Reaching the unreached through E-Health – Sehat Kahani

About the project

Sehat Kahani bridges these market failures via consistent, sustainable and easily replicable digital solutions, via its three unique service lines :

Access: By using trusted intermediaries in the communities and dormant health infrastructure, they create Sehat Kahani E- Health Hubs, where a front line worker is trained via a 5 step training on medical knowledge, leadership and soft skills to connect patients in these Hubs to qualified home based female physicians and skills specialists, using video consultation and Electronic Medical Records systems’-Health Hub caters to the primary health care needs of the community. They are providing weekly ultrasound service, lab collection points, pharmacy and tertiary care referral. Sehat Kahani Currently constitutes a network of 14 E- Health Hubs across Pakistan which have served to more than 53,000 patients directly through its digital health care services.
Prevention: Sehat Kahani, through its preventive health care portfolio creates innovative preventive health care, messaging activities in target communities to bring out a long term change in behaviours and health patterns. Working with partners in the pharmaceutical and corporate sector, they have worked on solutions of Hygiene, sanitation, calcium awareness, primary disease counselling, mental health, maternal and child health care to sensitize the communities to address their health needs keeping in mind the cultural and socials barriers. Sehat Kahani has reached out to more than 400,000 beneficiaries Nationwide through these healthcare messaging and awareness campaigns. The Key partners for these preventive health drives include GSK Pharmaceuticals, Unilever ( Lifebuoy), and Engro Polymers to name a few.
Efficiency: Through their specialized telehealth platform, they have designed digital health solutions to reduce the disease load of tertiary care hospitals by treating primary and secondary diseases via virtual home base female doctors part of Sehat Kahani network. Whether it is a consumer needing a consultation at odd hours, corporate employee having a need of mental wellness, insurer looking for cost effective health solution for its clients or doctors trying to reach out to more patients via virtual flexible clinics, their platform has solution for all of them in less than 3 clicks.The web portal was recently launched in a leading corporate in order to cater to the mental health needs of their executives.

