For years, some patients have moved from doctor to doctor, collecting the wrong answers. Recurrent infections. Possible appendicitis. Vague inflammation. In reality, what many of them have is a genetic condition that a single affordable test could have identified at the start. The tragedy is just undercounted, because in much of the Middle East and Africa, the test was never there to begin with.

Named this year among the Cartier Women’s Initiative’s 30 fellows, a program now in its 20th year recognizing women impact entrepreneurs driving solutions to the world’s most pressing challenges, Salma Tammam knows that gap better than most.

For a long time, the answer to that gap was the same one word: cheaper. Make the drugs cheaper. Make the equipment cheaper. Make the tests cheaper. It was a reasonable instinct, and largely the wrong one. Tammam figured that out during a pandemic, inside a national crisis, watching an entire testing system buckle not because of cost, but because of design. The whole model had been built for somewhere else, and no amount of discounting would change that.

So, she started over. Tammam is the founder and CEO of Reme-D, an Egyptian biotech company developing climate-resilient. These locally manufactured diagnostic kits are up to 6 times more affordable than imported alternatives and are built from scratch for the conditions that actually exist. Her test menu spans infectious diseases like HIV and hepatitis to a first-of-its-kind regional genetic diagnostic for Familial Mediterranean Fever, the condition behind so many of those years of wrong answers.

She shares what it really takes to redesign healthcare infrastructure from the inside out, and why, for her, it was never really about diagnostics. It was about the years lost, the wrong answers given, and the quiet injustice of a system that was never designed to find the right ones.

BUILT FOR HERE, NOT SOMEWHERE ELSE

The realization didn’t come gradually. It came during a pandemic, when healthcare facilities across the region found themselves stranded. The tests they depended on were imported, expensive, and simply “did not arrive when needed.” Tammam was part of Egypt’s national effort to build an affordable domestic testing system, and what she witnessed up close made one thing clear. Just making existing tests “cheaper was not enough.

The entire diagnostic model had been built “for high-income settings with stable supply chains and cold rooms everywhere,” and across much of the Middle East and Africa, that reality simply does not exist. A cheaper version of the same flawed design was never going to be enough. What the region needed was a full redesign, one built for its own context: “affordable, robust, and produced closer to where they are used.”

That thinking would go on to shape every aspect of Reme-D’s approach. Most diagnostic kits are designed for the ideal lab, then reluctantly adapted for everywhere else. Tammam flipped that logic entirely.

From the very beginning, Reme-D’s kits were built assuming high temperatures and unreliable cold chains, “not as a special case but as the norm.” The result is a range of climate-resilient PCR and RNA extraction kits that maintain performance without depending on continuous refrigeration.

But the design thinking went further than chemistry. Working across Africa forced a reckoning with how these kits actually move in the real world, “by car, by motorbike, sometimes over long distances,” and still need to be reliable when they finally reach a hospital or lab. That reality, she says, “influenced everything”: the choice of chemistries, the packaging, and the simplicity of the workflow for lab teams who don’t have the luxury of time.

THE ECONOMICS OF DIAGNOSTICS

Six times more affordable and three times faster than imported alternatives are numbers that tend to invite skepticism. But Tammam’s answer is rooted in scientific rigor rather than shortcuts.

Her training in nanotechnology and biotechnology gave her the tools to interrogate conventional PCR chemistry with “very simple questions: what actually needs to be there, what can be optimized, and what is only there because it has always been done this way?”

Working with her team, those questions led to a new formulation that makes the reaction “more efficient and more stable” in their conditions, rather than more fragile. Reme-D didn’t reinvent PCR. Instead, they “thoughtfully re-engineered the components, enzymes, buffers, and reaction design” to reduce waste, shorten run times, and maintain performance comparable to imported kits.

The achievement, however, was never simply about speed or cost. It was about proving that affordability need not come at the expense of quality. The result, she is clear, is a test that is more affordable and faster, “not because we lowered the bar on quality, but because we applied our scientific expertise to design it more intelligently for the environments we serve.”

There is a version of healthcare access that isn’t really access at all. Tammam is unsparing about it. “Access without reliability is not progress,” and when test results cannot be trusted, it becomes actively dangerous. “Building poor tests for poor people,” she says, “is unethical, and not just a step but a whole leap in the wrong direction.”

