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GOAL 3 - Its time for Change

Current funding

€768.200,-

102%
Invested by 73 investors
Co-Investment Philips Foundation Impact Investments €500.000 Convertible
Days left 12 days
Minimum amount €750.000,-
Maximum amount €1.500.000,-
Interest 6.0%
Duration 5 year
Closing date 20-08-2022
Type Convertible


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Documentation

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AFM vrijstelling prospectus




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Summary

Summary of the issuance

Important message: The first closing of the GOAL 3 investment round has been effectuated on the 20th of may 2022. With this closing, the investors who invested before the 20th of May are now Convertible Bond holder of GOAL 3. The campaign will still be available in a private mode for investors who missed the initial deadline of the 20th of May. If you invest, you will be part of the next closing of the convertible and you will be added to the convertible agreement with an addendum. The next closing will be in 3 months, or when there will be at total of €100K extra investment which can be added. For questions, reach out to the GOAL 3 team or Symbid. 

Potential investors should read this summary as an introduction to the information memorandum. Every decision to invest should be based on studying the full information memorandum, including the attachments. 

This funding round is a co-investment with Philips Foundation Impact Investments. Philips Foundation is investing €500.000 via a convertible bond into GOAL 3 on the same terms as the funders via the Symbid platform. Via the Symbid platform the minimum amount to be raised is €250.000,- and the maximum amount is €1.000.000,- 

The following milestones apply for the Philips Foundation Impact Investments ticket:

  • Anticipated deadline May 2022, €200.000 when €250.000 is being raised via the campaign on Symbid.
  • Anticipated deadline Aug 2022, €150.000, Succesfull study with 45 Impala products conducted, Role of Philips as technology partner is clear.
  • Anticipated deadline Oct 2022, €150.000, Full go to market plan is ready and reviewed by investors. 



Issuing entity: GOAL 3 Holding BV

  • Website issuing entity: www.goal3.org 
  • Type of issuance: Convertible bond 
  • Issuance amount: Minimum €250.000 - Maximum €1.000.000 
  • Minimal nominal value per participation: €200 
  • Issue price: €200 
  • Conversion option:
  • If you invest > €100k the bond can convert directly to shares of the issuing entity. 
  • If you invest <€100k the bond can convert to certificates of shares of the issuing entity via an investment cooperative.


Conversion discount:

  • 3 to 12 months after issuance of the convertible bond: 15% 
  • 12 to 18 months after issuance of the convertible bond: 20% 
  • >18 months after issuance of the convertible bond: 30% 


Use of funds:  Finalizing the product to a market ready MVP, Building first commercial leads, Strengthening the company and existing projects

Risk profile: Very high (Risk profile Very High because the issuing entity exists no longer than 3 years, click here for more information on Symbid risk profiles

  • Interest: 6% (single, accrued) 
  • Collateral: None 
  • Repayment: After 5 years, but issuing entity has option for extension of another 2 years 
  • Early repayment option: No 
  • Symbid costs issuing entity: 2%-6% success fee (Excl. VAT) 
  • Symbid costs investor: 1% administration fee (Excl. VAT)  
  • Target group issuance: Retail investors + Impact investors.
  • Expected return: Not fixed, depends on performance issuing entity 


The Concept

Summary in Dutch (NL), full proposition in English (ENG)


Wie zijn wij: GOAL 3 is een sociale onderneming opgericht in 2019 door een team van experts met complementaire achtergronden, die zich verenigen rond de visie "Eerlijke en toegankelijke gezondheidszorg voor iedereen". De zorgmedewerkers die deze zorg elke dag leveren, zijn essentieel om die visie te bereiken. Daarom is onze missie: "Zorgmedewerkers ondersteunen en empoweren op plaatsen waar dit het hardste nodig is." Ons doel is om voor 100 miljoen mensen de toegang tot hoge kwaliteit zorg te verbeteren in 2030. Door datagedreven besluitvorming mogelijk te maken met ons monitoring systeem en zorgplatform zorgen wij dat levens, tijd en kosten kunnen worden bespaard. Wij richtens ons initieel op gezondheidszorg in Afrika.


De noodzaak: De afgelopen decennia is er wereldwijd enorme vooruitgang geboekt in het verbeteren van de toegang tot gezondheidszorg. Inmiddels is de meerderheid van de 15,8 miljoen jaarlijkse vermijdbare sterfgevallen toe te schrijven aan lage kwaliteit zorg en niet aan gebrek aan toegang. Vooral in de kinderzorg is dit duidelijk; meer dan de helft van de 6 miljoen jaarlijkse kindersterftes kan voorkomen worden door betere kwaliteit zorg. In een groot deel van Afrika is de kindersterfte 10 keer hoger dan de rest van de wereld. In ontwikkelingslanden in andere regio's is dit 4 keer hoger. Daarom is er steeds meer aandacht voor en behoefte aan kosteneffectieve oplossingen die de kwaliteit van zorg verbeteren en het mogelijk maken om effectieve en betaalbare behandelingen op tijd te bieden.



De uitdaging: Veel ontwikkelingslanden hebben niet de beschikking over sterke gezondheidsstelsels met de benodigde mensen, middelen en capaciteit om zieke kinderen op tijd te herkennen en de (betaalbare) behandelingen in een vroeg stadium aan te bieden. Vooral op het gebied van personeel zijn er grote uitdagingen; Er zijn in Afrika 10 keer minder zorgmedewerkers per hoofd van de bevolking dan in Europa en deze zijn over het algemeen een stuk minder hoog opgeleid. Een tekort wat volgens de wereldgezondheidsorganisatie bijna zal verdubbelen tot 2030. Daarnaast is er een enorme behoefte aan geschikte medische technologie. Vrijwel alle bestaande medische apparatuur is ontworpen voor een Westerse omgeving en niet voor deze omgevingen met weinig middelen. Deze systemen zijn te complex in gebruik, onderhoud en bediening waardoor ze snel kapot gaan en in onbruik raken. Maar ook kennis en reserveonderdelen die nodig zijn voor onderhoud en reparatie ontbreken. Dit leidt ertoe dat tot wel 70% van deze systemen kapot zijn en/of niet gebruikt worden. Als gevolg hiervan worden veel ernstige aandoeningen te laat herkend en behandeld, terwijl ieder uur vertraging leidt tot een 10% toename in de kans op overlijden. Daarom is er een andere aanpak nodig die rekening houdt met de uitdagingen in deze omgeving en helpt met het vroegtijdig detecteren en behandelen van deze aandoeningen. 



Een complete oplossing: Daarom ontwikkelt GOAL 3 het IMPALA systeem; een slim monitoringssysteem voor Afrikaanse ziekenhuizen met geïntegreerde beslisondersteuning wat zorgmedewerkers in uitdagende omstandigheden optimaal ondersteunt bij het leveren van de juiste zorg op het juiste moment. Deze oplossing bestaat uit 2 belangrijke componenten:

Een gebruiksvriendelijk en duurzaam monitoring apparaat wat met behulp van verschillende sensoren de vitale waarden van de patiënt meet zoals hartslag, ademhaling, bloeddruk en temperatuur. Dit apparaat heeft naast de traditionele sensoren zoals ECG, bloeddruk, thermometer en saturatiemeter ook nog de ballistografische sensor. Dit is een erg gevoelige druk sensor, waarmee we door het matras heen de ademhaling en hartslag kunnen meten. 

Een ondersteunende applicatie op een tablet waarin een eenvoudig patiëntendossier staat en waarop beslisondersteuning wordt geboden via een interface dat toegankelijk en vertrouwd is voor de zorgmedewerkers. Via deze tablet kan informatie eenvoudig worden verzameld, weergegeven en gedeeld en wordt het makkelijker om kritiek zieke patiënten te herkennen en te bepalen wie er eerst moet worden gezien. 

Doordat dit systeem nauw aansluit bij de werkprocessen worden zorgmedewerkers ontlast, terwijl ze hogere kwaliteit zorg kunnen leveren. Naast de directe klinische toepassing van de data, zal de data van het systeem worden gebruikt voor het bewaken en verbeteren van de kwaliteit van zorg. Naarmate er meer data beschikbaar komt, zullen de gegevens ook een waardevolle aanwinst worden voor klinisch onderzoek. Door het IMPALA systeem geschikt te maken voor integratie van hardware, software en algoritmes van andere partijen, kan het IMPALA systeem uitgroeien tot een platform wat de impact en de waarde voor patiënten en gebruikers nog verder vergroot. De resultaten zijn betere kwaliteit zorg, vergrote efficiëntie alsook betere prioritering en allocering van schaarse middelen.

Waardeproposities: Via het faciliteren van datagedreven besluitvorming maken wij het mogelijk om hoogwaardige gezondheidszorg tegen lagere kosten te bieden. Onze conservatieve schatting is dat het IMPALA-systeem de sterfte met 10% kan terugdringen en ook de opnameduur met 10% verkort. Voor een districtsziekenhuis met 4500 pediatrische en neonatale opnames zou dit tot een kostenbesparing van € 50.000 leiden en het redden van 48 kinderlevens per jaar. Via de platformfunctie kan het systeem bijdragen aan het verlagen van de risico's, kosten en tijd die nodig zijn voor het ontwikkelen en opschalen van nieuwe digitale oplossingen voor deze markt. In de toekomst zal het creëren van inzichten in de data, alsook het gebruik van de data voor onderzoek en andere toepassingen steeds meer waarde toevoegen.

