Sehat Kahani

Pakistani women suffer the highest rate of maternal mortality in South Asia. In Pakistan only 37% of women have attended four or more antenatal care visits as mandated by WHO. Women in Pakistan face the discrimination of not being able to visit healthcare centers due to socio-cultural restrictions, inaccessibility and affordability. The situation is further worsened due to lack of female doctors as 77% of female doctors in Pakistan discontinue from practicing medicine post graduation. To bridge these failures, Sehat Kahani aims to democratize healthcare ensuring easy accessibility to quality healthcare for women and children who are particularly devoid of healthcare by building an all-female health provider network to deliver solutions through our e-health clinics and mobile health application. As we continue to seek global health equity, the proposed solution can empower women to make informed choices while continuing to build capacity of health professionals to deliver evidence based care

In low and middle income countries, women face a lifetime risk of maternal death of one in 160, as compared with 1 in 3700 for women living in high income countries. Most women die of preventable complications that account for nearly 75% of all maternal deaths. Pakistan has the highest maternal mortality ratio in South Asia accounting for 20% of the 8000 annual deaths among women of child-bearing age while currently being ranked 26th in the world for under-5 child mortality rates. Improving maternal and neonatal health outcomes requires the World Health Organization (WHO) recommended number of antenatal care (minimum of four ANC visits). In Pakistan, only 37% of pregnant women obtain the WHO suggested minimum of four antenatal visits. The coverage of PNC is also relatively poor and, therefore, nearly 40% of women develop complications following delivery and an almost 15% encounter potentially life-threatening complications. Furthermore, recently, Covid-19 response is impacting the availability of essential health services especially for pregnant women and newborns due to restrictions on travel and gatherings, health facilities with limited supplies and disrupted community health worker routines threaten to exacerbate the limitations when it comes to access to care, thus negatively impacting women’s health.

Our solution is to  connect pregnant and postnatal women to qualified home-based female doctors using IT-enabled platforms ensuring that Pregnant women are able to complete the WHO recommended 4 antenatal visits remotely through our telemedicine technology.

We also utilize our 24/7 mobile application and a customer support helpline to provide access of virtual consultations for pregnant women who might have COVID symptoms, to conduct follow up appointments, to support women at risk of or currently experiencing mental health problems, to tele-monitor the symptoms of COVID  pregnant women in home isolation and to be able to tele-triage for referrals for obstetrics complications as well as COVID related complications and to provide breastfeeding support and early parenting advice. 

In addition our solution empowers these women to view their lab reports and scans remotely while discussing it with our network of specialists in the comfort of their homes. Our technology is also integrated with SMS reminders to alert them for their virtual appointments; thus improving better service utilization. Our innovation ensures that women receive high quality care and regular access to essential services while minimizing the need for travel to antenatal clinics and face-to-face contact with healthcare staff during the current pandemic. 

At demand end our target beneficiaries are the women and children living in marginalized communities that do not have the accessibility to quality and affordable health care services. The already weakened public health system has been further overwhelmed by Covid that has resulted in poor utilization of ANC services by these beneficiaries. On the supply end our beneficiaries are the female doctors that are not being utilised to their full potential 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-centered design approach. Our network of doctors are trained to view women as customers (rather than patients), and customers are asked to provide feedback on the degree to which their doctors treated them with dignity and respect. Through these techniques, Sehat Kahani provides a service that women value, building a demand for low-cost, customer-centered maternal healthcare that has translated into a greater likelihood of women availing remote services for antenatal checkups before their delivery. Our solution is also paving the way for unemployed female health resources to continue their medical practice remotely while building their capacity to utilize ICT based solutions in their practices.

Sehat Kahani aspires to improve accessibility to quality maternal health services via consistent, sustainable and easily replicable digital solutions by accessing a large network of untapped home based female doctors. Through  our e-clinic model, mobile application and 24/7 helpline we have developed a viable product that provides quality and affordable healthcare services remotely. This enables us to not only improve maternal and neonatal outcomes but also promotes gender equality by empowering our beneficiaries to make informed health choices. In addition, reiteration and capacity building of female health professionals would help to promote economic growth and build sustainable communities.

