Javier Lozano

Ashoka Fellow
fellow-17714-MEXICO Javier Lozano-NYC (HS).jpg
Mexico
Fellow since 2012
This description of Javier Lozano's work was prepared when Javier Lozano was elected to the Ashoka Fellowship in 2012 .

Introduction

Javier Lozano has created a low-cost, one-stop-shop clinic to treat diabetes and prevent the complications associated with the disease. With advanced technology and diagnostic and treatment innovations, his clinic offers high-class yet extremely affordable medical care for populations that could otherwise not access it.

L'idée nouvelle

With Sugar Clinics, Javier provides specialized, low-cost medical care for diabetes patients from the middle and lower classes of Mexico, especially in rural and isolated communities. By offering low prices, reduced queue times, and quality care, Javier believes his clinics will become an attractive option for Mexicans who need diagnosis or access to diabetic treatment. Since most diabetes-related deaths and complications occur among low and middle-income populations, Javier’s project has the opportunity to create national impact.

Sugar Clinics provide all the services a diabetic patient needs in one place. It has developed automated tests, software, and specialized diagnostic algorithms, to detect and manage diabetes. With an economically efficient model based on economies- of-scale, it uses its sheer size to reduce average costs. Patients pay a fixed fee annually to have access all diagnostic and examination services, consultations, and diagnostics for laboratory tests and basic medications. Although there are a few social ventures that offer similar services in Mexico, Sugar Clinics is the only one to offer specialized care for diabetes patients with a sustainable model.

Javier has devised the clinic to have a social impact wider than its current location. In the future, he expects patients in agricultural areas and isolated communities to have access to the clinic’s physicians through phone consultations. Sugar Clinics has teamed up with the Nuevo León state government, thus cementing the basis for future expansion within the state and later throughout Mexico. Javier’s clinics will form a new venue for physicians to approach diabetic healthcare outside the private sector and the largely inefficient public sector. At the same time, the clinic will provide competitive salaries and help to alleviate pressures on public institutions. Expanding Sugar Clinics’ technology to other places will enable the clinic’s expansion to many offices in Mexico.

Le problème

In Mexico, more than 12 million people have diabetes. According to the Ministry of Health, diabetes is the leading cause of death (70,000 per year) and other health complications, such as blindness, amputations, and kidney damage. Mexico spends more than US$1 billion per year on diabetes care, of which 52 percent comes directly from patients’ income, and the rest from the public and private sectors.

Although no socioeconomic strata is immune to diabetes, diabetes is more common among middle- and low-class families, at 17 percent; than upper-class families, at 11 percent. Yet, upper-class families tend to be able to pay for private clinic treatment at US$1,000 per year. Diabetes and its complications cost on average US$45,000 per case, a cost that is financially devastating for most Mexican families.

The lack of diabetes care is especially pronounced in low-income, rural communities. Diabetes patients from these communities have poor treatment options and typically develop health complications. The impact of these complications can cause patients to lose their jobs, deplete their savings through surgery and dialysis costs, and endure severe emotional stress. Family members must often take care of the diabetic patient, which can render further strain on the family and thus increase the diseases complications.

Though diabetes is easy to diagnose, it requires the attention of many specialists. This makes it hard for the poor to properly address the disease. Furthermore, the follow-up and treatment can incur significant out-of-pocket expenses and patients can suffer significant complications or painful side effects from prescription medications. These factors, combined with poor diabetes education, cause more than 95 percent of patients to leave care and develop major complications. Past efforts have focused on developing new technology for high-income patients and developing better drugs, though these are still too expensive for the majority of patients. These efforts have not addressed the extreme need for better care and treatment among lower- and middle-income patients.

In theory, Mexican citizens have a right to low-cost healthcare from public institutions, but in practice the system lacks the necessary medical and financial resources. The overcrowded government health centers provide insufficient services, employ poorly trained doctors, and are largely focused on treating acute diseases. These issues are further aggravated in rural zones and isolated communities. This inadequacy of health service delivery capacity has worsened with the rapid increase in chronic degenerative diseases including diabetes, hypertension, and cancer.

Due to the exponential growth in the number of patients diabetes care has become a major challenge, a result of dietary changes and the increase of sedentary lifestyles. One million new cases of diabetes are detected each year in Mexico and total cases are expected to reach over 30 million by 2030; in just a few years the existing public and private health systems will be severely insufficient.

La stratégie

While studying at MIT, Javier identified the issues that lower and middle-income Mexicans had in dealing with public healthcare institutions to receive diabetes treatment. He found that treating diabetes requires the support of a myriad of operations working in unison. To solve this challenge, Javier developed a unique system of specialized care units focused on addressing diabetes.

