Diana Quintero Giraldo: BIVE makes healthcare services more affordable for rural communities

Diana Quintero Giraldo is the co-founder of BIVE, a social enterprise that facilitates access to high-quality healthcare services for 21,000 low-income and rural people in Colombia. She is a social innovator and passionate about unleashing the power of entrepreneurship to build sustainable solutions for the most pressing social challenges, especially in access to healthcare. Diana holds a Master of International Development Policy from Duke University, USA.

[Below is the interview transcript which is edited for clarity.]

Sotheary: Welcome to Next Women Generation. Today we have Diana Carolina Quintero Giraldo. She is the cofounder of BIVE, a social enterprise that facilitates access to high-quality and affordable healthcare services for low-income rural Colombian families.

Hello, Diana! Thank you so much for joining us today. Please tell me more about BIVE.

Diana: BIVE is a social business that facilitates access to high-quality healthcare services for more than 21,000 low-income rural Colombian people. It’s a low-cost healthcare membership. Our users can access more than 250 private healthcare providers. They offer the best quality services faster than the regular healthcare system that our users can afford. On the other hand, healthcare professionals have a high volume of patients; they receive cash immediately since BIVE users pay them directly. We also have social projects which provide health services to rural communities. Our social projects have improved the health conditions of 60,000 rural families in Colombia.

Sotheary: What motivated you to start BIVE?

Diana: My main motivation is that I grew up in a farmer’s family, which gave me a good understanding of the social and economic gaps between rural and urban communities. I grew up specifically in a city, but my grandparents lived in a rural area. I was moving between the city and the rural area. And it was an opportunity to experience the barriers that rural people have in accessing social services, particularly health, education, and sanitation. It motivates me to look for a solution for my grandparent’s community. It’s going beyond my grandparent’s community, and we are reaching all communities.

Sotheary: So tell us about your journey. How do you start it?

Diana: Yes, BIVE was started ten years ago. I was finishing my undergraduate studies; I studied Business Administration. I was interested in business. I was not interested in following a traditional business career in the corporate sector. I was involved in many volunteer activities because I loved serving and being helpful to the people in need. I have this passion.

However, in my last semester at the university, I learned about social entrepreneurship. I was involved in an initiative of one of the organizations of Professor Muhammad Yunus, a Nobel Peace Prize. At that moment, I learned about social intrapreneurship; everything made sense because I found a way to connect my passion for serving using my business background and knowledge.

I participate in a social business event at university. I had the chance to know a social entrepreneur from Argentina. She ran a Sistema Ser project that connected healthcare providers and people in need. Also, in that event, I met my business partner, a medical student at that time, and he was also interested in social entrepreneurship. So after the event, we were fascinated with the idea of Sistema Ser. We want to replicate this model in Colombia. And to prove it, it works.

So we decided to do a small pilot of Sistema Ser in Colombia. The pilot helped us reorganize our idea and adapt it to the Columbian context. Also, we wanted to create a social enterprise for the health care for rural communities.

So it was our starting point, and it was ten years ago. It has been a long path. It’s a beautiful way to connect these two passions.

Sotheary: When you start your business, you need a team. So, can you share your experience of building a team to grow your business?

Diana: Initially, the first two years or one and a half years, it was only the work of me and a student of medicine that I already mentioned. We were doing it on a small scale. We were students; we were not full-time dedicated to the business. So it took a little bit longer than people dedicated to it 100%. When we graduated, we were in this idea. We didn’t find any other jobs. We devoted ourselves to working on these.

So initially, it was just two people working on it. We also had initial support from the Grameen Creative Lab, an organization of Professor Muhammad Yunus. They had an incubation program. We started to work with some experts on different topics to refine the initial idea. Then we hired two people. It was like our first milestone. One of them was a person who was doing her internship. She worked with us more in organizing the healthcare provider network and supporting us in providing the services to people.

On the other hand, we had another lady with more experience in the commercial area and how to make sense of the organization’s business model. Because we were part of the Grameen Creative Lab, we had access to small funding. One year later, we had like our first investor; we had the opportunity to hire a BIVE team and establish the formal enterprise.

Sotheary: That is great. You have started an organization for one year, and you got an investor to invest in your organization. That is wonderful.

