25%. And I think that's important. That's why we also want to put together the Q1, Q2 and look at our growth in context here. And to start with the highlights before we go into some details. First of all, we are growing faster Then we need to follow the plan.
We are supposed to grow at about 40% annually to reach our targets. And in the first half year twenty twenty one, 6% revenue growth is fantastic. We're proud of that. And it shows that our plan is realistic and that we're moving on. And not only that, the very robust Growth in recurring revenues, 60% also there pro form a, put together with our recent acquisitions.
These two numbers, 56%, 60%, really shows what this is about. And then again, To the expense of, of course, the EBITA margin when we acquire companies as we have done 3 this half year and Those are of course sub performing or sometimes below 0 as well. And we put those together with our current Profitable business, of course, it will hit the EBITA margin a bit. That means we have 13% EBITA margin in the 2nd quarter. All in all, with the first half year, it would be 16% EBITDA.
So and then of course, most importantly, We are about to grow in different areas, and we also created a new niche called health analytics. And that happened through an acquisition. And I will go through today what that means to CISA. And also, in the Q2, we acquired a company called Optima, a fantastic company. Also and put together with MedSinet here, these 2 are type of companies that have been working for many, many years with Analyzing data, focusing on health care data, which is a growing area among our customers.
So the mix there is fantastic. Not only are we growing fast, but also we have done the right things when it comes to creating the future for the company. And then again, of course, you can see that we've been working hard the second quarter. You saw subsequently after the Q2, we had a win, a big win. And what does that mean to CSAM.
Well, to win such a contract, national contract in Denmark, It shows the viability of our systems, the need for a very important niche solutions. And they will be integrated with a lot of different systems in different regions in Denmark. And I will go through what that means in a bit as well. So these are the highlights and these are very important in the development of the company. And as you know, to reflect on that, what is really CSAM about.
I think you have to mark the 3 first words every time you think about CSAM, ehealth, niches and software. And as long as we stick to that discipline, we have been able to create a position. We are the leading one in the Nordics. We are gradually now going out in Europe and also the rest of the world. So I think our disciplined Strategy is part of the reason why we have had success so far and why I think the plan is good.
And also as you see from the growth numbers, we are soon there. And then of course, what is this about when it comes to CSAM? CSAM was created by a hospital. And of course, this is all about patients. It's all about the solutions and what they do.
And most of our people, our employees, our experts Coming from the health care sector and understands why we're doing this. And that is the foundation of all of our business areas and all of our types of software. And I'm going to go through these areas now just to summarize roughly what's got has happened in the Q2. And let me go through, 1st of all, the medication management area is has been existing for decades in the Nordics. And it's a de facto standard how to handle medication and oncology treatment.
And these systems we won a tender last year, So a new Nordic region adding to our current portfolio of customers and there we are also developing systems, new versions, new add ons and to continue growing organically as well. And again, also here, recurring revenues over time, low churn. And same here with the women's and children's health. We are the definitive leader in the Nordics when it comes to these types of specialized components. It's important to secure health care around babies and their pregnant mothers.
And I think this area is also a typical season Area where decades of development and user groups have created systems that are viable over time. And also during the Q2, We are now preparing emerging systems to create more efficient add on components over time for our customers. And then we have Medical Imaging. There's also a lot of smaller components put together to help Specialized Healthcare doing the work, integrate those again with the different types of EPR systems around the Nordics and also other places. And These are also things that we are developing, delivering now, putting together new components on top and also merging components from earlier acquisitions.
And that is how buy, integrate and build is working. We are creating new components and merging things and getting more efficient And then also, of course, increasing the EBITDA margin based on that. And then connected healthcare, what is that? That is our 2nd biggest business area, and it doesn't look like it is in a way a medical thing. But it is, because All of our customers, all these hospitals around the Nordics and also Europe and other places, they have their different type of system stacks, A lot of different systems, and we have to integrate with those.
So that means our current business is to make sure that all our niches are fully implemented into these stacks over time. And that is where our components are coming in that integrates. And these are software components as well with long term recurring revenues and also with add ons as we go to secure organic growth. So put together, those four Predictable recurring revenues, decades of history, viable components. And then to more specifically go into Happenings in the Q2, we created a new niche.
And why did we do that? Well, it's not only because of an acquisition, but as you see the development within healthcare, you take care of your data. You want to analyze the data to create a better business. And that is what Health Analytics is about. So we acquired a company here, which is a major stepping stone.
