A Roller Coaster of Innovation

Teresa Chahine: Welcome to Impact & Innovation. I’m Teresa Chahine, and I’m inviting you inside my classroom at Yale School of Management as we grapple with questions on social entrepreneurship and impact.

Welcome back, everyone. We have a very special guest with us here today, Kaakpema Yelpaala, who goes by “KP” and who is the director of InnovateHealth Yale, the faculty director and senior fellow and lecturer here at Yale. KP founded several companies, which we’ll talk about today, including Access Health Mobile in Africa and InOn Health in the U.S. And what we’re really going to talk about today is just that wild journey—

Kaakpema Yelpaala: Definitely.

Teresa Chahine: ... with all the ups and downs. You spoke to my class twice today, and I learn something different each time. And so the themes I was thinking about debriefing with you on in the podcast are really those different settings that you worked on. So you started off out of public health school working in foundations and nonprofits, like the Clinton Health Access Initiative, and then you decided to just start a business doing health tech, going from nondigital to digital work in Africa. So I wanted you to just reflect on similarities, differences, strengths, and weaknesses in those two different sectors in Africa, the nonprofit versus for-profit sector in the context of our shared mission of health equity.

Kaakpema Yelpaala: …of health equity. Right. Well, thank you so much for that, and this is really fun for me to be able to talk about all these different parts of my experience.

Teresa Chahine: It’s like processing.

Kaakpema Yelpaala: Yeah, it’s like maybe therapy.

Teresa Chahine: Yeah, it’s healing, right?

Kaakpema Yelpaala: It’s healing, yeah.

Teresa Chahine: In class when one of my students asked you to talk about one of your companies and what it was like to shut it down, and you were like, “It was trauma.” I was thinking, “Well, I hope this is healing.”

Kaakpema Yelpaala: Yeah, no. So I like to say, people now when they see my background, they see that I’ve done a lot in digital health, but I like the chance to share my early story, which is I didn’t start as a technologist. I started—

Teresa Chahine: Old school public health.

Kaakpema Yelpaala: Old school public health, and about outcomes and vulnerable populations and ensuring that everybody has access to quality care, to public health interventions. And so that’s what led me into your more traditional nonprofit route. Global health was my track at the Yale School of Public Health. And so we were trained to think about working with ministries of health, working with the World Health Organization, thinking about things in that way. And so my first projects were in Ghana, the country of origin where my family’s from. I was born in the U.S. and—

Teresa Chahine: And your dad was born and raised in a mud hut.

Kaakpema Yelpaala: Yeah, my dad was born and raised in northern Ghana near the Burkina Faso border in a mud hut. So came from a very rural, poor background and was really fortunate that they identified him as someone that had a lot of academic potential even though he was in that setting and he was able to find a way out through education. And so for me, that becomes part of my mission because when I look at that, I could have easily been that person if my dad wasn’t so lucky as to come out of those circumstances. My mom also comes from a low-income family in Ghana. I could very easily be in a different place, and to think about all the opportunities I’ve been able to have and potential, I think about all the other people that have the type of potential that I have, that are unseen and don’t have the opportunity, and that kind of drives my broader mission.

And so that’s just taken the shape of public health and wellbeing, and so it put me in a very nonprofit mindset. Let me go out into community; let me work with governments. And we did really interesting work I mean, and stuff I was proud of. And again, very grassroots. When I worked with the Clinton Foundation, I actually got an internship with them after my first year at Yale, and it turned into a job. It was different, because instead of me being a young public health student with a nonprofit in Ghana, now I’m working in this big organization founded by a former president. And so the scale and scope of what we were doing with the Clinton Health Access Initiative around HIV treatment was completely different from anything I’d ever done before. And it was in East Africa. As a kid with Ghanaian parents, I honestly knew nothing about East Africa.

Teresa Chahine: Yeah, West Africa and East Africa are two different worlds.

