Afya Limited (AFYA) Earnings Call Transcript & Summary

Hi, everyone, and welcome to Afya Day. Today, we are going to detail our evolution since the IPO almost 3 years ago and the consolidation of our strategy, which has allowed us to grow both in the medical education business and also building the largest digital services ecosystem for physicians across the country. Therefore, we continue strongly to grow our core segment, which we lead by a wide margin. We will have 5 different panels today. The first will explore what makes us unique. Many investors ask us about the coexistence of our education business, along with the digital service business. For me, it's precisely this combination that makes us unique and has allowed us to grow across different dimensions. In the second panel, we will review our strategy shared with everyone during our IPO when we highlight our focus on medical education, technology and health. For Afya's entire executive team and directors, it's strategically nonnegotiable to invest increasingly in technology for all medical programs and also in the construction of digital tools that contribute efficiently to the medical practice, focusing on prevention and cost reduction in health care system. Broadly speaking, we are preparing and training physicians to use the new technology we are developing. In the third panel, we will explore our vision of the future and how we will extract even more value for everything we are building and connecting. In the fourth panel, we will show the market dynamics that support our strategy and we will look at the strategy of players that will have similar digital strategies around the world and see how much they resemble our vision of digital. Finally and with great pride, we will highlight all our initiatives on several ESG fronts. To explore this entire agenda, I will count on the participation of our VP of Digital Services, Lelio de Souza; our CFO, Luis Blanco; and our Investor Relations Officer, Renata Couto. Beginning our first panel, what makes Afya unique? I'm going to split my vision into 3 parts: our unique operating model; the fact that we have an absolutely strong team with an incredible execution; and the fact that we chose the path of innovation every day, every morning. I could mention other aspects that make us unique, but I believe that these 3 components are the ones that better demonstrate the particularities of the company that we have building successfully since the IPO. Let's start then with our unique operating model. I want to make it clear: We exist to train and support physicians throughout their careers. We serve physicians through their entire journey. In this way, I'd like to resume the physician's journey that we use on Afya Day last year. After all, we look at it every day. It guides all our strategic decision and in particular, our M&A decision, in which we see and our undergrad medical student, who will stay with us during 6 years of under graduation. Next, we have John, a recent graduated general practitioner and a student in one of our prep course for the medical residency exam. Then we see Tom, also a general practitioner, who is a user of our clinical decision support solutions. It's important to emphasize here that there are 2 paths to medical training and we serve both, whether preparing students for residency exam, like in John's case, a path that will take 2 to 3 years of training; or the alternative path, in which we also operate by offering specialization programs. This path is represented here by Suzy, our postgraduate student in cardiology. And then we have Peter. He's a practicing physician who consumes several of our solutions: Proxy management, clinical decision, physician/patient relationship and others. Finally, we see Steve, who represents all physicians who continue with us, improving themselves throughout their professional lives and also as user of our digital services. This journey still exemplifies our strategic focus and the direction we are pointing to and the term, the addressable market that we pursue initially, amounting to BRL 22.1 billion related to medical education market. The digital market had a TAM of BRL 28.4 billion to our market. This new addressable market of BRL 50.5 billion symbolize all our focus and discipline in meeting physicians' needs and having them at the center of our value proposition. And we have been so successful in maintaining our growth focus on serving physicians that our health-related revenue from education and digital service reached 90% in 2021. It's precisely through the combination of segments that we are able to differentiate ourselves in the preparation of physician for the job market, guaranteeing the continuous engagement of professional and to boost our growth around medicine. Yes, we are and will continue to be increasingly focused on medicine. Other institutions are trying to follow our strategy. This has been a recurring comparison. But the difference in scale and depth of the ecosystem that we created to serve medical professional is vast. Many are starting to focus their efforts on medical degrees, some entering the continued education business. But with a much smaller scale, they have not created an ecosystem centered on the physician persona for all stage of their training-in-professional journey. And if you consider the training journey and the digital service offer, our business model becomes completely different and irreplicable. We have approximately 248,000 physicians in our ecosystem, which represents more than 33% of all physicians who work in the country plus students. And we also have more than 1,000 partner hospital in clinics where we carry out our practical activities. These agreements have also functioned as a catalyst for introduction of our digital products and expansion of the user base. In 2021, we had more than 60 million patient queries supported by Afya's tools, leading to higher efficient throughout the treatment process and proving to be a valuable source of data for the industry and public policy. Finally, we remain firm in process of consolidating the medical education market and created new digital services aimed to serve physicians and supporting their careers. Despite being the largest ecosystem of physician in Brazil, the focus on growth does not change, growing and growing in a consistent and sound way, it's one of the pillars of our culture as we will see in the next panel, great execution. Undoubtedly, our ability to achieve is one of our greatest strengths. Starting with our undergrad schools, our team has developed an incredible curriculum that creates a huge differential to our teaching and learning methodology. First, our curriculum is integrated in standardizing all units, ensuring quality in all campuses and operational optimization. Second, throughout the program, the students have access to practical classes in real and simulated environments, blended learning, using clinical decision support tools and telemedicine. Third, the students take a proficient test each semester, which allows them to develop individual learning path focused on measuring the acquisition of knowledge, skills and attitudes. Students results are compared across campus nationally. Fourth, our last year students have access to Afya's online preparatory courses. And fifth, more than 340,000 consultations per year from municipal health departments, philanthropic institution and our medical clinics creating the largest practical environment for medical education in the country. Another aspect that demonstrates our investment in quality is the large number of academic publications and congresses. We counted more than 500 publications last year, both in national and international congresses. And I'm pleased to say that we no longer have any higher education institution with an unsatisfactory quality general index. And that we have only received positive valuation from Ministry of Education. Looking now at continued education, the projected growth of alumni for undergrad programs added to the low increase in resident seats only strengthens the demand for continuum medical education. I'm proud to say that even through 2020 and 2021, we were unable to deliver practical activities to our students. We concluded the expansion plan that we presented at Afya 2021. We jumped from 5 units to now cover 11 carefully chosen cities, and we expanded out to 2 more. They are in the list of [indiscernible] cities in the country where 50% of the 500,000 practicing physicians are concentrated. Now some highlights regarding our continued medical education programs. 62% of the base is up to 35 years old. We have notes more young people looking for specialization as an alternative to residency, brand increasingly better received by the market. Several studies conducted by independent institutes point to a consistent increase in our level of recommendation. Our NPS surpassed 70 points, which were programs that are primarily face-to-face and require high investment is a great achievement. We continue to expand our partnership with several professional institutions and medical societies to offer co-branded courses. Portfolio continues to expand with offers ranging for fully online courses to gold standard postgrad programs, having practical workload equivalent to residency programs. Continuing on this panel about execution. Let's take a look at the following indicators: medical students through net revenue, comparing the 2019 IPO data with current figures. When I look at the number of medical students, we jumped from 5,500 to over 60,000 in just 2.5 years. And we jumped from 10,500 to almost 20,000 potential medical students in the period, a 90% expansion of our business with higher cash generation capacity. This accelerated growth can also be observed in the number of medical seats. We jumped from 1,500 to over 2,700 today. And when we look at the monthly active users, the number of physicians impacting monthly really take on new levels. We jumped from 9,000 students and physicians connected monthly 2019 to more than 247,000 students and graduate physicians. Yes, every month, this immense number of students and physicians connect with us. And our revenue jumped from BRL 751 million to an impressive BRL 1.87 billion. We grew 126% in this period. I think it's interesting to take a look to another dimension of this growth. I have 4 charts here to assist us. We analyze adjusted net revenue between 2019 and 2021, and I'd like to highlight the CAGR of 52.8% in the period. And since the IPO, we also improved our EBITDA constantly. We grew 68.9% in 2020 compared to 2019 and 34% in 2021 compared to 2020. When we look at our cash generation, one of the strengths of our strategy, we reached an impressive 100 points of conversion in 2021. Finally, when we look at our adjusted net income, we had a nominal growth of 75% since IPO with 32% CAGR in this period. In this screen, we highlight our commitment to the 3 pillars that support our business model: strong growth; high profitability; and cash generation. Still talking about great execution. I emphasize that growing numbers of digital business and the solid growth of our education operations were only possible thanks to the team that we put together and that we continue to expand. Today, we have more than 8,000 employees, of which more than 2,000 are physicians, everyone strongly focused on achieving our strategy. And this alignment relates from the fact that everyone understand clearly what are the key results they need to deliver. The fact that they are also evaluated for their innovative attitude and the performance gain that they bring for their business units and because they also clearly know our incentives and compensation structure. It's around this 3 management pillars that we have built the culture and musculature of Afya. It's essential to highlight that our entire vision involves monitoring 4 key dimensions. The first is the organization climate. It's a fact that we want high-performance professionals, but we want them to be responsible for maintaining a pleasant welcome and safe work environment for everyone. Likewise, it's mandatory for our management to be always focused on actions to have social and environmental impact and on maintaining the best practice in corporate governance. We'll have a panel on ESG today, where we will share many of our achievements. Our team is fully aware that the physician is the one who lives at the core of our strategy and our daily actions. Thus, everyone in management is evaluated based on NPS on their business unit. And everyone, absolutely everyone, is committed to revenue growth and cash generation. Both KPIs are 2 of the main triggers to unlock short-term and long-term incentive plans. The diagram illustrates well how we have aligned our people around the health growth of the company across different dimensions and how we have guided this growing team towards our long-term vision. A vision that is supported by our Board of Directors, in particular by Bertelsmann, who has been with us since the beginning and just reinforced their commitment with this recent share increase, for which we are still awaiting the formal closing. I leave you with a brief message from Kay Krafft, CEO of Bertelsmann Education Group and member of our Board of Directors.

