Sehat Kahani Psoriasis outreach Programme

Worldwide, there are over 6,000 diseases classified as ‘rare diseases’. The reported prevalence of psoriasis in countries ranges between 0.09% and 11.43%, making psoriasis a serious global problem with at least 100 million individuals. Pakistan has around 5% of psoriasis cases, many of them are misdiagnosed or  left untreated. uals affected worldwide. Rare Diseases present fundamentally different challenges from those of more common diseases, especially for diagnosis as well as long-term treatment. Despite the fact that over the past two decades, knowledge of skin pathologies, particularly psoriasis, has increased markedly, the challenges are much more complex needing more than only dermatological support. Estimating the number of individuals who are affected by Psoriasis is challenging because rare diseases are often misdiagnosed and patient numbers are small and doctors for each of these diseases are a scarce resource. In addition to the effects of the disease itself, patients with psoriasis have more comorbidities than the general population, with over 50% of patients having at least 1 comorbidity. Long-term, disfiguring scaling and redness on the face, neck, and other readily visible portions of the body which cause intense feelings of anger, anxiety, depression, mood disorders, substance abuse, and suicidal ideation in people with psoriasis who not only need medical support and often consider tis ailment a major societal taboo but also require mental wellbeing support, creating a major burden on Pakistan’s healthcare system. A lot of these psoriasis patients lead very complicated lives, women get divorced, children are bullied at school owing to their disease and people often do not understand the disease dynamics and consider it contagious creating social gaps with such patients in turn isolating them.  To top it off, Pakistan is a country which has a major dearth of Medical Professionals leading to further reduction in the overall coverage for such a grave ailment. According to estimates Pakistan has around 245,000 licensed Physicians. Around 80% of these are women - unfortunately only 40% of these ever come back to practice. Another whooping 15% physicians (from both genders) leave Pakistan for better work opportunities. As a result Pakistan has hardly 90,000 doctors for a population of 220 Million +, resulting in a doctor to patient ratio of 0.5/1000.There are only 420 dermatologists offering skin care across all of Pakistan, despite the fact that psoriasis affects 125 million people worldwide, including 3% of Pakistanis.

Sehat Kahani aims to democratize healthcare ensuring easy accessibility to quality healthcare for the population who are particularly devoid of it by building a network of Physicians who can get connected to patients in real-time using  our telemedicine platform. We create this access through 2 ways, for the marginalized communities we create nurse assisted telemedicine based E-Health centers and for the urban market, we have a mobile application allowing consumers as well as corporate users access to our services. The emergence of COVID 19 has significantly enhanced the acceptance of our telemedicine solution. Psoriasis is a condition that lends itself well to tele dermatology. Our solution is to innovatively integrate tele dermatology in our current telemedicine platform also enabling digital diagnostics such as a derma scope and connect patients suffering from psoriasis to enable  qualified dermatologists using the Sehat Kahani Telemedicine  platform a better view of the skin lesions these patients may be suffering from. The psoriasis care plan will also include mental wellbeing support which would help these patients fight their day to day battles and would enable them to develop mental strength and the ability to deal with their anxiety, depression and other challenges and be able to deal with life better. This will be achieved by  implementation of remote access through both our e-clinics as well as our Mobile application where individuals can avail a video consultation for their essential psoriatic follow up and connect with dermatologists, internists and wellbeing experts whenever they need to do so. The solution provides a complete cloud based EMR system that  keeps track of their health history, digital prescriptions, e-lab referrals and consultation summaries. For patients who are undergoing anxiety, depression owing to their psoriasis conditions, they will also be connected to wellbeing experts allowing a 360 degree solution to cater to their overall wellbeing. Our mobile application provides access to a wider population in a very simple to use, accessible and affordable manner which is helpful in delivering healthcare interventions, without requiring people to visit health services physically which would benefit these people tremendously who find it difficult visiting places due to their appearance related taboos. Sehat kahani ensures to  open the door for enhanced collaboration and communication between healthcare providers and patients, helping to advance a holistic and patient-centered approach to care.