Kaakpema Yelpaala: They’re completely different worlds, right? And the first place I went to work was in Tanzania. So I get to Dar es Salaam, and it was just completely foreign. Everyone’s speaking Swahili. But what was interesting is that if I just look at my two nonprofit experiences between Ghana and then working for Clinton Foundation, the scale was the big differentiator. The nonprofit that I was working on in Ghana that I founded doing public health work was very small-scale. Small foundations, family and friends would donate. We had a very modest office. We were doing really small but impactful programs, but it was the work. And I had fun. I was in Ghana, and I was kind of engaging with the culture and seeing family.

But now with Clinton Foundation, the mandate was very different. How do we increase access to HIV treatment from a couple million people? I actually think at the time that we started our work in Clinton Foundation, I’m going to age myself, it was 2004. And I’m going to throw some numbers, people can fact-check them, but I’m just going to guess. I think I’m in the magnitude. At that time, we thought that 2 million people were HIV-positive in Tanzania in this period in 2004. We thought that around 400,000 of them needed HIV treatment immediately. They needed access to antiretroviral drugs. So 2 million infected, 400,000-ish needed HIV treatment, ARVs immediately. But in the numbers, next to nobody was on ARVs. So the question was—

Teresa Chahine: How do you get from zero to those numbers?

Kaakpema Yelpaala: Correct. And it was a five-year plan. President Clinton’s view at the time is that he used to say it this way, “For better or worse, if all donors and all foundations left Tanzania tomorrow, what would be left is the Ministry of Health.” So he felt it was very important to work with and through the public sector for sustainability. And so the programs were owned by the Ministry, but then the Clinton Foundation was coming in as a supporting function to build the capacity of the government to be able to serve the people.

And so at that time, we developed what we called the five-year plan. So it was supposed to be bold and ambitious, so we were going to develop a five-year plan to get everybody inside of the care and treatment continuum that needed to be—

Teresa Chahine: Everybody? From zero to everybody?

Kaakpema Yelpaala: Everybody. From zero to everybody, in five years. And people thought the Clinton Foundation folks were crazy. All the USAID workers and others are like, “These people are coming in and don’t know anything about—”

Teresa Chahine: “They don’t know what they’re doing. We’ve been here for decades.”

Kaakpema Yelpaala: “Yeah, they don’t know anything about how things work.” But that was the mindset. So again, you could see, I think, that was the biggest differences, getting thrust into that frame of thinking after having done much more, like let’s just say modest small-scale nonprofit work early in my career.

Teresa Chahine: And so what made you decide to then shift into building digital health businesses in that same setting? What was your thinking?

Kaakpema Yelpaala: Yeah, the thinking process. So a couple things. So one, what I saw doing the work with Clinton Foundation is that we did do some great things. We pushed the envelope, and we pushed the envelope on the basis of people dying unnecessarily from HIV and AIDS. So we saw it as a moral imperative for speed. And so I learned a lot about just how ministries of health work, how to mobilize, resourcing, all the things that don’t work, working at that scale with ministries and nonprofits and where you find friction.

But also, something else happened. When I was traveling the field all over East Africa, this is when there was a telecom boom. And so everybody was having access to a basic mobile phone and able to text even in the most remote areas. So while I was doing all this other work, I had this observation, I was like, “Well, what if we could use the power of text messaging and technology to better connect patients and providers in remote areas and—?”

Teresa Chahine: So it was the opportunity.

Kaakpema Yelpaala: So it was the opportunity I saw with the digital infrastructure, because I was living there. I was traveling to the field all the time. I was in Rwanda and Uganda and Tanzania, and I was in the car for five hours, and I started to realize, “Oh, my phone works,” and I could be in the most remote area. And that was the seed of how I was like, “What if I tip my hat into this emerging digital health theme?” Back then it was called mHealth. You’ll remember.

Teresa Chahine: Right. I do remember.

Kaakpema Yelpaala: That was the term of art.

Teresa Chahine: I kind of didn’t notice that that stopped being the term.