Hello Afya shareholders. This is Kay Kraft from Bertelsmann. We're truly excited about our plans to increase our shareholding in Afya. Bertelsmann has been involved with Afya over the past 6 years. And during all these years, we've very much supported Virgilio and his team on the growth trajectory. We fully endorsed Afya's focus on the medical education journey. Like most of my colleagues at Bertelsmann's Group management, I've been with Bertelsmann for more than 15 years: Long-term value creation, entrepreneurship and partnering with management teams and core shareholders are part of our DNA. We operate in about 50 countries around the world with close to [indiscernible] employees in media, services and, over the past decade, also in education. We want to support Afya when it comes to access to talent, technology and tech platforms, or simply by providing best practices. We'll now support Virgilio and his team executing on the next growth chapter on Afya's mission to become the reference partner of physicians. Thank you.

Thanks a lot, Kay, and the entire Board of Directors for the constant support, support that has been fundamental, really fundamental for innovation to have across Afya since our foundation. We have always pursued the vision of being physicians' best partner in their journey. Since our IPO, we have positioned ourselves as a company that would operate based on the pillars of education, technology and health. And it was with a careful look at innovation and strong alignment with our initial vision of serving physicians that we dove deep into the digital service offer. I think it's important to highlight our motivations for choosing this path. COVID accelerated the introduction of technology in health care, a process that had been naturally occurring for years, but you all agree that it was vastly accelerated. We began to expand our view and realized that we were facing a parity: The insertion of more technology in the medical routine generates both the need to adopt the medical training programs with these new medical practice; and this new practice accelerate the adoption of new technology by physicians in their routine. For us, it became obvious that accelerating our entering in the digital services would put us ahead of an opportunity with addressable market that is even bigger than our initial one. And at the same time, it would also guarantee an even more up-to-date medical education. All this is enhanced by the fact that we train our students using these digital tools, which encourage them to continue to be our customers along their journey. On the other hand, our digital services customers can leverage our scale in medical education in an effectively virtual cycle of value generation, fully in line with our strategy. Basically, it was a natural evolution process of our mission, which we believe also represents an important competitive advantage and makes us unique as a player, and this ability to innovate, to look at the macro environment, perceive new possibilities and execute them with precision ultimately impact the definition of where we are going, towards the future we want to build. So far, we have seen what makes us unique as a player. Now I want to share with you the [indiscernible] that concentrates all of our attention and efforts. In our senior management meetings, we share our attention precisely thinking about how to continue expanding our core and building our future. As we highlighted earlier, we have done a lot since the IPO, and we expanded our TAM without losing efficiency in our core. We have created an Afya within Afya. But let's start from the beginning. From 2019 to 2021, our medical student base tripled, and we still have an opportunity to ask for additional 1,200 medical seats on our current units. In 2028, we will reach approximately 20,000 students considering only the maturation of our current seats. And since the IPO, we have been able to keep the profitability of our medical undergrad business intact even after 2 pandemic years, which had a strong impact on other educational players. We had really increased the average of our tuition. Our average ticket grew 7.3% between 2019 and 2020, compared to consumer inflation that fluctuated 3.2% during 2019. And even between 2020, 2021, with consumer inflation growing 4.5% in 2020, our average ticket grew 6.8%. And we added more than 1,300 medical seats during this period. Our gross margin in undergraduate medical programs has only grown since the IPO. We jumped from 52% at the IPO to 62% in 2020 and 63% in 2021. Even considering all acquisitions. I'm very proud of our undergrad medical operation and the resilience of our team during this past few years, which have been so challenging. Here are some highlights of our underground operation. We continue to mature our current units, which guarantees us organic growth and contribute strongly to the expansion of our margin. We still have a lot of growth related to maturation of our seats, pricing power and consequently margin expansion. We have been efficient in cost and able to transfer inflation to the market, while keeping our occupancy at 100%. Our integration team continues to do an exceptional job. I highlight the integration of UNIFipMoc and UNIGRANRIO, which were very successful and strongly contributed to the expansion of our margins. Besides all maturation, we still have the opportunity to ask for additional 1,200 medical seats to leverage even more our organic growth. And finally, our M&A team continues to focus heavily on the acquisition of new medical schools. We maintain our objective of acquiring 200 seats per year at least. And our pipeline remains strong with more than 4,500 seats mapped. Let's now take a look at our continued medical education. We also had a strong expansion since the IPO. We have 3,200 students spread across 11 campuses. We are present in more than twice as many metropolitan region as we were at the IPO. After the impact of pandemic we returned practical activities and resume student-based growth and continue to launch new campuses and new programs. Finally, we remain strongly confident in the growth of our medical education operations in both undergrad and grad programs. Emphasizing more what I have already indicated today, we remain leaders in medical education as the physician's main partner in training. And we specialize in building the largest digital services ecosystem also to serve physicians throughout their professional journey. This leadership enables us to be one of the main links between the health industry and medical professionals to opening a huge avenue of value for Afya that will be further explored by Lelio de Souza in the next panel. Therefore, it's the physician who is at the core of all our offerings. In the corporate environment, the expression business to consumer or B2C is often used to indicate that an institution's focus is to serve individuals. Afya exists to serve a very specific and special type of individual: Physicians at all stages of their journey. Therefore, we have increasingly used the term business to physician, or B2P, to refer to the people for whom we exist, for whom we will work so hard and the reason we are so proud here at Afya. We are here for Anne, for Tom, for John, Peter, Suzy, for Steve and every physician in the country. They are at the center of everything we do. Thus from now on, we only use the term B2P to refer to our operations that have physician as the end customer. Well, this consistent growth since the IPO both in our education core and in our digital offer gives us the confidence to launch Afya Digital Health that will serve as a new brand and organization segment for all digital services offerings. We understand that like other large groups that have grown rapidly, it makes sense to create some layers between our 2 businesses, but obviously keeping the gains that result from synergy of being part of the same company. In proxy, what we want to preserve is the speed of decision-making for both the education core and the digital companies to face the next cycle of growth. Now let's dive deeper into Afya Digital Health strategy. It is with great pleasure that I invite Lelio de Souza, our VP and Head of Afya Digital Health to the stage. I had the pleasure of working with Lelio for many years in the technology sector, a professional recognized for his ability to build strong and high-performance teams. I invited him because of his solid track record in execution. Lelio, I'm very proud to have you leading Afya Digital Health, please.

