Sncho Health

Primary healthcare service in Nepal is fragmented in a number of areas including access to healthcare, quality and safety of health services, and care for patients with non-communicable diseases. Nepal has a population is 29 million (79% rural) with 1 physician per 1,724 people (1:150,000 in rural areas). The top three leading causes of morbidity and mortality in Nepal are Neonatal disorders (10%), Ischaemic Heart Disease (8%), and COPD (5%). 

For patients suffering from chronic diseases or needing maternal care, access to care is the biggest challenge, which is further complicated by incomplete healthcare records because patients may have visited different care providers who only keep paper-based records (predominantly handwritten). It becomes a brutal chore for patients to keep a file of all their paper records every time they visit a care provider, and equally brutal for the care provider to assess a patient's overall health profile from such a file when they are already so pressed on time. 

Similarly, after each visit, often patients don't follow the care instructions as prescribed because the patient may not understand the instructions (both verbal as well as the ones scribbled on paper) and their care provider doesn’t have the resources to follow up to monitor care adherence. As such, either patients fail to follow up all together or only follow up when their conditions get much more acute, which could all have been avoided if the providers had a clearer picture of the patient's overall health and were able to monitor the progress of their care plan.

Unfortunately, these problems are contributing to the rising number of deaths due to Non-Communicable Diseases (NCDs) in Nepal, which have soared from 60% of all deaths in 2014 to 66% in 2018, top three being COPD (43%), cardiovascular disease (40%), and diabetes mellitus (12%).

Overview

Sncho is a combination of digital health tools and care coordination services to simplify patient-provider interactions and improve health outcomes. With Sncho, anyone can easily digitize their existing paper-based medical records for free and share with their care providers. This way, a care provider always has access to a patient’s comprehensive medical records, and they can develop customized care plans for each patient. Sncho also provides personal health coaches to work both with the patients as well as their care providers to implement, monitor, and adjust patient care plans to maximize care adherence and positive health outcomes.

Sncho stands for "Strengthening Nepal's Clinical Health Outcomes" and it means "well-being" in Nepali.

Solution Components:

Digitization of Paper Medical Records 

With Sncho, any patient can consolidate all their past (and future) medical records in one online system for free so that both the patients and all their care providers have the same full and comprehensive picture of their health. 

Patients who prefer self-service (and have the means) can easily create an online Sncho profile and securely upload pictures of their paper medical records with their mobile phone or any computer with an internet connection. For patients who don’t have such access, or where high bandwidth connectivity is not available, a Sncho health coach can help patients digitize their paper records offline. Once uploaded and annotated, both the patient or any of their care providers can securely access the patient’s records from any mobile phone or computer and don’t have to fish through pages and pages of paper files. This is a free service that Sncho commits to provide to everyone in Nepal. Patients can keep on adding new medical records to their Sncho profile using either the self-service tools or with the help of a Sncho health coach to keep everything up to date.

Personal Health Coach

When a Sncho patient visits a care provider, they have the option to have their Sncho health coach accompany them. The Sncho health coach helps the care provider access the patient’s medical history in Sncho so that the care provider can use majority of the visit time for exam, diagnosis, and evaluating progress instead of fishing through pages in old files. The Sncho health coach also serves as a scribe to document the visit. Since all activities are recorded in the same system, a patient's different care providers will have access to the same set of health records which then helps the different providers to coordinate the patient's care with each other. Ultimately, they form a full care team, each member with their own expertise and a clear role in improving the patient's health.

Personalized Care Plans with Systematic Follow-up

At each visit, the Sncho health coach works with a care provider to define a very simple and clear care plan in Sncho based on which Sncho can generate personalized meaningful content for the patient, including step-by-step instructions to monitor and improve their symptoms, diet plans, exercise videos, and relevant studies and literature. Sncho health coach then helps the patient follow all the care instructions and keeps track of their progress (and setbacks) in Sncho. A summary of this information is fed back to the related care providers so that they can follow up with the patient to adjust the care plan and maximize adherence. 