Roadmap en strategie voor ontwikkeling: Ons doel is de ontwikkeling van een intuïtief en eenvoudig te gebruiken product wat aansluit bij de specifieke uitdagingen van zorg in ontwikkelingslanden. In de eerste jaren ligt onze focus op de ontwikkeling van het monitoringsysteem. Op termijn zal dit naar onze verwachting in toenemende mate verschuiven naar de doorontwikkeling van ons platform. Via samenwerking met partners willen wij hoogwaardige en relevante content verzamelen die in het IMPALA systeem kan worden geïntegreerd, zodat de transitie naar een platform geleidelijk kan worden gemaakt. Voor onze ontwikkeling hanteren we een gefaseerde aanpak waarin commerciële, klinische en regelgevende aspecten op elkaar zijn afgestemd om optimale bedrijfsresultaten en impact doelen te realiseren.

  • Fase 1: Ontwikkeling van het monitoringsysteem IMPALA; de kern van ons platform. Verbeterde bruikbaarheid en duurzaamheid verhogen de waarde en verlagen de kosten voor onze klanten. Dit systeem zal in Q3 2023 CE-gecertificeerd zijn om schaalbare markttoegang in de belangrijkste markten te realiseren.
  • Fase 2: Ontwikkeling en integratie van op richtlijnen gebaseerde beslisondersteuning die de kwaliteit van zorg verbeteren waarvoor geen aanvullende certificering vereist is.
  • Fase 3: Focus verleggen naar interoperabiliteit en integratie van meer complexe digitale diagnosetools, hardware van derden en voorspellende algoritmen.
  • Fase 4: Transitie naar een volledig platform met toenemende focus op governance, kwaliteitscontrole en data-services.


Business model: in ons businessmodel combineren wij hardware in een leasemodel met servicemodel voor de applicatie met de beslisondersteuning. Door het IMPALA systeem als een service aan te bieden in een betaalbaar abonnementsmodel vergroten we de toegankelijkheid van het systeem en wordt het behalen van de gewenste resultaten een gedeelde verantwoordelijkheid van ons en de klant/gebruiker. Door de data die  door het systeem wordt gegenereerd te vertalen naar relevante inzichten, kunnen wij ziekenhuizen en gebruikers optimaal ondersteunen bij het gebruik van het systeem. Dit model stelt ons en onze klanten in staat om de interventie af te stemmen op hun behoeften en daarmee de waarde te vergroten. Daarnaast stelt het ons en onze content partners in staat om onze diensten en producten aan te passen aan de veranderende behoeften in de gezondheidszorg.


Market and go to market-strategie: GOAL 3 heeft Rwanda, Malawi en Zuid-Afrika als start markten gekozen. Deze zijn gekozen vanwege hun omvang, toegankelijkheid, innovativiteit, diversiteit en onze relevante en sterke netwerken en relaties ter plaatse. GOAL 3 start in deze landen volgens een gefaseerde aanpak, te beginnen met implementatie studies (Q4 2022) en vervolgens de eerste verkoop (pre-order eind 2022) begin 2023. In 2023 en 2024 zal de focus liggen op opschaling binnen deze beachhead markten. Vanaf 2024 breiden we uit naar andere landen zoals Kenia, Tanzania en Zimbabwe. De initiële marktomvang is € 135 miljoen per jaar voor Sub-Sahara Afrika. De initiële markt is € 1,2 miljoen per jaar voor Rwanda, € 1,4 miljoen per jaar voor Malawi en € 13,2 miljoen per jaar voor Zuid Afrika. Deze cijfers zullen aanzienlijk groeien naarmate we de waarde van onze proposities verbreden en ons systeem meer verschillende toepassingen krijgt.


Terugblik GOAL 3 - We All Health Crowdfunding 2021
In februari 2021 sloten we een succesvolle pre-seed crowdfunding ronde. Het minimale doel van € 250.000 werd met 163% overschreden, waarbij er maar liefst € 657.100 werd geïnvesteerd door 140 investeerders. In die campagne stelden we verschillende mijlpalen en doelen tot de volgende ronde. Wij zijn er grotendeels in geslaagd om de gestelde doelen te behalen en hebben sommige doelen zelfs overtroffen. Aan het realiseren van een aantal doelen wordt op dit moment nog gewerkt.
Hieronder delen we een terugblik op de doelen van het afgelopen jaar. 



De volgende mijlpalen hebben wij bereikt in het afgelopen jaar:

  • Verrichting en afronding van de eerste pilot studie. In 5 maanden werden met 10 systemen, 50 patiënten onderzocht op de kinderafdeling van het grootste kinderziekenhuis in Malawi. 
  • Patient zero; tijdens de pilot studie in Malawi werd een kritieke episode bij een kind ontdekt doordat het was aangesloten op ons IMPALA systeem. Als gevolg hiervan kon er tijdig worden ingegrepen en heeft deze patiënt het overleefd. 
  • Selectie en uitbouwen van de partnerschappen die benodigd zijn voor de ontwikkeling van het IMPALA systeem.
  • Ontwikkeling van een nieuw revolutionair design van het IMPALA systeem samen met de eindgebruikers en andere partijen uit Malawi, gericht op robuustheid, uniekheid en gebruikgemak.
  • Het ontwikkelen van de volgende versie van het IMPALA systeem. Met productie van 60 systemen bedoeld voor de IMPALA klinische studie welke start in juli 2022.
  • Er is een uitgebreid marktonderzoek verricht waarin Ghana, Kenia, Rwanda en Malawi werden bezocht. Dit heeft geleid tot het selecteren van Rwanda, Malawi en Zuid-Afrika als startmarkten
  • Er zijn sterke lokale partnerschappen opgebouwd in de startmarkten met onder andere de overheid, ziekenhuizen, verenigingen, distributeurs en doktoren. Er zijn letters of support, letters of intent en memorandums of understandings gesloten met verschillende ziekenhuizen in Malawi, Rwanda, Tanzania, Zimbabwe en Zuid-Afrika, het ministerie van gezondheid van Malawi en de associatie voor kinderartsen in Rwanda. 
  • Er werd een start gemaakt met een Quality Management Systeem (QMS) en protocollen die nodig zijn voor certificering van het IMPALA systeem in de nabije toekomst. 
  • Uitbreiding team van 10 naar 20 medewerkers met een sterker management team, groter software team en veel medisch-technische ervaring.


Er werden  verschillende onderzoeksconsortia opgezet rondom IMPALA studies, waarbij er nieuwe partners werden gevonden in Zimbabwe, Zuid-Afrika en Engeland op het gebied van neonatale- en spoedeisende zorg.

Naar ons inzicht zijn wij er goed in geslaagd om onze mijlpalen en doelstellingen te behalen in het afgelopen jaar. Er is in verhouding meer geld gebruikt voor de ontwikkeling van het product dan vooraf was begroot. Dit is onder andere veroorzaakt doordat de ontwikkeling van het product op een aantal punten complexer was dan vooraf was ingeschat. Daarnaast heeft de krapte op de arbeidsmarkt ervoor gezorgd dat de personeelskosten en kosten aan externe partners hoger waren dan begroot. Daarentegen was er minder geld nodig voor het marktonderzoek en het pilot onderzoek doordat er meer synergie was met het IMPALA project in Malawi dan waar we rekening mee hielden. 
Doordat wij nieuwe, sterke partners hebben geselecteerd voor ontwikkeling van het monitoringapparaat verwachten wij sneller een volwaardig product te hebben waarbij een belangrijk stuk van de productie en distributieketen al verzorgd is. Hiermee is het risico voor de verdere ontwikkeling en opschaling van productie afgenomen en kunnen wij ons nog meer richten op de ontwikkeling van de server en applicatie en aanvullende functies. 


Op het gebied van commerciële ontwikkeling zijn we verder dan vooraf werd ingeschat doordat veel interesse werd getoond vanuit verschillende landen in Zuid- en Oost-Afrika. Dit biedt de mogelijkheid om de best passende markten te kiezen die aansluiten bij ons product en business model. 
Op basis van deze ontwikkelingen zijn wij nog steeds op het geplande pad tot een commercieel product en duurzaam impactvol bedrijf. Door de positieve feedback vanuit verschillende marktpartijen en potentiële klanten verwachten wij conform planning begin 2023 de eerste verkopen te starten. Vanwege de positieve feedback alsook positieve resultaten uit de pilotstudie is de verwachting dat wij dat wij sneller kunnen opschalen in meer landen. Als gevolg hiervan is begroot dat wij al in 2026 een positief resultaat zullen bereiken wat een jaar eerder is dan ruim een jaar geleden was ingeschat.



GOAL 3 USP’s (From here on the pitch will English)

  • GOAL 3 consists of a team of complementary experts with a strong focus on and passion for healthcare in Africa
  • The strong purpose driven culture in GOAL 3 drives innovation and ensures that we are ambitious and goal focused. 