Virgilio, thank you for your kind words. It's a great pleasure to work with you again and with this fantastic team of Afya. For all of you attending this event today, I am glad to meet you. It's very gratifying to be here to talk about building the future of Afya. Especially today, the day we are launching our new brand, Afya Digital Health. This is an important move that will further strengthen our digital solutions arm, which now happens to have its own identity, important for communication with the market, whether with our customers, physicians and the health care industry as well as as an employer's brand to attract and retain talents in the area of digital solutions technology. Beside the launch of our Afya Digital health, we are also implementing some adjustments to the organizational structure that will allow us to keep capturing the benefits and the synergies of being part of Afya while giving us management flexibility to support the execution of our vision and growth and to ease the benchmarking with peer group of digital companies in Brazil and in the world. On behalf of the entire team at Afya Digital Health, I would like to say that we are very happy, confident and motivated with this moment. So to present our vision of the future, I [indiscernible] my panel in 2 blocks. In the first one, we will review Afya Digital Health's business model focusing on digital solutions for the physician routine from the early undergraduate days to the mature phase of their professional journey. We call this the business to P, business to physician digital offers, as explained earlier by Virgilio. Then, I will explore the digital offerings and solutions that bring innovation and efficiency to the physicians' relationship with the health care industry, pharmas, payers and providers, generating value for both physician and the industry. Those are called the B2B, or business-to-business digital offers, which is an important monetization lever of our business model. We started, as I mentioned from our business model and focused on offering physician-centered digital solutions. We operate along the physician's entire journey from their first day as an undergraduate, during their training and specialization needs, through the management and execution of the practical routine throughout their professional life. This digital ecosystem with highly engaged physicians and relevant data medical practice enables us to develop and offer innovative solutions that generate efficiency and assertiveness for these physicians' relationship with the health care industry, pharmaceuticals, providers and payers, as I mentioned before. In order to execute the vision of our business model, Afya Digital Health's team is focused on having the best digital solutions to serve physicians throughout their journey -- their professional journey, either by acquiring lead health tech as we have been doing with a strong M&A discipline or through in-house development, always committed to: Scale physician market share penetration; increase physician engagement to our digital solutions; and being increasingly relevant to them, including in their relationship with the health care industry. We have the big challenge of executing this technology integration whilst in a business-driven approach and focusing in value creation for our shareholders, physicians, the health care industry, employees and investors. I am confident that we are executing and building a robust digital physician centered platform. I invite you now for a brief review of our business-to-physician offerings, accomplishments and some figures. As it was presented at last year's Afya day, we have strategically structured our B2B offerings into 6 pillars, which have shown significant progress over the last year. To fulfill the 6 pillars, we did 9 acquisitions of exceptional companies for specific digital solutions as well as developed in-house ones, for which there were no target assets in the market or due to no viable business case for M&A. It is worth to highlight the uniqueness of being part of Afya and how we are contributing to deliver digital solutions to innovate in the medical education field. In our pilot run -- pillar run content and technology for medical education, we are offering digital solutions to improve and innovate in the learning experience for Afya students, as well as for the medical education market in general. Among these solutions, we have Medcel station, presented on the last Afya day, a suite to complement the undergraduate studies. Through a digital experience combining video, audio and text content, sort of a merge of Netflix, Spotify, Kindle and Instagram, social networks that the young students are very used to. It will be launched in May in 2 large private higher education institutions beyond the Afya's own undergraduate operation. We also remain strong in our digital offer of preparatory course for the medical residency and medical specialization degrees, Medcel are already consolidating the market and in a constant search for innovation. The education content portfolio has been reached and broadened by the recent acquisitions, Alem da Medicina offering mentoring for residents as well as financial and clinic management for physicians, led by 3 young digital influencer physicians entrepreneurs; and Medical Harbour which addresses very well issues relate to the teaching of anatomy, cytology and histology and that now also works in the cloud. Finally, Afya Digital Health, in partnership with Afya's undergraduate and postgraduate team has been developing innovative solutions with high technology embedded, which contribute to the digitization of part of the face-to-face experience in education institutions, thus enriching Afya's learning experience. To browse the accomplishments and some figures in B2P, business-to-physician offerings, I will use this image that many of you already know. We launched it in the last year's Afya Day and it has been presented in different formal interactions of the company with the market as well as in our daily operations. Afya Digital Health is oriented towards delivering value to physicians on 6 pillars: content and technology for medical education, which I highlighted in the previous slide; clinical decision software; practice management tools and electronic medical records; telemedicine; digital prescription; and physician patients relationship support. At the center, we have the physicians, the target audience for our business model. Each pillar has been built through acquisition of digital companies and in-house development, as I already mentioned, delivering solutions to physicians throughout their entire professional journey. As I mentioned earlier, these solutions create a robust digital ecosystem of engaged physicians generating valuable medical practice data, which is an enabler for our B2B business-to-business digital offerings, supporting physicians in their relationship with the health care industry delivering more intelligence and efficiency for both sides. Reinforcing the importance of our actions in Pillar 1, content and technology for medical education, last year we had excellent achievements. In Medcel, our strategy to grow the base remains consistent despite the drop in the average ticket as we had to adapt to the very competitive markets, the medical residency preparation turned to be. We basically doubled the paid student base at the beginning of the pandemic, exceeding 21,000 students. That was an exact 100% increase in the number of users. When we look at the most consumed content formats, what stands out is the increase in the consumption of the books on the platform, which basically doubled in the percentage compared to 2020. Video class and fixation exercise continues to be -- to represent 90% of the preference in line with 2020. It's essential to highlight that the offer of content in multiple formats and media continues to prove correct. Also important to note that in 2020, there was a not normal increase of online content consumption, most probably due to the lockdown period we all went through. During most of the year, no activities were offered in the undergraduate programs and the students were confined at home, which favored online content consumption. For us, it has been gratifying to see the sustained engagement even after the return to face-to-face activities, proving the value delivered to our students. A result of constant UX, or user experience improvements, and content development by the team and the more than 200 physicians involved in the creation of learning objects. In 2021, the sustained growth in consumptions is evident in the behavior observed in content consumption over the quarters. When we look at the monthly active users, we can see reflect the increase in the student base. Medcel shows a very positive engagement by the students, which is further evidenced when we analyze the [indiscernible] of log-ins, we grew almost 640% in relation to 2019, while we saw that the growth of the paying students base was 100%. In summary, we have more and more students that are engaged in consuming more content on the platform. Iterating that, as I pointed earlier, we are enriching the portfolio of content through best-in-class acquisitions such as Alem da Medicina and Medical Harbour, an in-house development of Medcel station to increase even more the users base and their level of engagement. Given the importance of Portal PEBMED as the largest medical update portal in the country, I also chose to present a few open numbers here on Afya Day. The portal continues to be an important gateway for physicians to get into our ecosystem. We have more than 9,500 publications in its 7 years of history. Currently, we continue with the monthly publication rate of around 200 pieces of content, including: Article reviews; guidelines; broadcasts; questionaries; coverage of Congress; and clinical cases. The portal has more than 3 million visitors every month. It's very important to highlight that 70% of monthly traffic comes from organic search, demonstrating our authority in search engines. In 2021, we made available the content of the PEBMED portal inside the clinic management solution, iClinic, in a [indiscernible] . There is one good example on how we are integrating the solutions and making the value of the Afya Digital Health ecosystem more tangible for physicians. PEBMED portal is always positioned among the main source of information for health care professionals. WhiteBook is one of our greatest strengths and it continues to evolve in features as we will see next. We are outstandingly the #1 player in the market, the most used medical support platform for decision-making in Brazil. We went from 105,000 to 125,000 paying subscribers between 2020 and 2021. Our monthly active users, paying and nonpaying, who used the solutions in previous months, following the same pattern of growth and jumped from 160,000 to 194,000 from December 2020 to December 2021. Overall, we exceeded 61 million queries on Whitebook in 2021 compared to 54 million in 2020, impacting more than 37 million patients in 2021 over [indiscernible] million of previous years. Whitebook's strong leadership is evidenced by a user base of more than 80% of Brazilian physicians with up to 3 years of undergrad and almost 30% of all physicians and medical students in the country. We have more than 9,500 topics designed and reviewed by a team of over 40 medical experts. Whitebook offers hundreds of tools such as calculators, clinical scores, checklist and professional codes. It also surpassed more than 422,000 contents consumed daily. To close the session of some B2P, business to physician figures, I brought an overview of iClinic, the practice management digital suite that has been keeping a great user base and engagement level growth rates. Here, we are also the main player in the Brazilian market. There were almost 18,000 paying physicians in 2021 compared to 13,100 in 2020, a 37% growth. We reached the mark of 2.3 million consultations per month in 2021 compared to 850,000 in 2020, also a great growth. The number of prescriptions grew. We went from 4 million prescriptions in 2020 to more than 5 million in 2021. We also reached an average mark of more than 8,500 teleconsultations per month in 2021, a 28% growth over previous years and yet with a huge room to scale. Along 2021, we integrated new features into iClinic such as our new prescription tool, financial services as well as enhancement in its functionalities, consolidating it as the most complete solution for medical clinic management in Brazilian market. The success of iClinic is confirmed by its users value perception, with NPS, Net Promoter Score above 50 points and turning below 1.3% per month. iClinic monthly active users KPI continues to grow consistent as you can see in this chart. These numbers reflect a strong discipline in execution both in the evolution of our current solutions and in the integration of different platforms. We will see 3 short videos that demonstrate improvements in the platforms focused on creating value for physicians. Whitebook remains the absolute market leader as a bedside decision-making tool. It continues to receive a lot of attention and it's being improved constantly. In addition to the successful and traditional format of presenting information, we recently launched clinical drops and decision tracks, two new ways of presenting content through videos and flow charts. We are also very successful in integrating MedPhone into Whitebook, offering an assistant system for physicians to fill up medical records and the integration of more than 30 calculators that provide support to the exercise of medical practice.

Since its launch, Whitebook has been a partner to physicians from their first on-call shifts. Now with its new features, the app will become increasingly indispensable for physicians in any patient care situation. The first major innovation are the clinical drops. Developed by our technology team, this feature shows video sorted by specialty introduced through relevant questions. In these short videos, the physicians responsible for Whitebook's content, answer questions related to several practical care situations directly and objectively. The second major innovation are the Decision Tracks. Created as guides for clinical decision-making. These interactive flow charts always start from a problem situation. When interacting with the flow chart, the physician is asked new questions that lead to the most appropriate diagnostic and therapeutic conduct. Finally, the third major innovation is the result of an acquisition. MedPhone, a solution that was acquired and incorporated to the product makes our app even more complete. Now you can access a vast code library that helps doctors fill in their medical records with copy-and-paste functions to make everything even faster. In addition, we have incorporated more than 30 calculators in our app. These calculators, which were considered the flagship of the competing app are now available to our users. Calculators like these have been carefully designed so that by inputting clinical data, users have access to complete results and diagnoses in a few seconds. More agility and precision for decision-making at the bedside.

