Sehat Kahani

Sehat Kahani addresses the following market failures and challenges: 

(1)Lack of accessible and affordable health care system: Pakistan, a population of 207 million and one of the fastest economies in the world, still struggles to provide basic healthcare to more than 50% of its total population. Around 78 million people live below the poverty line and lack access to good health and well-being. This takes a toll on the lives of low-income populations particularly women and children as seen by the critical health indicators such as high infant mortality (62/1000 live births) and maternal mortality (178/100,000 live births) rates and by the fact that every 3rd child has to suffer from stunting as a consequence. 

(2)Lack of convenient healthcare for middle to upper-income markets: On the other hand, 90 million inhabitants live near quality health infrastructure but lack the time and convenience in visiting tertiary centers and waiting in long queues. In addition due to the recent pandemic, OPDs are closed down due to nationwide lockdown and tertiary facilities are overwhelmed by increasing numbers of COVID cases. Hence an alternate solution is warranted that provides remote health care where needed without the fear of COVID exposure.

(3) Weakened human health resource: The dearth of health professionals can be seen by the current density of doctors being 0.8 per 1000 patients and the density of nurses being 3.8 per 10,000 patients. According to Pakistan Medical and Dental College, 60% of the students graduating from medical college are female, yet 77% of them disappear from the workforce within the upcoming years. 

(4) Lack of empowerment for female health professionals: A significant contributor to the dropout includes the placement of socio-cultural restrictions by in-laws after getting married and having kids, emphasizing their priorities at home. Thus the lack of support from family and society enforces female medical graduates to undergo the ‘doctor bride’ phenomenon where they are required to choose their families forsaking their careers and face gender inequality in the health workplace.

(5) Lack of employment opportunities: Alternatively, doctors, lady health workers, nurses, and community health workers are being trained by the government in abundant numbers but are deprived of employment opportunities that can help them in sustaining decent work and economic growth.  

This tragic situation calls attention to the need for greater investment and a strategic shift in healthcare in Pakistan.

Sehat Kahani is a health tech impact business that aims to democratize health care for all using a network of qualified and previously untapped network of female doctors using telemedicine. We have created a network of e-Hubs (walk-in clinics) that connects users to qualified female doctors online, while qualified nurses or health workers act as intermediaries. We have also launched a telemedicine-based mobile app that allows a patient to record their health history, chat and conduct an audio/video consultation with an available network of qualified doctors and obtain a prescription as well as the facility of at-home pharmacy delivery and lab tests (through partner organizations)  to increase convenience for people from the more urban markets. In addition, we have deployed a preventive health portfolio to improve health education and awareness in untapped communities. We have a 24/7 helpline for our beneficiaries to avail of health information or a consult from our network of doctors. Sehat Kahani has been able to make revenue over the net, create key collaborations and partnerships across all service lines with a female majority team.

1. Sehat Kahani runs two prominent verticals; i) which caters to the marginalized populations through a network of nurse-assisted telemedicine-focused e-health clinics in all 4 provinces and ii) A telemedicine-based mobile application. This app is available in the retail market as well as the corporate market. 

2. Sehat Kahani has a network of 6000 female health doctors and around 1000 allied health workers trained to continue their medical practice through telemedicine. Many were previously unemployed. 

3. Through these 35 nurse facilitated e-Health clinics, 750+ corporate partners, and more than 300,000+ retail users, Sehat Kahani has conducted over 550,000 consultations to date and reached 7.2 million beneficiaries through health promotion, expansion, and digital outreach.

Our innovation has made a significant impact based on the following metrics: 

(1) Earlier and faster access to medical care in low-income communities:  A major barrier to healthcare in Pakistan is the significant distance to a healthcare facility and the high cost of transportation. We have reduced costs and improved convenience by offering an alternative to costly travel to clinics or hospitals. Instead of face-to-face appointments, we are offering virtual consultations through our technology thereby ensuring cost-effective, earlier, and faster access to medical care. Through our e-health clinic model we have provided virtual consultations to 550,000 beneficiaries and provided health education, screening and referrals to 7.1 million beneficiaries through preventive campaigns. 

(2)Increased utilization of health services for middle and upper-income markets: For those middle and high-income populations that can afford healthcare but face time constraints in being able to visit a doctor, Sehat Kahani provides access to an efficient E-health solution based on its web as well as mobile application platforms to attain health coverage in the absence of alternatives. Through our mobile application, we have engaged 350,000 new active users and provided our technology to 750+ corporates. 