Kaakpema Yelpaala: Yeah, because now people like to say “digital health,” but really it was mobile health. mHealth was the term of art. Yeah.

Teresa Chahine: I don’t think it was you that decided that this should be a for-profit route. I think that the whole mHealth space was just kind of a for-profit space.

Kaakpema Yelpaala: Yeah, it was. There were a handful of nonprofit organizations that were trying to develop open-source technologies around this. And then there were a lot of people that wanted to bring... because basically the emphasis on starting a for-profit when I made this transition was about sustainability. So we always talk about sustainability when we think about health equity. And the question is, what model or models or mix of models can get us there? And I think when I worked in nonprofits, I saw a lot of opportunity for impact, but I saw a lot of challenges with sustainability, because you have foundations and foreign aid and all these outside agencies funding domestic—

Teresa Chahine: The second their agenda changes or their budget changes—

Kaakpema Yelpaala: Correct. Then all of a sudden funding’s—

Teresa Chahine: ... it’s over.

Kaakpema Yelpaala: It’s over, right? And that’s exactly what I was seeing, and I was seeing what that meant. When you had a program that was successful, then all of a sudden a donor decides not to fund it anymore, and then it just goes away. And then everybody’s chasing the new thing that the donors decided. And I found that very frustrating. And so I said, “What if we used a private-sector, market-driven model?”

Teresa Chahine: Then it’s less donor-dependent. Then it’s not donor—

Kaakpema Yelpaala: Yeah, exactly. So that was the experiment. Could I do that? Yeah.

Teresa Chahine: And so what were some of the similarities and differences that you saw operating in those two spaces in Africa, the for-profit and nonprofit space in terms of what was broken, there’s something broken in each, and also in terms of your ability to reach your goal of improving outcomes and equity?

Kaakpema Yelpaala: Right. So what I liked about the for-profit side is that I was able to generate some resources. I got an early customer, as we talked about in the class, in Uganda, that kind of helped me get started. Then I raised a little bit of money from friends and family. So what that allowed me to do is to go into the market and just ask people what they wanted and what they needed. Because oftentimes if you get funding from a foundation or a grant, it depends. In an academic setting, you might be pursuing a question and you have funding to pursue a certain type of question or issue.

In the NGO space for programs, oftentimes the donors set the agenda. So you find yourself being led by what the funders’ interest is, and then you’re trying to align the funder interest with the community the best you can as that broker. And there’s always a misalignment of some kind. And what I like with the company, when I raise a little bit of money, and I had these first clients, is I could just go to the market, and I could meet with clinics leaders, and I could just be like, “What do you need? What would you pay for?” So then I felt like there was a more direct connection to what people wanted. And because I had investment dollars, I could choose. I wasn’t forced by some other donor telling me, at least at the early point. Obviously I had investors who were expecting financial returns, but in the early phases, I had a lot more flexibility to be creative and engage the market. I’m like, “What do you actually want?”

Teresa Chahine: Okay. So I’m going to dig deep in two different places, and I think it’s because I’ve been hanging out with Yale students too long. They ask these tough questions. So the first one is, it’s more of an observation. Even in Uganda, your first customer was USAID. It was a multilateral organization, I think, if I understood correctly.

Kaakpema Yelpaala: Well, yeah, we were subcontracted. The technicality is we were subcontracting with a group that was funded by USAID. So it was kind of indirect. It wasn’t direct to U.S., but it was like that. It was resourcing.

Teresa Chahine: It just feels like everything is so deeply entrenched, even when you’re trying to operate an independent for-profit business, the multilateral agencies are still there trying to operate in that space. So it’s still kind of like their agenda is still there. It’s hard to escape that.