Differential diagnosis feature is the result of the integration of the [indiscernible] intellectual property into the white book offering physicians the possibility of real-time diagnostic simulations to support the decision make at the bed side.

Differential diagnosis is a new module for Whitebook, our bedside app. With this new functionality, doctors will be able to perform diagnostic simulations with a step-by-step guidance system. When advancing through a new simulation, the doctor fills in data about the patient: name, age and main symptoms. Our database is queued and the doctor has access to an infinity of symptoms, which can be selected. Next, the doctor can inform if the patient has any long-term illness. With this, our API does all the data processing, correlating the information and presenting the possible conditions afflicting the patient. The app shows the possible diseases, sorting them in high, medium or low compatibility. By clicking on one of the diseases, the doctor can see more information such as codes, prescriptions, treatments, exams, surgical procedures and more. With Differential Diagnosis, our users now have at their disposal a powerful simulator, which uses the app's entire database to generate even faster and more accurate results.

iClinic has also evolved a lot. Features for the clinic teams communication were improved, as well as the electronical medical record that has several possibilities for personalization by the physicians. The integrations with CliqueRX, our medical prescription solution developed in-house, called iClinic RX intra-clinic. And with Medicinae, now call it iClinic Pay were successfully completed. [Presentation]

These were just some examples of the normal work that has been done to evolve the current solutions aimed at creating value for physicians and grow their level of engagement. I'd like to reinforce our execution discipline in building house our new prescription tool, Clique RX and then integrating it into iClinic, where we call it iClinicRX, delivering innovative digital features to support the prescription task. iClinicRX is then a new prescription tool available in iClinic suite, as a great evolution of its previous one, delivering important enhancements and differentials such as: Intuitive interface; free sending via WhatsApp; digital signature, among others. iClinicRX has started being used since Q3 last year and reached more than 21,000 prescriptions issued up to February 2022 and a steep growing adoption phase 4. And it comes with more than 27,000 registered medication items, as you saw in the video. Another news I am pleased to share is iClinicPay, our health specialized financial services for physicians, a result of Medicinae integration with iClinic. This service is available in 25 of the 27 Brazilian states with a high level of satisfaction of the users. 78% of customers came from recommendations from other customers. It experienced more than 67.8 million payment processed in 2021. iClinicPay user experience delivers exclusive features such as online payment, sales simulator, reconciliation of receivables, financial panels and health plan receivables discount. Important to point that we count with an assistant team specialized in financial service for the health segment. As I said previously, all these digital solutions allow us to attract and engage more physicians, contributing to make them in turn able to attract more patients, generating more consultations and clinical routine data. This ecosystem of physicians plus clinical practice data is the great enabler for our B2B digital offers that innovate the physician relationship with the health care industry formed by pharma, providers and payers. This flywheel represents the growth levers for Afya Digital Health And value creation for our shareholders. Finally, I would like to share with you some of our accomplishments and achievements in the B2B business-to-business offers. There we've just started to focus on more recently, capturing the value of our current strong penetration in the physician market share and the level of engagement in our digital ecosystem. Let's go back to the points of contact we have with physicians. In every step of their day-to-day, there are opportunities to seek innovative ways to support their relationship with the health care industry, creating value for both sides. We structure our B2B offerings in 3 broad areas: access, demand and efficiency. The growth of these B2B offerings is the major vector for accelerating the monetization of our business model. As you'll see later in our presentation, when our CFO, Luis Blanco will further explore this BRL 24.4 billion total addressable market, as well as some global benchmarks. Access, demand and efficiency. This is how we are executing the offerings to serve the health industry and expanding the value creation of our digital ecosystem. Let's now take a brief dive into these 3 areas of B2B offerings, considering that we have strategically decided to prioritize the execution of access block to the pharma industry. In the access offerings group, we are providing innovative digital solutions for the health care industry prioritizing pharma to access physicians, generating value for both, reinforcing that physicians are always at the center of our solutions and decisions. Access digital offerings aim to: Empower physicians in this relationship; giving them the possibility to define if, when and how they want to be accessed; being relevant to the physician, valuing a very precious asset, time; contributing to bring new knowledge of interesting to physicians; educational content distribution, medical product promotion, specific health market research, electronic opportunity for physicians and physician recruitment for specific jobs are the offerings we are starting to deliver. To highlight one of these offerings, the medication in detailing that has come from RX PRO acquisition, dispatched 34,500 drug sample shipments in 2021 for more than 10 customers. A secondary focus of our B2B strategy, demand offerings, aim to optimize medication and health procedures demand generation for the health care industry. After digital health, through the acquisition and integration of the drug price search engine, Cliquefarma our prescription tool, Clique RX work as a demand generator for the pharma chain. It also makes easier to patients to adhere to the prescribed treatment, enhance the physician-patient relationship. Evolutions are planned to expand demand generation and to provide market intelligence to the health care industry. The offers in the efficiency area is our third priority of execution at the moment, but they are an important vector of value creation and a natural evolution of our B2B strategy. These are digital offerings that aim to increase the efficiency in the health care value chain as a whole. One planned area is to offer digital solutions to support chronic diseases treatment. Several research around the world points that the lack of treatment addressed is one of the big cause of chronic disease evolution to a severe clinic phase or death, causing pain to families, inefficiency in physician/patient relationship and high costs for the public or private health insurance organizations. We believe that for specific digital solutions that with better support, the treatment adherence and a timelier patient health condition monitoring, we can contribute to change this reality. We have, therefore, evolved our structure to execute our B2B strategy with a dedicated and experienced team focusing primarily on the access block, especially for the pharmaceutical industry, improving existing offers and creating new ones. Now I will show some videos that make these offers more tangible and also some numbers and testimonials that had ratify the achievements that we are starting to build in business to business. As previously mentioned, in the business-to-physician session, the PEBMED portal is a channel of high audience for physicians. We have developed innovations to increase physicians' engagement and enable distribution of industry content in a meaningful context to physicians. [Presentation]

With the integration of iClinic with RX PRO, we started to offer a digital access channel for the pharmaceutical companies to interact with physicians, facilitating the process of requesting the sending of drug samples. [Presentation]

Another important example is the content offer of PEBMED's portal on iClinic presented before, [ Medicine in Focus ]. It becomes a digital channel on a clinic that enables access for the pharmaceutic industry to distribute educational and promotional content into iClinic, strengthening one of our business-to-business offerings. [Presentation]

To close the sequence of examples, I share with you the evolution of Medical Harbour, and the launch of [ Bio Atlas ], bringing to a cloud environment, all the value that they already delivered in an on-premise version. These new cloud-based version simplifies the process of selling the solution both for the business-to-physician markets, but mainly in the business-to-business market, where we expect to leverage the monetization of this offer. [Presentation]

These were some of the achievements that we have already had in the execution of our business-to-business strategy. We are happy to announce that we have closed 23 contracts with 18 different pharma industries to use our access offerings. We are working on the 43 proposals right now as we are talking here. So I am confident that we are starting to build and deliver great value in the B2B front. Our strategy here is land-and-expand, providing the value of our digital ecosystem to these customers and building a long-term partnership, increasing the revenue from these contracts as we increase the value generated to our customers. Finally, I am proud and grateful to share testimonials from some of these important customers, we have the honor to work with. Thank you, Elisabete Mathias from Pfizer, thank you Cleiton Marques from BioLab, thank you to Natalia Mazza from Boehringer, thank you, Mirian Rodrigues for GSK Brazil, and to you Pedro Almeida from Roche, thank you to Mirella Vieira from Bayer. That was what I wanted to bring to this audience regarding the execution progress of Afya Digital Health. I hope it was helpful to clarify how we are building our future. To get in more details of the size of this market, I'd like to invite our CFO, Luis Blanco, to lead our next panel.