A Health tech company built by women for the women of the society; Sehat Kahani is innovative in it’s market preposition and the value it brings to not only the beneficiaries who seek helathcare but also to its supply end that is the doctors. Sehat Kahani uses secure technology that utilizes web standards and features HIPAA-compliant privacy controls and sharing preferences for each user while collecting and integrating data. We are data aggregators striving to streamline true health data in relation to maternal and neonatal outcomes that have been underreported in Pakistan. Sehat Kahani competes against gender based socio-cultural barriers to deliver authentic and reliable healthcare services. Being one of the pioneering teams being in the field for more than 4 years, piloting and iterating revenue streams, treating actual paying customers. Our competitors usually focus on 1 income bracket beneficiaries belonging to specific market segments whereas our solution caters to deliver maternal health services to all income markets with the 2 distinct verticals i.e the E-Health Clinics as well as the Mobile App with a special focus on women belonging in low income communities. In addition, unlike our competitors we are delivering a holistic solution that comprises virtual ANC appointments, SMS reminders, e-pharmacy, e-labs and referrals.  We pride ourselves for rebuilding an extensive network of female doctors, specialists and nurses by empowering them to reach their patients remotely, while saving valuable clinical time during current pandemic. 

Our technology is a complete end to end solution for our beneficiaries that include features such as: doctor’s profile with appointment slots booking, complete patient EMR system, video-consultation, chat to doctor, e-prescriptions and e-labs. We use real time data analytics to find disease patterns utilizing data that was never captured before. We use Power BI in analysing patient data that is automated into real time dashboards to understand existing health needs of our beneficiaries. In addition for data storage we utilize the Microsoft Azure cloud services, along with its compliance to HIPAA standards to ensure patient data protection. In addition, our technology is integration with SMS APIs that enables automatic SMS reminders to our beneficiaries with follow up appointment details. For follow up visits that do not require physical visit to e-clinics, beneficiaries can utilize our mobile application that is widely available on iOS and android app stores. Through the mobile application these beneficiaries can avail virtual antenatal care consultations, access counselling services as needed and view/download their labs, scans, e-prescriptions, referrals and health education material remotely. We also aspire to integrate machine learning in our existing technology to improve user engagement through AI integration in order to analyze user behavior to provide insight into the user. We will utilize this information to make changes for better user engagement. In addition, by integrating chat bots, predictive algorithms and real time automated dashboards, beneficiaries utilizing our solution will be able to make a well-informed decision.

Globally. Health professionals use video consultation for remote diagnosis and therapy, clinical consultations, education and training, and administrative/business functions. High levels of satisfaction are generally reported among patients with respect to timely access to specialty care and reduced inconvenience and cost of travel. A Virtual Obstetric Care program with normal visits combined with teleconferencing visits for low-risk pregnancy showed no increased risks in health outcomes besides an increase in preeclampsia diagnosis. Another demonstration project describes a promising system of a wirelessly enabled maternal-fetal monitoring system MiBebe, used for the improvement of perinatal care in rural regions in Mexico. In the group of 153 high-risk pregnancies, the remote monitoring in 74 patients resulted in markedly increased adherence to antenatal visits with no adverse health outcomes compared with usual care. One pilot study describes an alternative prenatal care schedule, including an integrated technology platform (mobile app, wireless weight scale, and blood pressure cuff), leading to a 43% reduction in outpatient visits. There was an increase in satisfaction and patient engagement and no change in perinatal outcome despite the decrease in face-to-face contact. Remote monitoring and consultation can potentially reduce outpatient visits for antenatal consultation as well as hospitalization for certain clinical reasons. 