On the demand side our beneficiaries are  the women and children who reside in underserved areas and are unable to receive high-quality, reasonably priced healthcare services due to  acute shortage of resources. People have to travel longer distances to access quality healthcare, incurring additional transportation costs and wasting time. In such communities, a variety of practical and cultural issues prevent the more vulnerable, for example the women, children and elderly from accessing healthcare. Women who may suffer from such ailments which create physical abnormality pushes them even further down into marginalization and solitude. Many women are bullied by family members, mocked and made fun of with some who either never get married or even if they do; the constant mockery continues oftentimes even resulting in divorce. Many women are severely depressed or even try to commit suicides because of this. On the supply side, the female doctors who are underutilized owing to social pressures, cultural taboos, and a lack of family support are our beneficiaries. Sehat Kahani applies a human-centered system design to address the challenges of turning need into demand. Our network of doctors is 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 the use of these techniques, Sehat Kahani offers a service that women appreciate, creating a demand for low-cost, customer-focused healthcare that has increased the possibility that women will use remote services in their time of need. Our service is also enabling female health resources who are unemployed to continue their medical practices from a distance while enhancing their ability to use ICT-based solutions in their practices.

Our aim at Sehat Kahani is to increase patient and beneficiary engagement in safe communications to improve their health and quality of life. Two female doctors, Dr. Sara Khurram and Dr. Iffat Zafar Aga co-founded Sehat Kahani after they both encountered socio-cultural barriers that put them in a position where they had to choose between either having a family or a career  They became aware of the lack of health resources that had a negative impact on Pakistan's health indicators and Sehat Kahani came into being with the passion to be able to create healthcare which was equal for everyone and were able to create the right mix of team when telemedicine was still very nascent in Pakistan. Through Sehat Kahani they have been successful in creating a Nationwide Network of 38 E-Health centers, have developed a mobile application with a customer interface with more than a Million users and a corporate interface which is currently in use by over 420 corporations in Pakistan including some leading National and international names. 

Our team of professionals is well-suited to design, develop, and implement mobile health solutions that are affordable and simple to use, providing our beneficiaries with convenient, accessible, and distant health care options. Patient-centeredness, high-quality care, collaborative approaches, sustainable financial models, and accountability are important characteristics of our team that promote a smooth transition in their healthcare delivery. Each department has been developed with a lot of hard work and a complete thought process ensuring smooth operations. The E-Health clinics have a dedicated team lead by a Clinical Lead based in headoffice supported by regional managers and community teams. The Tech team is a well suited 13 people team catering to all the technological needs ensuring constant upgradation, innovation and addition of new features is being done constantly to ensure an enhanced customer experience each time. Our team is extremely committed, working around the clock to provide the project's anticipated outputs and results. Because of our organization's democratic leadership approach, team members are constantly provided with feedback and ideas to create successful projects.. These solutions permit exceptional results in healthcare excellence and effectiveness. Our interdisciplinary team, which includes members from various backgrounds, evaluates beneficiaries' needs to identify any potential care-related challenges and assists in removing them by putting our services into place and continuously enhancing them.

We also have a department dedicated to Physicians and mental wellbeing whose  sole responsibility is to acquire and maintain the best pool of physicians, specialists and wellbeing experts, to train them and to manage their credentials who can provide quality healthcare services through their virtual clinics at Sehat Kahani. We have trained 7000 physicians and skills specialists to date.

We have a track record of creating e-health solutions that have been utilized by over a million beneficiaries however rare diseases will be a new niche which we would like to add to our portfolio. We believe that the MIT community can assist us in focusing on our collaborative strength to create initiatives catered to these special diseases. It can help us emerge as better leaders for our company as well as for our collective vision of global health accessibility. 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. The funding will enable us to integrate necessary technological upgrades such as AI integration, automated algorithms as well as ability to test into a new area using human-centered techniques which would subsequently let us establish an entirely new wing of business catering to the niche market of rare diseases initiating with psoriasis.

A Telemedicine based initiative enabling healthcare access in not only cities and for the urban population but also for the underserved marginalized communities the way Sehat Kahani does through their unique Network of E-Health Clinics opens many gateways to create healthcare accessibility solutions in many emerging markets in a way which has not been tested in many parts of the world. When the same service will be catered to rare disorders enabling a 360 degree approach just at a click, a patient suffering from psoriasis will have the opportunity to be treated for their skin as well as wellbeing concerns in complete anonymity hence increasing their compliance and visits frequency. This unique healthcare preposition will not only enable a one stop shop solution to patients but will also really empower not only the patient but also the physician who was unable to work to their full potential earlier. For a country with 220 Million plus population where more than 50000 drs are dormant or not working to their optimum level, this solution would facilitate in bringing about a major change in bridging those healthcare gaps. 

