Sehat Kahani

Leverage innovative healthcare delivery through telemedicine whilst providing employment opportunities for female doctors through mobile based solutions.

Dr Sara Saeed Khurrum- Co- Founder and CEO

Dr Iffat Zafar- C0-Founder and COO

Pakistan ranks 154 among 195 countries in terms of quality and accessibility of healthcare, according to a Lancet study. The country’s dilapidated public health system is already under stress with a ratio of one doctor to 963 people and one hospital bed to 1,608 people. There is an acute shortage of more than 200,000 doctors and 1.4 million nurses; moreover there are 194,000 registered medical practitioners in Pakistan, of which 30,000 work in ICUs  – figures prior to the onset of the COVID-19 pandemic. On the other hand, 90 million inhabitants live near quality health infrastructure are impacted by recent pandemic as OPDs are closed down due to nationwide lockdown and tertiary facilities are overwhelmed by increasing numbers of COVID cases. 

The COVID-19 pandemic has since exacerbated the existing weaknesses of Pakistan’s health infrastructure. Pakistan, being a resource-limited country with a lack of existing emergency preparedness mechanisms in place, needs to reinforce national public health capabilities, infrastructures, aggressive disease surveillance systems and laboratory networks, and trained human capacities. Women and children are more vulnerable and at-risk because of factors including discontinuation of reproductive, maternal and other healthcare, while the elderly are facing disruption in accessing essential and life-saving health services. 

At demand end our target beneficiaries are the general population that might not have the accessibility to healthcare services due to nationwide lockdown and closure of outpatient clinics. We will also be extending our solution to corporates and large organizations so that they can either provide access to our application to their employees or to their clients. On the supply end our beneficiaries are the female doctors that do not continue their medical practice due to  social pressures, cultural taboos and lack of support from family. Sehat Kahani approaches the challenge of converting need into demand through a human-centred design approach. Our network of doctors are trained to deliver quality health services while incorporating feedback from our beneficiaries to ensure shared decision making and informed health choices are being made. Through these techniques, Sehat Kahani provides a service that is data centric, building a demand for low-cost, customer-centred healthcare that has translated into a greater likelihood of patients availing remote services for their ailments or for suspected COVID cases. Our solution is also paving the way for unemployed female health resources to continue their medical practice remotely while building their capacity to utilize mobile based solutions in their practices.

Through collecting standardized data of patient records in terms of personal and family history and tracking disease history via consultation dashboard, Sehat Kahani offers a unique opportunity for the private and public healthcare providers to understand the immediate medical needs and policy interventions to cater to the emerging data trends.  This health dashboard, building onto the disease patterns and health indicators over the period of time will help formulate an effective case study to be utilized as a baseline and prepare for future health emergencies specifically in Pakistani context where segmented socio-economic strata calls for population specific interventions and strategies to cause impact. 

In addition to this, key learnings from  tele-ICU model of Sehat Kahani has helped the system collect case-based information and about the most vulnerable population of the country, and help provincial and government bodies to re-design the public healthcare dissemination plan of the country with evidence based health indicators.  This health dashboard and EMR system not only represents the national health data at large collected during the time where most of the physical health facilities failed to provide basic healthcare access to the individuals but also has the capacity to illustrate disease pattern breakdowns and transmission patterns.

The primary impact stakeholders for Sehat Kahani tele-medicine solution were not only vulnerable communities who lack accessibility and affordability to consult a verified doctor but also out-of-field female doctors whose ambitions were hindered by “doctor bride phenomenon” and provide them both with a tele-consultation solution to attain financial security and social empowerment.

With its hybrid model of service provision through diverse range of hub and spoke models, Sehat Kahani has facilitated more than 360,000 E-Health Consultations through its E-Health Application and 35 E-Health Clinics located in the most vulnerable communities across Pakistan while impacting more than 3.1 million lives with a vast network of 5000+ predominantly female doctors. The E-Health Clinic model utilizes community health workers and local clinics where a front line worker is trained via a five-step training to connect patients in these hubs to qualified home based female physicians and skills specialists using video consultation and Electronic Medical Records systems while Sehat Kahani renovates their clinical space and transforms it into a standardized Sehat Kahani e-Health hub. The feedback calls and surveys conducted post-consultations from patients from both the verticals have shown 99% patient satisfaction rate where the quality of consultation and platform and accessibility in terms of financial model and physical distance is measured as an impact indicator

Sehat Kahani; like all the other Global Players in the telemedicine market,  intends to grow its current business by expanding their Telemedicine Platform through the e-clinics and mobile application and not only become a market leader in Digital Health in Pakistan but also become a global player. With the current COVID scenario; the inertia towards telemedicine has already been broken and the acceptability of seeking a doctor’s opinion over a video call through a smartphone while being able to maintain social distancing and reducing the risk of exposure by not going to a hospital has grown tremendously.  Sehat Kahani  has already  build a strong network of corporates and industry magnets (Including Banks, Telecoms and Pharmaceuticals as the key giant players) as early adopters to champion Sehat Kahani’s vision and impact during the current COVID Pandemic where they are availing their services for their employees. In the next three years, we aim to be able to lock over 50 million active users availing e-health services through the E-Health clinics and our mobile application, shifting the trend from physical health towards virtual OPD consultations and other digital diagnostic services and become the next ‘Uber for Healthcare’ in Pakistan. Sehat Kahani is also in the process of creating strong Public Private Partnerships ensuring Primary Healthcare access is taken up by the government and creates potential impact.