Through our innovation we have been able to introduce technology in communities lacking awareness of it and use it as a medium to bring behaviour change to empower women to consider their health needs as priority. Our solution aids in consultation, diagnosis and management of data to reduce physical errors. Through our E-Health services, we have increased sensitization towards vital diseases reducing the burden on the economy and improving the health status. We envision being able to aggregate and extrapolate missing data from communities to measure definitive changes in health indicators of the country. While on the other hand at a social level, by being able to work from the comfort of their homes, these doctors can play a major role in managing the healthcare sector challenges while mitigating cultural and social sensitivities. Additionally, they gain financial inclusion, access to virtual continuing medical education sessions, recognition on social media, a chance to attain additional certifications and most importantly, a whistle-blower initiating behavioral change for telemedicine in Pakistan. Through our services, we strive to bring measurable social and health impact in its target communities and meet the global vision of access to ‘Health for All’.

Our logical framework is as follows:

Input:

• IT infrastructure: equipment and network

• Manpower: Service providers and patients

• Skills & Knowledge

• Funding

Activities:

• Telemedicine system development

• Access to Electronic medical records

• Video consultations

• Training and education

Outputs:

• Improved accessibility to health services

• Better professional communication

• Enlarged catchment area

• Improved affordability of services

Outcome:

• Improved quality of care

• Enhanced efficiency

• Patient satisfaction

• Provider satisfaction

• Improved quality

• Improved cost

Impact:

• Improved maternal and neonatal outcomes of target beneficiaries

• Improved health related quality of life

• Improved awareness of maternal and neonatal complications 

Current number of beneficiaries at supply end

Female doctors and specialists: 1500
Female community health workers: 50

Current number of beneficiaries at demand end

Women and children living in low income households: 1,230,000
Women and children in peri urban or urban communities: 185,000

After one year, number of beneficiaries at supply end

Female doctors and specialists: 2000
Female community health workers: 65

After one year, number of beneficiaries at demand end: 3000 

Women and children living in low income households: 100,000
Women and children in peri urban or urban communities: 200,000

After five years, number of beneficiaries at supply end

Female doctors and specialists: 5000
Female community health workers: 100

After five years, number of beneficiaries at demand end

Women and children living in low income households: 15 million 
Women and children in peri urban or urban communities: 30 million

Sehat Kahani intends to grow its current business by replicating our E-Health services and utilize in the infrastructure, technology and the number of staff. But more strategically Sehat Kahani envisions to not only become a market leader in Digital Health in Pakistan but also become a global player as well.  In next five years, Sehat Kahani envisions establishing 101 E-Health Clinics Nationwide and aims to train a Network of 5000 doctors, health providers and mobilizers developing independent micro entrepreneurs or consultants on the Sehat Kahani Panel. This would result in a cumulative impact of approx. 15 million lives both directly as well as indirectly through the E-Health clinic and health education services which Sehat Kahani provides creating a Gross Revenue of around 8.8 Million USD with an anticipated Net Revenue of around 2.7 Million USD.  Sehat Kahani also plans to build a strong network of corporates and industry magnets (Including FInca, Banks, Telecoms and Pharmaceuticals as the key giant players) as early adopters to champion Sehat Kahani’s vision and impact. As a greater target through its E-Health application, we aim to be able to lock over 30 million active users availing e-health services through the E-Health application, shifting the trend from physical 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. 

The following challenges and consequences are anticipated for adapting, integrating, and scaling our innovation. Foremost software and Internet related risks include disruption of Internet connectivity as well as software issues that can cause distortion in the real time consultation. This usually takes place due to climatic changes, electricity disruptions and low bandwidth issues. Social acceptance risk includes acceptance and encouragement of using telehealth services by the community as compared to traditionally visiting doctors and community health workers. Third challenge is affordability of community beneficiaries to access health services. Financial motivation may hamper the participation of these women to access our services. In addition there is also a risk of breaching privacy and confidentiality. This includes a breach of private data from a digital platform including online medical history form, current diagnosis and management plans. 