Remote Patient Monitoring

Sncho also provide patients with appropriate devices to track basic health data. Some of this is done with basic wearable trackers for steps, sleep quality, exercise, heart rate/rhythm, and oxygen levels, whereas other measurements like weight, glucose level, and blood pressure need specific devices. All these devices track data on a constant basis into Sncho so that health coaches, providers, and patients can all monitor progress together and fine-tune their care plan for maximum effectiveness.

Virtual Care / Telemedicine

Since Sncho is online, any care provider can become a part of a patient’s care team regardless of their physical location. This is really helpful if a patient needs to travel far to see a new care provider, or if a local provider wants to consult a specialist to review a case. In situations where high bandwidth connectivity is not available, Sncho facilitates asynchronous telemedicine making use of text messages and also relies on the health coaches to bridge any technology and connectivity gaps.

Research Collaborations

Since one of Sncho’s main focus is to digitize medical records, it is well-positioned to collaborate with research institutions and public health institutions to support potentially life-saving healthcare research work by contributing anonymized/de-identified datasets.

Our target population are patients with chronic conditions in Nepal (mainly COPD, cardiovascular diseases, diabetes, and thyroid) and also patients needing maternal and neo-natal care during pregnancies.

Following are the key areas how these populations are underserved and the way Sncho will address their needs:

Access to Care

With 1 physician per 1,724 people (1:150,000 in rural areas), it is not easy for patients with chronic conditions to routinely access care providers (especially in rural communities). Even if you get an appointment, the average consultation time is 5 minutes or less because of the high patient volume. And even within that limited amount of time, the care provider is typically diagnosing and providing care instructions without comprehensive view of the patient’s medical history.

With digitization of health records, home-based tracking of basic health metrics, and a local health coach to facilitate interactions with care providers (including virtual visits) and help implement their care plans, Sncho significantly improves access to care for patients with chronic conditions. 

Quality of Care

The current overburdened health systems, which lack easily accessible health records, are seeing increasingly poor experience for our target population as well as for their care providers.  

Patients often don’t understand care instructions, and even if they do, instructions may not be practical because care providers are not able to fully consider a patient's physical, social, and emotional/psychological environments. Also, there is little to no follow up on care adherence. So, care providers lose the ability and opportunity to fine-tune patient care plans in time, simple issues proliferate and become more complex and acute, and they pronounce themselves as major issues in follow-up visits.

Sncho provides remote patient monitoring tools and local health coaches who work with each patient to help follow their care plan and provide a constant feedback loop to their care providers about their progress and setbacks. This way, patients are more likely to get a much better quality of care, and providers can reduce the possibilities of severe health outcomes by making more timely interventions.   

Safety of Care

For our target population, any diagnosis or care instruction provided without acknowledging the full context of a patient’s medical history is extremely risky because such actions may have potential conflicts with a patient' current set of medications, allergies, or other ailments that the patient is suffering from.

Sncho avoids this by enabling a patient to share their full up-to-date medical history to any care provider they see. This includes current medications list, allergies, immunizations, existing health conditions, and social determinants of health. This way, care providers have a reasonably broad context of a patient's health before prescribing any care instructions and are thus able to avoid conflicts and provide more safe care. 

Sncho's founding team of Apurb Sharma, Sujen Maharjan, and Sandeep Giri have over 50 years of combined experience in digital health, care delivery, and software system development.

Apurb has been a practicing Anesthesiologist since 2009. He currently leads the Department of Anesthesia and Pain Management at Nepal Mediciti Hospital, one of the largest health systems in Nepal, and he is also the General Manager of their Artificial intelligence Program. Apurb’s clinical expertise is in Anesthesiology, Pain Management and Critical Care. He has also received training from Harvard University in clinical informatics, patient safety, and leadership. His work includes clinical research in the field of Anesthesia, cardiac surgery, and artificial intelligence.  
 
Sujen is a technology leader in Enterprise Applications Development and Data Driven Services. He has been working with technology startups since 2007 to develop and scale their products for large corporate clients. Sujen founded his first startup GritFeat Solutions in 2017 with offices both in Nepal and Japan to provide data and intelligence-driven tech solutions in retail, staffing, healthcare, recruiting, beverages and logistics, with clients including the Asahi Group in Japan.
 