Product USP’s - Why the IMPALA monitoring system

  • The IMPALA system is provided in an affordable business model with monthly subscription fees that make it accessible, even for hospitals with limited resources
  • The IMPALA system is co-developed in Africa to make it robust and sustainable in the context
  • The IMPALA system is designed with a human-centric design together with end-users to make sure health workers can use it easily without extensive training
  • Through the supportive applications with decision support, health workers are supported to provide high quality evidence based care. 
  • Because service and maintenance are included in the subscription model, the system is functioning more reliably and has a higher uptime compared to other systems in these markets. 
  • The plug-and-play multi-patient monitoring function is easy to implement and enables easy monitoring of multiple patient which increases efficiency at the ward
  • Improved data-visualization at the monitoring device as well as the tablet enable improved understanding and interpretation of a patient by contextualization of data 
  • Because the IMPALA system has a basic electronic Health Record (eHR) integrated, it enables digitization of time-intensive processes and it helps to improve insights by facilitating data collection and visualisation.
  • The IMPALA system automatically captures clinical data, usage data as well as meta-data which can be used for quality improvement, guideline development and other purposes to improve health care over time. 



Revenue model

Our initial target markets are hospitals in Sub-Saharan Africa. There are approximately 5,000 hospitals in Africa that need an estimated 15-60 monitoring devices per hospital. These hospitals procure either via local (governmental) tenders, local distributors, international (aid) projects or directly from the manufacturer. 

GOAL 3 services these markets using two main business models:

  •  1. Direct sales via Monitoring as a Service: Working with a fraction of the 5000 Sub-Saharan Hospitals in a full operational leasing model offering our systems for fees starting at €2 a day, cutting out upfront costs and integrating training, service, and maintenance to ensure uptime. This model ensures close collaborations with the end-users to work together on improving the quality of care through smart innovations.
  •  2. Indirect sales by distributors and agents: Scaling up after proving the system, we will start working with value-adding distributors that understand our product and business models and have a local foothold in hard to reach markets outside GOAL 3 catchment areas. The average margin for distributors is estimated at 30%. Together with these distributors, other models such as tendering and upfront sales are investigated based on local preferences. This model ensures localization, navigating the difficult sales process and offers options for scalability.



Achieved so far

Research

  • Initiated the IMPALA research consortium with world-class research institutes in pediatric intensive care around the IMPALA monitoring system. EDCTP grant from the European Union, € 3.44 million granted. 
  • First research papers disseminated on ballistographic sensor technology.
  • Initiated the Neotree-IMPALA consortium with academic partners from South-Africa, Zimbabwe, Malawi, Belgium, the UK and the Netherlands for developing an end-to-end clinical support system for neonatal care. Currently looking for funding opportunities.


Product

  • January-May 2021; Field pilot study in the Queen Elizabeth Central Hospital, Blantyre, Malawi. Results; first data captured of 50 patients, end-user feedback gathered, UI/UX tested, ballistografic sensor tested and validation of the first IMPALA prototype. 
  • Fall 2021: Product requirements finalized and validated with key stakeholders
  • December 2021: Partnership with manufacturer Witleaf/Zugmed for development of the IMPALA system
  • March 2022; New IMPALA design released together with Studio Mango, design patents filed for Europe.



Finances

  • Secured € 65,000 pre-seed investment from founders
  • December 2019: secured a € 40,000 take-off subsidy for the first pilot study in Malawi 
  • September 2020: Secured a € 20,000 MIT feasibility subsidy (September 2020) for market exploration and the testing of an innovative sensor technology
  • January 2021: € 50,000 MRE-stimulation fund for development and integration of a wireless sensor connection
  • February 2021: Successfully raised € 657,100 in GOAL 3 - We All Health I Symbid crowdfunding campaign from 140 Symbid investors. 
  • May 2021: Granted € 400,000 (soft) loan by Achmea Foundation, to be used in phases going from market exploration to market introduction
  • March 2022: [Pending] EIC Accelerator, GOAL 3 application, scale up game changing innovations by individual start-ups / SME's for € 3,5 million euro 70% grant, 30% investment
  • April 2022: As part of this round we are rounding off an investment with a larger company in a convertible loan agreement (comparing terms to the crowd, slightly different) and are in conversation with other formal investors


Concept

  • Created a multi-disciplinary team of 15+ members that are committed to bringing GOAL 3 to a success.
  • Nominated for 10 start-up and design awards, a finalist in 7 of these and;
  • Winners of the University of Technology Eindhoven start-up contest (€ 5,000) and the Everis Netherlands Start-ups awards (€ 10,000) in 2020, Best tech-idea 2020 the Netherlands, popular vote, KIJK magazine.
  • Became part of the top 10 selected African HealthTech Hub startups in Kigali, Rwanda by Norrsken Foundation, Novartis Foundation and Bridge for Billions. 


Partnerships and Sales

  • Active partnerships with 10 research institutes, 3 development partners, 2 Ministries of health (Malawi, Rwanda) and 6 African hospitals (Malawi, Rwanda, and Tanzania) established.
  • Market exploration research in Malawi, Kenya, Ghana, and Rwanda, leading to initial local partners, interest and ecosystem. 
  • Commercial implementation studies drafted for first 50-100 systems in Malawi and Rwanda.
  • First leads for project in biggest children's hospital in South-Africa (60+ systems).


The needed investment will be used for

  • Finalizing the product to a market ready MVP:
  • Finalization of IMPALA V0.9 for clinical validation study for June in 2 central hospitals in Malawi (Queens Elizabeth Central hospital Blantyre, Zomba Central hospital)
  • Design freeze and finalization of IMPALA V1.0 for implementation pilot studies for October 2022 in Rwanda and Malawi
  • Building first commercial leads:
  • Manufacturing run of first 50 devices for implementation pilot studies, to be scaled to 200 devices 
  • Costs for setting-up implementation pilot studies, building local representation
  • Strengthening the company and existing projects:
  • Costs for setting-up internal Quality management systems (QMS) needed for certification and regulatory approval
  • Costs for running existing research projects
  • Additional operational costs for running the company (office, salaries, travel)



In the event that the minimum raise of € 250,000 within this crowdfunding campaign is achieved, the funds will be spent as follows: 

  • €160.000 Start of final development prototype used in clinical validationstudy mid 2022 based on pre-mvp prototype
  • €50.000 Start on design freeze MVP for commercial pilots
  • €25.000 Start set-up QMS 
  • €15.000 Costs Symbid 


In the event that the minimum raise of € 1,000,000 within this crowdfunding campaign is achieved, the funds will be spent as follows:

  • €450.000 Finalize development prototype used in clinical validationstudy mid 2022 based on pre-mvp prototype
  • €150.000 Design freeze MVP for commercial pilots
  • €125.000 Implementation pilot in real life setting 4 hospitals
  • €75.000 Local office + regulatory approval + inports
  • €125.000 Set-up and certification of QMS 
  • €27.500 preparing technical file
  • €47.500 Costs Symbid 


For the investor

With this GOAL 3 crowdfunding, GOAL 3 offers an early investment in our company that is on its way to revolutionize healthcare. An investment will not only bring social returns for participating in making healthcare fair and accessible to all, but will also offer financial returns. GOAL 3 aims to do so via:


Return On Investment 
Being a high-potential start-up, GOAL 3 is expected to grow significantly in the coming years. In the current situation, investors step in, in a relatively risky and early stage. As GOAL 3 we want to reward this risk with offering a premium via a conversion discount when GOAL 3 receives its first valuation. The growth of valuation of the company could double in the coming years, which means that early investors profit from this growth. In the coming 10 years, GOAL 3 will be reinvesting (most of its) profits into further growth of the company, this means that the value of shares can keep growing, but also means no profits will be set aside for dividends. An example of this growth in ROI can be found no/limited below. GOAL 3 aspires to become a B-corp, using their fair values and guidelines for creating future shareholder value. 


Exit possibilities
Mergers and acquisitions: In the MedTech field, mergers and acquisitions (M&A) with big company valuations are common. GOAL 3 is currently not actively pursuing a M&A trajectory but is not excluding this option for the future. An optimal M&A partner can be found at the intersection where the acquirer’s mission-driven activity and corporate strategy converge with well-established experience in the MedTech field. A more detailed M&A strategy can be found below. 

Buy-out / Selling shares in next funding rounds: GOAL 3 has a big mission that will require more funding than the money that is raised with this crowdfunding. In future rounds, money will be raised at an expected higher company valuation. GOAL 3 aims to offer early investors the possibility to sell their shares during these rounds.

Next to a buy-out of shares, GOAL 3 is also aiming to make its shares tradable in the longer term. This means that GOAL 3 will look for modern platforms such as Nx’ Change to create a marketplace for making these transactions possible. 


Risks
GOAL 3 is currently in an early stage, this means that still there are many unknowns in the future of the company. Risks that can be identified are for example a dry-out of funding before reaching the market, not finding the right profitable customers for the product or GOAL 3 being overtaken by competition. These risks will be identified by ourselves and in consultation with our advisors and external experts. Mitigation strategies will be defined accordingly. 



