Aijaz-e-Hayaat (The Miracle of Life)

Various deficient aspects of healthcare systems need to be addressed immediately to provide any hope of creating a sustainable healthcare environment in the coming decades in Pakistan, specially the province of Sindh. These include developing strong primary and secondary care structures as well as strengthening tertiary care hospitals with an adequately trained healthcare workforce. The facilities required to improve patients’ access to healthcare cannot be developed and sustained solely within the local budget allocation and require major input from international organizations and chain of donor networks. To create and retain a local healthcare workforce, improved training and living conditions and greater financial security need to be provided. Finally, healthcare economics need to be addressed with financial models that can provide insurance and security to the underprivileged population to achieve universal health coverage.

Our solution works around a web based application utilizing artificial intelligence which is already established in Ziauddin University Hospital. EmNOC is a training program developed as module of excellence by Royal College of Obstetrics and Gynecology. It provides basic knowledge to handle emergencies during delivery process. It provide clinical skills in basic life support, neonatal resuscitation, shoulder dystocia, and cord prolapse. This program will be used through AI based web application to educate and train primary health care physicians in rural areas of Sindh, Pakistan to improve their clinical skills and knowledge in dealing with emergency obstetric care.  Contraceptive counselling will be utilized to improve family planning practices. Seminars will be conducted and related through this AI based web regarding environmental pollution and clean drinking water. All primary health care centers will be connected to tertiary care health centers for advanced maternal and neonatal care.

Pakistan is a low middle income country where sustainable development goals cannot be achieved without the use of external donors. Pakistan population is aggregated in income, education and availability of health care facility. Maternal mortality stands at 186 out of 100000 live births and neonatal mortality rate of 40.4 deaths for 1000 live births. Anemia is rampant. Major causes of maternal morbidity and mortality are PPH, pre-eclampsia and ecclampsia, obstructed labor, maternal sepsis and neonatal sepsis. Imbalance exist in integrating services delivery during childbirth. Interventions are needed at community levels in the rural areas for which are already well established AI will be utilized to impart training to primary health care providers in order to prove their clinical skills to reduce maternal morbidity and mortality and neonatal care. As a continued process we also plan to established a direct contact between primary health care centers and tertiary health care centers fir referral and advanced care services. Data would be collected to measure the progress of the program and to make it sustainable business plan in order to generate own fund. 

Ziauddin University is linked to nearby communities in low income areas actively working for the utilization of family planning services and betterment and improvement of maternal and newborn health care. The vision of primary health care in Pakistan is to provide easy and regular access of quality care throughout the life. This is typically not happening in LMIC where there are infrastructure barriers, critical shortage of health care providers and lack of quality care. There is an urgent need for quality health care specially for women and newborn in the province of Sindh. We have a well developed IT based web application system, which is known as HMS system used within the city of Karachi for provision of health care. We are going to utilize it to improve the adoption of the family planning services in Sindh province, and to train the primary health care workers in clinical skills to manage pregnant women and newborn.

Pakistan is one of the countries in South Asia ranking high in maternal and newborn mortality rate and low use of contraceptives. Lack of health care facilities, education, malnutrition, poverty,  gender inequality in rural areas, socioeconomic factors are some of the major contributing elements for elevated levels of maternal and newborn morbidity and mortality rate in Pakistan. By making inclusive policies at the provincial level to improve the reach of the rural population to healthcare facilities, educating primary health care workers  to improve their knowledge and clinical skills and introducing family planning interventions, we can reduce the contribution of preventable causes of higher maternal and newborn morbidity and mortality rate in Pakistan. Through our proposed solution we shall maintain data records essential for the continuity in efforts to improve maternal and newborn health and family planning utilization in Pakistan’s rural areas.

We propose the use of AI powered innovation to augment patient-clinician interaction at primary care level, connecting them with tertiary care center for improvement of maternal and newborn healthcare by enhancing health care delivery for both population and community.

This is the first time AI is being incorporated in the health care system in Pakistan, to be used to disseminate knowledge through web based application and to improve the clinical skills of primary health care providers in the province of Sindh. Hospital Management System (HMS) is a web based application developed by the IT department of Ziauddin Hospital. All clinical departments are integrated with this application in all the four campuses. All paramedical staff including health care provider have their individual passwords. This is how this application will be used in primary health care centers where doctors associated with women and child health will be connected by user ID. All data will be generated thorough this web application regarding patient diagnosis, management,referral in order to measure our progress. The objective is to bring about an improvement in the management ad care of pregnant women and newborn and to increase the utilization rate of family planning from 35 to 55% which is the target to achieve by 2030.