Diana: It was wonderful. It helped us a lot to be part of this program. Our key to success is being connected and collaborative with other organizations.

Sotheary: What brought you to the healthcare sector?

Sotheary: First, health is an essential condition to thrive. Healthcare has an impact on the social and economic development of society.

Second, health is a significant challenge worldwide, specifically in Colombia, in terms of social justice. In Colombia, 95% of people are covered by healthcare insurance. However, long wait times, bureaucracy, and low quality of services mean that coverage is not the same.

And finally, poor and rural Columbian families cannot access high-quality and timely healthcare services. So it was my motivation to enter the healthcare sector. I have learned from my co-founder; he’s a healthcare professional. I learned it by myself. It’s connected to rural development, health, and sustainable food production systems, which are associated with the planet’s health. So BIVE is a social enterprise model, and I try to find ways to make that this model works.

Sotheary: That is wonderful that you learn from what you have been through in life, and you want to make sure that other people will be able to access good quality healthcare. So how do you connect healthcare providers to low-income families?

Diana: We connect health care providers for low-income families through our membership system. So this is a solution. This is an easy solution for healthcare providers and people who need access to healthcare services.

Healthcare providers are also affected by the dysfunctions in the healthcare system because they receive a low payment per consultation. The system could take up to 90 days for the healthcare providers to receive payment for their services. Sometimes it restricts them from offering high-quality services in terms of time and treatment for the patients.

On the other hand, most of them have insurance in the case of the patients. So ideally, they could access healthcare services. There are many problems like the services are delayed in terms of quality. And also, in Colombia, private healthcare services are so expensive for low and middle-income families.

So basically, we provide a solution for these problems by connecting private healthcare providers with people who need healthcare services and usually cannot afford these services. So basically, every doctor and healthcare provider guarantees that our users can have an appointment within the following seven days. Usually, a specialist appointment could take two or three months through the normal system. They also can access the services with up to 70% of the price market. So, for instance, if a doctor charges $50 per consultation through BIVE, the user can access the same service at around $20 or less. In return, BIVE offers a connection with more than 21,000 users to a doctor. These are new users because private healthcare services usually see only high-income people, a small market, maybe 6% or 10% of the population. We provide them with a way they can access a larger market. Also, another advantage for doctors is that they receive the payment immediately because they never used to be paid directly.

So, this is how the model works for healthcare providers. It meets the needs of the people who want to have better health services, but the service is not affordable. So our users have access to a low-cost membership that only costs $7 per two people. When they access the membership, they can have appointments in the BIVE network in a unique way.

So users communicate directly with us, and we organize the appointment based on their needs. It is essential for rural people because most healthcare services or specialized healthcare services are in urban areas. Usually, the person needs to travel to urban areas to access healthcare services.

At BIVE, we have partnerships with other organizations to have our subsidies for transportation, accommodation, and food for people going to the city to access the services. Also, we have advisory services for free where people can ask when they have questions about the processes in the healthcare system.

So in some cases, people have access to diagnosis services, but the treatment is costly. So, in this case, we connect people with diagnoses to a healthcare system and tell them to ratify their rights as users so that they can access the treatment.

Also, a pioneer in this process is the farmer associations because we partnered with them. They are usually the ones who pay for the user’s membership. We also partnered with international organizations and donors, especially the healthcare services in rural communities.

We create our partnerships we doctors; most of them are located in urban areas. In most cases, people have access to the services at special rates, so it’s more affordable. And we also have additional partners so they can quickly move to cities and access the services. We also have some providers in more rural areas but more for the first level of services.

The second way we provide healthcare services to the rural community is to develop a healthcare brigade in social projects such as eyes care, oral care, and mental health. We bring healthcare services directly to rural communities. For instance, we have a project where we partner with a healthcare provider with a mobile health unit. So, we can move to rural communities where we do screening mammography to check for breast cancer. So these services are near rural communities.

In rural communities, there are several barriers to accessing healthcare services. One of them is the economic barrier, and the second is the geographic barrier. We have a model that makes healthcare services more affordable for rural communities.

Sotheary: How do you incentivize service providers to connect with BIVE because they will need to discount their services?

Diana: This is a social business. They also need to make economic sense for healthcare providers. So they have a lower price for their service, but they can access a larger pool of patients. So basically, in most cases, healthcare providers have the bed service; they have an office, and they provide services to private patients. But they were more focused on higher-income communities.