Sandeep specializes in developing technology products in high social-impact areas like healthcare and renewable energy. Sandeep has taken several Head-of-Product type roles since 2001. Sandeep currently leads product management for a number of digital health and research initiatives at University of California San Francisco (UCSF). Previously, he co-founded a startup providing marketing analytics in the cloud (acquired by Oracle); then a solar company in Nepal called Gham Power (growing profitably). He has sold to enterprise customers, pitched investors to raise funds, and built out teams to execute business. He loves using these skills to solve problems in the healthcare space to improve the overall experience and well-being of patients and their care providers. 
 
From a team-dynamics perspective, Apurb brings clinical expertise based on his experience as a practicing specialist in Nepal. He is intimately aware of the challenges patients face and how digital solutions can practically address those challenges. Sujen brings the technical expertise and resources based on his experiences of running a software technology company in Nepal. He is intimately aware of how technology solutions need to be adapted in the context of Nepali users for the most practical user experience (including language localization and integrations with Nepal’s culture of using SMS and smartphone apps). Sandeep brings the product management experience based on his experiences of developing digital health products and working with rural communities across Nepal. He is intimately aware of how new technology can be leveraged to address issues of access. 

All three founders also deal with Nepali healthcare system challenges on a daily basis as all of us are supporting multiple family members who are dealing with chronic conditions. 

In fact, the first users of our solution are our own family members. We first have our parents and other elderly relatives with chronic conditions use Sncho’s services to get firsthand (and very direct) feedback about their experience, and we are also assessing how their health outcomes compare before and after using Sncho.

Since Apurb is a practicing specialist, he already has relationships with many clinics, hospitals, and other care providers. This is the first group with whom we are actively seeking input and idea to see how their day-to-day practice can be improved by what Sncho can provide.

Since we are an early-stage social enterprise, the financial ROI aspect of investing in our business is still evolving as our transaction model and price points continue to mature. As such, our biggest need at the moment is to have adequate seed capital to carry out our pilot projects and refine our product and service offerings to become financially sustainable.

On the technical front, while we are leveraging open-source technologies as much as we can, we also need secure and reliable options to safekeep patient data over the long run, and also explore existing blockchain networks to assert the provenance of the health records in our systems. We hope the Solve challenge will provide us exposure to potential partners we can work with to address these issues.

On the cultural and market fronts, we need help to scale the adoption of our business model that is new and unique to Nepal. 

First off, there aren’t many digital health type solutions that focus on clinical health outcomes as most of the existing solutions in the market tend to focus on scheduling, financial, and administrative aspects like a typical Electronic Health Record (EHR) system. So, we need help with education and awareness of care providers as well as the patients about how digital health tools can help address some key gaps in their experiences in clinical care. 

Also, our business model incorporates both a for-profit as well as a not-for-profit model. We function as a non-profit to enable any person in Nepal to upload and share their medical records in our system for free, and we also enable other nonprofits and NGOs to use our systems for low to no costs. We function as a for-profit by charging a subscription fee to patients and care providers to access premium technology features as well as health coach services. Our aim is to scale both aspects of the business in a way so that the for-profit arm can subsidize the non-profit arm. We hope the Solve challenge will help us develop contacts with other organizations with similar goals and business models that can help us identify strategies and tactics to implement this hybrid model more effectively.

Following are the key innovative aspects of Sncho:

