Do you know Sana Bouyahia, a passionate advocate for entrepreneurship and healthcare innovation and athlete! Alongside a 10-year career as a high-level volleyball player, Sana earned a master’s degree in chemistry followed by a master’s degree in technical sales. With experience at Digital Pharma Lab, the first PharmaTech accelerator in Europe, as well as at Tech Care Paris, the Paris-based incubator dedicated to healthcare innovation supported by the City of Paris, Sana is committed to encouraging healthcare stakeholders to cultivate innovation. She develops strategic partnerships between stakeholders, accelerates innovative projects, and strengthens the healthcare ecosystem.

Denise Silber, who met Sana several years ago at Paris&Co incubator, was delighted to interview  Sana Bouyahia, an inspiring figure in healthcare and innovation.

Denise Silber: Why did you choose to move to Nice?

Sana Bouyahia: After a very enriching experience in the Parisian ecosystem, I decided to settle in Nice, where I have been living for several months now. I represent the economic interests of the healthcare sector within the Invest in Côte d’Azur agency, thus contributing to the promotion of the local ecosystem. In parallel, I offer private and public healthcare stakeholders trend studies and analyses aimed at helping healthcare companies leverage innovation driven by startups. In this regard, I recently joined Agora Health, the startup studio dedicated to the development of clinically validated digital therapies to assist pharmaceutical companies in assessing the commercial viability of these tools and evaluating market opportunities.

Additionally, the quality of life I enjoy here also allows me to resume competitive volleyball in Monaco in the 3rd division (National 2)!

DS: How do you view the organization of startup support in France, given your extensive experience in this field?

SB: In France, support for startups is robust, combining financial support with support structures such as incubators and accelerators. Incubators provide a conducive growth environment with long-term support (2-3 years) and real estate offerings. Accelerators focus on intensive support (6-12 months) with the goal of helping the startup either develop a first prototype or facilitate the company’s growth. With over 250 incubators and more than 100 accelerators in France, the survival rate of startups benefiting from these programs is around 70% after three years, compared to about 40% for others. The French Tech, a government initiative, plays a key role in bringing together the startup ecosystem in France, thus fostering the creation and growth of innovative companies.

Some figures highlight France’s efforts to promote startup development:

• France has 1 million startups employing 1.5 million employees.
• There are 29 unicorns like Qonto, Doctolib, and Black Market in 2023.
• 73% of all French startups are dependent on at least one of the GAFAM companies concerning data hosting and processing.
• French Tech startups generated €8.3 billion in revenue in 2021.

Other figures reveal shortcomings:

• Only 11.7% of founders in the French Tech 120 are women, and there are no female leaders in the Next 40.
• Only 50% of startups are located outside of Île-de-France.
• The startup failure rate across all categories is 40%.

(For more information on these statistics, please contact info@BasilStrategies.com.)

DS: What assistance is available for startups in France?

SB: BPI, or Banque Publique d’Investissement, plays a crucial role in financing and supporting startups in France. It offers a range of solutions, including loans, loan guarantees, and equity investments. Additionally, BPI provides strategic support and manages various aids, such as the “Prêt d’Honneur” (Honor Loan) and the French Tech grant, while also encouraging startup participation in competitions such as the i-LAB competition and the i-Nov innovation competition. Furthermore, BPI can act as a guarantor to create interesting leverage effects for loans obtained from other financial institutions, making it easier for young innovative companies to access funding. There are also organizations like Initiative France and Réseau Entreprendre that offer “Prêts d’Honneur” (Honor Loans) averaging around €20,000.

DS: What about the specificities of the complex French healthcare sector?

SB: Startups in healthcare should consider the following:

Themed Incubators and Accelerators:

• Quest for Health, funded by the East region, the largest healthcare incubator in France.
• PariSanté Campus, a national project funded by the State.
• Eurasanté, funded by the Hauts-de-France region.
• Tech Care Paris, now part of Paris&Co Santé, funded by several entities in the Paris region, offering financial support, real estate offerings, an accompaniment program, and networking opportunities within the healthcare ecosystem.

Hospitals:

• Some hospitals, such as CHU de Brest with W.inn and APHP with the @Hotel Dieu team, actively collaborate with startups to improve healthcare through new solutions and help them understand the real needs of the sector.

Regional Health Agencies (ARS):

• ARS coordinate healthcare at the regional level and play a crucial role in coordinating healthcare innovation initiatives. Through certain calls for projects, especially those related to the implementation of organizational innovation using digital solutions, some startups can be attached to a care center and test their solution. At Tech Care Paris, ARS IDF was a partner with whom I collaborated closely, and the innovation team was always ready to raise awareness among startups about the challenges in care pathways.

Competitiveness Clusters:

• Industrial clusters like Medicen, Alsace Biovalley, and Eurobiomed facilitate collaboration between healthcare stakeholders and startups by offering support, resources, and funding opportunities.

Research Centers:

• Research organizations like INRIA and CNRS offer support programs to help researchers pursue their research projects and facilitate the transition to entrepreneurship. Some programs are designed as startup studios with financial support and guidance in exchange for equity.

BPI Calls for Projects:

• BPI offers specific calls for projects, such as those dedicated to innovation in medical imaging, to finance and support startups in the healthcare sector.

