The Challenge

According to a Lancet study, healthcare in Pakistan currently ranks 154th out of 195 countries in terms of overall performance. This ranking can be attributed to a range of factors. Firstly, as a  developing country with a  mere  2%  of its  GDP  allocated for total health expenditures, Pakistan struggles to maintain a proper healthcare system in terms of quality and accessibility. Despite its population of 231.4 million and its position as one of the fastest-growing economies in the world, Pakistan struggles to provide basic healthcare to over half of its population. Approximately, 78 million people live below the poverty line and lack access to good health services.  These circumstances disproportionately affect the lives of low-income populations particularly women and  children. This is evident in critical health indicators such as high infant mortality (55.7/1000 live births)  and maternal mortality  (186/100,000 live births) rates, as well as the alarming prevalence of stunting, affecting every third child. Secondly, approximately 90 million inhabitants live within proximity to quality health infrastructure, yet they face challenges in terms of time constraints and the inconvenience of visiting tertiary centers and waiting in long queues.

Thirdly, Pakistan faces a shortage of human resources in the health sector. Reports estimate that there are roughly 175,000 doctors registered to serve the population. However, due to factors such as poor service structure, increased workload, lack of funding, and a rise in hostility, many Pakistani doctors choose to practice abroad. Moreover, many female doctors have stopped practicing due to family and social compulsions. Considering these factors, the doctor-to-population ratio stands at one doctor for every 1,764 persons. For adequate population coverage, Pakistan needs at least two doctors for every 1,000 persons.

Finally, there is the challenge of counterfeit and unregulated pharmaceutical system in Pakistan. The sale of pharmaceutical products over the Internet has grown rapidly in the last two years after the COVID-19 pandemic though the quality of the products remains questionable. This tragic situation calls attention to the need for greater investment and strategic shifts in healthcare in Pakistan.

The Solution

Sehat Kahani is a Leading Digital Health Company in Pakistan founded by two female physicians, Dr. Sara Saeed Khurram and Dr. Iffat Zafar Aga. Sehat Kahani has introduced a unique, multi-population-focused digital health platform that allows a patient to connect with a qualified doctor in less than 60 seconds. Sehat Kahani employs a two-fold approach to cater to a wider range of patients. Firstly, they create nurse-assisted telemedicine E-Health clinics or facilitation centers in low-income communities. Secondly, they offer a telehealth-assisted mobile application that allows urban users to access quality healthcare through online consultations with qualified doctors for both corporate as well as individual consumers. Sehat Kahani maintains a network of e-Clinics (walk-in clinics) that connect users to qualified female doctors through online channels, while skilled nurses or health workers act as intermediaries. These health workers receive financial compensation through a self-sustainable business model by charging clients USD 4 which is about one-fourth of the cost of seeing a doctor. Sehat Kahani has also expanded the capabilities and reach of its mobile health application, which allows patients to record their health history, engage in chat conversations, and conduct audio/video consultations with a wide network of qualified doctors. The innovation enables healthcare professionals to register and track users remotely, deliver health services using decision support algorithms, and share data so that it can be utilized for real-time consultation with virtual specialists from nationwide and globally thereby enabling real-time decision-making and informed health choices.

To broaden the scope of the technology, Sehat Kahani now endeavors to develop a state-of-the-art management information system for E-pharmacy and claim management in Pakistan to have a competitive edge in the market. The global e-pharmacy market is currently worth around US $81.6 billion and is expected to grow to US$244 billion by 2027. On the supply side, beneficiaries are the female doctors and community-based health workers who are not being utilized to their full potential due to social circumstances, cultural taboos, and militant operations with  suppression from  local forces. Sehat Kahani approaches the challenge of converting need into demand through a human-centered design approach. 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.

Deployment/Mainstreaming Potential

Sehat Kahani intends to expand its operations in a mainstream manner through a dual approach: national expansion approach and regional expansional approach. In terms of national level expansion, Sehat Kahani plans to utilize its current  funding to  invest in the following areas: (a) integration of the e-pharmacy system within Sehat Kahani telehealth platforms, (b) integration of the claim management system for corporate users into the mobile health application, and c) piloting a home health care model using Sehat Kahani telemedicine solution. Over the next 5 years, Sehat Kahani aims  to provide 24 million consultations to 15 million plus users, resulting in  a value of $277 million  along with reaching sustainability by 2024.Turning to regional expansion, Sehat Kahani’s approach in the targeted countries is: (1) building upon the existing success stories, and the entering the market through partnership to address the supply gap for healthcare services delivered through telemedicine, (2) pilot test Sehat Kahani mobile health application across corporate organizations with a large consumer base to gather data on user feasibility, market need, and accessibility of digital health services, (3) partner with other local micro health insurance companies to offer subsidized packages for corporate consumers and their families to minimize out-of-pocket expenses, (4) collaborate or partner with an existing telemedicine company or mobile health application in the target region/country to further boost the reach and provide the necessary  support, and (5) collaborate with digital public health initiatives to further expand user  reach  and  ensures  equitable  health access with favorable health  outcomes

“I am so grateful to Sehat Kahani for providing the services of a psychologist in our small community. My daughter has had developmental issues since she was born, and I have always felt helpless regarding her condition. I took her to the asylum in Hyderabad where the doctor gave her some medicines which did not alter her condition. After the psychologist taught me how to deal with her condition. After our series of online therapies, I see a remarkable improvement in my daughter. Sehat Kahani has given my daughter a new life.”- Sadia Bibi 36, Hyderabad

My wife was in the last week of her pregnancy, and she began to have complaints of pain at night with significant bleeding. I remembered that I had the Sehat Kahani application, so I made my wife speak to one of the doctors there. It was around 5 am in the morning so we could not access her doctor or any health center in our vicinity. But based on my wife’s complaint the doctor guided that it seemed she was going into labor, and we should indeed take her to the ER. Our baby boy was born that same day and I am so glad we were able to speak to the doctor who saved the lives of my wife and my son.” - Afnan Khan 43, Lahore