Risk factors

General risk factors

  • General risks associated with SME investing  
  • Risk of competition in markets where the issuing entity is active. 
  • Negative impact through changes in rules and regulations by political decisions.  
  • Changes in macroeconomic conditions. 
  • Performance of issuing entity is dependent upon functioning of board members. 
  • There is a risk the issuing entity may go bankrupt. 
  • Tax risks through changes in regulations, new regulations or political decisions. 


Company specific risks

The risk analysis, mitigation strategy and GOAL 3 warranties in place are defined and ranked as per date of this page. The probability that a risk will occur and the impact that it will have can change over time and will be periodically reassessed by GOAL 3 management team.



Identified Risk Risk mitigation  GOAL 3 warranties
User risk
Solutions that ultimately don't align with user values - Observe key users in the context of use.
- Walk them through your technology using story boards.
- Use their feedback to refine your solution.
- First pilot study in Malawi in 2020-2021. Clinical study (IMPALA) mid 2022 - final prototype. In both studies core user needs are central.- All development disciplines are under one roof.
- Working on MoU with association of paediatrics in Rwanda to ensure continuous collaboration in (further) development.
Certification risk
- Define intent for technology development- Identify class parameters (I, II, III) - Have close contact with Malawi (IMPALA consortium) and Rwanda authorities in order to get concrete agreement on documentation needed for regulatory approval.
- class identified and taken into account during product development- Experienced medical regulatory officer on team.
Technology risk
Functional issues in late-stage integrated solutions - Adopt subsystem development approach
- Focus first on proof of concept, basic science, and lab verification
- Then move to integrated Alpha and beta verifications
- Pretesting in lab of subsystems of monitoring device;
- Minimizing this risk by testing and using many different existing sensors, as well as continuously evaluating the safety of IMPALA on-site in collaboration with local health care workers in SSA;- Integrated Alpha verifications will be performed prior and during clinical trials mid 2022.
- Integrated Alpha verifications will be performed prior and during clinical trials mid 2022.
Funding risk
Compromised credibility from milestone shortcomings. - Consistently align milestones to realistic outputs.
- Afford yourself sufficient time to explore and fail.
- Commit only to what can be achieved in a short timeframe.
- Milestones are defined in GOAL 3 roadmap (by product). financials and funding need are aligned. Milestone are measurable;
- Funding strategy incorporates possible delay / overrun.
- Commitment only made for short term deliverables (main commitment is IMPALA study mid 2022).
- Experienced CFO on team.
Reimbursement risk
Erred reimbursement model assumptions - Engage a specialist at the offset of your program.
- Identify existing procedure.
- Based code for coverage- Embark on efforts for a new code with higher/better reimbursement.
- Engage several partners such as Quadraat Global.
- Field research performed in 4 different countries. Met with DMU from different stakeholders (hospitals, ministries, NGO's distributors, insurance companies, etc.)
- Different reimbursement models identified and to be assessed in coming period.
IP Risk
Competitive claims that halt development - Have a patent attorney uncover existing patents
- File provisionals for all ideas that hold value- File non
- Provisional patents after a year's time has passed
-  Experience with the core-team with filing patents / IP. Will be supplemented with legal firm specialized in IP / patent filing;
-  Provisional and non-provisionals (after a year's time) will be filled. 
Product risk
Solutions that ultimately do not meet user needs. - Focus on core user needs throughout the entire process.
- Ensure development disciplines are all under one roof.
- Develop your solution from start to finish collaboratively.
- First pilot study in Malawi in 2020-2021. Clinical study (IMPALA) mid 2022 - final prototype. In both studies core user needs are central.
- All development disciplines are under one roof.
- Working on MoU with association of pediatrics in Rwanda to ensure continuous collaboration in (further) development.
Team risk
Not have the necessary knowledge and competences on board - Ensure entrepreneurship experience.
- Innovative mindset to continuously meet evolving user requirements.
- High engagement of core team to ensure success on long term.
- Have entrepreneurial experience with the team. Needs to be extended in coming phases.
- Innovations as a mindset secured in company culture and specifically with team members responsible for innovation.
- Long term engagement secured with founders / core team members.


Product specific risks

Product specific risks associated with investing through convertible bonds 
The lender agrees that its claims against the borrower under the convertible bond agreement used on the Symbid platform rank below all other, non-subordinated, claims against the Lender as referred to in Section 3:277.2 Dutch Civil Code (‘BW’). 

Borrower issues a (subordinated) convertible bond, which the lender can convert at a later stage to depository receipts to become a Shareholder of the company. Lender expects an (exponential) growth of value of the company with the possibility to sell the depository receipts with a capital gain. However, in most situations, such capital gains do take more than an additional five years after conversion to be realized. In exchange for the possibility of a high return in case of a scenario of exponential growth of the value of the company, there is a risk the investment will be lost in case the company is not doing well.  

Order of payment: Payment of returns will happen after payments to creditors and redemptions have been done. There is a risk that the issuing entity has inadequate liquid assets to pay the returns. This means that (a part of) your return can't be paid, if this occurs. In case of a bankruptcy, the following payments have priority over the payments of the returns of this convertible bond: Outstanding creditors and existing loans. This means that in case of a bankruptcy the return on the convertible bond cannot be paid. 

There is no formal secondary market for the convertible bonds, hence options for trading these convertible bonds are limited. It may be that there is no buyer in case you wish to sell your convertible bond(s). This means there is a risk you can't get your money on the desired moment and have to hold on to your investment or sell the convertible bond for a lower price.




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Organisation

Team

The GOAL 3 team currently consists of 17 dedicated team members. This team is built on multidisciplinary and diversity hosting both talented and experienced professionals, working together on the same goals. The company is steered by a daily Management, overseeing the daily operations and an extended management team, overseeing the long-term strategy. The full team is split between the core team, working mostly full-time and all 16+ hours and the extended team of people working a few hours per week on specific terrains. In the coming years, the team is expected to grow moderately in technical experience and commercial experience. 



Legal structure

  • GOAL 3 is a Besloten Vennootschap incorporated on 29-03-2022 and located in Uitgeest. Chamber of Commerce: 85930539. The address of the B.V. is Kalverkamplaan 14, 1911 LS UItgeest.  
  • The company website: www.goal3.org. 
  • Contact person: Niek Versteegde  
  • The issuing entity is managed by Niek Versteegde
  • Contact Person: Niek Versteegde, niek.versteegde@goal3.org, +31 6 16915011




Human development

Growth of the team
The current team hosts all key positions needed for getting GOAL 3 to the next phase, getting the first product to the market. For additional roles in development, depending on funding choices will be made to outsource or hire based on the strategic direction of the company, the costs and the availability. Getting closer to the market, the commercial team is expected to grow with various local representatives and a strong and experienced commercial director leading this team. 

Upskilling the current team
Management follows the Impact Habits course provided by Pieter van Osch from scale-up impact over a period of 12 months. This method is based on the principles of scaling-up and entails courses on: strategy, implementation, people, cash, quarterly, sustainable impact, and personal growth. Furthermore, through several advisors and consultants, we  gather as much information as possible, on both product development as well as organizational matters. We aim to build an active GOAL 3 community that will collaborate on product development, exchange scientific and clinical knowledge, discuss organizational topics such as strategies and structure, and generate business development plans. Lastly, we believe every team member thrives when personal ambitions as well as professional talents are nourished and when they are positively challenged in their work. By encouraging development on a professional as well as on a personal level, we believe the team can grow, as the company grows, to make sure we stay ahead. Our strong internal company culture can elevate this process.


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Product

The IMPALA system

The IMPALA system is a complete and integrated vital signs sensing, monitoring and visualisation system in which GOAL 3 provides all elements needed for the hospital to use the system successfully. IMPALA is designed to be used either as a standalone system, or on-premise connected system. In the future the system can integrate cloud based services tailored to the needs and requirements of our customers. IMPALA will be provided as a service in which the system as well as deeper insights coming from using the system over time will be provided in a subscription model. 



The system consists of 4 core components which are being (co-)developed by GOAL 3. 


Monitoring device: The monitoring device of the IMPALA is comparable to existing monitoring devices and has ECG, pulse oximetry, non-invasive blood pressure and temperature sensors. The main differentiation in the monitoring device lies in improved usability and sustainability in low resource settings. The design makes it more accessible and more sustainable in hospitals in Low- and Middle Income Countries (LMIC). The core of the IMPALA monitoring device is based on pre-certified building blocks reducing  effort, risk, and time needed for certification. The monitoring device will be certified as a CE MDR class 2b medical device. 

Ballistographic sensor: The ballistographic sensor is a very thin pressure sensor that is put underneath the mattress and is able to measure breathing rate through the mattress. Due to its non-invasive nature, the fact that it does not need to be replaced in between patients, and the durability, make this sensor fit for use in low resource contexts. The hardware is available off the shelf. GOAL 3 is integrating this sensor with the IMPALA system and is developing the signal processing algorithms for monitoring breathing rate in neonates and children. Next steps in the development of the ballistographic sensor are: monitoring vital signs like heart rate, heart rate variability and patient movement. 