So I will go through that in more detail. And of course, our biggest niche or business area, if you will, is the public safety area. And the public safety area is really going to grow. And through the second quarter, We made another acquisition, the 30th June actually, Optima. And I'm also going to go through that specifically, which is a very important thing for public safety.
It's important for our customers and it creates possibilities on the income side. So both of those I have created new health analytics, a new niche and public safety has gotten a new area when it comes to health analytics as well or prediction, if you will. I'll go through that later. And all the last one here, the 7th, Blood Management, That is also in many ways defining CSAM. It has a 40 year history.
User groups have been working together for many, many years and created these software types that put together are now 100% market share in Sweden. And now after our contract mentioned With €100,000,000 contract with the Danish authorities, we are also 100% market share in Denmark. And these are very important stepping stones for CECL. And the Q2, of course, was hard work for all the people in the sales department and within this nice business area to secure that contract, which happened subsequently just after the second quarter. So that's roughly the summary of the business areas.
They're all performing well with positive EBITDA. They're all performing well when it comes to recurring revenue and low churn. So then let me just summarize the acquisition part of CSAM, which is extremely important. And just to remind you, we were created by a hospital. We were a small Norwegian company with some Swedish customers in 2010.
In 2015, we started accelerating our merger and acquisition history together with the private equity fund, Privek, from Sweden. Then as you see, when we IPO ed last year And until today, after Q2 2021, you will see that this slide and these logos are getting busy and busier. And that is what is CSAM is all about, because to get these market shares, to get these recurring revenue streams, Putting together, all this competence, all these customers and different components and create one business, that's really what this is about. And I will go through these specific acquisitions we did in the Q2 in a minute. And of course, as you see, The number of employees have increased dramatically through this history.
And of course, that is also defining us when it comes to growth. Experts on each of these niches and working efficiently together in one organization. That is what made our success so far. And that's how we're going to do it in the 5 year plan I referred to, SEK1 1,000,000,000 in 2025. So let me go through specifics here.
MedSciNet, what is that? Well, it is about clinical trials. It started with the professors in the Karolinska Institute trying to find out how to support these clinical trials with data and quality. And then this type of approach to health care data is important to all types of providers today. So that means this is a growing area in itself and not as only as a software area.
So When we initiated this, we see that we can get these health analytics components to help us get also More out of our other niches because the data there and these analytics platform and this clinical trial framework Put together as a SaaS based service, cloud based service is of course a modernized way to offer our customers a better future when it comes to handling the data. And then this software as well has a history. It's technology. It's proven Security, integrity and focus and is also compliant with the most important, of course, standards needed to be a serious provider within this area. And then all in all, this has also strengthened us More in the Nordics and also out of more in the U.
K. And also in the rest of the world. So put together, all this is a small company SEK14.4 million in sales And 11 employees, however, important, SaaS based and a very good thing with which helps the other niches that we already have. So this is a successful acquisition as we see it, and that's also with the second one that we did the last day of the second quarter. Optima, owned by the big company, Arvon, they also that's also same history, a highly specialized Component type and then again working with decision support and has done that for many, many years.
And This is helping these type of providers to actually plan their operations and to secure Prediction and real time analysis. And to put together, you can create a better health care business, especially within the public safety area. So and also that means that resources across the health care systems, you can use these data to create a better health care business as well, which is important to all our customers. That means that this component, this service is highly important for our current customer within public safety in the Nordics and in Europe. So this is going to be a good add on for GSAM.
And this is not a new thing for us. It's important to say since these are People coming from other places in the world, it's not new to us. We've been cooperating with this company before. That means we know The components, it's already installed with our major customers like Oslo University Hospital. So this is the way we think.
This is a low risk approach to get new customers, new components and new experts and employees. So it's been a successful transaction for CSAM. And also, this is creating a new value chain because we have a lot of Support for control rooms, for the ambulances and put together for the management here where you can actually use that data to create a viable business, which is more efficient that is valuable to all our customers. That's a new value chain for us as well and very important. So and of course, customers, it strengthens us here as well.
They have already customers here in the Nordics, but then also other places in the world, meaning that we are also more customers in Europe and also outside of Europe. So it's gradually getting there. And in a way, I think it's the best way to manage risk. So this is a good news for a growth company like CSAM. So the question then, we have made 2 of these acquisitions in the 2nd quarter and made a big one in the Q1, Carmental Public Safety, Put together, those 3 into our first half year numbers, what happens then?