DS: What are the selection criteria for startups seeking early-stage support?

SB: Selection criteria can vary depending on the support programs and organizations. However, here are some general criteria that are often considered:

• Innovation: The startup should offer an innovative product or service that addresses the needs of the healthcare sector. It is essential that this innovation provides real added value and addresses a concrete problem.
• Market Access and Business Strategy: Demonstrate the market penetration potential and the viability of the business model. The startup must have a solid strategy to reach its customers and generate revenue.
• Team: The quality and complementarity of the team are crucial. Some programs require the presence of an experienced board of directors and medical expertise in governance.
• Competition and Entry Barriers: It is important to analyze existing competition and demonstrate the startup’s ability to overcome entry barriers in the market based on the technology developed, patents, and growth potential.
• Financial Resources: A solid business plan is necessary to show how the startup intends to generate revenue and manage its financial resources effectively.

DS: Is it necessary to have a co-founder already? Under what conditions can one start “alone”?

SB: It is not mandatory to have a co-founder to start a startup. The essential thing is to consider the entrepreneur’s skills, network, and the product being developed. Healthcare is a multidisciplinary field that requires diverse expertise, ranging from technology and clinical validation to regulation and reimbursement pathways. A co-founder with complementary skills can facilitate the company’s development. You can start alone, but I would advise having a strong board that can guide the entrepreneur and provide access to decision-makers in healthcare.

DS: Once a startup enters an incubator, what are the success criteria ?

SB: I would cite the following criteria:

• Product/Service Development: Success is measured by the development and validation of the solution.
• Clinical Validation: For healthcare startups, conducting clinical trials or obtaining regulatory approvals is essential.
• Market Penetration: The beginning of market entry can be defined by the first sales or the first developed partnerships.
• Funding: Securing and optimizing dilutive and non-dilutive investments is a sign of success.
• Healthcare Impact: Improving healthcare or patients’ quality of life is a significant goal.
• Financial Sustainability: Managing cash flow and financial flows. It can’t be stressed enough that poor accounting is a significant risk.
• Team Expansion: Hirings can indicate stability and some growth. These criteria may vary depending on the incubator and the startup’s maturity level at the time of entry.

DS: You have closely interacted with about fifty startups in your recent roles. What were the characteristics of the successful ones?

SB: While there are many startups in healthcare with different products, I can offer some key characteristics of a “gem” :

• Relevant Innovation and Usability: Solutions that solve real healthcare problems with a low level of user change to ensure accessibility to innovation.
• Clinical and Regulatory Validation: A solid understanding of regulations and clinical requirements.
• Access to Funding: The ability to secure funds through dilutive and non-dilutive means to finance growth.
• Strong Team: A qualified and complementary team with diverse expertise and high-level governance, well-connected in the ecosystem and capable of supporting the team. The presence of a scientific committee is more than necessary in projects integrated into the care pathway.
• Societal Impact: The project should facilitate access to care.

DS: And for those that did not survive, were there any commonalities?

SB: Common denominators included:

• Lack of Market Understanding: Some startups launch without fully understanding the sector, with its multitude of actors and economic challenges.
• Regulatory Challenges: Regulatory requirements may be underestimated or not adequately planned in the product’s development.
• Insufficient Funding: Insufficient or mismanaged funding can lead to financial difficulties and startup closure.
• Incomplete Market Validation: The product does not address a market need.
• Lack of Vision: I often asked entrepreneurs questions like, “What do you want to do with this company? What is your projection?” Surprisingly, I did not always get a clear answer. Many entrepreneurs approach investors without an exit strategy.
• Team Issues: Disagreement among co-founders is a major cause of startup failure.
• Interoperability Challenges: Many startups struggle to integrate into the care pathway due to constraints in healthcare data management and governance.

DS: What advice do you have for startups that are just starting out, especially in the healthcare sector?

SB: Here’s what you should keep in mind:

• Understand the Stakeholders: Identify who the payer and buyer are and propose a coherent economic model.
• Manage Healthcare Data Security: Align with hosting standards, data structuring, and consent to ensure data security.
• Listen to Healthcare Professionals: Involve healthcare professionals early in product development to ensure their buy-in.
• Address a Market Need: Avoid solutions without users because they do not fulfill a market need.

DS: Finally, has this mentoring experience impacted your own desire to become an entrepreneur, in one way or the other?

SB: I am often asked this question. I already had an interest in entrepreneurship, having started as a self-employed entrepreneur during the COVID-19 pandemic when I lost my job. However, being surrounded by passionate entrepreneurs and meeting unique and interesting profiles is inspiring. Furthermore, I also have prior experience in founding a company with Y Group, a brand strategy agency with a former volleyball teammate, which I had to close as she switched to a pastry business.

These various experiences have allowed me to understand that I do not want to be the CEO of a single company but rather want to develop multiple projects. I have managed to identify what I would really like to implement; the venture studio model suits me the most. Additionally, I do not intend to focus solely on healthcare, as I am also drawn to projects in sports, thanks to my background as a high-level athlete.

DS: Thank you, Sana, for a fantastic interview that will undoubtedly be widely read in the healthcare community!