IMPALA

Link to pitch deck for graphics 

The 2018 WHO AFRO report on the state of health in the WHO African Region shows a staggering health system performance score of 0.49 for the African Region,  showing that health systems are only functioning at a possible 49% of their achievable level of performance. Nearly all countries in the African Region are challenged by critical shortages of health workers, skill-mix imbalance, poor working conditions, weak knowledge base, and maldistribution of health care workers . According to the WHO more than 15,8 million preventable deaths occur annually. More specifically every year 6,2 million paediatric deaths occur of which 47% are neonatal deaths. 

A large majority of these children are treated in health facilities before their death. From all paediatric and neonatal deaths, an estimated 50% and 66% respectively could be prevented through improved quality of care. Affordable and effective treatment is usually available, but the conditions are diagnosed too late to be treated effectively. Every hour delay in detecting critical conditions, like sepsis, causes a 10% increase in mortality risk. To a large extent, this is a consequence of health systems being less developed and severely under-resourced. In addition there is an enormous resource gap, in which countries like Malawi (0.5/1000) and Rwanda (1.2/1000) stay far behind the WHO recommended 4,5 health workers per 1000 population. On top of that these health workers are often low qualified and hardly receive any in-service training. This human resource gap will continue to increase up to 2030. Although it may seem logical to build this capacity, this does not take into account that it will take decades to train sufficient numbers of health workers up to a certain standard. In addition, every health worker on the payroll increases pressure on overstrained budgets. 

Technology could be used to mitigate many of these challenges. However, the large majority of medical equipment is not designed nor suitable for this context and breaks down in the first years of use, leading to 40-70% of medical equipment failure. Health facilities in LMICs in an African context have significant restrictions on their financial and human resources while facing large patient loads. In essence this means that it is an unbalanced system in which health workers with limited training and experience  are overworked while having insufficient and often unsuitable resources and equipment to serve a large population with complex healthcare needs. At the same time the patients experience different needs and challenges in these settings whereby they often have to travel long distances, have to incur significant expenses and lose out on income if they are utilizing healthcare. Even if their costs are reimbursed,  barriers are high due to the indirect costs incurred. This suboptimal care and high costs lead to large numbers of preventable deaths and impoverishment of patients.

GOAL 3 has developed the IMPALA solution: a combination of the IMPALA monitoring device for vital signs monitoring wirelessly connected to the IMPALA software that enables health workers to manage and monitor their patients better in a resource constrained environment. This solution allows them to pro-actively detect and manage critical conditions at an early stage when treatments are more effective and low-cost and enables them to allocate time and resources more effectively. It reduces pressure on health workers by reducing workload associated with monitoring and facilitating task redistribution. The IMPALA solution is tailored to the context in collaboration with local implementing partners, ensuring the system fits the needs of the health workers and provides sustainable high value impact.

The IMPALA monitoring device is a multiparameter patient monitor with an intuitive touchscreen that has ECG, pulse-oximeter, non-invasive Blood Pressure, and 2 temperature probes. It continuously measures vital signs: Heart Rate, Pulse rate, oxygen saturation, Respiratory rate, Non-invasive blood pressure and temperature. The system is designed in Malawi and Rwanda with African health workers and biomedical technicians making it intuitive, easy to use and ensuring it is resistant to heat, water, dust (IPX2) and insects. It has a battery life of 6 hours and is designed for portability as it is lightweight (weighs <2.5 kg), easy-to-carry and comes with a protective sleeve.

The IMPALA software provides a central patient overview, insights into the health status of patients and decision support. It integrates up to 20 continuously monitored patients in one central overview. With easy-to-understand patient information records vital signs can be followed in time to detect changes and assess if a patient is improving or deteriorating. With intuitive visual representations of patient health status (called patient avatars), historical patient data and visual warning signs, the IMPALA Application supports (inexperienced and less well-trained) health workers in prioritizing patients with critical needs. 

The software is expanded with clinical decision support tools. The first clinical decision support tools consist of rule-based decision trees based on officially recognized guidelines for pediatric and neonatal care that enable less well-trained health staff to provide the first emergency care and notify the doctor/specialists when needed. The development of these solutions is done in a stepwise manner in close collaboration with the key stakeholders. The first decision support tool that is currently being implemented is the Pediatric Early Warning Score. At a later stage we will integrate more complex decision support applications such as the “Integrated Management of Childhood Illnesses”. Combined with the other data, these tools create a data-pipeline of high quality and well structured clinical, demographic and vital signs data in time series that will enable development of new decision support tools and algorithms over time.