Our goals are clear but socio-political conditions in country may have an impact on achieving them. We are hoping the extensive use of AI powered web based innovation in primary health care centers throughout the province of Sindh, through ensuring family planning utilization and imparting training workshops to improve clinical skills of Primary health care providers, to reduce major causes of maternal and newborn morbidity and mortality like PPH, sepsis, anemia, newborn sepsis. Currently our maternal mortality rate is 186 per 1000000 live births and neonatal mortality is 40.4 per 1000 births. The goal is to reduce this disparity by creating awareness to maintain environmental hygiene and ensuring optimum use of clean drinking water in rural areas is also in plan and also make it sustainable. The success will be measured by achieving the maternal mortality rate to at least 100 per 100000 live births and neonatal mortality to 20 per 1000 births significantly in coming years.

Reduced maternal and newborn mortality rate, and decline in fertility rate in the the province of Sindh are indicators to measure the success and progress of our solution. 

1- reduction in number of women dying due to PPH, sepsis, anemia, pre-eclampsia, and eclampsia 

2- reduction in rate of newborn sepsis and stillbirths 

3- increased utilization rate of family planning methods

Our vision for primary health care in Pakistan is to provide easy and regular access of quality care to people throughout their life. This is typically not happening in LMIC where there are infrastructure barriers, critical shortage of health care providers and lack of quality care. There is an urgent need for provision of quality health care especially for women and newborn in the province of Sindh. We have a well developed IT based web application system which is being used within the city of Karachi for provision of health care. We are going to utilize it to improve the adoption of family planning services in Sindh province, and to train the primary health care workers in their clinical skills to manage pregnant women and newborn.

We are using an IT based web application to bridge primary and tertiary care centers, where online training sessions are already being carried out by IT department, Ziauddin University. Tele-communication facility is provided where the primary health care provider can contact tertiary care centers anytime in need of emergency.

Artificial Intelligence is incorporated in this application to save, analyse and maintain data records obtained from the patients presenting at primary health care centers during ante partum period or with obstetric and neonatal emergencies.

Currently, we are in collaboration with Government of Sindh under whose domain the primary health care centers work. The data has been provided by Government of Sindh. Future data collection will be done through our web based application system from the primary health care providers.

The leadership team is a group comprising of both females and males working at the university level. To make our team more diverse, along with the departments of Obstetric and Gynecology, research department, pediatrics, IT, AI, and the marketing department we have incorporated the department family medicine, who are already working at community level since last 20 years. Each one of the group members will be provided an equal opportunity to represent themselves for solution's advancement so they will be able to have full participation with equal respect and support.

The business model can be described in terms of its impact in improving maternal and neonatal health, family planning services and their utilization, early recognition and management of obstetric and neonatal high risk conditions, thereby reducing overall mortality in population. Further How its implementation will improve knowledge and clinical skills of primary health care providers and impart knowledge at community level about the importance of clean drinking water and cause reduction of environmental pollution in their homes will be adressed. 

The revenue is improving skills of primary health care providers by a web based  application incorporating AI,in rural areas improving maternal and neonatal health and increased utilization of family planning, having a generalized impact on maternal well being and reducing the burden on health care provision by the government.

Incorporation of AI in collaboration with corporate sector, for provision of better health care facilities at community level and rural areas in order to reduce the disparity in health care services.

For long term sustainability of our program we plan to raise investment capital with both private sector, pharmaceutical companies and government sector. considering the ever rising cost of health care and physician burnout to the inconsistent and complex nature of health data, life science and health care organisations need to adopt machine learning to accelerate the pace of innovation and improved efficiency as AI delivers unmatched reliability, security and date privacy. Our established AI system would provide us financial stability in future by commercializing our AI based health care system to other organisations.

Ziauddin University is a private sector organisation. We have received different national and international fundings and grants for various research programs currently being conducted on breast and cervical carcinoma, covid19 related research, drug discovery programs. However we are yet to receive any grant which can be used for the this robust program to reduce maternal and neonatal morbidity throughout the province of Sindh. It will not only train primary health care providers but will be a continuous process of providing quality care to women and newborns. Future program is to work on environmental pollution and provision of clean drinking water to rural population.