Kaakpema Yelpaala: It’s very hard to escape the agenda. Exactly. But the thing is, I wasn’t fully reliant on that money. So it’s one thing if—

Teresa Chahine: It’s different if they’re a customer—

Kaakpema Yelpaala: It’s different if that was my only source of capital, but it was basically revenue to help offset cost or investment to learn the market. So that’s what makes it a little different. If I was just a USAID subcontractor, and those were the only resources I had, then I’m kind of starting to fall into their priorities. But to me, it was opportunistic. I happened to have alignment, so I was able to have a little bit of money—

Teresa Chahine: There was more freedom to have your own agenda.

Kaakpema Yelpaala: Yeah, and then by raising money from family and friends, I had freedom to pursue, in the early days, the market and understand without that, having a foundation tell me, “This is what you have to do,” or, yeah.

Teresa Chahine: And then the other nuance in terms of having a plot twist in the wild journey of the international health entrepreneur is that when you were growing the for-profit business, after you did the proof of concept in Uganda and everything, you got venture capital money from the U.S. Because at the time, 10 years ago, there was no venture capital firms there in Sub-Saharan Africa. And so then they also, because they were on your board and there were decision-makers, at the end of the day, basically told you to shut it down, because it wasn’t profitable enough, right? They wanted you to try it out in the U.S. market.

Kaakpema Yelpaala: Right. So the only catch that I would say is that my investors were also Africans. So that’s the difference. So the luck I had is that when we say my investors are from the U.S. I don’t want to infer that my investors didn’t understand the market.

Teresa Chahine: Yeah. Right, that’s true.

Kaakpema Yelpaala: I found investors of Liberian descent who were business leaders in the U.S. and wanted to invest in Africa. So actually my board and investors were very knowledgeable of the African markets and had aligned incentives, because they were also people like me of the diaspora. And I think it’s very different from if I had an investor that didn’t have a personal connection to the continent or knowledge of the continent. And that’s why I was actually lucky. But then at the end of the day, having the for-profit motive and having venture capital... and I would say my investors would’ve said they were patient capital, which I think they were.

Teresa Chahine: That’s true. They weren’t sharks.

Kaakpema Yelpaala: They weren’t sharks.

Teresa Chahine: Yeah. They weren’t [inaudible 00:15:50] investors.

Kaakpema Yelpaala: But at the same time, we needed financial returns that we weren’t able to achieve in the model at the time.

Teresa Chahine: Yes. That is the third nuance, to be honest. For-profit and venture capital are two different things.

Kaakpema Yelpaala: They’re two different things.

Teresa Chahine: You can start a for-profit SME—a small or medium enterprise—fund yourself through revenue, bootstrap—

Kaakpema Yelpaala: And organically grow.

Teresa Chahine: ... and not take funders and still exist as a successful business-making revenue. But it wouldn’t be that high-level revenue.

Kaakpema Yelpaala: Yeah. It wouldn’t be that high-level growth. And honestly, a lot more health equity innovators that I talk to are going that route.

Teresa Chahine: Really?

Kaakpema Yelpaala: And some of them actually, when they look for advice from me, what I’ve come to learn, I mean, I wanted to experiment with venture capital, but I came to the observation you’ve mentioned, which is, not all businesses need to be venture capital growth businesses. And you might be able to build an equity-centric model that is profitable and grows organically without the need for having to secure a lot of external capital. And so you can also own your work more, right? You’re not beholden to investors the same way. And I think a lot more health equity innovators now and where I’m kind of pivoting, but in the U.S. and some are thinking about this more.

Teresa Chahine: That’s so interesting. You don’t hear that kind of advice very often. I’m sure our listeners would be really grateful to hear that, just like that unique point of view, because everyone’s chasing venture capital. So then your investors saw the opportunity of, “Hey, wait, right here in the U.S. we also have under-served populations where there’s this digital divide between what providers offer and what they’re able to receive.” And so they wanted you to test out the model you were employing, in Africa, right here in the U.S. Tell us a little bit about that.

Kaakpema Yelpaala: Exactly. So what was our offering? So in terms of what the product was on the African side, the African market was primarily paper-based, as we talked about in class. And so there was a push to help clinics and hospitals, we just use the term “digitally transforms,” so get all their records into an electronic format, be able to use tools like texting and other things to communicate with people in an interactive way.