(3)Increased accessibility of holistic health solutions for end-users: access to virtual treatment; Crystal-clear video and the image upload feature allows patients to interact in real-time and physicians to diagnose and treat their patients remotely. In addition utilization of Electronic Patient Records; a complete, exportable record of the visit that can be submitted for tertiary referrals, and easily added to a practice’s EMR. Furthermore, access to pharmacy, labs, and diagnostics in the clinics and at-home lab and pharmacy services on the application via partners. 

(4) Cost-effectiveness: 1/10th of the price of a physical consultation along with time and effort saved for traveling far off to get a consultation.  

(5) Empowering medical professionals and Health Workers:  Sehat Kahani has provided avenues for job creation of unemployed female health care professionals. We have built a network of 6000 healthcare professionals that are delivering healthcare services through Sehat Kahani E-health clinics and mobile applications. In addition, we are also continuously training our network of health care workers with updated SOPs. This enables them to deliver evidence-based health care services to beneficiaries.  

(6) Empowering patients by Self-screening technology: We have integrated self-screening SOPs in our 24/7 helpline that allows patients to guide themselves through a screening process for their health issues and timely referrals for further testing and screening.  

 (7) Improved access to health education and promotion through Webinars: Sehat Kahani through its series of webinars educates individuals on various aspects of healthcare benefits to increase the appropriate utilization of resources. 

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. 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 to 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 further improving 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. We periodically conduct user validation for our human health resources by engaging them in ongoing feedback sessions regarding any modification of our technological solution to improve its interface or effectiveness. We also conduct in-depth interviews to understand any challenges they might face while using our solution. 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. We conduct focused group discussions with our users so that their experiences can be shared. We generate beneficiaries' reports that comprise end-user requirements and formal assessment across technical, clinical, usability, and cost domains of all vertices of our solution.

We have a five-year track record of creating e-health and m-health solutions that have been utilized by over a million beneficiaries. With the current pandemic implications, we aspire to expand our solution that is accessible to a wider, eventually global, audience. With the MIT Solve, we want to empower and create employment opportunities for the female health workforce to utilize remote solutions in order to improve health outcomes in Pakistan. We feel that the community can help us emerge as better leaders for our company as well as support our collective vision of strengthening primary healthcare in Pakistan by integrating 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 the utilization uptake of our beneficiaries. The resources from Solve will also enable us to integrate necessary technological upgradations such as AI integration, chatbots, and automated algorithms that will enable us to predict the health patterns of our target beneficiaries which is extremely pivotal for us to understand and analyze especially healthcare needs of our users thereby creating a more affordable and accessible solution for our beneficiaries. The support will be used to expand our operations while continuing to build the skills and capacity of health practitioners to utilize and integrate our services and products in their practices while expanding our reach to communities and beneficiaries in need of quality affordable, equitable, and accessible healthcare services.

Led by a team of mostly females, Sehat Kahani competes against gender based socio-cultural to deliver authentic and reliable healthcare services. Sehat Kahani has the first mover’s advantage of being in the field for more than 3 years, piloting and iterating revenue streams, and treating actual paying customers. We are the data aggregators striving to streamline true health data that has been underreported or misreported in Pakistan. We have made revenue from over the net, created key collaborations and partnerships across all service lines and won national and international recognition for our work. We have a wide market reach and a potential to scale our solution to 76 million Internet users and 165 million cellular users. We pride ourselves for rebuilding the human health resource of Pakistan by creating an extensive network of female doctors, specialists and nurses who have been unemployed. In addition, our solution is designed to give doctors a greater ability to reach and effect positive changes for their patients, while saving valuable clinical time. For any health care situation, patients and providers can collaborate on an "action plan" to drive greater engagement and adherence – from anywhere.

 Sehat Kahani technology utilizes Web standards and features HIPAA-compliant privacy controls and sharing preferences for each user. Powered by the convenience, ease, and affordability of Sehat Kahani telehealth mechanism, providers and patients alike could no longer be burdened by the longstanding paradigm that patients bear the responsibility of physically traveling to the care they require. Due to its remote access, we have the competitive advantage to remain operational during the current pandemic where OPDs and many hospitals are shut down due to risk of exposure to COVID. Sehat Kahani web and mobile health solution promises improved outcomes, significant cost and time savings and the agility to compete profitably moving forward.