To overcome the barriers mentioned above, Sehat Kahani has developed a strategic contingency plan. To mitigate software and Internet related risks, Sehat Kahani will conduct an extensive field technical assessment to assess bandwidth and internet coverage issues. In addition, internet dongles and boosters will be placed to ensure seamless connectivity. Furthermore, our technology will be integrated with an offline model to store and forward patient information once internet connectivity resumes.. For social acceptance risk mitigation strategy includes focused group discussion, community based marketing for e-health model and digital marketing for our mobile health application to induce awareness and increase acceptability. To mitigate affordability of community beneficiaries to access health services Sehat Kahani has developed and implemented cost effective and subsidized models on health services. To mitigate risk of breaching confidentiality, Sehat Kahani will sign Non-Disclosure Agreements with all doctors and frontline health workers enrolled in the program. Furthermore, Sehat Kahani technology utilizes Web standards and features HIPAA-compliant privacy controls and sharing preferences for each user.  In addition all electronic data will be controlled by an admin based in HQ only. Access to data will be restricted to relevant personnel only.

N/A

Full time: 92

Part time/ contract based/ project based: 32

At Sehat Kahani our goal is simple: to improve health accessibility by engaging patients and beneficiaries in secure communications to improve their health and enhance their quality of life. Sehat Kahani was co-founded by two female doctors, Dr. Sara Khurram and Dr Iffat Zafar who had each faced the socio-cultural barriers of not being able to have a supportive environment to fulfill their career ambitions while realizing the dearth of health resources that has negatively impacted health indicators of Pakistan. Our team of experts is well equipped to design, develop and deploy mobile health solutions that are cost effective and easy-to-use, thereby creating convenient, accessible and remote health care options for our beneficiaries. Key qualities of our team that facilitate a seamless transition in telehealth delivery include patient-centeredness, high quality care, collaborative approaches, sustainable financial models, and accountability. Our team is highly dedicated working round the clock to bring about the desired outcomes and results expected from the project. We have a democratic leadership style in the organization that allows for constant feedback and flow of ideas among team members that further improves the likelihood of project success. Our experienced development team will create telemedicine solutions that will enable excellent results in healthcare superiority and effectiveness while providing safe and accessible remote care to our beneficiaries. Our multidisciplinary team with diverse backgrounds assesses beneficiaries’ needs to see what their barriers to care may be and helps to address them by implementing and continually improving our services. 

Our strategic partnerships and collaborators include: (1) Engro Fertilizers- utilization of Sehat kahani telemedicine model to deliver health services amid the COVID-19 pandemic. (2) Aga Khan University, Saaya Health, Taskeen and IRD for COVID-19 Pakistan Mental Health Response.  (3) With Yaran-e-watan (a Governmental initiative to tackle COVID) we are providing a telemedicine platform through our mobile application to medical professionals in diaspora to deliver healthcare services in Pakistan. (4) Collaborated with Digital Pakistan to expand Sehat Kahani users for mobile application through awareness and marketing activities.  (5) Partnership with 10 pearls for the development of mobile health application for Sehat Kahani smartphone users. (6) Partnership with digital care and medical city online for electronic medical systems. (7)  Microsoft 4Afrika for our Sehat Kahani server application support. (8) Our telecommunication operators such as Jazz and Zong who are involved in subsidised SMS bundles, SMS notifications, 24/7 helpline and education/awareness messaging. (9) Our development partners include UNICEF, UNDP, GSMA, World Bank, DFID, Australian Aid, Amplify, USAID, SPRING and Engro Foundation (10) To improve access to mental health services across low-income communities in Pakistan, we have collaborated with British Asian Trust, Taskeen Health Initiative, Karwan-e-Hayat, Legal Aid Office and IRD Pakistan. (11) To provide access to virtual consultations through our mobile application to corporate employees we have partnered with several corporations including 10 Pearls, Avery Dennison, Novo Nordisk, ICI, Roche, Samaa, Philip Morris Pakistan, GEO TV, Dawn, Jazz, Jazz Cash, Careem, Abbott, CCL, Adamjee Life, Smart Choice, Daraaz and Coke