Sehat Kahani intends to grow its current business by scaling up our mobile app consumers, by increasing our reach into corporates and also by replicating and scaling our E-Health services by utilizing the infrastructure, technology, and physicians from our ever growing healthcare professionals pool. But more strategically Sehat Kahani envisions not only becoming a market leader in Digital Health by working towards becoming a super-app in Pakistan but also becoming a global player emerging out of Pakistan. In the next five years, Sehat Kahani aspires to create 150 E-Health Clinics ( walk-in clinics) Nationwide and aims to train and educate a Network of 50,000 doctors, health providers, and mobilizers developing independent micro-entrepreneurs or consultants on the Sehat Kahani Panel. We aim to be able to lock over 17  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 and become the next ‘Uber for Healthcare’ in Pakistan. We aim to completely change the entire healthcare ecosystem of Pakistan through digital health through our dedicated team, by creating strong local as well as international partners with the right kind of partners (such as Microsoft, Unilever, UNDP, USAID,MIT) to name a few. We also plan to raise equity based investments. We have raised 500,000 USD in 2018 and 1.2 mil USD in 2021 as our seed and pre series a funding and we hope to raise our series a funding in the years 2022-23 which would again pave the way for us to be able to reach our impact goals through strategic growth, investment in the right teams and resources, investment in technology and ultimately growth. 

We work with 2 SDGs: SDG 3 and 5. Our key focus is on health and wellbeing for all and gender equality. We measure our success using the following indicators: 

For the E-Health clinics:  Number of clinics expanded each year, No. of consultations, number of follow ups, number of value added services. 

For our Consumer app: No. of users, no of active users, No of downloads, No. of people who do the 1st consultation, 2nd and 3rd consultation, Beneficiaries who avail specialty care services and who also avail online pharmacy and online diagnostics. 

For corporate app: No. of corporations onboarded. Users, active users, no. of consultations. 

The implementation of the feedback system in our telemedicine platform is one of the key markers to assess progress towards the impacted goals and to be able to assess the quality of these metrics. Call center representatives  call each and every one of our mobile app beneficiaries to solicit their opinions in order to promote collaborative decision-making, informed health decisions, and feedback on the services delivered.  At e-clinics, 30% of our patients also receive feedback calls. This feedback not only gauges their experience as patients but also seeks opinion for any required opinions and whether they felt improvements in their health after consulting the doctors. Our Monitoring learning and evaluation panel is continuously auditing the doctor’s performance to understand the improvement in health of each patient. 

Through our innovation we will be  able to introduce technology in communities lacking awareness as well as access around rare disorders initiating with psoriasis and use it as a medium to bring behavior change to empower individuals to prioritize their health and to reduce  the burden on the economy and improve the health status. 

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

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 patients with psoriasis disease.

• Treatment management for rare diseases like psoriasis cases.

• Continuity of e-monitoring and follow-up for psoriatic patients in e clinics.

• Improved health related quality of life

• Improved awareness of psoriasis,  its complications and management.

• Increased employment opportunities for providers to utilize remote solutions to reach their patients.

Our technology is a complete end to end solution for our beneficiaries. 

For our application based users that include features such as: doctor’s profile with instant consultation as well as  appointment slots booking, complete patient EMR system, video-consultation, chat to doctor, e-prescriptions, e-labs and also now the capability to order online pharmacy within the mobile application only. We use real time data analytics to find disease patterns utilizing data that was never captured before. We use Power BI; a microsoft tool in analyzing 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. This application is available on both Android and iOS Platforms. 

For physical visits to our E health centers, the technology plays a centralized role enabling a clinical intermediary (the online nurse) to connect the patient with the doctor who is virtual through our intermediary assisted clinical module. Along with online consultations, these patients can also utilize digital diagnostic tools such as e stethoscope, e derma scope, etc. to further enhance examination. After checkup, doctors write a prescription which is then printed at the clinic and handed over to the patient. 