Telemedicine is a growing market globally that is expected to grow and become a 202 Billion USD market by 2025. Sehat Kahani; like all the other Global Players in the telemedicine market, intends to grow its current business by expanding its Telemedicine Platform in Pakistan and markets with similiar challenges such as Nepal, Bangladesh, etc. 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 has grown tremendously. We raised our Pre-Series A round of investment of 1 million USD in March this year and we aim to move towards a Series A of around 8 Million USD in the next 18 months to facilitate the growth. Sehat Kahani has already built 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. In the next 5 years, we aim to be able to lock over 10 million active users availing e-health services through the E-Health application, shifting the trend from physical health towards virtual OPD consultations and other digital diagnostic services. Sehat Kahani is also in the process of creating strong Public-Private Partnerships ensuring Primary Healthcare access is taken up by the government and creating potential impact by creating more than 100 nurse-led E-Clinics across Pakistan. By 2027, Sehat Kahani envisions scaling up the E-Health Application both within Pakistan as well as Globally and becoming a leading global brand in the arena of telemedicine. Our long-term sustainability plan includes not only enhancing the services in the current mobile application to enhance the overall user experience but also being able to integrate modules such as chatbots, integrated modules as well as AI enabling to scale the current Mobile Application operations.

E-Clinics:

a)Number of patients reached via general physical consultations/ specialist consultations, VAS services, Laboratory services, Ultrasound services and tertiary care referrals monthly, quarterly and yearly in next 5 years b) Number of follow up patients monthly, quarterly and yearly in next 5 years c) Number of doctors/CHWs/Nurses engaged/working actively within the network yearly d) Number of beneficiaries mobilized monthly, quarterly and yearly in the next 5 years e)  % of patient conversion after mobilization monthly, quarterly and yearly in the next 5 years f) % of patient satisfaction after using the clinical services  g) % of employee social and financial upgradation yearly h) % sustainability and growth achieved per vertical yearly 

Health Education and Preventive Campaigns:

a)Number of beneficiaries impacted per campaign b) Number of doctors, Nurses, and community health workers engaged in each preventive care campaign c) % decline in targeted health burden of the community after campaign d) % of percentage of patient sent for tertiary care referral after campaign e) %Enhanced knowledge of the community members After campaign f) % sustainability and growth achieved per vertical yearly 

Mobile Health Application:

a)% of corporates/ Third parties bank, insurers engaged for the concierge model  b) Number of beneficiaries covered under the corporate concierge model monthly, quarterly and yearly c) % of new and follow up patient consulted under the model monthly, quarterly and yearly d) % of patient satisfaction after using the corporate concierge model monthly, quarterly, yearly e) % of employee retention and social/financial up-gradation yearly f) % sustainability and growth achieved per vertical yearly

Our theory of change is as follows:

Input:

• IT infrastructure: equipment and network infrastructure for strong connectivity

• Manpower: Service providers and patients- Create job opportunities by hiring female doctors and specialists and community health workers for adoption of our solution in their practices. 

• Develop skills & Knowledge of at least 5000 more female health workforce 

• Funding (Internal and External)- 8M USD funding is required to have envisioned scale-up is next 18 months; 1.2 M funding has been raised through pre series round A in 2021

Activities:

• Mobile based application development and troubleshooting on 1000 users with upgradations

• Provide access to video-conferencing and value added services to more than 350,000 beneficiaries through our e-health clinic model and more than 300,000 beneficiaries through our mobile health application in next one year

• Build partnerships with at least 50 corporations and organizations for scaleup and adoption of our solution.

• Integration of AI, machine learning and predictive algorithms in existing solution in next six months 

• Interface for e-labs, e-pharmacy, e-referrals and e-monitoring (for home isolation for suspected COVID cases) in existing technology

• Increase efficiency of our 24/7 helpline to screen suspected COVID Cases

• Training and education of at least 5000 healthcare professionals to implement our solution

Outputs:

• Improved accessibility and affordability to health services to 1 million beneficiaries collectively in next one year

• Better professional communication among 5000 female health professionals network build to adopt our solution

• Enlarged catchment area by reaching out to 500,000 beneficiaries who are smartphone users and can adapt out innovation in order to avail services in the next one year

Desired Outcome:

• Improved quality of care

• Enhanced efficiency

• Patient satisfaction

• Provider satisfaction

• Improved quality

• Improved cost

Impact:

• Improved accessibility to health services

• Increased avenues for screening and referral of suspected cases

• Treatment management for primary health ailments including mild COVID cases 

• Continuity of e-monitoring and following for suspected COVID patients in home isolation

• Improved health related quality of life

• Improved awareness of primary health as well as for COVID and its complications 

• Increased employment opportunities for provider to utilize remote solution to reach their patients