Sehat Kahani utilizes the World Health Organization (WHO) framework to monitor and evaluate for following domains (a) Health Outcomes: We compare outcome measures following telehealth and in-person visits among patients with chronic conditions as well as data on COVID-19 disease burden which we use to compare endemic areas with and without telehealth. With a 3.1 million users one-fourth of our patients have reported come back for a follow-up consultation with reduction in tertiary care referrals by early treatment opportunities. (b) Health Delivery – Quality and Cost: We also assess impact the quality and cost of healthcare delivery, including areas of access, effectiveness, cost, safety, and equity. Our patients have reported to spend 50% or less when getting a consultation on our platform with better compliance. (c) Experience: We also utilize tools such as Telemedicine Satisfaction and Usefulness Questionnaire to asses patient provider experience and compliance. Other experiential factors like encounter duration, video and audio quality, and connectivity are also tracked. (d) Program Implementation Indicators: Through our program, a network of 5000 female health doctors have been trained to utilize telemedicine that were previously unemployed and are earning 1.5 times more of what they would be earning in a physical setting.

The following challenges are anticipated for adapting, integrating, and scaling our innovation. 

• Regulatory Risk: While the benefits of using mobile devices may be easy to see, the fact remains that healthcare is one of the most highly regulated industries. There are a number of regulations that includes consultation guidelines, prescription regulations and payment mechanisms

• Reimbursement: While clinicians may be willing to jump on the mobile health bandwagon, they need help from governing bodies to be successful. Much like the regulation issues, the reimbursement opportunities for mobile health are falling behind the demand. Telehealth consultations are often not reimbursed from medical benefits of beneficiaries resulting in out of pocket expenses.

• Security: Security in the healthcare landscape is a never ending challenge. The need to avoid HIPAA violations and keep patient information safe has only become more complicated as the use of digital technology has expanded.

• IT Support: Mobile devices and telemedicine require more than just the right devices. They also require the right backend support. These devices need a strong and consistent wireless signal to be effective. This means having a facility-wide network that can support multiple kinds of devices and can secure all the information that is shared over it.

We are working with developmental partners UNICEF, UNDP, WHO, Amplify, Ministry of Health (Pakistan), USAID, DFID, UKAID, GSMA, British Asian Trust (BAT), AKU, Taskeen; technical partners- 10 Pearls, Microsoft4africa and Human resource partners Pakistan Medical Association, Pakistan Medical and Dental Council, Yaran-e-Watan, Digital Pakistan and TDSP

With the current pandemic implications we  aspire to expand our solution that is accessible to a wider, eventually global, audience. With the Trinity Challenge, we want to utilize and expand our data resources to improve health outcomes in Pakistan as well as globally. This challenge can help us emerge as better leaders for our company as well as support our collective vision of strengthening primary healthcare of Pakistan by integrating data tools through e-health and m-health solutions. To reach this global vision of health for all, we require partners, mentors and advisors. We want to reflect on our experiences and share our knowledge to cross learn and grow. In addition, receiving mentorship from experts will enable us to expand our solution sustainably while improving utilization uptake of our beneficiaries. The resources from the challenge will also enable us to advance and upgrade necessary technological upgradations such as AI integration, chatbots and automated algorithms that will enable us to predict health patterns of our target beneficiaries which is extremely pivotal for us to understand and analyze especially healthcare needs of our users.

Sehat Kahani aims to develop partnerships with MIT to connect with mentors, experts and advisors to build and expand our solution by integrating AI into our existing solution  thereby gaining consumer insights, integrating predictive algorithms and supporting our research processes.

We also aspire to expand our partnerships with mobile operators across Pakistan such as Ufone, Telenor and Mobilink to broaden its reach by gaining low cost customer acquisition and market insights, access to mass communication channels including API access for SMS and IVR, access to mass payment channels for easy payment collection processes, access to retail customer touchpoints, access to technical and commercial support and gain visibility and credibility 

In addition we aspire to build partnerships with tech giants such as Google, Apple, Microsoft, Amazon and Facebook to access cloud computing, Telemonitoring through wearables, customer data acquisition and artificial intelligence resources,

We are also actively seeking large organisations and corporations such as Philip, GE healthcare, Nestle and Samsung to adapt our solution either for their employees directly or utilise it for their clients as a white label solution. This will enable us to expand our reach and customer base.