Teresa Chahine: We’re not that far ahead in the U.S.

Kaakpema Yelpaala: It’s true, right? And that’s what we were trying to do. And that was the software we sold, and we got lots of users on it. And so what we found is in the U.S., low-income populations like Spanish-first speakers, multicultural, you don’t find them in the patient portal. So the patient portal with health reform during the Obama administration had a meaningful use clause, which is really trying to portal people to adopt the electronic health record. The catch is you need an email address, you have to log in all these things. When we think about vulnerable populations, low-income folks, many of them don’t have email addresses. They find it inconvenient. They prefer to text or use WhatsApp, and they’re culturally diverse. And this is very much the same type of user persona, if I can put it that way, that we had in Sub-Saharan Africa.

Teresa Chahine: Right, because you were serving the rising middle class.

Kaakpema Yelpaala: The rising middle class with a lot of cultural diversity. They preferred texting; they weren’t going to go in a patient portal. That wasn’t the thing. And so my investors said, “Maybe you’ve got an idea that is just in the wrong market environment. Let’s try this out.” And it actually got traction. Our first client was Adventist Health White Memorial at East Los Angeles. We worked with an initiative that was serving about 50,000 Spanish-first speakers that were what we call covered lives. So there was a payer that was paying White Memorial to take care of these people.

Teresa Chahine: Like value-based care.

Kaakpema Yelpaala: Basically. And so our job was to develop communication protocols in Spanish and English, where relevant, that were personalized to help them know that White Memorial is a place they could seek care and to get them directed to the right services. And it worked quite well. We had that client for the life of the company.

Teresa Chahine: And so then I’ll ask you a similar question. What similarities and differences did you see in these two settings of serving the African middle-class patients versus the U.S.? In this case, Spanish-first speaking communities in Los Angeles.

Kaakpema Yelpaala: Right, where we started and then we started—

Teresa Chahine: And also with the providers. They’re very different providers.

Kaakpema Yelpaala: They’re very different. Yeah, so on the surface people would say, “This sounds strange. These seem like completely different environments.”

Teresa Chahine: Totally different financing, yeah.

Kaakpema Yelpaala: “I don’t understand how he’s going from this place to that. It doesn’t make sense.” But what I got to learn is, I’ll use a term that we use in healthcare, and I think people listening to this would understand, but the African healthcare market from a private-sector perspective, so again, we’re talking about private hospitals where people pay to access care, it’s what we call a “fee-for-service market.” So there’s not wide coverage with health insurance. So on the public-sector side, ministries of health and governments have these national health insurance schemes, which are supposed to make it free or very low-cost for people to seek care. However, that’s for government facilities. And it’s not a popular thing to say, but I like to sometimes say, for all the millions and then billions of dollars that have gone into the public health sector, if you went to the average African anywhere, they’re not going to tell you they would choose to go to one of those facilities.

Teresa Chahine: I know. And many low- and middle-income countries, like in Asia and other countries in the world.

Kaakpema Yelpaala: Right. So then people would say, “I’d rather wait and die at home than go to...” And that’s the public—

Teresa Chahine: I was literally told that in a South Asian context, when someone told me, when you go to the public hospital, it’s a last resort. You go there to die.

Kaakpema Yelpaala: Right. So there’s a national health insurance cover, but that gives people access to public-sector facilities they do not want to go to. So what’s the alternative? Private hospitals and clinics. But now in the U.S. we have employer-based insurance for a lot of people, and then we have other safety net programs for insurance. But in African countries there’s no widespread private insurance. So then just when you go, it’s only the money you have that determines what care you can get. And so in that fee-for-service context, people aren’t driven by quality of outcomes but by generating money. I want to either retain my patients or get new patients because that’s the lifeblood. So then there’s no incentive for quality. This is actually the big conundrum of the U.S. healthcare system, and we all experience—

Teresa Chahine: I will say just as an aside, before we shift back to the U.S.—

Kaakpema Yelpaala: Yeah, go ahead.