Thank you, Lelio. Hello, everyone. It's a pleasure to be here with you all today. I have prepared 2 panels to go over with you. The first one is focused on [ exporting ] what supports our educational strategy; and the second one is focused on [ exporting ] what supports our digital services strategy. Let's start with the education strategy. There is an attractive dynamic for the development of educational business in the medical segment in Brazil. I brought the diagram so that we can look from different angles at how structural this demand is. Here in A, we will explore the fact that medical graduates receive high salaries and this generates a strong interest in the undergrad studies. Following, we will talk about the asymmetrical distribution of doctors across the different regions of the country. Then we will dive into the increase of the growing demand for medical service. And we will continue to assess the regulatory barriers to enter the segment. Anyway, we are facing a structural demand, which strongly support our visions for a solid and lastly, expansions of our educational core. Let's dive into A, on rewards that medical career offers. Medicine is the only career that has virtually 100% employability. Salaries are higher than those of the more traditional majors in the country. Physicians are able to produce 3x more income than the lawyers. Even engineers make 70% of a physician's salary. The payback on investment in medical school is seen 5 years after graduation. The high employability followed by high salaries and the excellent investment return ratio continue to make medicine a program with a very high number of applicants per seat. It is very important to make this point: Medicine is an excellent business for young people and for the family that finance them during the undergrads. More younger people study medicine as an excellent business for Brazil. OECD countries have 3.5 doctors for every 1,000 inhabitants. Brazil has only 2.4 doctors for every 1,000 inhabitants, a 46% gap that needs to be reduced. The picture gets even worse when we look at the situation in Brazil, excluding capitals from the calculation. We dropped from 2.4 to 1.5 doctors for every 1,000 inhabitants. We have a big problem of medical density that becomes even bigger considering the asymmetry problems in the distributions of these physicians across the country. This graph shows the exact dimensions of this asymmetry. More than 94% of the Brazilian municipalities have less than 1.5 doctors per 1,000 inhabitants, and less than 50 cities have 4.9 doctors per 1,000 inhabitants. There is a broad space for new physicians in cities with less than 500,000 inhabitants without being a drop in demand for their service or a reduction in their potential earnings. In the regions and states where we offer medical schools, the rates are also very low. North and Northeast regions have the worst medical densities. It is important to reinforce the social aspect of our campuses being in regions of low medical density. Historically, medical programs have been primarily offered in large cities. In addition to being the biggest player in the country in medical undergrads, we train them in regions that need them the most. We also seek to impact the micro regions in which we are based. Both true, the medical care we provide to the populations, but also true the offer of other health care undergrad programs. Our view is that these other programs contribute to raising the level of the local workforce in different specialties, which tends to have an impact on the development of the economy as a whole in these areas. This impact culminates the rising of better economic conditions so that part of our medical school graduates can settle locally and start their professional activities in the region. Another aspect that continues to contribute to the growth in the demand for medical service is the rapid aging of the Brazilian population. Our populations age 2x faster than the populations in the U.K. and 3x faster than the one in the U.S. In 2033, the population over 65 years old will represent 14% of the Brazilians, compared to the 7% in 2012. This trend is clear when we look at the claims per user of the private health insurance segment. Population aging directly impacts the needs for health care service. This increase in health spending is evident in the percentage of GDP allocated to the sector. When we compare ourselves with other countries, it becomes evident that in our case, the percentage has been increasing. The aging of the population and a change in population habits reinforce the trend of increasing demands. It is worth mentioning that even in the face of excellent demand dynamics, there are barriers to enter for the offer of medicine and medical specialization programs in Brazil. The offer of undergrad courses is regulated by the Ministry of Education and Health. There is great influence and supervisions of solid institutions, such as the Federal Council of Medicine and the Brazilian Medical Association. Specialization degree are governed by more than 50 different medical associations, and only higher education institution with a degree in the health field can offer specialization courses. In April 2018, the Ministry of Education effectively froze the number of medical schools for the next 5 years. Programs such as Mais Medicos I and Mais Medicos II show regulation controls in the capacity increase, providing additional seats where they are most needed. It becomes clear that there is a high financial rewards for medical graduates. The asymmetry in the distribution of physicians in different parts of the country, strong growth in the demand for medical service and regulations in the offer of undergrad medical programs. It is possible to conclude that we will have an expansion of physicians if you guarantee their financial earnings, supporting our thesis of demand growth for medical educations in the long term. This scenario is validated by the number of applicants per seat that has remained stable for years, and there is no declining trends. The number of applicants in residency program continues to grow as the number of seats in the residency programs are not expanding, reaching 7.6 applicants per seat in 2023. An increase of more than 200,000 physicians working in the country between 2018 and 2028 points to an expand into demand for continued education programs through the career; and an increase in the demand for graduate courses as an alternative path to the specialization title. Now let's look at what sustains our digital services strategy. As we spoke here today, the pandemic has profoundly influenced the use of technology by Brazilian physicians. This is a macro aspect of market change that I would really like to highlight. The demand for digital service that facilitates access to the patients has boomed. The digital service provides full access to information and faster decision-making and can contribute to the greater adherence to the treatment and better management of the proposed plan for each patient. Let's dive deeper into these aspects. In addition to the arrival of more physicians in the market, as we saw earlier, that are naturally more likely to adopt new digital solutions. Physicians are more open to the use of technology due to the COVID-19 pandemic. In telemedicine, for instance, there was an acceleration that tripled the use in 2 years. In January 2022 alone, more than 1.4 million visits were made, representing almost 14% of the last year's total. There is an expectation of more than 30 million until the end of this year. Digital transactions costs are 50% lower. The risk in use has been low and the perceptions about the expansion of the scopes of the use and applications only grow. 50% Of the Brazilian doctors already use telemedicine. As Virgilio pointed out, the pandemic brought an acceleration that was unthinkable years before. 70% of the health institutions use telemedicine. And there is an opening for expansion in digital service. There is clearly no indications that the health sector will regress in usage. 94% of the doctors say they are satisfied with the digital prescription method. This percentage is equivalent to that presented by the pharmaceutical industry, which also signals satisfaction with digital prescriptions. When we look at the types of digital service to which physicians are more open and interested in using, electronic medical records, physicians-patients relationship, digital prescriptions and telemedicine stands out. Very much in line with our 6 pillars and our view to empower the physicians and increase their productivity and success. Now let's look at aspects that supports our B2B strategy, focused on access, which is our major priority for 2022. Currently, an impressive 28% of sales are reinvested in marketing by the pharmaceutical industry. And there is still a great concentration of face-to-face activities that can be replaced by digital interface according to our value propositions, generating [ greater ] creating efficiency for the industry. In addition to the relevance of marketing expenses, Brazil is one of the countries that most increased spending on the pharmaceutical market. The pharmaceutical companies demand in continuing to access physicians only tends to grow. Brazil slipped from 10th position in 2016 to the 8th in 2021 and points out at 6 in 2026. Once the points that support our strategies are clear, I would like to analyze 2 other very successful companies in their strategy in the digital service segment, which is very close to ours. Doximity, a North American company; and M3, a Japanese company. Here, I have cut out some operation metrics from Afya that are considered relevant. Our ecosystem that starts to be built in 2020 accounts for more than 33% of the more than 750,000 doctors and medical students in the country. Doximity and M3 also points out a large penetration. Their number of doctors are more than 80% in case of Doximity and more than 90% in case of M3. Continuing with our analysis, let's see how the companies are assessing the physicians. Afya is already positioned among several health care stakeholders, such as hospitals and pharmaceutical companies, in line to what we can see in Doximity and M3. It also makes sense to look at the solutions that engage usage and enable the development of an extraordinary channel to access the physicians. Afya business-to-physicians, as we have already seen, is organized into 6 pillars. The first is the support for the clinical decisions, supported by management tools and electronic medical records. With telemedicine and digital prescription features, adding on physicians/patients relationship. All of it supported by our content and technology for medical education. And to enhance this pillar, welcome [indiscernible] and his team on [indiscernible] concluded last Tuesday. These new acquisitions will reinforce our value propositions in content and technology for medical education. At Doximity, they have DocNews similar to our PEBMED portal: Colleague Connect, a social network platform; Patients Connect, similar to our AgendaConsulta; and Dialer Enterprise as the telemedicine feature. M3 also support doctors' daily activities and the health care industry, offering services such as doctor communications to link pharma industry and physicians; market research and physicians analytics; career service; clinical trials and data service to hospitals. As you can see, we are well positioned in our service offering to reach a large penetration of physicians in Brazil. And doing that, we are ready to be the leader in providing physician access to hospitals and pharmaceutical industries. During the physician journey, we pointed to the expansion of the TAM arising for our roads to digital service. Let's see how this additional TAM is composed. The first layer of this new TAM is the one resulting from service provided directly to physicians, B2P itself. We have there an addressable market worth of BRL 4 billion. We will attack this market using our 6 pillars. The second and very strategic layer points to a TAM of BRL 24.4 billion, and results from the establishment of business with different players in the health care industry, for which we will work: One, providing access to the physicians; two, acting as a demand catalysis; and three, providing efficiency gains as we put it into detail by Lelio. These 2 major layers of activity built a TAM of BRL 28.4 billion. Penetrate in this market is the absolute priority of Afya Digital Health. And we'll do as we continue to expand our market share in undergrad and continued medical education. Anyway folks, I hope that the foundations that support the growth of our education and our digital service are clearer to everyone. Thank you very much for your time. I now invite Renata Couto, our IR Director, and future mother of Maria to lead the next panel