Javier founded Sugar Clinics in 2010. He established his first clinic in Guadalupe, Nuevo León, a municipality in the greater Monterrey metropolitan area that is characterized by its high prevalence of diabetes and marginalization. Javier made it a point to enlist the support of influential parties for the clinic to achieve its goals. For example, he connected with the state government of Nuevo León, whose Health Secretary came to Sugar Clinic’s opening ceremony. The establishment of the first clinic at Guadalupe as well as a relationship with the state government will later facilitate the expansion of Sugar Clinics across the region. He also recruited the Dean of the Harvard School of Public Health and former Mexican Health Minister, Dr. Julio Frenk, who sponsored Javier’s project from its inception while Javier studied at MIT, to help launch the project.

The clinic in Guadalupe has served as Sugar Clinics’ pilot. While focusing on a “retail” approach to developing the clinic’s healthcare service, Sugar Clinics uses the high volume of patients to reduce costs through economies-of-scale. Javier has utilized his knowledge of processes and algorithms to cut costs significantly and improve services, which are translated into reductions to the fees paid by the clinic’s customers.

Sugar Clinics provides high-quality services comparable to that of private care institutions. The staff, comprised of nutritionists, psychologists, nurses and other professionals, targets families in isolated communities or rural areas using a system of consultations over the phone. They also provide patients with workshops for preventing and treating diabetes. Sugar Clinics institutes a system of annual payments. It currently offers three different packages to its customers: the preventive package costs about US$70, while the integral plus package, which offers more specialized services, is priced at about US$260. At low costs, these plans cover laboratory tests, consultations, basic medicines, and diagnostics.

Over the first four months of activity, the clinic served over 1,000 individuals and signed up about 250 members. It prevented seven amputations, two cases of potential blindness, and a possible suicide. Additionally, technological innovation has helped Sugar Clinics create unique diagnostic and specialty care, thus helping to reduce complications by 50 percent, wait times and transfers by 80 percent, and costs by over 60 percent, while increasing patient adherence by 70 percent. Technological innovations take the form of automated tests and software, which can help anticipate whether one’s diabetes is likely to run out of control.

In its first year of operations, Sugar Clinics integrated and adjusted the clinics practices. Javier is finishing refining the pilot clinic’s technology and operational practices. He also plans to gather more data regarding the real necessities of the clinic’s patients. Once the algorithms have been perfected, Javier will integrate these into mobile clinics, which will enable Sugar Clinics to pursue diabetes prevention in underserviced outlying areas. Sugar Clinics aims to perform 10,000 assessments, out of which 2,000 will become patients.

Within five years, Sugar Clinics plans to have fifty clinics and 50,000 patients. The clinic will develop a relationship with Mexico’s universal insurance, Popular Insurance, to individuals who do not have private insurance policies. Sugar Clinics will thus be able to expand its practice and reach the poorest corners of Mexico. Javier is evaluating different expansion plans using funding through donations, private capital, or a system of franchises. Standardization of Sugar Clinics’ innovative technologies will facilitate expansion in Mexico.

Through public policy advocacy, Javier will use his experience and his clinic’s data to ensure that the prevention of diabetes will become a national priority. In ten years, Sugar Clinics will also expand its thematic focus, encompassing other widespread chronic diseases like hypertension. It is now on its way to becoming a leader in innovative treatment and services throughout Mexico and the rest of Latin America.

La personne

Javier has shown initiative since his youth. At the age of 17, Javier spent a year in the indigenous community of the Sierra Tarahumara. Living in such dire poverty without the most basic sanitary services, his life perspective changed. Javier witnessed several community members die from a lack of basic healthcare. This experience helped plant the first seeds of his later social ventures and guided him toward solving social health issues. Javier founded an immersion project for the Sierra Tarahumara that brought hundreds of individuals to live and experience life in the indigenous community. The CO was committed to agricultural development, small business creation, and education.

In college, Javier studied engineering physics. After graduation, he taught social development while working full-time at a manufacturer of aluminum and plastic products, and developed a keen understanding of efficient organizational processes. As a professor, Javier was also engaged in leading undergraduate students through social programs.

Equipped with professional understanding and the goal to begin his own health project, Javier began his Master of Business Administration in 2008 at the Massachusetts Institute of Technology. He followed the Entrepreneurship and Innovation track to learn the hard skills necessary to start his own initiative. Javier gained practical experience in rural health by participating in major health projects in Boston, Tanzania, and South Africa. He later co-founded Global Cycle Solutions, a social enterprise for pedal-power devices in Tanzania, enhancing Javier’s experience in developing social projects.

Combining Javier’s experiences in the private sector and his education, he explored ways to create a center for innovation and low-cost treatment for diabetic patients in Mexico. Javier has long felt a personal connection to diabetes, as the chronic disorder affected his mother. From a young age he saw the difficulties involved with controlling one’s glucose levels. Javier is now rapidly devising a plan to replicate the success of Sugar Clinics around Mexico; to prevent and treat one of the most entrenched health crises in the country.