Our technology:

(a) Software for e-health clinic model: The first constitutes licensed software provided by our technical partner named Digital Care and Virtual Healthcare Professional to facilitate tele-consultation through the access vertical. This software is a complete end to end solution for the telemedicine module being operated at the Sehat Kahani E-Health Clinics. A few features of this software include:1)Doctor’s profile with appointment slots booking2) Complete Patient EMR system 3)Complete patient history and patient's record created by clinical assistant (nurse) and then updated by the online physician 4)Tele-consultation with the physician 5)Online E-Prescriptions 6) Complete doctor’s notes and final case summary 7)Other features include possibility of uploading lab reports, x-ray reports and linking it with the patient’s file 8)Monthly data collection through an internal dashboard 9)Data Analytics providing monthly summary of the disease patterns, service utilization etc. A typical tele-consultation process entails that as the patient enters the clinic, he/she is registered on the system with all relevant demographic details. Once registered, this patient is given an appointment for consultation. This is also reflected at the doctors’ end. The doctor then starts video consultation with the patient. This process is mediated by the nurse at the patient’s end, who collects vitals and records them along with any other important information (history, examination) into the patient's profile. The doctor also adds any relevant information obtained during the consultation into the patient file and saves the file in her record. Once she has completed the entire procedure, consultation is ended. The summary of consultation and drug prescription is shared by the provider with the patient to initiate the treatment. The data of this software is recorded on the cloud with an access only available with the admin of the portal which is under Sehat Kahani. To increase the efficiency and utility of the software both the doctors and providers are given training and refreshers every quarter.

(b) Software for mobile health application: 1)A complete web based platform which can be operated through an android and IOS app as well 2) Patient’s Login 3) Patient’s Medical History form 4)Features to either book appointment with the respective doctor or conduct instant consultation 5) Tele-consultation through video or audio call with the physician 6)E-Prescription from the doctor with complete doctor’s notes. (7) A free forum with chat option with the physicians This software has a web portal as well as application (IOS and Android) Keeping in view the sensitivity of the data stored on this system, two databases are used to store data on. This will allow complete security as well as ability to lease the software to other providers as well.

To ensure that we incorporate the perspective of our target population and encourage women leadership; women occupy roles in every level of Sehat Kahani resulting in 90% of senior leadership and 75% of the core team comprising women. While designing or expanding the scope of our implementation design, we assure that women providers, patients and advocates participate in the design and implementation of telemedicine tools. We also aspire to utilize new data gathering tools and assure gender parity in collection. We realize that when girls and women have better access to information, they also have better health outcomes. Through extensive advocacy and awareness building in the community we are creating early adopters for telemedicine innovation and empowering women to realize their right to access physical and mental health services. On the other hand, we are collaborating with women experts in technology and healthcare to design, implement and lead programs and services that best meet the needs of our end users. We are actively creating training programs that address the problem of unconscious gender bias for healthcare providers and its consequences. We are also conducting research focused on women’s health outcomes and raising awareness of the gap. While creating partnership linkages, we ensure that we are working with companies, academic and intergovernmental institutions that use their resources and influence to accelerate women’s leadership and participation in healthtech. By creating the right ecosystem, networks, and incentives, we can begin to unpick the entrenched biases which have created the inequities, and start to close the gaps in health access for women around the world.

When we implement telemedicine services in the targeted communities we conduct pilot testing and focused group discussions to gather evidence. Direct communication with our potential beneficiaries enables us to identify pain points and breakdowns in the telehealth video visit experience for patients, providers, and staff. We also learn about patient, provider, and staff perceptions of telehealth, including what makes users more or less likely to continue using telehealth. Collaborating with community partners and women influencers in the communities helps us to identify the barriers they face in accessing telemedicine services within their vicinity. Using insights from this feedback helps us to design and implement improvements in telehealth visits. We generate customer reports that comprises end-user requirements and formal assessment across technical, clinical, usability, and cost domains of all vertices of our solution. In addition, when we think of users in the telemedicine space, we realize that our mental health and healthcare professionals might not necessarily be trained in technology solutions. For this purpose, we build design capacity into our teams through training, professional development, and partnerships. We periodically conduct user validation for our human health resource by engaging them in on-going feedback sessions regarding any modification of our technological solution to improve its interface or effectiveness. We also conduct in-depth interviews to understand any challenges they might face while using our solution. Having diverse teams - in terms of gender, ethnicity, training and background - is therefore critical for our organization as unconscious biases will be recognised and addressed. This will in-turn improve the impartiality of the data upon which care decisions are based resulting in increased uptake of our services by our end-users thereby contributing to the success of achieving the desired vision of our organization.