Our ultimate aim is to have integrated predictive models for various populations to a) provide improved risk stratification and b) to predict acute worsening health episodes, allowing health workers to intervene early on in the process of deteriorating health by patients, which will increase survival rates and reduce (child) mortality.

In our current proposition we mainly focus on hospitalized children and neonates with high risk conditions in need of continuous monitoring. Additionally we support the HCWs delivering this care. However, by driving innovation in our IMPALA system we want to make it suitable for other populations. For example by developing spot check functionality we want to make it suitable for lower risk patients, enabling improved monitoring for all admitted patients. In addition we aim to develop risk assessment models to identify and monitor vulnerable populations better. 

For example by integrating HIV, gender and/or social characteristics in these models. Collecting this kind of information in our models will allow us to detect and monitor health inequalities when applying IMPALA in different situations. This data will then again allow us to adjust the models based on real-life data. Last but not least we want to increase (financial) accessibility and therefore scale and impact by 1) reducing costs related to hardware through innovation and integration of third party solutions 2) providing flexible business models 3) innovating technology to make it more accessible in remote and under-equipped areas by enabling remote care as well as advanced decision support tools which allows use in environments without a doctor. This will allow us to reach underserved populations and reduce health inequalities.

My name is Niek Versteegde MD. MSc. (CEO), trained as a tropical doctor and experienced in setting-up a neonatal intensive care department in a district hospital in Tanzania.

Seven years ago, when I was working in Tanzania as a tropical doctor, I had an experience that changed my life. A premature boy was named after me after I helped to save his life. An amazing experience that became even more special when I saw two years later how this small Niek was playing with my one year old son Guus. Unfortunately I have also seen many children and neonates die. Treatment was available but we could just not recognize and treat the condition in time due to shortage of staff, lack of adequate equipment and an enormous workload. 

Still I feel sad when I think about the deaths of these children and what impact their loss had on their families. Still I feel my own pain and frustration of being powerless to help. This injustice was the reason for me to start GOAL 3. A social enterprise with the goal of stopping preventable paediatric deaths. 

I have been managing global health projects and foundations for the last 10 years and founded GOAL 3, 3 years ago with the vision of enabling and empowering healthcare workers with smart technology at places where it is needed most. This passion has enabled me to attract a diverse and highly talented team around me who share this same passion with me. 

Bart Bierling, is co-founder and Product Manager of GOAL3. An industrial designer working on the design, development, and implementation of the IMPALA monitoring system for the last 5 years as product manager and inventor. Bart has been living in Malawi for 15 months in the last 2 years and was intensively involved in the first pilots, usability research and collaborating with the IMPALA consortium partners from Malawi

Jelle Schuitemaker MSc. (CMO): Jelle Schuitemaker is a commercial manager, living in Rwanda, specialized in commercializing medical technology in LMIC.  

Eveline Geubbels PhD (Head of clinical research): holds a PhD in clinical epidemiology, has worked in Global health research for over 20 years and is living in Eastern Africa for the same period. She has set up several research institutes and has led multiple research programs in Africa. 

Next to the team this we have an active investor/advisory board with experienced entrepreneurs, both with experience doing business in Africa as with doing business in the field we are operating in. Philips Foundation Impact Investment (on the background also Philips corporate) are part of the board.

Last but not least we have a very strong and large network of academic partners, governmental organizations and non-governmental organizations who support us in our endeavors. We are part of the international IMPALA consortium which is leading the IMPALA project with 3 Malawian and 3 European academic partners. We collaborate closely with AMREF, UNICEF, ministries of health of Malawi and Rwanda and the paediatric associations of Malawi and Rwanda. 

Currently the IMPALA system is used in 3 hospitals in Malawi. In total these are 45 monitoring devices that have monitored approximately 800 patients to date. 

We believe we have a game-changing idea which can revolutionize the way how health care is provided in low resource settings. An idea which integrates business, clinical, regulatory, research, political and other perspectives into a single approach focused at strengthening health systems and improving effectiveness of the whole system. 

To really achieve our full potential we need well networked partners who can help us share our story and can link us to relevant partners that can help us accelerate and grow. We believe that Solve is by far the best platform to achieve all this. 

IMPALA differs substantially from other approaches or solutions aimed at a) addressing growing shortages in human resources in health b) improving quality of care c) strengthening health systems and/or in reducing pediatric mortality. 