I guess you all will see the mathematics That most of those companies are sub performing and of course put together it will affect our EBITDA. And then what do we do then? And I think we've shown you before, we call it buy, integrate and build. And I think if you look at the facts, The numbers, see some numbers, 2019, 2020. We did a lot of acquisitions.
We integrated 5 companies in 2019. We had an EBITDA below 20%. We did this by integrate and build process. And then what happened in 2020, back to 30% margin, EBITA margin. And that is the craftsmanship of this.
So that's why we're not worrying about The EBITDA quarter by quarter, as long as we acquire companies with these recurring revenue streams and put together in one organization Through buy, integrate and build, that is what this is all about. So then again, it's a good quarter and it's according to our plan. And one thing is the plan. And then secondly, we have the ambition. And we like to say, and I think Based on where we are at the moment, I think that from 2,005 being created by a hospital.
And if you look at it now, well, we have become the leading player in the Nordics when it comes to focus on these niches. And what is the plan really about? One thing is the numbers. But secondly, as long as we can stick to that strategy, We don't have that many competitors doing the same. So we think it's realistic to become a champion In the European area, focusing specifically on these types of systems and being the leading player there as well.
And of course, in the rest of the world, we have started, and I think that we will also, over time, be a notable international player. And that is CSAM's ambition. And the only way to do that is, of course, to grow. And we've shown you that 56% Growth pro form a, including the M and As in the first half year, should really show you that we are on our way. And then you also see from the numbers, of course, in the first half year here, you see that we have 7% In the rest of the world, and you see that we are becoming stronger and more mirroring the Nordic market as well, being stronger in Sweden because Sweden is bigger, obviously.
So I think now with a huge diversification you see in our recurring revenue streams And when they are put together like this within different countries, different regions, different hospitals, different departments with different niches. It's highly diversified and a very good position to be in. And having said that, I think I will bring my colleague in here to then show you the numbers behind the quarter and then go through these before we have a Q and A just after Aynor is finished with his presentation.
Thank you, Sverdrup, and good morning, everyone. Let's go through the numbers. Mix of the quarterly and half year highlights, We have tried to put everything into context for you. We've also done some pro form a calculations to make it easier. 1st and foremost, the revenue growth is 56% For the pro form a for the first half year, we are ahead of our communicated plan growing 40%.
Even Stronger is the growth in recurring revenues, almost 60% growth in recurring revenues. And that, as you know, is really the backbone, The core of our income. This is at the expense of the EBITDA margin. As we have Before, when we acquire businesses, we acquire and we look for the quality in the potential. And then we try to acquire the metric at reasonable terms and then take out the synergies and realize the synergies.
On the way, we dilute the margins. We have communicated that clearly before, and you see that demonstrated In the first half year and the second quarter. The reported EBITDA is NOK 10,000,000 in the 2nd quarter, a 13%, 16% for the first half year. And you just clearly see the effect of the dilution. Bear in mind also that the EBITDA is impacted by the high M and A activity In the quarter and in the first half year.
Again, as I said, we are growing ahead of our communicative 40% Per per annum. And you see there quarter over quarter from comparing on the left chart the Q2 2020 with the Q2 21. And you see a demonstrated growth of 33% in the reported numbers. But again, 56% in the pro form a numbers. That is if you include CarMenta, MedSinet and Optima for the 1st full half year.
And you also see on the right there the growth in the recurring revenues, growing more than 40% Reported and 60% pro form a. Recurring revenues, the Proportion of the sales and sort of quality of earnings, if you like, is improving as well from 72% to 77% of total sales. So very high quality, very high quality, the earnings. And let's take a deeper look at the recurring revenue Amounting to €61,000,000 reported in the second quarter. What you see here is a chart that We've shown you before, and that is the last four quarters development in the recurring revenue, growing from Around a little more than NOK 70,000,000 in 2017 to actually surpassing for the first time in company history more than kroner 1,000,000 based on the last four quarters.
So that is a great comfort to us and to bondholders and to shareholders. And keep in mind that these are the last four quarters. The run rate is, of course, higher, €61,000,000 in the second quarter alone and multiply that by 4 and you have the run rate. So it's actually a very, very strong growth and a very, very strong fundament for future growth. And again, Almost all the customers, they are in the public sector, very, very little churn and very high visibility going forward.