Sehat Kahani on the supply end caters to women needs by providing a platform of employment to female health care providers who lack the facility to out-stand social taboos and join the healthcare workforce. It provides a means of earning to females who are marginalized and are considered an insignificant role in the economy of the country thereby allowing them to sustain themselves and obtain equal rights in the male dominated society. On the demand end, the organization also sustains the need for females to have access to quality and affordable healthcare particularly in terms of reproductive health and wellbeing by providing such healthcare facilities through the use of technology. This enables women to learn how to incorporate technology and build their confidence and skills so as identify and self-sustain their rights. In addition, Sehat Kahani is also actively working in improving health access for refugee women and children in disaster prone areas of Pakistan. Many women who are refugees or IDPs face unwanted, unplanned, and poorly spaced pregnancies, due to a lack of access to contraceptive services and supplies, overburdened providers with little time to educate or counsel clients, pressure from husbands or other family members to “rebuild” the population, and increases in rape and prostitution. Through our services women in stable refugee settings are now able to receive comprehensive care through telemedicine health services including services such as risk screening, early detection, and management of complications; and providing health education and preventive medication establishing 24- hour referral and early/ subsidized referrals to emergency facilities when needed. In addition, we are also integrating mental health services to deal with the psychosocial trauma these women and minorities face due to displacement.

Sehat Kahani has a sustainable revenue sharing model that offers services focused on all market segments via: (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 who are charged $0.5 to $3 to connect with qualified home based female physicians or a specialists virtually. Sehat Kahani also conducts preventive health care drives to bring out a long term behavioural change in communities capped at 20% net revenue profit. (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 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. For our corporate models we charge a per user annual subscription fee of $5-$20 for GP only, $10-$30 for GP+specialist and $15-$50 for GP+specialist+mental health expert (iii) B2C solution is for retail users targeting more than 74 Million of smartphone users with subscription charges $10/user/year or per consultation charges ranging from $2-$15 per user. 

Sehat Kahani will come as an implementation partner to operate and manage telehealth units in northwest regions of Pakistan whereafter initial establishment costs, annual costing will be managed by Sehat Kahani teams deployed in these communities. This cost will be maintained through a sustainable business model and consumer traction that will enable these units to break even and sustain Economies of Scale are defined as when more units of a good or service are produced on a larger scale, yet with (on average) fewer input costs. As Sehat Kahani Grows and production units increase, we will have a better chance to decrease the costs. According to this theory, economic growth may be achieved when economies of scale are realized. Referrals will be created at the telehealth units to resource centers which will result in a reduced patient burden at the unit level. We will partner with local organizations and the government to expand our scope of mobile health applications to increase user traction and utilization rates. More and more specialized patients will then be consulted at the primary health care level within their vicinities resulting in a more focused approach to primary healthcare patients within these units resulting in enhanced patient quality of primary healthcare services at these units. The cost will also be maintained through this prospective partnership and referral. At a social level, we benefit our doctors by being able to practice medicine remotely from the comfort of their homes. The inclusion of these unemployed human health resources plays a major role in managing the healthcare sector challenges while mitigating cultural and social sensitivities. Additionally, these doctors and frontline health workers 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. In Sehat Kahani’s e-clinic model, each E-Clinic is leveled at sustaining themselves over a period of 12 months post establishment which helps them in achieving a target of 450 clients which helps them in generating enough revenues which are cash flow positive. This allows them to sustain the E-Hub clinics themselves in the upcoming years as well as help fund other scaling projects across the country.

For our long term sustainability plan, Sehat Kahani in the next five years 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. Additionally Sehat Kahani through its E-Health application, will 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 in Pakistan.

Some of the examples of our funding includes:

• SPRING Accelerator provided a grant of $83,000 in Feb 2017

• Cartier provided a grant of $30,000 in 2017

• GSMA Fund provided a grant of $169,793 in March 2018

• Raised equity from Elahi group of companies for $100,000 in Feb 2018

• Frontier Innovators provided a grant of $75,000 in March 2018

• Amplify Grant provided a grant of $100,000 in July 2018

• Raised equity from Zeehan Ahmed of $100,000 in Dec 2018

• USAID provided a grant of $18,460 in Feb 2019

• Rolex provided a grant of $75,000 in August 2019

• Acumen provided  a grant of $48,194 in May 2020

• Microsoft provided $5,000 worth of cloud support.