• Unlike solutions that primarily serve a health system, our focus is directly on the patient. Sncho is designed for the patient to be in complete control of their medical records. They own it, they decide who gets to see it, and no health system or government can ever deny (or make it difficult for) a patient to access and share their own medical records.
• Creating a patient profile and digitizing existing paper-based medical records is a completely free service.
• With a patient’s consent, any care provider in the world can access the patient’s medical records online – regardless of whatever electronic health record (EHR) system the care provider’s organization uses.
• While digitized health records are the basic ingredients in Sncho, our care plan system is the secret sauce. Patient health outcomes primarily depend on whether a patient was successfully able to follow the care instructions, all of which happens once a patient leaves a care provider’s office. Sncho ensures that each visit ends up with a very simple and clear care plan that a patient can easily understand AND a Sncho health coach can follow up with the patient regularly to help implement, monitor, and make adjustments. This unique combination of digital health tools and personalized care coordination services in Sncho helps maximize care adherence.
• Sncho provides a Learning Health System (LHS) for primary care providers by collecting patient health data which helps create better knowledge and improves performance with a continuous feedback loop. 
• Sncho enables "Data rounds" by health coaches to identify patients at risk and provide information to their care providers as well as the patients and their family members to improve care.

Our key goals are:

• Timely access to care
• Provide comprehensive medical history at each visit
• Improve quality of care by improving:
  • Care adherence
  • Patient health outcomes
  • Patient experience and Care provider experience
• Reduce safety-related errors

In relations to Global Goals or Sustainable Development Goals, we focus on:

• Goal 3.1 - Reduce Maternal Mortality
• Goal 3.4 - Reduce Mortality from Non-Communicable Diseases and Promote Mental Health
• Goal 3.B - Support Research, Development and universal access to affordable vaccines and medicines
• Goal 3.C - Increase Health Financing and Support Health Workforce in Developing Countries

We plan to achieve these goals by implementing Sncho's solutions in Nepal. We are first working on pilot projects with a few select partners with a goal to support up to 1,000 patients within 12 months, for whom we estimate to onboard 10 care providers and 14 health coaches in our system. The goal of this pilot is to create a financially sustainable operational model that is ready to scale. We then plan to raise additional funds to scale our business with a target to serve 150,000 patients in Nepal within 5 years.

Following are the metrics we are using to measure our progress around key goals:

Goal: Timely Access to Care

• # of patients in Sncho
• # of care provider visits enabled by Sncho
• Mean/median time duration between appointment requested and appointment scheduled
• Sncho service utilization time 
• Average time spent by Sncho health coach with the patient 
• Average time spent by primary care provider with the patient
• Home to healthcare institution travel time for patients

Goal: Provide comprehensive medical history at each visit

• # of times care providers consulted a patient’s medical history in Sncho
• Evaluation of completeness of medical records by an independent healthcare professional (scored in percentage)

Goal: Improved Quality of Care

Sub-Goal: Improve care adherence 

• Completion of care plan goals (%)
• Progress towards the goals (trend of completion of care-plan goals captured over time)
• Patient perception of care coordination survey

Sub-Goal: Improve patient health outcomes 

• Patient reported outcomes
• Structure measures 
  • percent of patient that have providers followup, 
  • number of patients tracked in our SNCHO program
• Process measures (examples include)
  • use of aspirin for secondary prophylaxis, 
  • percentage of patients completing yearly screening for eye, heart and kidney diseases, 
  • percentage of patients having reconciled medication list
• Outcome measures for the five chronic conditions (Hypertension, Diabetes, COPD, Thyroid disease, Chronic kidney disease)
  • percentage of patients achieving targeted values 
  • hospital admission rate for long term complications of each of these 5 conditions
  • Composite measures like comprehensive diabetes care (preventing short and long term complications)

Sub-Goal: Improve Patient and Care Provider Experience

• Patient satisfaction scores
• Provider satisfaction scores

Goal: Reduce safety-related errors

• Record safety-related errors within Sncho patients and track it across time to identify trends against any available baseline data

Since we are following a Learning Health System model, we anticipate discovering new metrics to collect based what we learn from the abovementioned metrics.

Existing Problems of Nepali Patients, their Care Providers, and Health Systems 

• Patients cannot easily access care providers.
• Care providers treat patients without being able to see their full past medical history, which often leads to poor quality of care and safety issues.
• Patients find it extremely difficult to put together their full past medical history.
• Care providers don’t get timely feedback about the progress of a patient’s care plan and lose the ability to make timely course corrections, which then leads to decreased care adherence and poor health outcomes.
• Patients find it extremely difficult to follow a care plan that leads to decreased care adherence and poor health outcomes.
• Health systems waste a lot of valuable care provider time in rehashing patient medical history with paper records, which leads to decreased care provider productivity and poor experiences both for patients and care providers, all resulting in poor health outcomes.