I mentioned that we have some costs related To the M and A, and Sverd also said, we have completed 3 acquisitions thus far in 2021. And that has an impact on the cost base. We see that the Personnel expenses increase and so does other cost and COGS. And That is a lot of those costs, they are temporary. What we will do, as we have done in the past, It's to make sure that we right size the total cost base with the M and A activities and the expected sales growth.
We see that it is a huge increase in FTEs. You saw from 168 to 262, so almost 100 new employees or the last acquisitions. And That is, of course, driving the cost base of the sales and personnel up. Then we see the other cost So that increases again as a consequence of the higher M and A activity, coupled with some one off integration costs and also Bear in mind, more extensive use of external consultants in some of the acquired companies, they have a different approach to CSAM. CSAM typically insource Such costs and activities, and we can also benefit from economies of scale.
Again, the improvements will not be made overnight, But you will see them as a part of the 24 month buy, integrate and build activities. And then last but not least, you will see that the COGS have increased as well, mainly due to higher third party software in acquired By businesses, again, as a part of the buy, integrate and build process, we will work hard to replace such software with internal offerings whenever And wherever possible. But again, it's not done overnight. It's a part of the process. So So when we have acquired a company, there is a lot of work to do.
And don't worry, we will do it. You also saw that the margin the EBITDA margin is reduced as a result of higher M and A activity, But all and part of that is also reduced CapEx. You saw that the CapEx is going down from 10% to 6%. And this is because The CapEx in the acquired companies, they have a different investment philosophy than we do. Remember that season When you have CapEx, you just don't transfer some cost from the P and L to the balance sheet to get rid of it.
It's actually investments that are identified. And when we develop software, the actual people working actual hours being in a cost bracket, that Is the reason and the fundament for those things put on the balance sheet? It's an investment. We invest in software that will Pay money back to us for many years to come. Acquired companies, they are typically they have no scheme at all or don't have This is the same system as we do.
Until we have our system put in place in the acquired companies, most of these costs are In the acquired companies. So it has an effect on the reported EBITDA, but of course, less so on the cash EBITDA. This and we will also see that Compared to the Q2 2020, keep in mind that, that was a very well trimmed company. We haven't done any acquisitions for more than a year. And we were entering the late stage of the BIB model.
So that is the numbers in a nutshell. Let us take us back to the big Plan, we said when we IPO that we were around NOK 200,000,000 in sales. We ended last year on 200 and just south of NOK 230,000,000. We are now growing More than 40%, and 40% is what we need to grow annually to reach the SEK1 1,000,000,000 in sales in 2025. We are growing ahead of that plan.
And we will continue to work very hard to continue this pace also going forward. And again, being in the same business, focusing on ehealth niches and continue to focus relentlessly On recurring revenue from well reputed customers in the public sector and elsewhere as we move out into the world. And that was that. Just Before we continue on the Q and A, let me just To give you the opportunity to if you want to stay ahead on and up to date on what happens in season, subscribe to our news. And you find that on this on the on our web page and you can subscribe to our news and also follow us on social media.
Okay. Then to the questions. So let's move on to the Q and A session. And We are ready to roll. First question here already from Eddy.
So with investor presentations, when we do an acquisition, Like we had a presentation on MedSinet and Optima. When it comes to endless coverage, we are working hard To increase that. So if possible, we would love that. Currently, Carnegie is covering us. And we hope for more.
So it's not we are stopping it for sure. All right. And the next one, again from Edi. What can you say about organic growth in the quarter? I guess that is one for you, Sverre.
Organic growth is what we see, as you know, like Maybe a less some quarter, maybe more another quarter. It was difference between 1st and second quarter. But to us, That is not the main thing. So that's the main thing I would say about organic growth in our plan. Objects that are either smaller, so it's irrelevant to many or they are complex, Like the one we did with Optima to acquire There's always competition, but so far it's not Increased too much on those type of objects that are relevant to us.
However, I see that the game in Europe and the world It's accelerating also here in Endo Nordics. So I think that is a good thing for the business. It's a good thing for the market. Quarterly presentation then.
Most probably. Okay. We can wait a few seconds to see if anything Poops into the Q and A box. Doesn't seem so. So I'll hand it back to you, Svero.
Thank you, and thank you all for watching this quarterly presentation, and we are looking forward to seeing you soon again.