I wrote this from the perspective of the entrepreneurs I met, currently forging digital health solutions in Brazil, and where I see the opportunities and pitfalls for other entrepreneurs interested in the Brazilian market.

1. The Opportunity is ‘MUITO GRANDE’

The Brazilian healthcare market is dysfunctional and urgently needs an overhaul, combine that with a population of 210 million people, and the right solution has the potential for hyper growth (and that ain’t hyperbole) The public health system promises care for all but in reality there is inconsistency of availability across states, long waiting times and ineffective triage. With 7/10 Brazilians using the public system, this is where the big opportunity lies

2. Its WHO you know then WHAT you know

To make it as an entrepreneur particularly as a foreigner it is critical to build relationships and trust with various stakeholders including payers, decision makers, investors and other influencers. This connection and trust is key to getting traction but ultimately you need a good product or service to back it up.

3. Venture is not adventurous

There is plenty of cash swishing around the higher echelons of society with many folks prepared to invest it. But the venture capital model is rather immature, particularly in healthcare. The backers generally prefer short term, lower risk projects, and healthcare projects tend to be neither. VCs from the US are generally clueless about the market.

4. Bureaucracy Rules

Patience is not so much of a virtue rather a vital requirement to do business in Brazil. Things tend to move slowly, particularly stuff that involve public office and even banks and finance. The good news is its likely to be the same for your competition. If this is not part of your cultural DNA or you don’t have a regular meditation practice then the inefficiency can leave you feeling frustrated!

5. The infrastructure is both a challenge and an opportunity

The WiFi and mobile data is pretty ‘patchy’ and that is being polite to my hosts! And that is just in Sao Paulo, as you travel to more rural areas the problem gets worse. Some expressed frustration at this but one telemedicine entrepreneur, did not seem phased, citing the opportunity to switch from video, to voice to chat, and ultimately schedule a house call from the app if no remote call was possible.

6. Developments tend to be localized

Many entrepreneurs try to get a critical growth of services in one area e.g. Sao Paulo or other major cities. It makes sense not spreading yourself too thin but it also means innovation in rural areas is often lacking, specifically where it is most needed. Combine that with the lack of consistent WiFi and there is a risk of digital health further driving the divide of the ‘Haves’ and ‘Have nots’

7. Tech is embraced

Infrastructure issues aside both patients and doctors seem to embrace technology. Whats App is the norm for communicating with your doctor at all times of the day. The step to video calls and more sophisticated remote medicine is a natural next step. Entrepreneurs I met are training many keen doctors on telemedicine solutions and patients seem very open, particularly if it obviates the need to hang around a hospital waiting area all day

8. Execution trumps ‘innovation’

The entrepreneurs I met are doing exciting things, from the perspective that they have the potential to change lives and radically improve health. They have a technology solution that solves a specific problem in the care pathway, for example appropriate triage in primary care to get the patient efficiently to the right service. They then focus on this relentlessly and scale. It is definitely not about shiny tech.

9. Consistency is king

Communication of healthcare services tends to be ad hoc and inconsistent in Brazil. As an entrepreneur having a consistent brand and communication message about your service with a relentless focus on getting your message out will pay dividends in rising above the other inconsistent noise

10. Patients have power

Patients have a lot of say when it comes to getting on a specific drug treatment in Brazil. This is usually via the support of an advocacy group. They will also have a lot of potential say in the choice of digital solutions and therapies. The key challenge is health literacy is poor, especially related to digital health

Thats my list of ten, I am interested in any additions, disagreements or variations on the above?

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