Our Desired State of Nepali Healthcare System

• Patients have timely access to care.
• Each care provider has on-demand access to their patient’s full and easily searchable up-to-date medical history so that they can provide much better quality of care while minimizing errors.
• Patients have simple and easy options to keep track of their medical history so that they can share it with any care provider and also have a much better awareness of their overall health.
• Care providers get timely feedback about a patient’s care plan progress (and challenges) so that they can make timely course corrections, which leads to much increased care adherence and better health outcomes.
• Patients can easily understand and follow their care plan with almost-instant access to their care team if they run into any challenges. This increases care adherence and produces better health outcomes.
• Health systems utilize care provider time to focus more on care delivery which leads to increased care provider productivity and much improved experiences both for patients and care providers, all resulting in better health outcomes.

Behaviors that need to change to achieve the outcome

• Patients should scan, upload, and annotate their medical records in a secure online system, either by themselves, or with help from a health coach. This way, patients can leverage virtual care options much more effectively to get improved access to care. Patients will find this option easier to maintain and share their up-to-date health record compared to keeping a file of paper records where it is very easy to lose pieces of paper and also difficult and cumbersome to share. 
• Patients should work with a personal health coach who accompanies the patients to all their care provider visits and helps the patients understand and implement their specific care plans. Patients will find it easier and more comfortable to have just one easily accessible contact person to coordinate all their healthcare needs as opposed to working with multiple care providers who are also much more difficult to access.
• Care providers should consult a patient’s up-to-date medical records online each time they see a patient, and if a patient doesn’t have an online medical profile, care providers should encourage a patient to digitize their medical records for easy access and sharing. Care providers will find this much easier and less time-consuming compared to shifting through a patient’s paper file (if one exists), and they can also be more confident about providing much better and safer quality of care by having a much broader perspective of a patient’s medical history and social determinants of health.
• Care providers should use digital health tools and services to track a patient’s care adherence as per their care plan. Care providers will find these options to be much more effective compared to only being able to follow up when patients come back for a visit. Also, with a systematic approach to patient follow-ups, providers can track a lot of the patient activities outside of the clinic as a part of their clinical profile (e.g., blood pressure, weight, and glucose levels tracked at home) and use that to refine the patient care plans.

Theory of Change Model

Key technology solution components:

• Patient mobile application
• Open source EHR - OpenMRS as the backend store of medical records
• Blockchain to certify the veracity/provenance of medical records (i.e., they are untampered)
• Optical Character Recognition (OCR) to digitize records when possible
• Fast Healthcare Interoperability Resources (FHIR) interfaces to share data
• Sncho Care Plan application is a Smart-on-FHIR application that can integrate with any EHR supporting Smart-on-FHIR 

Tech Stack:

• BackEnd: MicroServices based API Architecture with Java, Spring Boot, NodeJS,combined with some serverless service
• Web FrontEnd: VueJS + Quasar
• Mobile: Flutter for cross platform development
• Data: Mysql, MongoDB
• CI/CD: Jenkins, Kubernetes, Docker
• Application Server: Tomcat
• Cloud: AWS
• ML: Python, Scikit, Tensorflow, Keras, OpenCV, PyTorch, AWS Sagemaker
• UI/UX: Figma, Adobe XD
• Dev Methodology: Scrum
• PM Tool: Atlassian JIRA
• Wiki/Documentation: Atlassian Confluence
• Repo: Atlassian Bitbucket

There are 3 main sources to collect primary health care data for our solution: 

Patients

Majority of patients' past medical history is in paper records, which the patients can upload into Sncho themselves using a smartphone or a computer. If such means are not available, patients can contact a Sncho health coach for this. Once uploaded, patients (or their health coach) can add simple annotations to the uploaded document, and Sncho also provides sophisticated Optical Character Recognition (OCR) tools that help transcribe the paper records into searchable digitized content when possible.

