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Massachusetts Institute of Technology Legatum center for development & entrepreneurship

Legatum Center Blog

Below is an article from the Legatum Center

Beyond Right Time, Right Place: How Entrepreneurs Around the World Amplified their Impact During COVID-19

Source: Deloitte Insights



Across the globe, COVID-19 has put health systems under the spotlight. The underlying strengths or fragility of public health infrastructure and public policies have enabled or hampered nations’ ability to manage the crisis.

As evidenced by personal protective equipment (PPE) shortages and late or limited testing capacity, the United States demonstrates that resources alone do not determine the effectiveness of pandemic responses. A government’s will to establish policies and a population’s willingness to comply based on societal norms and cultural values have proven to be essential.

COVID-19 has exposed systemic weaknesses in some unlikely places, and revealed strengths and resilience in countries with many fewer healthcare resources.

As the interconnectedness between systems and local resilience — or lack thereof — were laid bare due to COVID-19, innovators across regions, sectors, and roles responded. Some entrepreneurs found themselves on the front lines of the crisis with solutions ready to scale. For these entrepreneurs, the global crisis created opportunities to amplify their businesses. Beyond simply being at the right place at the right time, these entrepreneurs had been addressing the very gaps that created business opportunity in the first place. These efforts positioned them to seize unexpected growth opportunities during crisis.

A Flare for Possibilities

When Kenya reported its first COVID-19 case on March 12, 2020, and its parent company Flare Emergency Response were as ready as they could have been.

An Uber, of sorts, for ambulances, Rescue is the largest network of Kenyan first responders connected via Flare’s technology platform. Founded in 2016 by MIT Sloan graduate and former Legatum fellow, Caitlin Dolkart, and her business partner Maria Rabinovich, Rescue fills a dangerous void: like most of Africa, Kenya had no centralized emergency response system. Kenyans could die waiting hours for an ambulance to arrive in an emergency.

By the time COVID-19 arrived, Rescue had spent four years building enabling infrastructure to fill many of these structural weaknesses. They had created a single, centralized dispatch center. They knew where and how many ICU beds and respirators were available. They had built a centralized knowledge base — and processes to keep it up-to-date — so ambulance operators could know where to take which patients. Rescue built a membership-based business model and payment processes to capture fees from consumers up-front, reducing time during emergencies figuring out where a patient could afford to be treated.

Perhaps most critically, Rescue had recruited ambulance operators from around the country and earned their trust.

“We took an incredibly fragmented system and had to create a cohesive team,” Dolkart said.

This gap was more than operational; it was emotional. Many operators believed some level of failure was inevitable; it was all they had seen. They felt at fault, but Dolkart took the blame off them and built processes, training, and tools to support them.

Based on this foundation, Rescue’s small Nairobi-based team jumped into action, securing sometimes scarce PPE to protect paramedics and training ambulance operators to safely transport COVID-19 patients in tight ambulance quarters from their homes to the hospital, and between hospitals for higher levels of care. ICU beds are few and far between in Kenya, just one bed for every 200,000 Kenyans, according to Dolkart. And Rescue knows where they all are.

Dolkart attributes the company’s success to being in the market at the right time and being able to leverage her connections to MIT and other access points around the globe. But it is her mix of grit, resilience, and leadership that have positioned her well to face the COVID-19 crisis.

“When I see a problem, I [think], ‘We can fix this,’” Dolkart said. “I really think it’s the gumption to keep going and keep fighting.”

In 2020, Flare was named to Time Magazine’s Best Inventions list.

Filling Gaps to Move Forward

COVID-19 hit Libya at an already vulnerable time, ten years into an ongoing civil war. Parts of Libya suffer shortages of medical personnel because doctors often settle abroad after getting foreign training. Like many Libyan doctors, Mohamed Aburawi wanted to help, but returning home from the U.S., where he was training as a transplant surgeon at Massachusetts General Hospital, seemed inadequate.

“One person will never make a difference if I was just wearing my lab coat and seeing one patient at a time,” he said.