To bridge the gap between access to underserved populations and an untapped resource of health professionals, Sehat Kahani aims to empower female doctors to rejoin the workforce by providing them with opportunities to use IT enabled solutions to deliver quality healthcare to patients located far away. Sehat Kahani has now evolved to be complete and holistic telemedicine solutions with services focus on all market segments via two health care verticals: (a) E-Health Hubs and Health Education: At Sehat Kahani E- Health Hubs a front line worker is trained to act as an intermediary for our beneficiaries to connect with qualified home based female physicians and skills specialists using video consultation and Electronic Medical Records systems. Sehat Kahani through these E-Health hub associated communities also conducts preventive health care drives entailing healthcare education to bring out a long term change in behavior and health patterns.  (b) Mobile health Application: Through this application, users can obtain quick consultations with general and specialist female doctors along with keeping track of their health history and obtaining digital prescriptions. Our target users who benefit from these services include: (i) B2B solutions enable corporate businesses to use this app as a tool to meet the primary health needs of their employees.  (ii) B2B2C solution is for corporations with a larger consumer base, such as banks, insurance companies and telecom firms who are able to provide app services to their clients and (iii) B2C solution is for retail users targeting more than 74 Million of smartphone users.

Sehat Kahani follows the following revenue model for its respective services: (a) E-Health Clinic Services: Sehat Kahani charges $0.5 per patient / virtual clinic consultation for General Consultations and $3 for specialists. For every consultation we have a shared revenue model, 30% is for nurses and 70 % is for Sehat Kahani. For Health Education Drives, the company creates revenue from management fees capped at 20% of the total activity cost. (b) E-Health Application: The revenue model for e-health application is designed based on the three segments of users: (i)B2B: For every user a subscription fee of $4 is charged. With shared revenue, 15% is for doctors, 5% of the revenue is for sales commission and 5% is for software support and 75% of the revenue is the net revenue for Sehat Kahani. (ii)B2B2C: For every user a subscription fee of $5 is charged. With shared revenue, 13% is allocated to doctors, 20 % is for corporations that are adopting the Sehat Kahani e-health application, 9 % for sales and software support and 58% of the revenue is the net revenue for Sehat Kahani and (iii) B2C: For every user a fee of $1 is charged for consultation. With shared revenue, 50 % is for doctors, 20% is for software support and 30% is the net revenue for Sehat Kahani. For our envisioned scale-up we are also seeking investment of 1 Million USD. The company is in the process of raising this investment/funding by extensive due diligence with potential investors. 

We feel that the MIT community can help us work on our collective strengths. It can help us emerge as better leaders for our company as well as for our collective vision of using our untapped female doctor force to create health accessibility for not only undeserved segments in our country but also globally. 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 mentor-ship from experts will enable us to expand our solution sustainably while improving utilization uptake of our beneficiaries. The funding will also enable us to integrate necessary technological up gradations such as AI integration, chat-bots 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 to meet the overwhelming healthcare needs due to COVID.

Our partnership goals are focused on:

(1) Scale Up – We aspire to build consortiums at National and international level to build synergies for sustainable development. We are looking for partners who can match their resources with ours to scale our solutuion, gain new active users and maximize utilization of our services to a greater number of beneficiaries that may be beyond our reach at the moment.

(2) Strategic Development: We are actively seeking support to improvise the business development strategies.

(3) Technological Support: We are looking for synergies that help us integrate machine learning and AI in our existing technology while improving our interface for better user experience and engagement. 

(4) Human Resource management – We are looking for a network of doctors and specialists across the globe that will be interested to utilize our solution to continue their medical practice. 

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.