• Firstly we use a technologically enabled approach to mitigate the human resources gap by a) facilitating task redistribution b) reducing (cognitive) effort needed for patient management c) reducing workload by enabling reduced admissions and early discharge. All factors reduce the pressure on the health workers. 

• Our approach is transversal in nature and links closely with trends in digitization, quality improvement and a focus on resilient and responsive health systems. It is suitable for patients of all ages and can be used to strengthen emergency and critical care services at all levels of the healthcare system. 

• Our approach helps to generate and unlock value of data to guide implementation but also create additional value for front-line health care workers as well as health managers at a local, regional and national level. In contrast to the vast majority of quality improvement programs, IMPALA is focused on the primary care process and is using data which is automatically generated. 

• Our strong services approach in which we apply our unique (in-house developed) frameworks for analyzing challenges, opportunities and bottlenecks in emergency and critical care, combined with strong local implementation partners allows us to identify and address bottlenecks which are typically not addressed by other medical technologies.

From a technological perspective the closest competitive solutions are 1) existing patient monitoring systems (developed for higher resource settings), 2) existing software solutions, such as EMRs, 3) the current status quo, manual measurement of vital signs and lastly 4) new innovations in vital signs monitoring, such as wearables. With regards to existing monitoring systems, IMPALA differs from the high-end patient monitoring systems offered by large global companies such as Phillips, GE and Welch Allyn, because it is tailor-made for the low resource context. While offering high quality, these high-end monitors are not suited for these contexts due to high costs, fragility, complexity, as well as difficult to use and maintain. In comparison to the low-end patient monitoring systems by manufacturers predominantly from Asia (e.g. Contec, Narang Medical and Biolight), the IMPALA solution is more user-friendly and durable. Partial solutions and nichemonitors designed for LMICs developed by non-profit organizations (e.g. LifeBox) are durable and affordable but offer limited functionality and do not address relevant needs in high care and intensive care units. Finally the new innovations in vital signs monitoring through wearables (like NeoPenda) provide more real-time information and are easily adaptable to a low resource setting, however, in comparison to IMPALA lack a bed-side screen decision-support, algorithms for interpreting the data and a user interface designed for hospitals in LMIC. These properties make it unsuitable for monitoring in critical care settings. Additionally it is only intended for use in neonates and not other age groups. 

The overall aim of the IMPALA solution is to save lives, costs and effort by facilitating a transition from reactive to proactive care in environments with constraints in resources. Although it is difficult to quantify the exact impact as this still has to be proven from ongoing research, we estimate based on literature that mortality can be reduced by 10-30%. In an PICU/NICU with 500 admissions and a 12,5% mortality this would save 6-19 lives per year. In addition we expect that admission time/total number of admission-days can be reduced by 10-30% as well by enabling early discharge and reducing readmissions. Based on an average admission time of 7 days this would save 350-1050 admission days. This of course would reduce the pressure on the healthcare system, the health workers as well as the patients and their caregivers who currently are often exposed to catastrophic healthcare expenditure. The societal gain from these two factors combined will be significant but are not yet taken into account.

An important advantage of the IMPALA system not yet taken into account in the impact calculations, is that the generated data can be leveraged in improving quality of care, assessing care implementation, effectiveness of new interventions and compliance to guidelines. The generated data can also be leveraged for  research purposes or health system management. Last but not least, it can be an enormous accelerator for development and deployment of new digital applications, algorithms and other decision support tools as the time, risks and costs associated with development and scaling up of such interventions can be dramatically reduced. 

In the tabel below we have written out what our projected growth path is for scaling up our intervention and the anticipated impact we will have. 

At the heart of our approach is that data from routine systems are used to guide and monitor implementation, facilitate quality improvement and continuously assess impact on quality of care as well as key process and outcome indicators to follow progress over time.

Using real-life data to guide and monitor implementation and user adoption 

The IMPALA system automatically stores data and meta-data relating to the use of the system. E.g. the number of patients, duration of monitoring, duration of alarms, response-time to alarms, alarms settings, up-time, bed occupancy rate and numerous other data points are automatically stored when using the system. These data can be used to assess system usage and responsiveness of health workers to alarms in addition to other factors. These data are used to guide implementation in the initial phase and thereafter to assess if usage is improving/reduced and/or if there are specific challenges in using the system (e.g. differences during nights and weekends vs daytime). These data will be fed back to the users and managers to detect and address potential bottlenecks towards adequate use of the system. IMPALA can also be used to collect data on other interventions (e.g. CPAP in neonates) and assess a) if it is used and b) the fidelity to guidelines if it is applied adequately. 