Data and EMR application:  Multiple monitoring devices can connect to an on-premise GOAL 3 server. This server hosts a Data and EMR application, essentially there is a simplified EMR that links the  monitoring device to a specific patient’s record. Initially the focus is on intuitive, real time actual and continuous data trend visualisations and enabling multi-patient monitoring. As a next step we will implement rules based risk-assessments and prioritization. Amongst other things we will be integrating decision support tools like PEWS, documentation of observations streamlining general  nursing tasks. The application will be the central interface for future platform functions. 

Enabling infrastructure: For the system to function properly local infrastructure like servers, tablets and communication networks are needed. This infrastructure  may not be  in place, in such cases GOAL 3 will provide support. The hardware components of these elements will be offered and relevant software needed may be bought-in or if not available, developed by GOAL 3. We do not plan to CE certify the enabling infrastructure.



Unique selling points

We provide an integrated solution specifically designed for these low resource settings. This includes a robust, user-friendly and context-specific monitoring system, with a connection to tablets to make the management of the ward  and general nursing work more efficient. The system can be updated with additional eHealth applications and supportive algorithms. This, combined with an innovative business model, offers a complete solution to hospitals. 


Product USP’s - Why the IMPALA monitoring system

  • Sustainable in the context: The system is being designed with (Malawian) healthworkers and hospital technicians to make it robust and reliable in a setting in which currently most of the equipment fails. 
  • Affordable for LMIC: GOAL 3 offers a complete solution to the hospitals, supporting with providing education, installation, service and maintenance. This is done with an innovative business model that works via a subscription model, cutting high upfront costs and ensuring that the systems stay up and running. 
  • User friendly interface: The user interfaces are co-developed with the end-users to make the system easy to use and learn and increase productivity. GOAL 3 has the systems UI/UX design in its core team and capabilities. → Reducing adoption barriers and making the system as intuitive as possible. 
  • Clinical decision support applications: Through the tablet additional supportive software applications and algorithms can be added over time by ourselves but also partners to support healthworkers in their work. First applications for calculating Early Warning Scores are being developed and implemented in 2023. → Supporting even lower trained healthworkers in making the right decisions. 
  • Local service, support, and maintenance: By focusing on low resource settings, GOAL 3 builds local service, support, and maintenance hubs and networks to ensure that support can be delivered quick, affordable, and hassle-free. → Making sure systems always work, ensuring uptime. 
  • Multi-patient monitoring: The tablet with monitoring software provides an intuitive interface with a central patient overview and enables health workers to monitor 10-20 patients at the same time. → Bringing efficiency to the often overcrowded wards. 
  • Integrated electronic Health Record (eHR): By integrating eHR solutions in the system, GOAL 3 enables quick digitization of health processes, reducing time and effort at the ward and providing patient insights at the fingertips → Seemless digitization of time-intensive processes with improved insights.
  • End-to-end system facilitating data capture and continuous improvement: By focusing on a data first system, GOAL 3 enables the capturing of both health and system data at Low- and Middle Income Country (LMIC) hospitals, supporting hospital management, local government, and international policy makers with insights for improvement. → Facilitating the learning.


Offering and pricing Model

It is our goal to provide a complete and integrated solution to hospitals that helps them to address their needs adequately and sustainably. From that perspective we prefer to provide our offering in a full-service model in which all elements are combined in a monthly or annual fee. 
In this model a hospital would acquire the IMPALA monitoring devices including server(s) and tablet(s) as well as the clinical support application. This system would then be implemented through local GOAL 3 staff. Services and maintenance needed over time would be covered by these fees as well. Additional products and services from the GOAL 3 platform would be charged separately. 


Full leasing model (prices are indicative and subject to change)
1 operational lease that stays constant over time ⇒ € 700 a year per monitoring device + server (starting at €2 a day)

In addition there are several other business pricing models under exploration in which upfront costs are paid for hardware, software fees for the clinical support application and separate service and maintenance contracts are closed. We expect there will be a high demand for flexible pricing models for different customer segments.  

These models will be optimized in price points and will be tested among different customers. It is expected and validated that tender-buyers like the UN will be more inclined to go for full upfront models, whereas private hospitals and faith-based hospitals are more interested in full-leasing models. Hospitals with attached donor organizations are more interested in the combination of upfront costs (paid by the donor) combined with the subscription fee. 
These models are tested by the direct sales efforts from the GOAL 3 commercial team and by working with value-adding distributors that understand the local context. The first Letters of intent with such distributors are signed.




Service, training, support, and maintenance plan
GOAL 3 aims to focus on delivering high quality service needed to keep the products active, adding value, and relevant. Subscribed customers: full service and maintenance, software updates, training with regular on-sights visits to offer support, learn, and upsell (every 3-6 months).

 
Scaling strategy (2024 - )

GOAL 3 has developed a distributor strategy differing on the type of coverage that is aimed to be reached in different markets. Initially GOAL 3 will be highly involved in high coverage markets to deeply penetrate the markets and create lock-in advantages for the healthcare system. As GOAL 3 will be growing and scaling the company, more medium and low coverage markets will be added, with a hybrid distributor strategy, depending on the size and opportunities in the market. 

  • Deep-market penetration Markets (High coverage)  Choose markets that are fully linked, integrated, and interoperable in the care chain with strong EMR linkages, full data capturing, 50%+ market share etc. First countries for this are Rwanda and Malawi. High coverage markets will have a sales & service office nearby, ideally in the country. 
  • Hybrid in-between Markets (Medium coverage)  Using a hybrid approach with value adding distributors or partners that work together closely in making deals and navigating the landscape, likely countries near high coverage such as Zimbabwe and Zambia. Medium coverage markets will have a sales & service office nearby.
  • Distributor / dealmaker model Markets (Low coverage) Bring scalable products to the far corners of the globe (Nigeria, South Africa, India, Brazil, Ukraine) by working with distributors and dealmakers (agents) for the sales and having a scalable service division and strategy (videos, paying local technicians, good manuals). Low coverage markets will have no sales office, these will be handled by distributors.


Product and business model transformation (2027 onwards)

The vision for the future of GOAL 3 is not in making medical devices, but more in the software and data functions leading to the platform. This means GOAL 3 focuses on software, data, and AI as future directions. For the GOAL 3 products this means that the focus will shift to creating an enabling healthcare platform, consisting of eHealth applications, decision support, algorithms, and clinical guidelines. This platform will initially only work on GOAL 3 systems but can in the future be integrated into more medical equipment and products.




Customer and business model transformation

This shift in product will lead to a shift in customers, from directly selling to hospitals to selling integrations to developers of applications, algorithms and hardware. This means that GOAL 3 will become more and more of a platform company enabling the creation of applications targeted to support the clinical work in practice. This will also lead to alternative business models based on the platform. We expect to create revenue from charging platform fees to other companies who want to use our platform for implementation and scaling their products. At a later stage as we have a growing user base we expect that governmental organisations or insurance companies will be paying for obtaining high quality management data relating to clinical care and quality monitoring. 
 

Current status

Development steps

Our initial focus is to develop the first monitoring systems that will be used in the controlled context of the EDCTP Impala project in July 2022. For this project we will develop a server for data collection, a tablet application to improve clinical insights, as well as 50 patient monitors equipped with ECG, SpO2, NIBP and Ballistography. The patient monitors are developed in close collaboration with Studio Mango for the industrial/mechanical design and Zugmed for the electrical hardware. The monitoring device will be based on an existing device which will be modified in several aspects to better fit the needs of the users in our context. This approach will derisk the development process and support CE certification.


In the first months of the IMPALA project we will validate and improve our monitor, server and the supportive tablet application. This will be done using a mixed methods approach together with our partners from the IMPALA consortium. This will be input to the continued development of the monitoring system towards a final design that fits the context and user needs and can be manufactured in volume. We expect to reach our design freeze in October 2022. At that moment we will be able to produce the samples that will be used for additional testing at certified test facilities. These test results along with all the required paperwork will be gathered in the next months, which will ultimately result in our CE certified patient monitor in the second half of 2023. 


These systems will also be suitable for use in implementation Pilots. In these pilots we will confirm system fit with the user needs outside of a research context, in hospitals in Rwanda and Malawi. This will be done in a small scale commercial pilot for which we are in contact with local authorities and hospitals. 
While we are pursuing certification we will continue to test the IMPALA system in the IMPALA study as well as in the real world setting. This will generate the insights needed for further improvement of the system and the implementation plan. In addition, it will help us to collect user feedback and suggestions for building our innovation and feature pipeline. 
 
Further development

GOAL 3 is currently focused in getting IMPALA V1.0 to the market and working in the starting markets. Based on the initial sales, smaller iterations to the product will be done to fit the system to the market and improve its effectiveness. After iterating to a well-functioning system, focus will shift more to enhancing the system to integrate more supportive applications and algorithms. Next to enhancing functionality, also by getting the development costs per system down, GOAL 3 aims to make steps in increasing the accessibility and profitability of the system over time. The image below shows these steps on a timeline. 



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Market

Market dynamics

The market for sales and distribution of medical technology is scattered and mainly controlled by wholesalers and distributors that offer a variety of brands and products and have limited knowledge and expertise regarding the application of these systems. In addition supply chains are not reliable or not in place. This places a lot of responsibility on the purchaser (hospital) to buy, implement and maintain the products while there is limited expertise in this domain.

