JORDI MARTí

Spain,

Jordi Martí is making early diagnosis of infectious and non-communicable diseases affordable for disadvantaged communities and poorly funded health systems. By developing his own new technology and delivering it through a global cross subsidization model, he is not only widening the range of easily traceable risk factors for certain chronic diseases, but he is also allowing rich mass-volume data analysis to quickly reach health policymakers. 

This profile below was prepared when Jordi Martí was elected to the Ashoka Fellowship in 2011.

INTRODUCTION

Jordi Martí is making early diagnosis of infectious and non-communicable diseases affordable for disadvantaged communities and poorly funded health systems. By developing his own new technology and delivering it through a global cross subsidization model, he is not only widening the range of easily traceable risk factors for certain chronic diseases, but he is also allowing rich mass-volume data analysis to quickly reach health policymakers. 




THE NEW IDEA

Jordi is making early diagnosis and prevention of a wide spectrum of medical conditions available and affordable through a data-rich dry blood testing technology and strategy. He is working at two different levels to make this happen: Jordi is developing a new blood testing technology and also implementing a new business model that allows this solution to scale. 

Jordi’s solution is integrated within local, regional and national governments, healthcare systems, and other key players in the country or region (citizen organizations, medical associations, or hospitals). He establishes different agreements with the health authorities to define the scope of the project based on an initial diagnosis of the most common pathologies among the population. These are tracked from both an individual as well as a population-wide perspective to help policymaking. Once general health needs and risk factors are identified, Jordi helps the government establish the methodology and infrastructure needed to analyze blood samples and to use the software that can process large volumes of data. To do this, Jordi is testing different business models and agreements. For instance, in Rio de Janeiro, he is working in partnership with Instituto Vital Brazil (a public company) to provide training to local staff, as well as follow-up, equipment, and all needed advisory services. He has also designed different sizes of labs to help reach scale while adjusting to local specific needs.

To drastically lower implementation costs by reaching an optimal volume, Jordi leverages his efforts on systems already in use by governments or other major health organizations to complement different awareness campaigns with testing. In these campaigns, he does not only include biochemistry parameters—his new technology—but important other indicators for other factors, such as HIV and covering large gaps of information from both the perspective of the patient and the authorities. 

This method of capturing blood samples is simple, effective, and economic. It does not require special conditions for storage and transportation, and the investment in training the personnel that must handle the samples is minimal. All of these factors: Subsidized scaling, simplicity, leveraging local healthcare efforts and distribution channels, are each important for its introduction to the market, and together, open ample opportunities for scaling. 




THE PROBLEM

Early diagnosis and health prevention are long promoted measures by every public healthcare system, as well as international organizations working in the field of healthcare. Although prevention and early diagnosis have resulted in significant savings for both public health systems and the treatment-related costs to individuals, the implementation of these measures is often limited by the lack of appropriate technology and policy prioritization. 

According to the World Health Organization (WHO), 35 million deaths are caused worldwide due to non-communicable diseases, which include heart disease, stroke, diabetes, cancer, and chronic respiratory diseases. The majority of these non-communicable diseases occur in low- and middle-income countries. Of these estimated 35 million deaths, around 40 percent are premature and preventable. In addition, obesity is one of many risk factors for serious cardiovascular conditions. An estimated 43 million preschool children are obese or overweight. The main risk factors for obesity are not consistently tracked in children, both in the developed or developing world. 

In addition, developing countries also struggle with infectious diseases and weak health systems. They face grossly inadequate numbers of staff, shortages of medicines and funds, and sometimes a total lack of insurance schemes to protect patients from catastrophic healthcare costs. In large parts of the developing world, health systems are geared toward the management of infectious illness, which results in the patient either surviving or dying. Needless to say, these systems are hardly prepared to cope with the demands and costs of chronic care.

The current diagnosis industry—based mainly on intravenous puncture—is oriented toward developed markets where there are not logistical burdens, such as those relating to refrigeration and transportation. These costs in developing economies, however, are unaffordable for the system and especially for individuals and families. In addition, inadequate technology creates discrimination against certain geographically remote areas that cannot afford the costs needed to maintain stable samples. Also, such expensive methods are not appropriate for the mass population studies, both in developed and developing countries. This limits the information communicated to policymakers who set the priorities for action. Moreover, intravenous puncture is not the most adequate method to track certain populations, like children. 

Alternatives to intravenous puncture, such as dry blood test technology, are already available. However, solutions and applications are still very narrowly focused. Around 70 percent of these kinds of tests correspond to widely applied (in both developed and developing countries) neonatal tests that measure certain hormone levels and genetic and metabolic disorders. A further 20 percent are used to test for HIV and malaria, and 10 percent are used to prevent prenatal mother-child infections. More importantly, current widespread dry blood tests only run positive/negative results, unable to discriminate levels of concentration (e.g. cholesterol).