Using real-life data for quality improvement and impact evaluation

In addition to the data mentioned above the IMPALA system also collects data on clinical parameters (e.g. average temperature of neonates throughout admission). Although currently the data entry is limited to vital signs, other inputs will be added soon to further support health workers in their work. These data will be complemented with outcome data and data from routine systems to monitor quality of care and support a process of continuous improvement. This will increase the impact of the intervention over time.

More details about the data we expect to collect can be found in the table below:

In the current situation there are insufficient health workers and they do not have the right training to monitor and manage their patients adequately. This causes a reactive way of patient management in which critical deterioration is detected only at a very late stage and treatments are more costly and less effective. Simultaneously discharge only happens when it is very clear that the patient has recovered, contributing to long admission times. Exposing patients and caregivers to risks and costs associated with admission for longer than needed.

The overall aim of the IMPALA solution is to save lives, costs and effort by facilitating a transition from reactive to proactive care in environments with constraints in resources.

This is achieved by 

a)Facilitating systematic collection of high quality data with less effort 

b)organizing and visualizing data more effectively facilitating faster and easier interpretation 

c)providing decision support to health workers 

d)provide tailored capacity building/training together with local partners. 

Combined this approach leads to improved insight, oversight and follow-up of patients which allows for early detection of change and improved and more timely decision making and management of patient. This will contribute to saving lives and costs as each hour delay in treatment increases mortality rate by 10% 

In addition to that we expect that there will be a significant reduction of (cognitive) workload for health workers in this setting, especially for nurses but also for doctors. We expect that by improving the working conditions of hospital staff, in the longer term IMPALA implementation will lead to increased job satisfaction and lower staff turnover. 

1. By automating data collection through continuous monitoring approximately 5 minutes per vital signs check can be saved. In an average intensive/high care setting, vital signs are checked at a minimum of 6 times per day, reaching as high as hourly measurements. Per patient the time can easily add up to an average of 1hr per day, which would save 1 hour saved * 500 admissions *7 admission days = 3500hr per year equivalent to 2 fte of health workers per year. Of course this will mainly have an impact on quality of care of nurses in overstrained environment 

2. Because the IMPALA system systematically collects and organizes the information real-time in the application in an intuitive way, it facilitates improved interpretation of essential information. This makes it easier and less time consuming to assess one or multiple patients. This will also facilitate task redistribution to lower qualified staff and free up time for direct care provision. 

The improved balance in workload will likely lead to a direct benefit for patients as scarce time and resources can now be concentrated on those who need it most. This provision of care is supported by real-time information about the condition of patients which can now be more easily observed and responded to in time in case of deterioration. This is further stimulated by providing decision support tools that help health workers to take the right evidence based action at the right moment. 

Background: 

Monitoring in itself is not lifesaving, however it is aimed at timely detection of a critical condition and should lead to early and effective action by health workers. We conceptualised this process into a model called the monitoring cascade (Attachment I; Figure 1). This model maps out the clinical care process and helps understand what steps are needed before successful and timely intervention can be done. Moreover it helps to identify gaps in this process and combined with qualitative interviews improve understanding of why these gaps exist. We used the model to adjust the system design, enabling us to address potential bottlenecks in the care process, guiding the baseline assessment and tailoring the implementation to a specific hospital context.

The technology

The IMPALA solution has been iteratively designed, developed and improved over the course of the last 4 years in close collaboration with end-users and biomedical technicians from the target context. The IMPALA system is in the core a software platform for decision support and data-driven services.  Although the IMPALA monitoring device is currently an essential component, we anticipate that in the future it will be replaced by 3rd party monitoring equipment. Through continuous innovation and by leveraging existing solutions, we aim to increase both the relative impact as well as the accessibility of our interventions. In 3-4 years from now we also expect to provide standalone decision support applications that do not require any specific hardware (e.g. for antenatal care or triage). 