In innovative countries like Kenya new players selling third party equipment like Ilara health are coming up that provide full services in a subscription model, but these are targeted at small private clinics and not much at hospitals. We see potential synergy with many of such players as our value proposition lies in the deep domain knowledge about what is needed and integrating that into a complete tailor fit solution. By collaborating with existing local suppliers we can accelerate and expand our services based on locally available resources. 


Market segmentation 

Although health systems differ from country to country, generic levels can be recognised. The customers are split into three core customers (CC) groups. Future customers (FC) that can be defined are lower tier care facilities like health centers and health posts, but these are out of scope for the current phase. The three core customers in countries are:

  • CC1: National referral/central hospitals, hosting the most advanced clinical procedures, have more advanced NICU and PICU departments, 400+ beds. DMU consists of a medical director, a CEO (general director), the CFO, the (senior) pediatricians, the technicians, the procurement officer, and the nurses. GOAL 3 estimates that these customers will on average host 40 patient monitors. 
  • CC2: District hospitals/county hospitals, being the main point of referral for a significant catchment area with 150-250 beds, often with basic NICU and PICU services. DMU consists of an administrator (general director), a medical director (or head of clinical services), the main pediatricians, nurses and technical staff. GOAL 3 estimates that these customers will on average host 20 patient monitors. 
  • CC3: Private hospitals differ a lot in size and services, with giants like Aga Khan Hospital, but also smaller private clinics offering maternity services and hosting NICU’s. DMU has a more formal structure with a medical director, CEO, COO, CFO, procurement officer, and consulted pediatricians. GOAL 3 estimates that these customers will on average host 20 patient monitors. 
  • FC1: Health centers and health posts, in many cases the first  step in the referral chain. These centers and posts are numerous in Sub-Saharan Africa and perform triage and low-complex interventions. A large part of them are doing deliveries and have a limited number of beds for low-complex cases. Innovating in their triage, data capturing, and providing applications for virtual care and consult on a distance can significantly reduce referral related healthcare costs. 


The market can be further segmented into government run and faith-based health facilities. This has a significant influence on their funding streams as well as their autonomy in deciding on purchasing equipment and software. Faith based hospitals in general have more autonomy but are more reliant on donor funding for their capital expense. Government hospitals in general have less autonomy but are facilitated better with funds for both recurrent costs and capital expense. 
For each market we are performing in depth exploration to determine the best starting point for commercial development.



Market analysis

The problems GOAL 3 is addressing, such as the scarcity of health workers, the lower training levels of health workers and malfunctioning equipment are concentrated in low-and middle income countries. There are 142 countries categorized as Low- and Middle Income countries (OECD), which host 6,4 billion people (2019), being 84% of the world population. Of these 142 Low- and Middle Income Countries (LMIC), 50 of these countries are situated on the continent of Africa. The English proficiency, the reachability, the availability of donor funding, and the strong partnerships made GOAL 3 focus on Sub-Saharan Africa initially. In Sub-Saharan Africa, there are approximately 5.000 hospitals, a total of 100.000 health facilities and a total of 1.890.000 hospital beds. All LMIC combined host around 16.500 hospitals. 


Following market research reports, the TAM for patient monitoring in Africa and the Middle-East is estimated at $810 (€735) million, growing to $1,01 billion (€909 mln by 2026 (CAGR 4,45%). Based on our research a hospital will be currently needing 20 monitoring devices on average, which is approximately 1 monitor per 12 beds. Based on the number of hospital beds and an estimated pricing of € 700 per monitoring device in full-lease per year, this translates to an annual SAM of € 110 million for Africa. In addition the software subscription would add up to SAM of € 25 million per year based on our current pricing estimates. Based on these assumptions and the number of hospitals and hospital beds the SOM for Rwanda will be € 1,2 million per year for Malawi € 1,4 million per year and for South-Africa € 13,2 million per year.


As the number of services, decision support tools and algorithms increase, the field of application will expand and the value of the system will increase as well. Therefore we expect that over time hospitals will be purchasing more monitors in relation to the number of hospital beds. Furthermore we plan on expanding our services by selling spot check devices which integrate with the IMPALA system and expanding our horizon to primary care facilities (2024 onwards). Lastly we expect to increase the software fees over time as more (freely available) decision support applications become available. Combined with the anticipated population growth and economic growth we anticipate the TAM will significantly increase over time.   

Beachhead markets and go to market

After an elaborative screening of all sub-saharan African countries on aspects such as stability, corruption, GDP, innovation index, size, healthcare expenditure and child mortality, GOAL 3 has selected Kenya, Ghana, Rwanda, South Africa and Malawi as potential starting markets. These markets were visited in the second half of 2021 and further analyzed on opportunity, growth potential, governmental collaboration, regulatory efforts, and strength of partnerships. This has led to selecting Malawi, Rwanda, and South Africa as GOAL 3’s initial beachhead markets.



Competition

The combination of a healthcare platform with clinical decision support, combined with the functionality of patient monitoring itself is unique. The closest competitive solutions are 1) the current monitoring systems, and 2) the currently used software solutions, such as EMRs. Lastly, 3) the current status quo, manual measurement of vital signs. 


Other monitoring systems
The main competitive monitoring systems can be divided into three groups:
High-end patient monitoring systems by large global companies as Phillips, GE and Welch Allyn. These offer high quality but are not suited for these contexts due to high costs, fragility, difficult to use and difficult to maintain. 

Low-end patient monitoring systems by manufacturers in predominantly Asia (e.g. Contec). These systems are affordable (in a range of € 1,000-2,000) but not durable and do not offer the functions or user-friendliness that are needed.

Partial solutions and small monitors designed for Low- and Middle Income Countries (LMIC) developed by non-profit organizations (e.g. LifeBox). These are durable and affordable but offer limited functionality and do not address relevant needs in high and intensive care units. 

The GOAL 3 system is a robust and durable monitoring system that is easy to use while still offering all relevant functions high-end westerns systems have. 
In addition to these functions offered by our competitors, we will offer unique functionalities like decision-support, algorithms for interpreting the data and a user interface designed for hospitals in LMIC. Moreover, the innovative business model of the GOAL 3 system will make the systems more affordable than current solutions.



Current customers

In the last year, GOAL 3 has gained significant interest in the IMPALA product and the GOAL 3 proposition. Doing so, the following strategic partnerships for launching customers where formed: 

  • MOU with district hospital Malawi (St. Lukes) + strong collaboration with  IMPALA hospitals (Zomba + QECH) 
  • MOU with Rwanda Pediatric Association for implementation pilot study in Rwanda at 2 hospitals
  • [Pending] MOU with MOH, Rwanda Biomedical Council (Ministry of Health Rwanda)
  • Relations to Ministries of Health (MoH) of Zimbabwe, Malawi, Tanzania, Rwanda, South-Africa
  • (10+) LOI/LOS from key stakeholders (NGOs, distributors, hospitals, consultants) in Malawi, Rwanda, Tanzania, Kenya, and Ghana
  • First quotations and sales opportunities initiated; potential launching customers: Rwanda government, Malawi mission hospitals, South Africa children hospitals

 

New customers

To be able to sell, qualification and certification are needed, this process will be finalized in 2023. At this time, GOAL 3 expects to have the first commercial roll-out of products by Q1 2023. In the phases before that, the product will be both technically as commercially piloted and tested. As GOAL 3 works with subscribed customers, sales are expressed in systems active on a cumulative basis.

Based on experiences from similar healthcare scale-up companies and innovations, the expected sales for 2022 till 2027 are: 

  • 2022: Implementation studies of 50-100 systems in first 3-5 hospitals
  • 2023: 284 systems active
  • 2024: 976 systems active
  • 2025: 3,399 systems active
  • 2026: 7,920 systems active
  • 2027: 16,085 systems active

Following the go to market strategy, these systems will be sold scaling from country to country, starting in the beachhead markets Rwanda, Malawi and South Africa and growing based on existing network and opportunities to neighboring countries. 



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Sales

Value proposition and impact

GOAL 3 enables others to deliver better care at lower cost. We achieve this by truly enabling health care workers with our IMPALA products and using data to their advantage. Instead of only spot checking manually we enable continuous monitoring of vital signs, we run high quality decision support models and are pioneers in implementing predictive algorithms in the day to day. By monitoring the usage and performance of the IMPALA system and feeding this back to the end-users and managers we enable them to optimize the monitoring process on their wards. 


In low resource settings other monitoring interventions such as the Pediatric Early Warning Scores (PEWS) demonstrated to decrease mortality and the number of ICU admission by as much as 30%. With IMPALA in place, we facilitate collection of the PEWS through an integrated application, and expect to achieve 10%-30% lower mortality and a 10-30% reduction in hospitalization days for patients. As our platform evolves and we increase the number of decision support applications we expect to improve on these numbers.