. Through both our mobile application as well as these E Health center, these beneficiaries can avail virtual consultations, access counseling 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.

Sehat Kahani promotes a vibrant, collaborative and diverse culture that is open-minded and embraces change. By reintegrating 7000 female healthcare professionals into the workforce who were barred from practicing due to socioeconomic constraints we have gained tremendous recognition within Pakistan for our work towards women empowerment and gender equality. 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.  We have helped people living below the poverty line get access to quality healthcare through our E-clinics across Pakistan. At head office, We have an ethically and religiously diverse and dedicated team from different ethnic as well as financial backgrounds who are well-experienced, passionate individuals with a keen interest in implementing innovative ideas belonging to inclusively different income brackets.

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) B2C solution is for retail users targeting more than 74 Million of smartphone users.

 Business & Revenue Model

Sehat Kahani Business Model:

E-Health Clinics:

1. Online OPD Services charged between 50-300 PKR. (30% revenue share with Nurse)

2. Value Added Services : 100 - 500 PKR (50% revenue share with nurse). 

Sehat Kahani Corporate App: 

Customized B2B Plans: Price ranges between 1695 PKR to 4995 PKR ($9 to $30) based on the package as well as the employee base.

i)  Silver Plan includes General Physicians only, 

ii) Gold Plan includes General Physicians + Specialists

iii)  Platinum Plan includes General Physicians + Specialists + Mental Health Experts

Sehat Kahani Retail App

Pay as you go: Retail payments. Ranging from 500 PKR to 3500 PKR per consultation. 

Subscription Plans: Ranging from 999 PKR to 10999. (ranging from series of services/bundled up)

Sehat Kahani since the very beginning gas focused on developing sustainable solutions to not only maximize social impact but also ensure continuity of care by ensuring the organization is able to generate a substantial revenue on an year on year basis to become sustainable on itself while it eaises funding to facilitate scale and growth  

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. 

(b) E-Health Application: The revenue model for e-health application is designed based on the three segments of users:

 (i)B2B: An Annual payment plan whereby corporations pay on behalf of their total number of employees. Silver plan entails access to general physicians only, Silver plan entails access to general physicians and specialists while Platinum Plan entails access to general physicians, specialists as well as wellbeing experts. 

(iii) B2C: For every user a fee based on a pay as you go model is charged for consultation. With shared revenue, 60 % is for doctors,40% is the net revenue for Sehat Kahani. 

We have also raised both equity as well as non - equity based funding 

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. 

Sehat Kahani has raised $3.2 million USD  in funding out of which $500,000 was raised in seed investment and $1.2 million USD in Pre Series A in 2021. Another 1.5 million has been raised through soft funding, a few of the funding bodies names are as follows:

SPRING (DIFID) -$ 82,000-Apr-17

GSMA-$ 180,000-Mar-18

Good Fund Fellowship-$ 10,000

Amplify-$ 100,000-Aug-20

Frontier-$ 75,000-Jul-18

Acumen-$ 43,000-May-20

Rolex-$ 75,000 -Jul-19

Cartier-$ 30,000-Jul-18

British Asia Trust-$ 46,667-May-19

British Asia Trust-$ 120,000-Jun-21

British Asia Trust-$ 71,000-Sep-20

UNDP -$ 10,000-2019

UNDP -$ 10,000-2019

GSMA Covid Fund-$ 64,337-Jul-20

GCC-$ 186,507-Jun-20

GCC-$ 37,242-Apr-21

British Asia Trust-$ 71,000-Jul-21

Mulago Foundation-$ 50,656-Oct-20

UNDP-$ 8,700-Nov-20

UNDP-$ 60,900-Jan-21

WHO-$ 41,538-Mar-21

Dawood Foundation-$ 26,531-Jun-20

BAT-$ 48,251-2021

UNDP-$ 13,050-Feb-21

MIT Elevate -$250,000-2020-21

Apart from that, Sehat Kahani has been creating sustainable revenue through their business lines. For example in the fiscal year 2019-20 the Gross Revenue was around $270,000 while in fiscal year 2020-21 the gross revenue was $455,000