Teresa Chahine: ... because I kind of feel bad opening that can of worms and not closing it. There are some social entrepreneurs in the Global South who are working on this exact problem.

Kaakpema Yelpaala: Of course, yes.

Teresa Chahine: …of “let’s provide high-quality care with the goal of making it low-cost so that we’re not....” But that is this whole other can of worms of like, are we building parallel systems?

Kaakpema Yelpaala: Correct.

Teresa Chahine: …investing in the existing systems. But that’s a topic for another episode.

Kaakpema Yelpaala: Right. And I think that’s right to acknowledge that’s an opportunity that innovators are going after, which is, can they offer low-cost, high-quality care to fill this gap?

Teresa Chahine: And can they do it in a way that strengthens and connects with the existing system?

Kaakpema Yelpaala: Correct. And it’s a really challenging fee.

Teresa Chahine: It is really challenging.

Kaakpema Yelpaala: But people are out there doing.... I appreciate you flagging that. So I don’t want to—

Teresa Chahine: But I don’t want to go on a tangent. Yeah.

Kaakpema Yelpaala: Yeah, I don’t want to disacknowledge that. But in the fee-for-service context, and people will know this is true that live in these contexts, is what you can pay determines what care you can get.

Teresa Chahine: Yeah, absolutely. In the U.S. and elsewhere.

Kaakpema Yelpaala: In the U.S. Exactly. And that became the commonality that I realized, which is, in the U.S., in a fee-for-service setting—

Teresa Chahine: We don’t have these public systems.

Kaakpema Yelpaala: Yeah, we’re not driven by outcomes. And so that’s why in the U.S., we use the term “value-based care” as a term to start to talk about aligning financial incentives with health outcomes, because we know in a fee-for-service setting, basically you’re driven to get more patients, and physicians don’t feel empowered. They feel like they’re told, “You have to see so many patients a day.” They don’t feel like they can spend time with patients and really get to know what they need. And so it’s also leading to burnout for a lot of physicians. Actually those two dynamics are very similar between the private health sector in African countries and the U.S. healthcare challenges.

Teresa Chahine: Interesting. That’s not something I would expect, but you’re right that it is very similar in terms of the incentives not being aligned with improved health outcome.

Kaakpema Yelpaala: Right. And I think we talked about in the class, the other observation I had is that when we talk about that value-based care in the U.S., we talked about aligning financial outcomes or financial incentives and outcomes. I look at foreign aid in African countries for global health a little bit like that. But the payer isn’t an indigenous or local agency. It’s a foreign one. But USAID or Gates Foundation will basically pay you on the basis of driving certain types of outcomes. So when you really think about it, they’re like a value-based payer, because they say, “Hey, I’m going to fund you to reduce malaria burden here. I’m going to fund you to deal with TB there.” And so the money is tied to outcome, but they’re a foreign entity working on behalf of these local problems, which creates its own distortion.

Teresa Chahine: Yeah. Then it also goes back to the question of to what degree do we want to invest in the ministry of health versus in private providers?

Kaakpema Yelpaala: Correct. And issues of sovereignty, and yeah.

Teresa Chahine: Yeah. We talk about that so much in this course, how innovators can lead to systems change. Which kind of leads to the third area I wanted to talk to you about. So we talked about similarities and differences between for-profit and nonprofit in Africa, and then between the African context and the U.S. context. And we’ve been talking about direct service versus systems change, and I know that now you’re focusing a lot these days in various roles in Colorado where you chair the—

Kaakpema Yelpaala: The eHealth Commission. Yeah.

Teresa Chahine: ... eHealth Commission, and with the American Medical Association, where you’re on the—

Kaakpema Yelpaala: Equity and Innovation Board.