The IMPALA solution: a comprehensive approach that combines medical technology, software, training and data-driven services in one package that can be tailored to various contexts. At the heart of this approach is the IMPALA system: a combination of the IMPALA monitoring device for vital signs monitor which is wirelessly connected to the IMPALA software that enables health workers to manage and monitor their patients better in a resource constrained environment. This allows them to allocate scarce time and resources more effectively and intervene at an early stage when treatments are more effective and low-cost. In addition, it reduces pressure on health workers by reducing workload associated with monitoring and facilitating task redistribution. By providing the IMPALA system in a service model providing installation and implementation tailored to the context with local implementing partners, we ensure the system fits the needs of the health workers and provides sustainable high value impact. We increase the value of our IMPALA solution, by providing updates of the software and data-driven services guiding health care implementation and quality improvement. 

The IMPALA monitoring device: is a multiparameter patient monitor with an intuitive touchscreen  that has ECG, pulse-oximeter, non-invasive Blood Pressure (NiBP), and 2 temperature probes. It continuously measures a variety of vital signs: Heart Rate (HR), Pulse rate (PR), oxygen saturation (SpO2), Respiratory rate (RR), systolic, diastolic and mean blood pressure and temperature (TEMP). The system is designed in Malawi and Rwanda with African health workers and biomedical technicians making it intuitive, easy to use and ensuring it is resistant to heat, water, dust (IPX 2 rated) and insects. It has an extended battery life of 6 hours and is designed for portability as it is lightweight (weighs <2.5 kg), easy to carry and comes with a protective sleeve. 

The IMPALA software consists of two main components: the IMPALA server and the IMPALA application that work together seamlessly to serve the needs of the HCW. The IMPALA server is the central on-premise communication and data-storage hub that wirelessly connects up to 20 monitoring devices with the IMPALA Application. Although internet connection is possible this is not required. All patient data is stored in an electronic patient record for each unique patient, which allows HCW to follow patients over time and detect trends. The usage data, clinical data and process data are automatically stored on the server. All data can be used on an individual or aggregate level for a variety of purposes including quality improvement, scientific research and health system management. 

The IMPALA Application retrieves the information through the server and is the central interface for doctors and nurses. It provides a central patient overview, insights into the health status of patients and decision support. It integrates up to 20 continuously monitored patients in one central monitoring overview. With easy-to-understand patient information records vital signs can be followed in time to detect changes and assess if a patient is improving or deteriorating. With intuitive visual representations of patient health status (called patient avatars), historical patient data and visual warning signs, the IMPALA Application supports (inexperienced and less well-trained) health workers in prioritizing patients with critical needs.  

IMPALA as a platform for decision support: To further support health workers in their responsibilities GOAL 3 is expanding the software with clinical decision support tools. The first clinical decision support tools consist of rule-based decision trees based on officially recognised guidelines for paediatric and neonatal care. The clinician will make the final decision, however, the decision support can enable less well-trained health staff to provide the first emergency care and notify the doctor/specialists when needed. The development of these solutions are done in a stepwise manner in close collaboration with the key stakeholders. The first decision support tool that is currently under development is the Pediatric Early Warning Score. At a later stage we will integrate more complex decision support applications such as the “Integrated Management of Childhood Illnesses” and the “Emergency Triage and Assessment Tool” developed by the WHO. Combined with the other data entered into the IMPALA system, these tools create a data-pipeline of high quality and well structured clinical, demographic and vital signs data in time series that will enable development of new decision support tools and algorithms over time. 

Current stage of development: None of the technologies used in our approach are new in the sense that they are already widely used in other applications and therefore do not require validation from a technological perspective. It uses off-the-shelf hardware components which were adopted to the specific context of hospitals in a low resource setting. The essence of our innovation lies mostly in integrating the various components into one complete solution and ensuring that it is sustainable, accessible and easy-to-use. The complete system as described in the previous section was iteratively developed and tested in Malawi in two clinical studies (EdoScic pilot in 50 patients and IMPALA cohort 1000 patients) and has proven to function stably and serve the needs of end-users as well as research purposes in these settings. The IMPALA system is currently being used in a Malawian setting and is approved by the ministry of health of Malawi for commercial use. A request for regulatory approval is submitted in Rwanda. The complete IMPALA solution including services is delivered in the St. Luke’s hospital in Malawi where successful user-adoption as well as a positive impact on quality of care is observed which is closely aligned with the preliminary results from the IMPALA project. The IMPALA solution and the associated business models still have to be validated at scale.