Thank you, Blanco. Me and Maria are very happy to be with you guys today. Hello, everyone, and thank you for being with us in this event. In this last section of Afya Day, I will share with you our ESG journey, presenting some of the practice we have adopted in the environmental, social and governance spheres. As you have seen through our event, our activities are genuinely impactful. Education and health, which guide the company's business, are everyone's rights and factors that lead societies to progress into quality of life improvement. For 23 years, Afya has contributed to the social and economic development of the locations where it operates, bringing high-quality medical education in undergrad, prep courses or continued education settings, or even through digital solutions offers. We use this diagram to present our main actions. We will start by pillar S. Let's talk about social impact. I would like to invite everyone to watch a short video that simplifies the high impact that a medical school generates in the countryside of a country like Brazil. [Presentation]

Amazing, right? Initiatives such as those capturing these images are part of the routine of our medical students and other health specialists. This video specifically records a beautiful project developed by Medicine and Dentistry students from our institution, ITPAC PALMAS, in Tocantins in the north of Brazil. They travel 250 kilometers to serve the elderly, children and all adults in a municipality that has only 1 basic health unit, 2 doctors and dentist. There are several actions fronts like this, taking place in our units in all regions of the country. In the governance pillar, we have made consistent advances, such as those related to transparency and compliance practices. On this front, we highlight our committees, policies and training of employees in key teams, initiatives developed with the aim of contributing to the [perpetuity] of the organization. We highlight our Audit, Risks and Ethics Statutory Committee. For our code of ethics and content based on human rights, and which repudiates any form of slate or child labor or similar, prohibits bribery and cover several other aspects. For Ethics channel, it is available to employees and service providers and is made -- it's managed by an independent company. We also have specific policies to deal with transactions with related parties and conflicts of interest in anticorruption and anti-fraud policy and hiring policies. Finally, several mandatory training courses are offered at our corporate university. We highlight those related to the code of ethics, compliance and anticorruption and insider trading. In the environment pillar, we are aware of the impact that our operations may have on the environment and in particular, on climate change, one of the most urgent issues facing society today. We continue to improve our practice on this front. Due to the characteristics of our operations, the main source of emissions is the recharge of gases in air conditioning, followed by energy consumption. In 2020, Afya started measuring the volume of greenhouse gases, immediate by our activities. 2020 wasn't a typical year, with operations taking place almost internally in digital environments. The resumption of activities in 2021 will naturally reflect in a higher volume of emissions. These are 2 different pictures. But the 2021 data will serve as a basis for us to plan the next steps. In 2022, the priority is the strategic planning for the management and reduction of the main sources of emissions. Building a diversity agenda is one of Afya's great advances in 2021. Our first public commitment assumed before the UN Global Compact is on this topic. We will work for more women to be in leadership positions at Afya, which contributes to the achievement of the sustainable development goal 5, gender equity. 55% of our employees are women, and we have around 38% of our leadership positions held by women. This trend also applies to our student base, 60% are women. We have structured programs to foster diversity across Afya. We highlight the program "We are Plurals." We had 5 affinity groups. We went back to gender and disability issues, and we have expanded our training base on diversity and inclusion topics at our own corporate university. Finally, we are extremely proud to be signatories of the UN Global Compact and of the commitment we have to gender equity. Another recent achievement is our presence on the Bloomberg Gender Equality Index. Back to Pillar G -- let's talk about governance and about the ESG culture itself. We are certified by Women on Board, we made a commitment to have at least 2 women in our Afya Board of Directors, where we also have 4 independent members. Our ESG Committee continues to play an important role in the daily life of the company. And we remain strongly committed to the dissemination of the ESG culture in all our action fronts. Whether direct or indirect, we publish our sustainability report annually. We maintain a technical commitment to support our education institutions and our digital ecosystem. The focus here is to contribute to everyday decision-making, that is increasingly aligned with the ESG agenda. And we can proudly report that we achieved more than 92% of our employees [indiscernible] to ESG-related training at our corporate university. We are also proud that our incentive structure, as Virgilio has shown, which is strongly linked to our ESG vision. Since 2020, half of the variable compensation of our VPs has been linked to compliance with the company's ESG agenda. And starting this year, more than 70 leaders we also have their compensation impact by meeting ESG goals. Back to pillar E. It is important to highlight that the way we generate energy is a characteristic of our operation. We have innovated, consistent on this front with the implementation of photovoltaic plants in our operations. Most of our education units are in the north and northeast of the country, regions that favor energy generation from sunlight. Let's look at this action front of the company into more detail. [Presentation]

Let's talk about internal controls. We are in the final certification phase of all our relevant internal process, subject to the provisions of the North American Act, Sarbanes-Oxley. We are increasingly mature in internal process and in the risk management culture and respective controls. We are also seeing a growing increase in transparency and security in the disclosure of our numbers, and in mitigating the risks associated with critical process in our operation. Today, we have more than 300 controls in all our departments, over 200 mitigated financial risks. 48 people in charge of controls and more than 100 employees dedicated to the correct execution, all reflected by a positive evaluation from the external audits. Since 2020 Afya's -- a signatory to the UN Global Compact and follow the Global Compact principles. This approach has been very rich for us, providing a consistent journey in SDG and commitment to the UN 2030 agenda. Our environment perspective has also advanced. Acting in an environmentally responsible manner for us means using natural resources such as water and energy in a rational way. Since last year, we have structured an internal environment policy that lays out clear principles that should be followed in all of our operations. In our quality management system, all those supports the implementation of these principals. Finally, we are also focused on improving disposal practices and disposal of solid waste generated in our operations. We have advanced in the management of these issues, establishing policies, guidelines and process. There have also been many advances in cybersecurity, information security management and to ensure that the systems that store data operate with integrity, continuity and confidentiality. In Afya, the routines are based on 3 pillars: technology, giving access to tools that help to work correctly; process; and people, offering training. The project related to the Brazilian General Data Protection Act, LGPD, is 100% implemented. We have a global maturity plan in 8 dimensions, and training programs on the subject continue with very high adherence at the Corporate University. Given the nature of our work, it's not surprising that the social pillar is one of Afya's strengths. Our main stakeholders are in the health ecosystem. As medical students, professors, physicians at different stages of their careers and other professionals in this chain, they all have something in common: a commitment to promoting health and well-being in society. [Presentation]

I am personally proud that in a situation like this, we were able to help. Well, our strategy and our actions adopt in the scope of the ESG contribute to 12 of the 17 SDGs. Thank you, everyone, for participating in this panel. I now call Virgilio to lead our takeaway.

Thank you, Renata, to summarize and show all the great accomplishments in the ESG front here today. When I look at expectation regarding our IPO in 2019, we see that: we have delivered a predictable growth; a strong profitability; and a high cash flow generation; and on top of that, combined with academic excellence. It's also important to remember that we had this performance during the 2 years of a pandemic and global crisis. Those years were devastating for the large majority of company in different industries. We have grown both our revenue and EBITDA and operational cash flow more than 2x since the IPO. We can be proud of our resilience, which is the result of a strong culture of execution and amazing focus of our leaders in fulfilling the commitments we have made. And we will keep growing and delivering. We have just released our 2022 guidance, setting another round of strong top line and EBITDA growth. And we can say that not only because of our ability of execution and high predictability, but because there is actually a lot of room to grow, and as shown by Luis Blanco, the market dynamic remains very attractive, with solid and structural demand for medical education and digital services in the long term. In Medical Education, we will reach approximately 20,000 medical students by 2028 just maturing our operation, a highly predictable growth to continue expanding in this segment. On top of that, we still have 1,200 additional seats that we can add organically to our operation by the current regulation. Our M&A pipeline remain robust and we will continue to aim 200 new additional seats per year starting this year. Considering only 50% of the potential organic expansion and the 200 M&A seats, after we reach more than 4,500 seats by 2028, what represents 32,000 students at maturity. When I look at Afya Digital Health, it allows us to more than double our addressable market. As Lelio showed today, we remain consistent in the implementation of our strategy to expand our physician ecosystem and to implement our new B2B revenue streams. And we will also remain strong in the integration of the acquired companies and in the M&A front. As we saw in the benchmarks presented by Blanco, we are on the right path of high value generation and in line with what has been happening in other relevant markets. Thank you all for coming along with us in this very important day for everyone here in Afya. It has been a great joy to train new physicians and prepare many others to better practice their profession. And today was an amazing day, the day we were able to view in more detail our strategic vision as well as much of our execution so far. We will continue strong in the implementation of our vision, managing our segments in a way to extract as much value as possible from both. And more importantly, ensuring the specific focus that each one needs to continue growing consistently and healthily, building an increasingly better Afya in an increased better world to expand access to health for all of society. Now let's start our Q&A. Thank you.

We are really happy to be here with you today, presenting our main initiatives on the day that we celebrate the World Health Day. So let's start our Q&A session. [Operator Instructions] We will start with our sell-side analyst questions. First, let's start with Luca from Itau.