More efficient and better care at lower cost
We realize that success is multi-facetted and, therefore we focus on creating value for all key-stakeholders. First, the most important stakeholders are local communities and paediatric/neonatal patients in LMICs. Despite decades of innovation, these vulnerable populations have been left behind and are still confronted with paediatric and neonatal mortality rates far higher than the global average. Second, we offer a ground-breaking innovation for the local Health Care Workers (HCWs), who are currently so thinly spread that they must choose which lives to save. IMPALA will help them in allocating their scarce time and resources to the patients that are most in need. A reduction in the number of patients will decrease their workload further.  In addition, less skilled HCWs in SSA are offered a user-friendly interface with decision support based on automated clinical guidelines, which will enable better informed, evidence-driven decision making. For local hospitals, this aids their operational management and increases their capacity. Finally, IMPALA can generate valuable health data in the local context which can be leveraged by governments or NGOs to implement evidence-based guidelines.




Quantified value proposition

Based on a conservative estimate that we will reduce mortality and the number of hospitalization days by at least 10% each, we can calculate the (social) return on investment for our core customers. The calculations below are based on paediatric and neonatal admissions in Sengerema Hospital in Tanzania where our CEO has worked previously. 
Based on average costs of 20$ (€18) per admission day (conservative estimate as most sources found costs between 30-41$ in African health systems), a total of 4500 admissions with an average admission time of 6 days and a mortality rate of 10,6%. In addition we expect that a maximum of 15 monitoring systems per department would be needed. The following numbers can be calculated:

  • Costs = 15 systems * 2 departments * €700 for the decision support application = €21.000 per year maximally
  • SROI = 10,6%*4500*10% reduced mortality = 47.7 children's lives saved
  • = €21.000/ (47.7*63 years remaining life expectancy)=€6.99 per disability-adjusted life year
  • (DALY) averted
  • Costs saved by 10% reduced admission time = 4500*6*€18*10% = €48.600 saved per year
  • ROI =  €48.600/€21.000 = 231% per year 


This would mean that for every live saved, you would save €579 as well. This means that by enabling timely interventions and reductions in admission time IMPALA can save >45 children’s lives and ~50,000 euro per hospital per year* for an average district hospital. 
*Based on a district hospital with 4000 pediatric admissions, and 10% reduction in mortality, 10% shorter admissions time, using an estimated 25 monitoring devices.


What has been done before

In the two last years, GOAL 3 has been active in market exploration. In this process, many contacts, reviews, support and interest in sparkled. The key actions of this process are:

  • Visits to 40+ hospitals in Malawi, Kenya, Ghana, and Rwanda combined, getting feedback, meeting DMU stakeholders, and gaining interest.
  • Interviews with 100+ doctors and health workers, with a positive response rate of over 90% to the GOAL 3 approach and solution
  • Community building with 2350+ LinkedIn followers, with many engaged health workers, policy-makers, directors and stakeholders involved
  • Piloting in hospital in Malawi, which created many new opportunities and partnerships with local companies, universities and hospitals
  • Conversations and starting partnerships with NGOs and possible African partners. The GOAL 3 team already had various conversations with major NGOs such as MSF, Save the Children, Amref and Cordaid. 
  • Partnerships and letters of interests with 14 established (African) businesses, research institutes and hospitals. 




Marketing & sales channels

GOAL 3 expects that to sell its systems throughout Africa, many traditional marketing methods will apply. From conversations with similar businesses, GOAL 3 knows that the pilot and first sales will mainly drive the early growth of the company. In these markets  word spreads fastly via ‘example setting’, ‘reference sales’ and ‘worth-of-mouth marketing’. Also, building a credible local organization doing the last-mile delivery, training and educations will be part of the strategy to ensure credibility. More concretely this means that marketing & sales will mainly be done via:

  • Networking with doctors, stakeholders and key opinion leaders.
  • Participation in tenders, events and research studies.
  • Creating full service integrations (providing financial donor).
  • Content marketing sharing examples, cases, numbers. 


Communications strategy

GOAL 3 will use communications in three directions, namely:

  • Advocating & Networking: To find the right subsidies, partnerships, consortia and financial streams, GOAL 3 has to tell its story to the right key opinion leaders, policy- and decision-makers active in the LMIC healthcare systems. GOAL 3’s networking strategy is set-up for this purpose. Through the close connection with research institutions and key-opinion leaders in the IMPALA and the Neotree-IMPALA study, as well as the strong scientific advisory boards involved in these studies.
  • Piloting, Reference sales & Example setting: The second goal for GOAL 3 in the use of marketing is finding the right opportunities for testing and validating the solution. From previous experience we have learned that these pilots work as references and examples for further developing and rolling-out the GOAL 3 systems, leading to sales and revenue generation.
  • Community building: One of the core capabilities for GOAL 3 in the current stage is the creation of a community of doctors, health workers, companies, policy-makers and other stakeholders to join in the GOAL 3 vision. The community is of vital importance for finding the right partnerships, funding, subsidies and contacts. Currently, this community is built using events, presentations, videos, newsletters and LinkedIn. 



Partners

  • Clinical research partnerships 
  • IMPALA study


GOAL 3 is developing the IMPALA system together with stakeholders and academic institutes from Europe and Malawi within the 3,5 year, EU funded (€3,5Million) IMPALA project. The objective of the program, initiated by GOAL 3 and the Amsterdam Institute for Global Health and Development, is to provide affordable, user-friendly and durable monitoring and decision support tools for local clinicians in southern Africa, and assess the effect of IMPALA on clinical decision making in relation to child disease progression and mortality. IMPALA is being developed in Malawi in the Queen Elizabeth Central Hospital and the Zomba medical hospital. 
Following successful development and improvement of the IMPALA system and development of the predictive algorithms in the first phase, these algorithms will be integrated into IMPALA for further pilot testing in the first half of 2024. This in effect will contribute to the GOAL 3 innovation pipeline.


In addition to GOAL 3 the following partners are involved in the IMPALA project:
Imperial College London is a world renowned research institute in emergency and critical care in global health. Within this project they are responsible for developing and testing new blood based biomarkers which can differentiate at the point of care between a bacterial, parasitic and viral infection as well as differentiate in severity of disease. In addition, they provide significant data and physiological modelling expertise to develop the predictive algorithms.  


The Amsterdam Institute of Global Health and Development (AIGHD) is a world renowned research centre on global health systems; the AIGHD is the main applicant of this project and is responsible for coordinating the project and in addition provides a lot of expertise on the social sciences, health economics and future implementation of the system. Dr. Job Calis has co-founded the Paediatric intensive care unit in Queen Elizabeth Central Hospital in Blantyre and is the coordinator of this study.
Leiden university medical centre - the National eHealth Living Lab (NeLL) is an expert centre on eHealth; the NeLL is supporting the development of the system by providing expertise in a compliance by design approach. In addition they are charged with building a high quality robust data infrastructure that complies with all regulations. 


Malawian partners
The Research Unit of Excellence (TRUE) is an academic research centre located in Blantyre with various sites and supports large scale research projects from USAID, the European Union and many more. They  play a major role in the setup and execution of the study in the Zomba study site. 

  • Kamuzu University of Health Sciences - College of Medicine (KUHeS) is a constituent college of the University of Malawi and is responsible for execution of the study in the Blantyre site. Their expertise, network and previous experience makes KUHeS an excellent reference site for the trials and crucial in future adoption to other hospitals.
  • Malawi University of Business and Applied Sciences (MUBAS), formerly known as Polytechnic, this academic research institution is charged with the responsibility to co-develop the IMPALA system and in ensuring that the system meets local needs and requirements together with GOAL 3. 


Furthermore the IMPALA consortium has a strong connection to key stakeholders and key opinion leaders through the stakeholder committee and the scientific advisory board. Key stakeholders include two hospital directors from Malawi, the program director of AMREF Malawi, the ministry of health, the head of nursing of the Queen Elizabeth Central Hospital and a guardian of a child who has been previously admitted to the pediatric intensive care department. 

The scientific advisory board consists of strong global leaders and researchers with extensive research experience in critical care and vital signs monitoring in Africa as well as e-Health solutions and implementation research. Several of these scientific advisors have been involved in writing the clinical guidelines in emergency care and critical care from the WHO.

Neotree-IMPALA

The Neotree-IMPALA is a collaboration between the Malawian based IMPALA and the Neotree consortium based in Malawi and Zimbabwe. Neotree is a program which has existed for 7 years and is currently being used in 2 hospitals, 1 in Malawi and 1 in Zimbabwe. The system provides decision support for managing neonates on admission and at discharge. 


The aim of the program is to integrate the Neotree decision support with the GOAL 3 clinical support platform. This should lead to an integrated clinical support and data collection system named “NEO3”: a tailored neonatal care EHR that fits seamlessly with the workflow of health workers, providing relevant clinical decision support, educational materials, real-time risk assessments and other supportive tools at the point of care. This system is provided in an end-to-end digital care environment which automatically captures relevant data for continuous quality improvement, medical research and development of data-driven policies and guidelines. We are currently looking for funding opportunities for this collaboration, after an initial application was not successful. 