With BIVE, we provide a larger pool of patients that they can access through our network. So the idea is that they can decrease the price of the consultation and increase the number of consultations that they have per day or week. Also another advantage that they have is that they receive the payment immediately. Usually, they have a good volume of consultations through the healthcare system, but they can access the payment in two or three months. Some healthcare providers are required to pay suppliers, which is too long. So it economically makes sense because it has a larger pool of patients and also because they receive the payment immediately.

On the other hand, our healthcare providers are not so motivated for economic reasons in some cases. They want to find a way to provide health care services to rural communities. Healthcare providers deliver healthcare services in rural communities through the healthcare brigade program. We have healthcare providers who are part of our network to bring the services to the rural areas. In some cases, the services are paid for by the farmer associations or international partners that support us to deliver this mission of providing healthcare services in rural areas.

Sotheary: How do you encourage low-income families to connect with BIVE because you also charge services? Some low-income families may think twice when they subscribe to the services that will cost them.

Diana: Yes, that’s true. However, there are two things. First, they have options: they can access the [low-cost] healthcare services required to purchase or find private healthcare providers that charge them something unaffordable to access health care services.

So BIVE is a solution. It is not free, but it is timely, and it is something more affordable to their capacity. Also, there is a high cost of the time they lose in rural communities because they are sick and cannot access healthcare services required to record their capacity to work. One day they don’t work is when they don’t receive payment because it’s an informal market, and they sell what they produce. So it’s also an economic reason behind that. They need to be healthy to work and provide support to their families. We provide a more intermediate service or focus on their needs on something affordable for them. They will be more willing to pay even when the service is free through the healthcare system, but they cannot access it, or they cannot access it timely.

On the board, I also work with farmer associations. Farmer’s associations want to keep the productivity rates high in the cooperative or the association because they have commercial commitments with other businesses. For instance, we work a lot with coffee grower comparatives. They have fair trade agreements with organizations, so they have particular social funding to invest in social projects.

So this is another way that also we partnered with farmer’s associations. We create a specific project for them. They use the budget from the trade agreement to partially support members’ cost of the consultation. They have an additional fund for their associates to access the services.

It depends a lot on the context, but it’s a mindset of people who are willing to pay for services when they are affordable. It is also an investment because health can help them continue working. So, people are willing to pay for something that makes sense, is easy, has no challenge, and can be accessed.

Sotheary: How this initiative challenges you personally and professionally?

Diana: First aspect is that being an entrepreneur reasonably is not like our traditional professional. For so long, I could not pay a fair salary to myself. Fortunately, I had to support of my family. We try to connect paths with organizations that can invest in us and help us. So, we were able to pay for the people working with BIVE.

The second professional challenge is that I started young when I finished my undergraduate studies. I had a lot of passion and a lack of professional experience. So for me, it creates a more extended learning and developing journey for BIVE.

We created an advisory board consisting of professionals with experience in different areas to advise us to run a social enterprise. I have learned so much from other people’s experiences. So having someone to provide advice is significant because you have much passion but do not have this professional experience when you are young and decide to create an enterprise.

A challenge for me has been defining the proper role in my team. So initially, I was more commercial and administrative director. Because of my business background, I moved to the CEO position. And since two years ago, I decided to move out of the CEO position in BIVE. I chose to enroll in a master’s degree, but I continue working in the strategy part of BIVE. So it has been a significant challenge for me to define the best one and how I can continue supporting BIVE and working in BIVE. So it has been a challenge for the organization because it is the first time they are led by one of the co-founders. So, in this case, we hired a new CEO, and it has been a different process to identify their role and the way of serving the organization.

Sotheary: Do you have any message for other young people, especially young women who want to carry out their initiatives?

Diana: If you have a passion for serving society or have an idea, try to start it. Make your dreams real.

Sotheary: Thank you. That is a beautiful message. Thank you very much for joining me.  

Diana: Thank you so much to you for inviting me.

Thank you very much for listening to Next Women Generation. If you like this episode, please click Like and share your network. If you would like to give us feedback or comment, you can leave a comment here or send us feedback through social media, such as Facebook, Twitter, and Instagram. You also can send us feedback or comments on our website. Stay tuned to our next speakers.

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