Inclusive design is part and parcel of the approach we take as GOAL 3.  The IMPALA solution has been iteratively designed, developed and improved over the course of the last 4 years in close collaboration with end-users and biomedical technicians from the target context. Dozens of user interviews, cognitive walkthroughs and heuristic interviews with end-users were done during this process. Throughout there have been close interactions with other key stakeholders from the ministry of health, iNGOs and managerial functions at the nursing, hospital and regional levels.  In this period a clinical pilot was done (EdOSciC) evaluating the conceptual models as well as the IMPALA solution. Based on these inputs plus the combined experience of the GOAL 3 and IMPALA project team we developed several conceptual models analyzing the current challenges in emergency and critical care services in low-resource-settings, while improving our understanding of what was needed to address this challenge. 

2. Setting up the IMPALA consortium: The pilot also made us realise that for successfully designing and applying a monitor in  a LRS we would require a broader expertise. We formed an international multidisciplinary consortium with experts in the field of critical care, social sciences, artificial intelligence, e-health and Point of Care laboratory diagnostics. This consortium consists of 3 Malawian partners (TRUE, KUHeS, MUBAS), 3 Dutch partners (AIGHD, NeLL, GOAL3) and 1 British partner (Imperial College London) each bringing their own expertise. In this consortium we tried to match experts in Europe and Malawi to work on projects to share knowledge in both directions. The EDCTP funding opportunity boosted the formation of the consortium and consecutive studies and monitor development.

3. IMPALA clinical cohort: The main aim of the current stage of the IMPALA project is to further develop the IMPALA monitoring system to feature predictive algorithms based on vital signs, sociodemographic data and biomarkers for early prediction of critical illness in children in LRS. This project was started in May 2021 and consists of three stages (Attachment I, Figure 3). In the first stage the feedback from the pilot study using IMPALA 1.0 was used to develop an upgraded monitoring device (IMPALA 2.0), to perform a baseline clinical assessment prior to implementation and design and prepare the clinical studies. In the second stage IMPALA 2.0 was implemented, evaluated and data gathered for training and validation of the predictive algorithms for critical illness. The iterative design and usability allows improvements of the monitor. In the third phase IMPALA 3.0 will be developed through integration of the predictive algorithms and the final User Interface  and hardware design. IMPALA 3.0 will then be evaluated in a mixed-methods pilot study to test the performance in terms of critical illness prediction and impact on clinical decision making.

GOAL 3 sees itself mainly as a software, data and platform company that offers software to enable data-driven decision making at the various levels of national and international health system. In our current go-to-market and scaling strategy we aim to provide a complete solution with a) High quality fit for context and intuitive monitoring equipment at affordable costs b) clinical information and decision support software to improve patient management and provide quality improvement and ensure that this tailored to the local context with local implementing partners. In this model we aim to have a very compelling offering by providing hardware at low costs and software as a subscription model in which updates and upgrades are included in the subscription fee. We anticipate that we will sell hardware at or below costs and that our margins will come predominantly from the software subscriptions.

This translates to a business model in which the monitoring equipment and other hardware is sold at cost price (approximately 1000$ per device) and that over years the revenue is made based on the software and service model (1$ per device per year) 

In this approach we distinguish the following sales channels:

1) Direct sales to hospitals 

2) Indirect sales to hospitals with a 3rd party funder

3) Sales to iNGO's / through implementing partners

4) governmental sales. 

On the short term we expect that 2 & 3 will be our main drivers of growth until we reach the point where we can clearly demonstrate the cost-effectiveness and other benefits of the intervention. After that we expect 1 and 4 will increasingly become drivers of growth.

As a social enterprise GOAL 3 aims to become self-sustainable based on revenue generated through sales as explained in the previous section. This means that we can only be sustainable if we achieve a sufficiently large scale that allows us to sustain a blended European-African team. Our current calculations show that we would become cashflow positive upon reaching 2500 installed devices, which milestone we expect to achieve in 2026. 

As we are just entering the market we are still dependent on obtaining investments from investors to reach this point. According to our current budget an additional 3M is needed. We are in close contact with several investors and funding agencies to obtain this funding.

More details about the models behind can be seen in this pitch deck

GOAL 3 has successfully raised €3M to date1.6M 

€1M in grants and subsidies

€1.6M in convertible loans through crowdfunding, angel investors and a €500k investment by Philips Foundation

€0.4K soft loan from Achmea Foundation

In addition to these investments GOAL 3 is close to making the first sales for which the first sales are expected in Q2/Q3 2023. For this we are in close contact with several iNGOs, hospitals and the ministry of health of Rwanda