Other partnerships
Next to the partnerships in the IMPALA research studies, GOAL 3 developed a broader base of partners supporting in bringing the company to a success. Additionally, GOAL 3 works with partners such as MeduProf-S, and NeoTree to create synergistic products and services. A broad range of partners is shown in Image XXX below. Other important partners entail:

  • Achmea Foundation: Supporting GOAL 3 financially in business model research and implementation of first products in beachhead markets.
  • Philips Foundation: Supporting GOAL 3 with knowledge in developing the product and company by peer-reviewing, brainstorming, and offering network.
  • Norrsken Foundation / Novartis Foundation: Supporting business development of GOAL 3 as part of the HealthTech Hub accelerator program at the Norrsken Kigali Hub in Rwanda. 



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Finance

Current financial position

The issuing entity has been active since 29 March 2022 (new holding structure replacing GOAL 3 Coöperatie u.a.) and GOAL 3 itself is active since 2019. The following financial information is the most recent information available.


P&L
The following information applies to the period of 1 january 2021 -
28 february 2022 and is the most recent available information.

  • Grants € 419.000
  • Awards € 20.000
  • Other income € 12.000 
  • Operation costs € 566.000 -/-
  • Other Costs € 182.000 -/-
  • Result before tax € 299.000 -/-


Balance sheet and Guarantees
The balance sheet date of this information is 28 February 2022. 
Total equity equals  -/- € 313.000 and consist of:

  • € 65.000 Share premium capital
  • € -/-378.000 Other reserves

Total liabilities equals  € 789.000 and consist of:
Long Term liabilities:

  • € 657.000 Convertible loan  Crowdfunding Symbid
  • € 61.000 Loan Achmea Foundation

Short Term Liabilities

  • € 47.000 Accounts payable
  • € 16.000 Wage tax payable
  • € 17.000 Accrual holiday allowance

The following information is about the situation after issuance of the securities offered in this investment round. The equity/debt ratio is 0/100. After the issuance of the convertible bond with the minimum target of €250.000 this ratio equals 0/100. After the issuance of the convertible bond with the maximum amount of €1.000.000 this ratio will be 0/100. 

Net Working capital equals €388.000 and consist of:

  • € 40.000 VAT
  • € 428.000 Cash at bank
  • € 47.000 -/- accounts payable
  • € 16.000 -/- wage tax
  • € 17.000 -/- accrual holiday allowance

The following information is about the situation after issuance of the securities offered in this investment round. After the issuance of the convertible bond the working capital will be € 638.000 with the minimum target amount of € 250.000, and with a maximum target amount of € 1.000.000 this will be € 1.388.000. This contains of:

  • VAT: € 40.000
  • Cash at bank: € 678.000 (with minimum € 250.000 raise) or € 1.428.000 (with maximum € 1.000.000 raise)

Short term Liabilities: € 80.000


Securities
The issuing entity has provided no securities to the investors in the convertible bond or other loans.

 

Revenue

  • 2022: 0 (will be commercial pilots - funded by non-dilutive grants)
  • 2023: (284 monitors; cumulative 284 monitors; beachhead market) - EUR 2.35 per day
  • 2024: (691 monitors; cumulative 976 monitors; beachhead market) - EUR 2.35 per day
  • 2025: (2,464 monitors; cumulative 3,399 monitors; beachhead & scale up market) - EUR 2.73 per day
  • 2026: (4,520 monitors; cumulative 7,920 monitors; beachhead & scale up market) - EUR 2.91 per day per monitor
  • 2027: (8,165 monitors; cumulative 16,085 monitors; beachhead & scale up market) - EUR 3.10 per day


Invested so far

  • Share Premium Account - GOAL 3 team members € 55,000
  • Convertible loans Symbid Cooperative € 657,000


Investment requirement

GOAL 3 is seeking capital of € 250,000 to € 1,000,000 to finalize development of our prototype (IMPALA 0.9) for the clinical validation study in Africa in 2022 and to develop this prototype further to our Minimal Viable product (IMPALA 1.0) in Q4 2022 for commercial pilot studies. This allows GOAL 3 to take the next step towards market access and first launching customers.


 
Purpose of investment

The image below summarizes the minimum, medium and maximum needed investments for this current crowdfunding campaign. The general notion is that the mission of GOAL 3 requires investments and that these investments partially determine the speeds and level of development that can be reached. 


Return 

Interest
The return will be single accrued interest of 6% on the convertible bond. Next to that in case of conversion to shares (Borrowers A >€100k) or certificates of shares (Borrowers B <€100k) there may be dividends and/ or increase in value in case of selling these shares or certificates of shares.
 
Conversion
Each investor can convert his/ her full investment
to shares or certificates of shares via a Cooperative of the issuing entity in all situations in which:

  • The convertible bond becomes payable.
  • The issuing entity issues equity to one or more third parties for a total consideration of at least € 1.000.000.
  • A transaction is executed as a result of which one or more third parties will become a shareholder for more than half of the outstanding shares in the issuing entity.
  • The initial or extended duration of the agreement will expire within a month.

 
Conversion discount
As a Borrower-A in the convertible bond, you will receive shares in the issuing entity and as a Borrower-B you will receive certificates of shares in the issuing entity via an investment cooperative on the same terms as
a follow-up investor, but with a discount. This is to reward investors for the fact that you have invested already at an earlier stage. The discount applied in case of a conversion will be according to the following scheme:

  • 15% - Conversion after 3 months, but within 1 year after making the Loan available 
  • 20% - Conversion after 1 year, but less than 18 months after making the Loan available.  
  • 30% - Conversion after 18 months after making the loan available 

 
The lender will receive single interest for the duration of the convertible bond over the initial loan amount. This amount will not be paid but is accumulated to the initial invested amount and paid out when the loan will be repaid or converted to shares or certificates of shares.
Redemption of the convertible bond can take place at the initiative of the issuing entity, at the end of the duration, and only if the issuing entity is capable of doing so.
The return will not be paid from the investments of other investors.
Next to the investors there are no other persons who receive income (other than "costs") from this investment.
 
Exit scenarios
GOAL 3 has large ambitions with an enormous market to serve, still on a shorter term, there are several exit scenarios for future shareholders. The main exit scenarios that have the focus of GOAL 3 are set out in the exit strategy 5 pager and are summarized below:
 

Main exit strategy - M&A


2) Alternative exit strategy - share trading platform


Verklaringen uitgevende instellingen 

Declaration issuing entity 
No significant changes 
Since the most recently published and audited Financial Statements of the issuing entity, no significant negative changes have occurred in the issuing entity’s prospects. 
 
Trends 
There is no information about known trends, uncertainties, requirements, obligations or events that can reasonably be assumed to have material consequences for the prospects of the issuing entity, for the current financial year. 
 
No significant alteration in the financial or trading position 
Since the most recently published and audited Financial Statements of the issuing entity, there has been no alteration of tenor in the financial or trading position of the issuing entity and the group to which the issuing entity belongs. 
 
Corporate Governance Code 
As the Dutch Corporate Governance Code only applies to companies with registered offices in the Netherlands, whose shares or certificates of shares are admitted to the official listing of a government-approved regulated market (securities exchange), the issuing entity (unlisted) does not apply this code. 
 
Potential conflicting interests 
There are no (potential) conflicts of interests between the obligations of the executive board members of the issuing entity on the one hand, and their own interests and / or other obligations on the other. 
 
Procedures 
There are no government interventions, court cases, or arbitrations, including such procedures that are pending or may be initiated, to the best of knowledge of the issuing entity, over a period of at least the previous 12 months that may have a significant impact, or have recently had, on the financial position or profitability of the issuing entity or the group to which the issuer belongs. 
 
Figures 
All figures in this information memorandum are not audited, unless explicitly stated otherwise. 
 
Symbid and the platform 
Symbid's operations largely consist of the acceptance and disclosure of orders for retail, wealthy, and professional investors. Through its activities, Symbid supports the interaction between affected investors and progressive start-ups and growing companies in the SME in the Netherlands. This involves the financing of various types of projects that realize a positive impact the society with the help of an affected group of investors or ambassadors. Our platform provides a non-personalized, online recommendation to a broad audience, by allowing organizations to profile their project in a transparent and financially sound manner, and to professionally build and maintain the relationship with its financiers / investors. 
 
Tied agent 
Symbid BV is a tied agent of the Limited company (Besloten Vennootschap), Ilfa Tools & Services B.V. as defined in the Dutch Act on Financial Supervision (Wet op het financieel toezicht (Wft)). Ilfa is an investment firm as defined in the Wft and has a license  as defined in article 2:96 Wft. As a result hereof Symbid and Ilfa are both under supervision of the AFM.  
 
Other parties involved with issuance 
During the issuance, the following legal entities play an important role: 
Symbid Crowdfunding, a trade name of Symbid BV., a cooperative association with limited liability, registered in Rotterdam, office at Schiedamse Vest 154, Rotterdam, and registered in the commercial register of the Chamber of Commerce under number 52466825; 

 
GOAL 3 Holding BV. : a private limited (BV) company which is the issuing entity;
 

Online Payment Platform B.V: Symbid has a partnership with Online Payment Platform - a Dutch financial institution that specializes in providing services in the field of settlement of payment transaction. In order to be able to offer its financial services in accordance with the applicable financial legislation and regulations, Online Payment Platform has a license as Electronic Money Institution and Online Payment Platform is supervised by De Nederlandsche Bank (DNB) plus the Netherlands Authority for the Financial Markets (AFM). 



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