Teresa Chahine: ... Equity and Innovation Board. And so you’re thinking about policy issues these days. And so I just wanted to ask you to tell us a little bit about that and how it fits in with the roller-coaster ride you went on in trying to start these companies for health equity, for outcomes and access. What are the policies you’re working on that can support innovators trying to do that work?

Kaakpema Yelpaala: Right. Yes, so as I did this work, and one, I feel really proud of what my teams have done over the years. I feel really fortunate to have had the investors I had and the people and institutions that came along the journey, because without them being willing to invest in me and the teams, I couldn’t have had these experiences and learned these things that I’ve learned. And I think they were also willing to go on the journey of trying to experiment to find new models.

And so I think my observation is that you have to have an enabling environment for innovation that supports health equity, because that’s where this all started for me is really thinking about vulnerable populations, thinking about the fact that my parents are immigrants to the U.S. from Ghana. My dad grew up as a rural poor person near the Burkina Faso border, and thinking about how much what I see as latent potential is out there in the world that we never get to see shine. So to me, that’s been my mission. And so when I think about health equity and innovation, it’s the policy environment, it’s the funding environment which creates these incentives within which innovators can operate.

Every now and then we have some innovation that comes that changes how the world works. It’s very rare, and I think it’s hard to predict sometimes what those things will be. And I think we could list plenty of things we see in the world that have just changed the dynamics of how we interact. But I really feel like you have to, for the type of change I would like to see, we have to, one, focus on how to better align financial payment and outcomes. Because again, in a fee-for-service setting, if your only goal is to make money, then our system works as it does to the detriment of so many people. So that’s like a policy question. And there’s lots of really smart people trying to figure this out.

And in the U.S. they say “50 states, 50 health systems.” It’s like there’s so much diversity, but there’s organizations like Cityblock and others that are starting to crack the code, little by little, in how we bring these value-based models to scale. So that’s why—because policy enables that. But then also when we think about inclusion and diversity, if only certain types of people have the opportunity to innovate, it’s pretty clear why a lot of the innovations we have don’t serve everybody. We need people with very lived experience. So I’m working with some friends on a diversity venture, diversity reporting bill that started to get some traction in the U.S. and bringing it to other states. So California just launched this bill last year, late last year, and now states like Massachusetts and New York are, and even in Colorado, we’re going to look at it, but the idea is to mandate that venture capital forms have to disclose the diversity metrics of their portfolio. So we can start to really see what that looks like. And then people can really start to consider how we invest in a more diverse cadre of innovators. And it’s the same in an international setting. There’s something that was going around a couple years ago that was showing that if you look at the faces of all the unicorn companies, so companies that have reached a billion dollars or more across Africa, the faces of the founders are primarily white and East Asian. There’s almost no indigenous Africans that are on that. So basically we’ve got a lot of—

Teresa Chahine: Tying it all together.

Kaakpema Yelpaala: ... expatriates that are coming into Africa. They’re able to raise money through their networks and whatever wealth they can access, and they’re actually generating wealth on the continent, but they’re from the outside. And so these are the things that we have to improve, whether it’s the U.S. or we need more representation as well.

Teresa Chahine: It’s interesting, but the common thread across these three pillars we’ve talked about today in terms of nonprofit versus for-profit in Africa, U.S. versus Africa, and profit versus startup, sorry, and policy versus—

Kaakpema Yelpaala: And policy, yeah.

Teresa Chahine: ... startups. The common thread I’m seeing is that where and how innovation happens and who gets to innovate is informed by where and how money flows.

Kaakpema Yelpaala: Right, and the system.

Teresa Chahine: And that that’s informed by policy.