By utilizing a pool of qualified female physicians, Sehat Kahani created its state of the art Telemedicine solution which has successfully catered to more than 165,000 patients across Pakistan to date. Clubbed with its health education drives, Sehat Kahani has successfully impacted more than 1,230,000 people across Pakistan.

During the current COVID crisis; An already fractured and fragmented healthcare system in Pakistan is struggling to meet the increasing needs of patients being detected for coronavirus every day while the regular Outpatient departments of hospitals have been shut down. In this time of national crisis we have played a very prominent role to ensure people are able to access qualified healthcare professionals while maintaining social distancing through Sehat Kahani and the providers of all of these services have been female physicians. We strongly feel that because of this; Sehat Kahani definitely deserves the Innovation for Women Prize. 

We envision to become  Global Leaders in E-Health and Mental Health and to leave a legacy behind. While the Globe is undergoing a complete transformation in terms of healthcare access; telemedicine is sure to become the new normal and through Sehat Kahani Dr. Iffat is confident that this will be one of the pioneering Female Led Pakistani initiatives which leaves a major Global Impact. 

The push towards Universal Health Coverage (UHC) in the global health agenda is currently challenged by a lack of women health workforce that is related to gender equality. Poor health indicators in Pakistan are attributable to a weakened public health system and shortage of human health resources as 77% of the medical female graduates in Pakistan do not practice medicine due to socio-cultural barriers. We are rebuilding all female health workforce in Pakistan in the following capacities

• Female medical doctors are employed to provide consultation to communities deprived of primary health care. They are required to make decisions on the mode of treatment provision.
• Community midwives workers belonging to marginalized communities are engaged to be made in to micro-entrepreneurs within their areas so that they can serve as intermediaries for women in communities to avail health care through our telemedicine solution

The funding will be utilized to increase employment opportunities for these women to utilize our solution to reach their beneficiaries. Funding will enable Sehat Kahani to develop training programs that are internationally recognized thereby providing capacity building and leadership skills to women who belong to the healthcare workforce. It will also be utilized to increase telehealth capabilities in response to the COVID-19 pandemic. This will enable these professionals to maximize telehealth for COVID-19 referrals for screening and testing, case management, outpatient care, and other essential care during the crisis.

While maternal deaths worldwide dropped by 44 percent between 1990 - 2015, roughly 800 women still die every day from preventable causes related to pregnancy and childbirth. Almost all these deaths occur in low- and middle income settings due to conditions that include severe bleeding, infection, high blood pressure, and complications during delivery.

Against this backdrop, we need to make faster progress—particularly if we are to achieve the 6 to 9 percent annual reduction in mortality rate that is required to meet the Sustainable Development Goal targets by 2030. Primary health care systems are often ill-equipped to prevent or address underlying causes of illness or other complications, and links to functional referral level care are often missing. Resourcing for health is often insufficient or fragmented and accountability for policy implementation is lacking in many settings.

Sehat Kahani envisions a world in which healthy mothers deliver healthy babies, receiving quality care from skilled and well-equipped health care workers. We invest in efforts to better understand and develop products to address underlying vulnerabilities and promote resilience among women and children. We also prioritize efforts to develop and deploy innovative systems and practices to improve the productivity, quality, and responsiveness of primary health care systems through ICT based interventions. We also provide an alternative to traditional record keeping by allowing parents, providers and community health workers access to patient records, whenever and wherever the information is needed, using simple, ubiquitous technology. 

By utilizing the funds, we aim to remove the barriers to achieving high utilization of primary health visits by utilizing an electronic, cloud-based system for beneficiary registration, medical record keeping, incentivizing, and interactive knowledge and belief assessment about availing essential primary health services for safe antenatal care. Our ehealth clinic module is designed to focus on the poorest and hardest-to-reach segments of the population. The funds will help us to scale our solution in other communities, upgrade our technology as well as will help us to identify (in real-time) regions where service utilization is limited, and to permit community-based, targeted interventions aimed at increasing health service coverage.