Good morning, everyone. So my question would be [Technical Difficulty] within the health care industry because of the pharma segment. Just looking ahead and considering the consolidated business, what should we expect in terms of relevance for general medical courses, business services and other initiatives within the health care space. In other words, if you could please comment on which is where do you expect to extract the most value from would be very helpful.

Okay. Great. I think that Lelio can get this one.

Yes. Thank you for your question, Luca. We are working very hard to provide best solutions for physicians, as I mentioned in the presentation, to have a great market share, great penetration in the physician space, students and physicians in practice and enabling us to build the offerings for supporting the relationship between those physicians and the pharma industry and the health care industry in general, starting with the pharma and providing access -- intelligent access from pharmas to those physicians. And maybe I can share with you an example, a very recent example. We ran a digital campaign for a pharma here in Brazil. And we've been 13x more efficient in 10x shorter time for a specific digital campaign. So that's how we believe we will deliver the value for both sides, meaning being more relevant to physicians, valuing a very important as for the end time and also more efficient to the industry to get to those physicians, right? So this is the beginning, just the beginning, we have around 23 contracts with 18 different pharma and growing this base, proving the value and then increasing the monetization of those type of offerings.

So our next question comes from Vinicius from UBS. Vinicius?

Good morning, everyone. Thanks for the event, and thanks for taking our questions. So 2 questions on our side here. The first, you have mentioned before Virgilio reiterated today that you guys see another Afya within the Afya with the Digital Health segment that the guys have been developing. So -- in the midterm, what should we expect for revenue acceleration and impact on profitability for the next 2 years? And what do you guys see as the main challenge to getting there? Is it a matter of customer acquisition cost? Is it increasing user base? Is It Contracts on the B2B side, what is the main challenge? And the second is on -- the second is on the [indiscernible] segment. We understand that [indiscernible] had an important impact here, but we have also seen other players acquiring the 3 acquisitions in that space. What do you see as the most relevant competitive factors that Medcel has? And should we expect any strategic changes here?

Okay. So I think that we can start with Luis from the revenue and EBITDA perspective and then we can jump to Lelio.

Vinicius, thank you for your question. Regarding the size of the opportunity in the digital business, we see that we can achieve net revenues of BRL 1.2 billion in 2028. This is our view on that. We are exploring this flow of net revenues from the B2P and from the B2B side of the business. We -- in the B2P side of the business, we'll start, as Lelio mentioned, in the pharma industry, providing access. And then providing demand for the providers. And at the end of the day, we want to provide efficiency for the payers. So this is our view right now, BRL 1.2 billion in 2028. Regarding profitability right now, when we compare us to international benchmarks, as I mentioned, M3, Doximity, we see that the margins that they achieved right now is something about 30% to 40% EBITDA margin. So this, we can expect that on this kind of profitability in this segment.

And thank you for your questions. So first, I would like to highlight the challenge you mentioned on building this ecosystem. So right now, we have, I would say, a very good penetration in the physician market share. We have a high level of engagement with a great satisfaction from our physicians. So we are always, always physician centered. And we keep evolving this ecosystem for a physician. And to unlock the value of this ecosystem, we are bringing more value to the physicians through the integration of those solutions. As I mentioned in the presentation, for example, we deployed the PEBMED update -- medical update into iClinic, delivering more value to our physician in the practice management tool. And also starting to build the B2B offerings, right? So this is a land-and-expand strategy. We want to start having the relationship with the health care industry, and increasing our revenue as we prove the value of our ecosystem. And up to now in this first quarter, I would say that we have been very successful in this -- in starting this relationship with the pharma industry. Regarding the residency market, what we are seeing right now is some changes in the market. So the demand, it's kind of flat over the 3 last years. We see students more in debt during the pandemic time. Most of the families in Brazil have struggled during this period, and the ticket of undergrad is quite high, we all know that. So in our vision, students are looking for opportunities to monetize faster and pay the debts and maybe delaying a little bit the search for specialization, both in residency or specialization, we are seeing this. And a lot of new competitors in the market as well. So as you mentioned, so we are seeing more than the double of number of companies offering residency preparation. And we have some very important strengths, I would say. We are investing every day in new technologies to improve the learning experience, 3D Bio atlas, just to give you an example, artificial intelligence, to personalize the learning experience of our students. We have cross opportunities offering the student access to Whitebook, for example. So we have the strength of being part of a big ecosystem here and how we are differentiating the market. We are investing in 2021 in new offerings of content to be even more competitive in this market.

If I may add something here, Vinicius, one point that is very important. We are investing in bringing more talent people, more very are high recognition physicians to this market. Our last 2 acquisition, CardioPapers and Alem de Medicina, they are very well-known professionals in this area, successful on their specialties. So we are bringing them not only as a tutor, but also as a specialist for some areas to get approval on that residency. So this is a word-of-mouth business, and we are bringing the best people to have on our ecosystem here.

Thank you, Vinicius. [Operator Instructions] The next question comes from Vitor Tomita from Goldman Sachs.

We have 2 questions from our side. The first one is that Afya has a significant undergraduate footprint, not only medical schools, but also in adjacent areas within health care. So how do you see the potential opportunity for expanding your digital solution strategy to the lifelong needs of other health care professionals, potentially similar to how you already have nurse book along with Whitebook? And a second question from our side would be how do you see right now the international opportunity for Afya, particularly in the Digital Solutions segment. Are there any particular areas where you plan to tackle that opportunity in the near term? Thank you very much.

One more for you, Lelio.

Thank you. I'm very glad with your question. Thank you for that. So -- for sure, we have a lot of opportunity to expand our digital solution to other health areas, right? So it's a matter of prioritization. Right now, we are very, very focused in executing our vision and deliver the value for our shareholders, meaning physicians, employees and investors. So we have a lot to do yet to consolidate our vision for physicians, right? But we do have Nursebook, for example, it's focusing on nursery. And we have an opportunity to broaden it with the Bertelsmann, some of the Bertelsmann assets outside Brazil, so maybe addressing your second question as well. So it's a matter of prioritization. Our second wave of growth will for sure take in consideration the expansion to other health areas. So right now, we are very focused on delivering value in the physician -- all the vision that we built for a physician, right? So opportunities outside Brazil, yes, we do have. We already have some customers outside Brazil, mainly in our Medical Harbour offering, the 3D Bio Atlas, and we are starting to explore avenues for growth outside Brazil. But again, our main focus is to consolidate our position in Brazil for physicians. Short term, we need to deliver more value, capture more value of the ecosystem we have already built in Brazil.

Yes. An important point here, Tomita, is that we have today, 33% of market share, right? And when we look to the other competitors in the world, the benchmark that we look for, they have over 90. So we still have a long space to work.

Yes. And if I may add to your first question, Tomita, this TAM of providing this digital service for other health care professionals such as dentists, such as [Audio Gap] are not considered in BRL 28.4 billion addressable market. So it would be additional to that. But as Renata just mentioned, we are focused to increase these penetrations within the physicians and providing the B2B opportunity within this phase of physicians.

So our next question comes from Marcelo [Dos Santos]. Marcelo are you there?

Hello, I'm here. Good afternoon to all, Virgilio, Lelio, Luis, Renata, Thanks for taking my question. The first question is about the content business within digital, what's the risk of disintermediation in this business? For example, prep courses, lifelong learning. The professionals who are providing these courses, they could reach directly the physicians through platforms such as Hotmart and others. What is the risk that you lose this part of the business? That's the first question. The second question is more specific about PEBMED and iClinic. Could you please discuss what cross-selling initiatives have you being employing to -- for one, drive revenue of the other?

Me again. So thank you very much for your question. Very interesting. The first one, I see it more as an opportunity than a risk. So a creator's economy, it's already happening, right? So Internet, Instagram and all the facilities that we have nowadays make it easier to have new entrepreneurs offering any sort of course to students. I would say that in the mid- to long term, the best place to sell any content to physicians will be Afya Digital Ecosystem. So we have a high penetration in physicians. And we are working with this open health tech concept. I didn't explore it in the presentation, but that's our vision. So to have an open health tech platform. Right now, I would say that we have some advantages here. We have a high investment in technology -- in the learning experience. We are improving the relationship with our physicians, professors, bringing them more to the central -- to the central role in this learning process as Virgilio mentioned. So we are bringing more and more digital influencer physicians, so taking advantage of this creator economy that is happening. So it's a reality. We're going to have more competitors, if you will, exploring this digital reality that we have right now, but also as an opportunity for us. As we increase the penetration in physician, both students and professionals, I would say that we're going to be the main platform to offer any relevant training for physicians. So the second one is?

PEBMED and iClinic.