Kaakpema Yelpaala: Correct. That’s informed by policy and other things. So as I started to think about it, me as one person can’t solve these problems. And even if with these companies I founded that for different reasons they kind of did their journey and I’ve had to move on, even if I was wildly successful with them, unfortunately, it would still only be a drop in the bucket in terms of the problem. That’s my bigger reflection. No one company that I founded, and even if it reached my wildest dreams of success, we’d still have billions of people that don’t have what they need. And so that’s where you start to think about systemic change and how we can be more catalytic for more people to take this on, because that’s the only way this improves. It’s not one person or one issue. It’s actually how the system enables. Because people are thinking about these problems day in, day out. I’m not the only one, right? But how do we create an environment where they have the opportunity to bring their ideas to fruition?

Teresa Chahine: And where they’re all talking to each other—

Kaakpema Yelpaala: And where they’re all talking to each other.

Teresa Chahine: ... innovation. And then innovation is geared towards strengthening these systems—

Kaakpema Yelpaala: These systems.

Teresa Chahine: …that are building parallel systems.

Kaakpema Yelpaala: Right. Exactly.

Teresa Chahine: So it all kind of fits in together, all the global players, all the different kinds of innovators and the policymakers, because it is one big global system.

Kaakpema Yelpaala: Exactly. And the different modalities. So sometimes there’s this pitting of for-profit and nonprofit models against each other. And I think for me, I’ve just been experimenting. I did the nonprofit models. We had some impact. I also saw some challenges. So then I said, “Let me try a for-profit model.” Then I did that, and I wasn’t exactly pleased either there with what I... so I’ve just, like any entrepreneur, have been experimenting. Yeah.

Teresa Chahine: And I think that these experiences have been really important in informing how you’re participating in policymaking.

Kaakpema Yelpaala: Exactly. And feeling like I can advocate. Yeah.

Teresa Chahine: Yeah, exactly. Any closing words of wisdom you want to share with aspiring entrepreneurs innovating the health equity space?

Kaakpema Yelpaala: I mean, I think what I’d just like to say is I know it’s hard, so I think the work is hard no matter how you’re approaching it if you’re mission-oriented. And so I just want to acknowledge that it’s challenging and that also you need to consider your mental health and wellness, because it’s a marathon. And also community matters. You need to find your community of other innovators and supporters and people that are going to be on that journey with you, because it’s a daunting task, and it’s even more daunting—

Teresa Chahine: You can’t do it alone.

Kaakpema Yelpaala: ... if you’re thinking about doing it alone. It is not really going to be in your interest or the people you want to serve. So to be able to achieve persisting through the marathon, you need community, you need to think about your health and wellness, and you need to understand you’re going to learn as you go. And how we define success really matters. And sometimes things may, if we use external metrics of validation for success, sometimes they may not align with what our mission is, right? I started two different companies. They’ve done some great work. I didn’t have a huge exit and sell it for a billion dollars, but I still think we were a success. I still honor the work that my teams did. I still feel proud of the people we reached, because I know that in that moment we were impacting them. And I think how you frame in your mind what success is and what progress is is really important.

Teresa Chahine: Sometimes success is that you tried and that you didn’t just sit there and talk about everything that’s wrong, but you saw a different way of doing things and somebody’s got to try it. And so many people have to fail at it before somebody’s able to figure it out.

Kaakpema Yelpaala: Something cracks through. Exactly.

Teresa Chahine: Exactly. So I think success is being part of that movement.

Kaakpema Yelpaala: Exactly.

Teresa Chahine: You’ve been through a lot of ups and downs, and you’re still here. And you’re still kicking.

Kaakpema Yelpaala: I’m still here and I’m still smiling. I am still smiling. I still have gratitude.

Teresa Chahine: Yeah, thank you so much, KP. Thanks for the work you’re doing to shape policy and the work that you did in the trenches as an entrepreneur.

Kaakpema Yelpaala: Thank you so much. This has been a wonderful conversation.

Teresa Chahine: We appreciate you.

Kaakpema Yelpaala: Likewise.

Teresa Chahine: I am Teresa Chahine, and you’ve been listening to Impact & Innovation. Subscribe to stay tuned and follow us at Teresa Chahine and SOM Ventures. Special thanks to the broadcast center at Yale School of Management.