The initial start-up playbook on scaling companies to success was conceived and edified in Silicon Valley. Over the years, it achieved near universal application from aspiring founders worldwide. Entrepreneurs from around the globe were relocating to the Bay Area to launch their businesses alongside Silicon Valley’s unrivaled access to talent, customers and potential acquirers. The United States is a $21 trillion economy and has the largest technology and software market globally. For start-ups, that meant that organic growth could be achieved locally, without having to consider a geographic expansion. Talent was readily available locally and product market fit was achievable by using the immediate market as a testing ground. In this playbook, common practice was to internationalize incrementally, always starting with a domestic focus and exploring foreign markets much later in the company’s lifecycle.
Today, we are witnessing a paradigm shift in innovation. Tech hubs are sprouting across the globe, and successful businesses are emerging from frontier markets, from Cairo to Singapore. This shift also means that the traditional start-up rules are quickly losing relevance as local realities and nuances trouble their universal applicability. Crucially, this generation of entrepreneurs is writing its own playbook and one of its foundational premises goes against Silicon Valley’s narrow local view.
In these markets, companies are built global from the get-go. A multi-market model is embedded within the business plan from the early days simply because it is a strategic imperative. Some of the most successful companies from these markets attribute their success to market expansion. Among the ten unicorns built in Southeast Asia over the past decade, seven had scaled internationally within their fourth year. In Africa, 64% of the most valuable tech companies, had launched into a second market by year four.
In the majority of these economies, the total addressable market is often too small (and unattractive to potential investors) if founders don’t account for geographic expansion as an avenue for scale. The multimarket approach allows for economies of scale, refines product development and builds an offensive advantage. For many of these start-ups, staying local is not an option. Bigger companies will eventually penetrate the market and outcompete the smaller ones. In this context, being born global is a requirement for survival.
Importantly (and often missing from the analysis of the born-global start-ups), emerging market founders build for a global market because the problems they are addressing affect millions of people globally.
Proximie is a case in point. Dr. Nadine Hachach-Haram was young when her family migrated to the United States to escape the civil war happening in Lebanon. When she was eight, she moved back and witnessed firsthand the socio-economic inequities that plagued war-torn Beirut at the time, especially in terms of access to healthcare services. As she went on to become a surgeon, these memories never left her. She realized that inequalities in surgical care existed everywhere. 5 billion people worldwide lack access to safe surgery due to the absence and remoteness of surgical expertise in many markets globally. That is two-thirds of the world’s population. Of these 5 billion, 18.6 million die every year from that lack of access; that is more than HIV, malaria and tuberculosis combined.
She began asking herself: how can I scale expertise? Why is surgery so location dependent? Can surgery only happen in co-presence? For Nadine, it was crucial that the solution truly and meaningfully democratized surgery, and is independent of location, available hardware or bandwidth. The solution had to be made available and accessible in the most rural and remote areas as well as in the most sophisticated training and research facilities in the biggest cities in the world.
Proximie was thus born, an augmented reality tool that allows surgeons to virtually scrub into any operation theatre across the globe. By creating a tool based on AR, but on very low bandwidth to handle even the poorest of internet connections, the idea was that surgeons anywhere can follow more senior and experienced surgeon’s directives on a screen in front of them with the same level of precision that would be possible if that surgeon was actually conducting the procedure. The advising clinician can, with simply a Google Chrome account and a computer, live-feed what should be done by using their hands. AR was the game-changer because surgery is practical and hands-on. It would be difficult to describe the steps with words. By being able to reach with his/her hands into the screen, doctors in the operating room are able to emulate every move.
Since being founded in 2016, Proximie has managed to attract 2500 users across 300 hospitals and has had its tool used in over 7000 surgeries. The technology is being deployed to help connect clinicians and train the next generation of surgeons. It has helped save lives across the globe, scrubbing in surgeons from Eastbourne to Africa, America to Asia, South America to Europe, and was used on the front line by the British military.
Critically, what has allowed the company to generate this impact is first and foremost, Nadine’s global intention and second, the software’s adaptability to specific market contexts that allows for global applicability. The product is built with an architecture that can be modulated for different realities. Ultimately, this inherent flexibility allows start-ups to scale globally at a much faster rate than their counterparts in more mature markets who are still moving slow and steady.
In emerging markets, start-ups are addressing gaps in access to basic services such as healthcare, education or financial services. Per 1,000 people, the Middle East and Africa has 1.3 doctors — as opposed to the U.S. which has 3.7. Per 1,000 people, the number of hospital beds is around 1.7, as opposed to 4.5 in OECD countries. This is a problem that impacts 1.5 billion people. In Africa alone, 66% of the population is unbanked. With these statistics in mind, the region’s start-ups are inherently solving challenges that affect millions of people in the region and the world. The potential socio-economic impact of SMEs means that global scale is built into their DNA from the get-go.