With Reme-D, the line was drawn early. Products must be financially accessible to public hospitals, but technically comparable to imported gold standards. That means investing in quality systems and validation, never cutting corners on reagents or controls, and being transparent with partners about how their tests perform in real clinical settings. Affordability, in her framework, is an engineering achievement. Not a compromise.

The conversation naturally extends beyond diagnostics themselves to the broader role they play within healthcare systems. Better diagnosis changes treatment. It changes prevention. But Tammam is most interested in what it does to trust.

“Better diagnosis touches all three, but I see trust as the real multiplier.” When patients know that the health system can accurately and early detect conditions like HIV or hepatitis, they are more willing to come forward, test, and stay connected to care.

The healthcare system, in turn, learns to rely on local supply, reinforcing the entire cycle. Earlier and more reliable diagnosis does, of course, lead to better treatment and smarter prevention programs, particularly when testing tens of thousands of patients every month.

But the deeper shift, she believes, lies in how communities relate to the health system as a whole. “When accurate testing becomes a normal part of care, not a luxury,” something fundamental changes in that relationship. And that, more than any single clinical outcome, is what she is building toward.

WHY LOCAL MATTERS

For companies operating in low-resource environments, the science is often only one part of the equation. Tammam says one of the biggest challenges is that everything surrounding the test can be unpredictable, from funding and logistics to power supply and storage infrastructure. “You can design an excellent assay, but if a shipment is blocked or a cold room fails, patients will not see the benefit,” she says.

That reality has pushed Reme-D to think beyond the diagnostic product itself and consider how it functions within often fragile healthcare systems. The company works closely with local partners, ministries, and NGOs to ensure that supply chains, training programs, and maintenance requirements are realistic for the environments in which its products are used.

In markets where disruptions can occur at almost any point in the process, Tammam believes success requires more than scientific expertise. Building a diagnostics company under these conditions, she says, demands “not only science, but resilience and stubbornness.”

That emphasis on resilience also shapes how Tammam thinks about the future of healthcare systems more broadly. For her, the conversation extends beyond individual products to where they are designed, manufactured, and supplied.

The case for local manufacturing runs deeper than economics. It is, Tammam argues, a matter of sovereignty. When diagnostics are designed and produced on the continent, countries are less exposed to export bans, currency shocks, or “being last in line during global crises,” a reality the entire region lived through during COVID-19.

Beyond the structural argument, there is something she clearly feels more personally. Local innovation “sends a powerful message: that Africa and the Middle East do not have to wait for solutions from elsewhere.” The scientists, engineers, and entrepreneurs to build what the region needs already exist here.

What has been missing, she says, is the long-term investment in that capacity. Reme-D, in her telling, is as much a proof-of-concept as it is a company.

BUILT HERE, FOR HERE

For Tammam, the next frontier is not a choice between growth and depth. Reme-D’s next chapter is about expanding its test menu, widening its geographic footprint, and embedding more deeply into public health systems at once.

The company began with infectious diseases like HIV and hepatitis because the need was urgent, but the frontier has already moved. Reme-D has launched its first genetic diagnostic test, Familial Mediterranean Fever, a hereditary autoinflammatory disease that causes recurrent attacks of severe fever and pain, most commonly in the abdomen, chest, or joints.

It is significantly more prevalent across the Mediterranean basin and the Middle East than global averages suggest, yet awareness and testing remain limited across much of the region.

Without a clear diagnosis, patients can spend years cycling through clinics, being treated for “recurrent infections” or “appendicitis,” living with unpredictable, debilitating pain, and carrying, as Tammam describes it, “the psychological burden of not knowing what is wrong with them.” What makes that particularly hard to accept is that FMF treatment is relatively simple and inexpensive once the diagnosis is made.

A low-cost lifelong therapy can dramatically reduce attacks and prevent long-term complications. The bottleneck, she says, has never been the price of treatment. It has always been access to timely and accurate diagnosis.

At the same time, Reme-D is working with governments and partners to ensure locally manufactured diagnostics are integrated into national programs and long-term planning. Her vision, stated plainly, is for Reme-D to prove that “high quality diagnostics can be built here, for here.”