Health Coaches

• When a patient initially joins Sncho, they have the option to be visited by a Sncho health coach who will conduct an extensive interview to document their past medical history in Sncho. Then, in addition to helping patients upload and annotate their paper-based medical records into Sncho, health coaches also provide the services of a scribe during care provider visits to document the visit details into Sncho and record the care plan prescribed by the care provider.
• Once a patient’s care plan is defined, Sncho health coach follows up with the patient to document their progress and any adjustments to the care plan, including ongoing recording of their vitals and any other metrics recommended by the care provider. This also includes documenting medication prescription and intake, as well as any lab tests, and additional care services such as physiotherapy. 

Smart health devices

An option of a premium subscription to Sncho is to provide patients with wearable devices (such as Fitbit wristband, or Apple or Samsung watch) to track activity, sleep, oxygen saturation, as well as other connected devices to measure weight, blood pressure, blood glucose levels, and similar devices for home-based monitoring. The data generated from these devices is fed into Sncho so that their summary is also available as a part of a patient’s Sncho profile. This way, everyone in the patient’s care team can monitor the patient's physical activity and relevant stats (with the patient’s content).

Sncho’s leadership team (all founders) are fully aware that all three of us are Nepali men with relatively stable socioeconomic backgrounds, and do not exactly reflect the diverse population of Nepal whom we aim to serve. However, we are fully committed to becoming more diverse, equitable, and inclusive, and we plan to take the following actions to achieve this goal:

• As Sncho emerges from its pilot phase to full-scale product launch, expand the management team with hires that are representative of different social, cultural, and gender-identity groups in Nepal, starting with at least one executive (at full-scale product launch) who does not identify as a male.
• Next, as the Sncho team continues to grow, implement HR policies in practice that make Sncho’s job opportunities visible and available to wide ranging social, cultural, and economic groups within Nepal. This mainly means hiring and training local health coaches in rural areas to serve their local communities, as well as partnering with local nonprofits and NGOs who are committed to improving healthcare in rural regions of Nepal. Our goal is to create a diverse team of health coaches whose diversity is reflective of the population they serve.
• Similarly, since Sncho is in the business of improving access to healthcare as well as improving quality and safety of care, we plan to track clear metrics on the diversity of the populations we serve and see how closely they reflect the actual diversity of a region’s population.
• We feel that inclusion is most effectively practiced at each individual point of contact, whether it is our health coaches interacting with patients, or if it is our own team members interacting with one another. For this, we are primarily going to rely on ongoing inclusion training for all our staff, including the training staff in leadership positions to closely observe how (or if) inclusion is being practiced. Our aim is to be continuously reflective enough to recognize our individual biases, and work on addressing such biases to create an inclusive environment for everyone we serve, including our own members.

Overview

We are a social enterprise that serves our customers with both a for-profit as well as a non-profit model. We offer a freemium model where all customers have access to a free tier with basic services and a paid subscription tier with premium services. Our for-profit model primarily targets selling to clinics where the clinic pays a subscription fee for each care provider and patient in the Sncho system. For specific customers in disadvantaged communities and for non-profit and academic organizations, we plan to offer our premium services at a low or no cost subsidized by our own profits and any applicable grants or subsidies. 

Key Customer Segments and Product/Service Offerings

Following are our key customer segments and the products and services we provide:

Patients with chronic conditions and maternal care needs

• Free tier
  • Ability to create a Sncho profile to upload all medical records and securely share with any care provider so that the care provider can easily review their comprehensive medical history at each visit
• Premium tier
  • Personal health coach assigned to patient to accompany on each visit to care provider to document visit details so that they become a part of patient’s digital medical records help define a care plan 
  • Help implement, monitor, and adjust the care plan
  • Update the care provider on progress and facilitate any changes to the care plan ordered by the care provider (e.g., get new medications, blood draws and lab tests, physiotherapy visits, changes in diet and exercise regimen). Depending on the order facilitated, Sncho will issue a nominal service charge.  
  • 24/7 access to health coach by video call or secure messaging
  • Share health records and progress summary with family members designated by the patient and also update and alert them on patient’s progress with their care plan
  • Access to a panel of primary care providers and specialists for virtual consults