Oh, yes, the cross-selling opportunities. We are already taking advantage of this. So I presented Medicine in Focus, right? Medicine in Focus is the integration between the 2. So we are taking the update, medical update from PEBMED inside clinic. Sometimes, the main game is not monetization over physician directly, but we are increasing the relevance and the engagement of physicians to our digital channels and being more relevant also to the industry, to the health care industry. having Medicine in Focus inside iClinic and being relevant to physicians. So it's a new channel for the pharma industry, for example, to access those physicians. So that's how we are making more tangible the value of our digital ecosystem for both physicians and the health care industry.

If I may add something here, Marcelo, it's important to remember that the usage of Whitebook and iClinic in different parts of the journey of these physicians. The Whitebook is mostly used by physicians until the 10th, 15 years after graduation, and iClinic is after he got their specialization. So the big opportunities that we have is to use the Whitebook users as lead for iClinic that we are working on it. And that's the bit of the ecosystem.

And maybe reaching this, just remember that PEBMED offers 2 main products. So one is a medical update. So that's what we used inside a clinic with the same audience so we have physicians in all their journey looking for medical update, and Whitebook as a decision support too for -- more for the end physicians who are working in the hospitals and using this tool to help them in their daily routine.

Yes. Just one last point here, Marcelo. As we are just launching and leveraging the B2B opportunities. If you increase the usage and engagement of each app or each solution, we will be generating much more value when we are giving access to our ecosystem. So -- this is very important, not only increase penetration, but also the usage and engagement of our physicians using different pillars, different functionalities on our ecosystem.

And our next question comes from Samuel Alves from BTG.

Good afternoon, Virgilio, Lelio, Blanco, Renata. Good afternoon, everyone. Thanks for the presentation. Two questions here from our side. The first one is regarding the integration of recent M&As, especially in the core business of the company, like UNIFipMoc like UNIGRANRIO, if you could please provide some color on the road map of integration, how long it should take to fully integrate these assets not only in terms of maturation of the seats but especially in terms of costs/expenses, opportunities, okay? This is the first question. And the second one is regarding capital structure. I mean the company was a tad below 3x net debt EBITDA last quarter. So we should consider this as the maximum level that the company could reach or not? Just to understand the sustainable financial leverage target. And in some point in time, it could make sense to have some dividend payout.

So Virgilio can start and Luis, of course, complement.

Thank you, Samuel. I'll get the first question here about integration. So starting on UNIFipMoc, the first action on our integration road map is to integrate the curriculum, or to take action on our financial process, but all the system in process that will bring a lot of value synergies in terms of costs and G&A is expected to happen along 2022. So we are just kicking off all this process to roll out our ERP, our academic systems and also to push all the transaction activities to our shared services at Afya. So UNIFipMoc and UNIGRANRIO, it's following almost the same work plan. So we're expecting by the end of 2022 to have fully integrated all the transaction and administrative process into our shared services into our cooperative areas. So the maturation is following the regulation. So we have -- both of them still have opportunity to increase the top line and the volumes coming from the students and also mature our curriculum. So we started last year and with the new curriculum for the first year students. So we're keeping -- strengthening synergy, getting synergy as we mature year-over-year the new curriculum on these operations.

Yes. It's important to remember that our playbook is tested in those acquisitions that we've already made and integrate with fully success. And we have this window of 1 year to integrate them because we have to remember that as a NASDAQ-listed company and not an emerging growth company anymore. We are a large accelerated filer. We have to be SOX compliance, and we have this grace period, I would say, for 1 year, to have our controls in place. So we need to do this integration fast in this window of 1 year. And doing this fast, we can get the synergy faster. Coming to your second question, what we say, Samuel, that in our scenario that we're going to do to complete our ecosystems with the digital solutions and acquiring 200 seats per year, we are pretty comfortable with our cash flow and our capital structure regarding this speed of growing. If come -- some assets in mostly on the undergrads that is over this 200 seats, we would -- we have to analyze. But our base scenario is that we are being comfortable financing these acquisitions, these expansions through that. So we want to see at least in our best view right now, any kind of follow-ons or nothing like that, okay?

Or any debt increase, right?

Yes. Just remembering, we are a little bit over 1x EBITDA in terms of leveraging, starting 2022. We are generating a lot of cash. You see the guidance, the conversion over the EBITDA guidance will be very high also in 2022. So we have room on our balance sheet to go beyond that and have additional power from our sizable acquisition. But this is opportunistic.

Okay. So our next question comes from Mauricio Cepeda from Credit Suisse.

So first question we'll go back to specialization forces. It's a great dish in terms of size, profitability. And you still have a low market share, which implies that you have a lot of potential there. So the question is, what do you think are the features that make you unique or differentiated? And what is your plan to expand this share? I know that you commented before that the market may be not evolving in the short-term a lot, but you have this kind of opportunity ahead. And possibly comment if there are some limitations in terms of facilities or partnerships you need to make, something like that. And my second question is about the prep courses I think you commented a little bit during the earnings, right? It's -- the competition is kind of increasing. So my -- the same question about what your differentiation edge, and is this not the time to think about M&As or consolidation move there.

Of course, let's start with Virgilio.

Thank you, Cepeda. I'll get the specialization and Lelio help me here with the prep course. So the opportunity on specialization continue [indiscernible] this is huge. I think it's one of the most important levers that we have for growth on the next 5 to 10 years. First is the concentration, it's very, very low. We have a huge opportunity to consolidate this market. We increased a lot our facilities, our distribution channels we had in 2020 -- the beginning of 2020, only 5 locations, 5 campus specialize to offer continued medical education, top-notch facilities. Today, we have 12. We opened the 12 facility campuses to offer our continued medical education. Also, we launched different programs for different facilities with partnership very well recognized associations that you can increase the reputation in some areas that we are distributing -- start distributing this program. So on the last quarter of 2021, when we resume our practical classes, we could enroll and start delivering the content of once again and all the practical -- we have a very successful intake, the same rhythm, the same [indiscernible]. We are seeing on this first semester of 2022. At this moment, we are 40% above last year. So we are resuming growth on continued medical education. So we have a very high expectation going forward here, not only in 2022, but also as to be more representative on our continued education on medical education net revenues, okay.

In the prep market, as I mentioned before, yes, the competition is higher. We are seeing more and more competitors. Just to give you an example, in 2019, we are competing maybe against 6 companies. Now we have more than 20 in the market, growing. So every day you have new physicians offering something through Instagram, for example, Creator's Economy. It's a fact. We are also investing in this. We have more and more digital influencer physicians, digital influencer in our group. I think we have a lot of advantage in our technology, so we are innovating technology every day, 3D Bio-Atlas, like data intelligence, improving the learning experience. We have some innovation products that we are about to launch, more flexible and lighter, giving more flexibility to our students. We see the market more flat, some students delaying their decision to go into residency. And also some delays in the residency test by the government. So we all -- all the competitors are suffering the same here. But we are looking for -- to capture more value from the strengths that we have already built along the time. So we have technology. We have cultures, for example, so it's also a differential. We have coaching services to the students, helping in the entry study for residency. And we are very attentious to acquisition opportunities as well, very disciplined. So we just brought two Alem da Medicina and CardioPapers, very target companies with a high talent physicians running those business that we are very confident that will help us to be even more strong in this competitive market.

So our last, but not our least question is from Javier from Morgan Stanley.

Can you hear me?

Yes we can. We can't see you but yes -- Now we can see you and hear you.

You can't see me? I have to move a little bit. Okay here. Sorry about that. So I wanted to ask you, if you have noticed slowdown on medical school prices, a rebalance between supply and demand and the dynamics being a little bit more rebalanced and a slowdown in prices -- prices now growing with the inflation? And what is your main assumption going forward on prices for medical schools? .

Thank you, Javier. We are viewing this type of concern in the market. On our case, the demand that we have in this first semester and also during the pandemic was very sustainable and high, keeping the same levels that we had before the pandemic. Our brand is much more stronger, our commercial process to attract the student all around the country, to enroll on our different campuses, it's moving in a very good -- in a much better way than we had in 2019, 2018. So we were able to have 100%, a [ few percent ] of very healthy candidates proceed all over of our programs, all of our campus around the country. And another thing about the inflation, we saw the inflation increasing a lot in January and February, reaching 2 digits. But when we have to set our prices back in September 2021, it was around 7% and 8%. That's why we announced our price 7.5% on that at that moment. So that's for the student base. So for new students, we have pushed our prices higher than that, so we will be very close to inflation once again and still have the opportunity to do this on the half of the -- on the middle of the year and the second half to change a little bit our price for institutions that change usually on the second half. So we are not seeing any different dynamic in terms of attraction, enrollment and also our capacity to pass inflation to prices moving forward, Okay?

So that was our last question. Thank you all for all the questions and the participation of over 500 people on Afya's Investor and ESG Day. If you couldn't ask a question, please follow up with the IR team. We will be happy to assist you. We really appreciate your participation and hope to see you in person on our future investors meeting. Thank you, and have a nice day.

Thank you.