-of-the-line harbour machines there, right? But then that means that the cost of the reagents in dollars, you might not be able to consistently maybe the first government that did it would buy it. The second government is like, oh, yeah, it's not my priority. Yeah, you're screwed. Yeah. So it's about rights in everything to what it needs to be. And I think that now those sort of conversations are happening finally, now that there's no you know, sugar daddy somewhere to give you money for all distance.
SPEAKER_01Yeah, yeah.
SPEAKER_00So yeah.
SPEAKER_01I like that. I like that. Sugar, thank you so much for sharing your experience for the work that you do. Um, and the MDAS team are doing to put real diagnostic infrastructure in places that need them the most. I think I've taken a lot away from today's conversation. Defragmentation, I think, is ringing in my brain very heavily. Um, what it takes to actually build brick and mortar, what brick and mortar actually means, and demystifying it in a way that you know makes it feasible. Um, and just some of the big picture kind of plans that you have for MDAS. We'll come back in in 10 years and maybe we'll have you back on the podcast.
SPEAKER_00It's real my pleasure. Yeah.
SPEAKER_01But thank you so much. Um, for our listeners, you can follow MDAS Global, you can follow Beacon Health Diagnostics to see the work that they're doing across Nigeria. You can also read our piece on TT Health on oil pipelines, cell towers, and bottling lines for a deeper case on healthcare as a capital-intensive industry where we spotlight MDAS and what we can learn from other capital giants. One last note before we go, don't forget we're gonna be at WHX Lagos 2026, taking place from the 2nd to the 4th of June at the Landmark Center here in Lagos. We'll be bringing you conversations with some of the most important voices in West African healthcare. So if you're there, come find us and don't forget to register at www.worldhealthexpo.com. And lastly, don't forget to subscribe to The Cure and share this episode with anyone who cares about building the rails that make healthcare innovation possible in Africa. And Shoga, you sign off your investor updates, Optimistically yours. And that is the spirit of this whole podcast and what this podcast is built on. So if you will indulge me, I will sign off this episode the same way. Optimistically yours, Nintobakuka. See you in the next episode.
SPEAKER_00Thank you. This this was great. Yeah. It's a great conversation.
SPEAKER_01Thank you. Bye.