Clinics, Hospital Systems, and Independent Care Providers

• Free trial period
  • access to all premium services for free to service up to 5 providers and 100 patients 
• Premium tier
  • All the selected patients in a clinic or a hospital system will receive Sncho premium tier services. Such clinics and hospitals can choose to either pass on the Sncho premium subscription costs to their patients, or they can absorb it in their patient visit fee. We assume both the care providers and patients will be able to justify this cost based on the improved quality of care and their improved experience in delivering and receiving care.
  • Ability for Care providers to conduct video/virtual visits
  • Optional integration with the clinic or health system’s health records management system or EHR to synchronize related patient care data into their systems
  • Comprehensive reports and analysis of a clinic’s care delivery operations which can significantly help in improving operations and influencing future growth strategy. These include:
    • Access to care metrics
    • Quality of care metrics
    • Safety metrics
    • Staff productivity metrics

Healthcare Nonprofits and NGOs serving Rural and Disadvantaged Communities

Free or subsidized model to:

• Use Sncho’s systems to upload all their patient’s past medical records
• Train their community health workers so that they can use Sncho to log patient visit details, define care plans, and help implement, monitor, and adjust the care plan for the patients

Academic research organizations

• Free or subsidized model to access anonymized (de-identified) patient health records (with patient consent) to support academic research projects 

Unit Transaction Models

For Sncho premium services for patients:

• Monthly subscription fee for patients: Nepali Rupees (NPR) 2,000 -> USD 20
• Service fee for facilitating orders:
  • Lab Order - 5%
  • Pharmacy Order - 5%
  • In-Person Clinic Visit - 1 free visit per month, 20% of visit fee for each additional
  • Virtual Clinic Visit - 1 free visit per month, 30% for visit fee each additional
  • Home visit by health coach - 1 free visit per month, NPR 1,000/additional visit (USD 10)
  • Virtual visit by health coach - 4 free visits per month, Rs 500/additional visit (USD 5)

For Sncho premium services for clinics and health systems:

• Monthly subscription fee per care provider: NPR 5,000 (USD 50) / month
• Monthly subscription fee per patient in Sncho + service fee for facilitating orders (as defined in patient unit transaction model)

For Nonprofits, NGOs, and academic research institutions: 

Provide tools and services at cost, or for low to now cost, based on availability of subsidies and grants

We are planning Sncho’s operations in 3 distinct phases:

• Phase 1 - pilot phase where we implement our products and services with select pilot partners and get them ready to scale
• Phase 2 - go to market with a fully-featured version of our products and services with the primary focus on achieving scale
• Phase 3 - upon reaching a certain level of growth, expand products and services horizontally to provide a wider range of benefits to our customers

For phase 1, we plan to utilize seed funding from Snho founders and their friends and family, as well as seek grant and subsidy funds to scale our product development and refinement. We expect this sum to be approximately USD 1 million to support a pilot phase of about 1 year. 

For phase 2, we plan to raise capital (ideally from strategic impact investors) to scale our operations and achieve profitability while generating market-rate ROI for our investors. We will also continue to leverage grant and subsidy funds, as well as leverage a portion of Sncho’s own profits, to scale our work with nonprofit and NGO partners and also with academic research institutions. We expect the fundraising to be in the range of USD 2 to 5 million to support a phase 1 period of about 3 to 5 years, while reaching profitability at the end of the 2nd to 3rd year of operations.

For phase 3, we plan to raise capital from institutional investors to expand our breadth of services while continuing to invest in developing new products and services. The exact amount of capital needed for this phase is dependent on the outcomes of phases 1 and 2.

A high level financial projections for Sncho’s operations is as follows:

This assumes an initial funding of up to $1M to support the pilot and go-to-market, and another $2M to $5M in series A funding to scale the operations from years 1 through 5.

For the pilot, Sncho has raised $100k from its founders and their friends and families and is seeking grants and subsidy fundings to cover as much as possible of the remaining needs.