These facts demonstrate the urgent need for cost-effective early diagnosis systems that (i) help identify main population health needs to design better health systems and their response (ii) drastically lowers the costs of healthcare by reducing the number of people that need intensive treatments over an extended period of time (as morbidity rises over mortality) (iii) decrease the cost of early diagnosis and prevention itself (iv) improve the quality of life of millions of people, extending the time before serious illnesses appear. 




THE STRATEGY

Jordi has developed a method to analyze specific biochemical parameters—uric acid, creatinine, cholesterol, HDL, LDL, triglycerides, hemoglobin and glucose—in dried blood samples. These variables allow tracking of critical risk factors of non-communicable silent maladies like cardiovascular diseases, diabetes, and so on; currently the main causes of death and increased disability. Unlike traditional campaigns that only test for one specific condition, such as HIV or tuberculosis, Jordi’s system allows testing of multiple other parameters at a lower cost and reaches more people at a faster rate. This not only improves individual life conditions, but also provides local governments with relevant epidemiological information useful for designing effective health system policies and measures. 

Jordi’s strategy to scale dried testing solutions is based on the establishment of strategic partnerships with local institutions including local, regional or national governments or healthcare institutions. These institutions already have experience on the ground and understand the local context. Jordi’s model is based on establishing and improving the local government’s capacity and infrastructure by providing the equipment, inputs, training, and education needed to conduct large testing campaigns. 

Jordi is also testing different business models and strategies to guarantee that early diagnosis and testing is widely available to the targeted population. One of these strategies is a cross pricing scheme. In order to make this massive effort sustainable, Jordi plans to subsidize prices in developing countries, with other campaigns in developed contexts where added services are most valued. These include: Painless procedures, proximity or timeliness, and application for testing parameters outside of regular procedures. For instance, a massive campaign to track cholesterol and triglycerides levels in school children will help track the development of these risks factors and their consequences. 

In this model, local laboratories are in charge of commercializing the testing kits and reading analysis results, while a central lab will conduct R&D, systematization and standardization of procedures, producing the testing kits and other inputs, installing local lab equipment, and providing local training. The location of the local labs dictates their business model. In wealthier contexts with complex health systems, labs will specialize in added value services with higher margins. In developing countries or in poorer areas, labs will specialize in tropical diseases, and/or obtain their income from processing basic analysis to cover their operating costs. 

Jordi is also exploring opportunities to engage with private sector companies through their corporate social responsibility efforts. Companies concerned with healthcare issues can sponsor a specific campaign (i.e. World Diabetes Day). They will also benefit from different marketing options, such as printing logos on filter paper and other materials that will be spread among participants. 

As it is designed, the model benefits everyone in the value chain. At the individual and end user level, early diagnosis and prevention opportunities are made available (in remote areas for instance, where no infrastructure is available because refrigeration is needed) and affordable. This directly translates into better living conditions and gives solutions to help cut the health-related poverty trap in most developing countries or impoverished areas. At a policy level, healthcare systems benefit from epidemiological information for better policymaking and also in terms of economic solutions at a cost 20 to 50 percent cheaper than conventional blood sampling. 

Jordi has established a pilot project in Rio de Janeiro in partnership with the public company Instituto Vital Brazil. This project will test mother-child vertical transmitted infections in 150,000 women. According to statistics, around 4 percent of these women are infected with AIDS, syphilis, hepatitis B, or toxoplasmosis. Thus, it is estimated that 6,000 to 8,000 infections will be avoided. Jordi is also negotiating with Guatemala, Liberia, Angola, Rumania, Peru, and Mexico to establish pilot projects. In India, with a high incidence of diabetes, a pharmaceutical company has expressed interest in partnering with Jordi to implement these dry tests. 




THE PERSON

Jordi’s obsession with the importance of early diagnosis and prevention dates back to his time in the military service. Because of his degree in chemical engineering, he was assigned to the intensive care unit of the military hospital where he served. There Jordi had close contact with patients and families, and saw many cases where future plans were sadly changed due to heart attacks or other preventable diseases. Jordi then pursued his professional career in the diagnosis industry.

In 2008 Jordi read an article by a recognized cardiologist about the number of heart diseases that could be prevented, had the patients controlled their cholesterol levels from early ages. At the same time, he realized how difficult it was to blood test children when he took his son for a vaccine. Then, Jordi’s crusade to make early diagnosis an easy, available and affordable solution started. Being a “people” person, Jordi made contacts to make DBS happen, and soon he had a pilot project in Brazil with many other countries now in the pipeline to replicate. 




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