Aburawi made a hard choice to step away from his prestigious medical training and focus on systemic change in his home country


Speetar — which means “place of care” in the local dialect — was born. Staffed by a consulting network of Libyan doctors, Speetar is a telemedicine platform that connects Libyans to medical specialists around the world, or across town. Speetar enables professional visits, tracks patient health information, and allows doctors to refer to other specialists if necessary. Consumers, most of whom pay the bill directly, can choose whether or not to accept the physician.

When the pandemic struck, Tripoli’s main hospitals transformed into COVID-19 care facilities, and routine care paused. Stay-at-home orders plus fear of infection exacerbated health risks. Like elsewhere in the world, telemedicine emerged as the logical solution, and Speetar was there.

Building on relationships with key government agencies spurred Speetar from early-stage operations to full national implementation. Speetar onboarded more than 1,000 Ministry of Health-affiliated physicians, and leveraged its home-grown electronic health record system for data collection and reporting. The team developed a questionnaire-based COVID-19 application to triage, manage, and categorize according to patients’ risks, based on their COVID-19 symptoms and possible exposure. Speetar gathered and sent test results to patients’ mobile phones and to Libya’s National Center for Disease Control. Speetar shed light on likely COVID-19 clusters, even where testing was not available, using data on where patients were reporting more coughs and fevers.

“We acted like the group that connects all the players in order to direct patients [and] to streamline the process of getting care,” Aburawi said, though he recognized that Speetar’s limitations. They cannot create medication supplies where they do not exist, nor can they perform procedures remotely. Critically, though, Speetar relieves strain on the system by adding capacity for mental health, dermatology, and medication management, among other remote services.

“We’re making sure that whatever resources are available locally are better allocated,” said Aburawi. To improve resource allocation, Speetar first had to map what medical personnel, medications, and diagnostic tools are available locally so doctors could prescribe treatment patients could actually access.

To address some conditions that cannot be handled remotely, Speetar partnered with local pharmacies and clinics to install “Health Boxes” or kiosks with diagnostic equipment like portable ultrasounds. Junior physicians and other staff perform in-person exams, guided by remote specialists. From afar, Speetar trains local professionals and strengthens local capacity.

Aburawi believes Speetar’s Libyan growth holds promise.

“If it can work in Libya, it can work anywhere.”

Building the Tracks for Future Success

Entrepreneurs like Dolkart and Aburawi are contemporary health system reformers who use private-sector innovation to transform their local system. Each faced steep entrepreneurial challenges, from access to capital and talent that all entrepreneurs face, to gaping structural holes within their emerging market health systems. Without chipping away at these gaps in basic infrastructure, each would have found their businesses blocked or seriously curtailed. Because each had invested energy in filling as many gaps as they could before the pandemic, they were poised for growth amplified by the crisis.

Common elements in these two stories offer a potential roadmap for sustainable healthcare innovation in the face of uncertainty. And in healthcare, there is always uncertainty. Key lessons include:

  • Experience on the ground, immersed in local systems and societal structures, is an advantage. The ability to move quickly in a crisis depends on accumulated credibility, relationships, cultural context, and knowledge of a specific health system’s interdependencies.
  • Where the pandemic exacerbated the problem an entrepreneur was already trying to fill, such as emergency response or telemedicine, the crisis served as an enabler and fuel for business growth.
  • Market opportunities are born of systemic gaps. Entrepreneurs, especially in emerging markets, may need to reach beyond their immediate business objectives to backfill those gaps and become the glue in fragmented systems.
  • Commercial success cannot be the only driver in these environments. A broader mission fuels both Dolkart and Aburawi. Mission-driven businesses may require entrepreneurs to address foundational challenges but also opens up much larger growth opportunities.
  • Building local capacity may not seem mission-critical, but professionalizing the health workforce and improving underlying capabilities improve the system while solidifying the business’ position within it.

Deep and sustainable health system reform may start with a single, if ambitious concept. It requires, though, focusing beyond any one enterprise to strengthen health systems’ foundations. What may be considered distractions elsewhere become essential for deeply rooted and meaningful improvement.


This post was authored by Deb Gordon, Author of The Health Care Consumer’s Manifesto and Forbes contributor. This blog is the first in a three-part series exploring how entrepreneurs in developing markets have amplified, pivoted, and created ventures to address new healthcare challenges in light of COVID-19.

If you would like to learn more about these innovators and their ventures join us for an upcoming webinar on February 4th 2021. Register.

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