Sehat Kahani utilizes the ever-changing technology to surpass sociocultural and economic barriers that discourage female health providers from participating in the medical workforce. By using co-creation mechanism, Sehat Kahani can tap into thousands of underutilized female health workers, and develop them into micro-entrepreneurs who will dispense healthcare services to the unmet health needs of millions of marginalized beneficiaries in Pakistan, in particular in rural and sub – urban areas. And this through technology ,in a manner that their usual sociocultural restrictions are still met with. Sehat Kahani aims to revolutionize primary health care system of Pakistan, by linking data from mobile phones and from internal or external telehealth instruments, with desk-based or free-standing kiosk education devices or centres and integrate algorithms to enhance safety and decrease the risk of harm. This self-service electronic system is enable and empower beneficiaries to check-in to appointments, request medication, generate early referrals and provide other health care purposes. Beneficiaries are able to receive education about the meaning of data, and receive instructions about the plan of care based on e-data findings. This not only creates an extensive healthcare data, but it also enables every beneficiary to be self empowered about their own health. Through creating their own personalized healthcare history, a strong database about every beneficiary will be created providing extensive insights about the various healthcare trends affecting the health ecosystem in Pakistan at large. Alongwith data, this also creates an easy access to physicians who are difficult to reach otherwise. New employment opportunities for these physicians enable financial inclusion for those female physicians who were not able to work otherwise. On the whole, Sehat Kahani envisions that every cell phone user, every bank account holder has access to specialists and physicians through the specialized Sehat Kahani healthcare mobile application ensuring that the society at large has easy access to healthcare. Digitization is completely changing the local economy and Sehat Kahani envisions to play a very pivotal role in impacting the economy positively by creating this marriage between digitization and healthcare in turn creating new employment opportunities, new financial avenues and new market segments altogether. In the next 5 years Sehat Kahani aims to replicate the hub and spoke model and integrate Sehat Kahani telehealth portal in underutilized health facilities, basic health units and rural health centres. In addition, Sehat Kahani will be able to create a network of 10,000 female doctors and frontline female health workers who will deliver quality healthcare services by utilizing telehealth portal. This will result in impacting 35 million lives by providing access to quality and affordable healthcare. Sehat Kahani also projects increase in uptake of telehealth portal among beneficiaries by 60% to access primary health services thereby contributing towards improving efficiency and lower health care costs through fewer hospital admissions, shorter hospital stays, reduced travel times, and improved management of chronic diseases.
By 2022, Sehat Kahani envisions to establish 200 E- Health Centers Nationwide and aims to train a Network of 5000 female physicians,1000 nurses [&] Community Health workers; developing independent micro entrepreneurs or consultants on the Sehat Kahani Panel. These 200 centers envision to employ around 200 micro entrepreneurs in the form of nurses and Community Health Workers, around 400 online female physicians, 200 male mobilizers [&] 200 female mobilizers. This would result in a cumulative impact of approx. 8.1 million lives through all the services Sehat Kahani aims to provide and an average of approx. 500,000 patient consultations per year. Additionally, through our Sehat Kahani web portal we will be able to impact 3 million lives in lower, middle and upper income market via our direct to consumer, corporate and insurer enabled channels. At the company level, Sehat Kahani is aiming to break even at second quarter of March 2019 and will create a cumulative revenue of 9 million USD by 2021, creating employment opportunities for more than 5000 people and bringing more than 10,000 female physicians currently out of work back to workforce through these flexible work options, in turn creating a very positive impact on the local economy.
Business Model [&] Distribution Channels: Sehat Kahani has the following distribution/sales channel for revenue creation: 1)Channel: Sehat Kahani E- Health Hubs- Brick and mortar clinics in low income communities where trusted intermediaries connect marginalized patients to home base female doctors. Distribution Strategy: Female mobilizers conducting door to door marketing, weekly community sessions (Mohalla meetings) mass sms activation, monthly health awareness drives, activities in schools, universities and mosques and community elders session for community sensitization Partners: Community partners including government and on ground partners such as Sangi Foundation, Kaawish Foundation, Rotary Foundation, Benazir Income Support Programme(BISP), maternal and child health care Pakistan (MNCH) UNDP, UNICEF. Business Model: Sehat Kahani E- health Hubs: · Sehat Kahani charges 50 Rupees ($0.5) per patient/virtual clinic consultation for General Consultations at e-hubs in the communities. For every consultation 30% of the earned revenue will be allocated to the nurse and 70 % will be allocated to Sehat Kahani · Sehat Kahani charges 300 Rupees ($3) per patient/virtual clinic consultation for specialist Consultations at e-hubs in the communities. For every consultation 50% of the earned revenue will be allocated to specialists and 50 % will be allocated to nurse with Sehat Kahani yielding a net profit of 25% · Net Revenue generated from 4 Value added services namely ultrasound services, lab collection point, secondary care services and tertiary care referral will be co-shared between Sehat Kahani and nurse or third party vendor on 50/50% basi.
2)Channel: Sehat Kahani preventive health portfolio: Distribution Strategy: Corporates, pharmaceuticals, insurance companies Partner: Lifebouy, Engro Polymers, Lifebouy, GSK, Legal Aid Office, Engro Foods. Business Model: The company create revenue from Management fees taking per activity which is capped at 18% of the total activity cost.
3)Channel: Sehat Kahani Mobile application- Direct to consumer model Distribution Strategy: Telecom partners, social media, Sms activations, discount packages, mobile bundled offers. Partner: Telecom partners such as Telenor and Jazz Business Model: Sehat Kahani will charge 3$ for the general physical virtual consultation, 7$ for a specialist consultation and 30$ for mental wellness consultation session that will be divided between the consulting doctor and the company on 50/50 shar.
4)Channel: Sehat Kahani mental wellness Portfolio Distribution Strategy: Corporates, insurance agents, companies, direct consumers. Partners: Jazz, Unilever, Legal Aid Office Business Model: Sehat Kahani will charge the corporate or the insurer a subscription fees for group consultations. This will be priced at 500$ per month for consultative and technical management services. Every consultation will be priced at 3$ for general, 7$ for specialist and 30$ for mental wellness expert session respectively.

Pakistan is a culturally conservative and poverty ridden society suffers from two major market failures:
1) Inaccessibility of marginalized communities, especially women and child, to quality health care services. This is due to lack of female doctors, and also because cultural taboos limit a female to be seen by a male doctor.
2) Inability of female doctors that make the majority of health workforce in Pakistan, to continue their careers post marriage and children again due cultural taboos, lack of support from family and cultural barriers.
Pakistan struggles to provide basic healthcare to 51% of its total population due to a shortage of healthcare professionals. Additionally, inadequate distribution of medical specialists, and poor infrastructure of roads and transport make it even more difficult to provide health care in remote areas. According to the Pakistan Demographic Survey done in 2012-13, 37% of the women are unable to access healthcare facilities due to the distances resulting in prolonged healthcare issues which remain unresolved. Due to these gaps in healthcare, even today the Infant mortality and Maternal mortality of Pakistan is very high with the IMR estimated to be 66.8 per 1000 live births and the MMR to be 260 deaths/100,000 live births. In rural areas where clinics do exist, they are often ill-equipped, giving rise to high mortality rates and low quality of healthcare services. There is also often a strong prevalence of faith healers, quacks and other forms of medicine being practised in such areas adding further to the actual healthcare burden The total GDP spent on Healthcare is only 0.9% of the total GDP, which equates to 12% of the recommended World Health Organization Level.
At the same time, 2016 statistics by the Pakistan Medical and Dental Council indicate that of the nearly 50% of medical graduates that are women, only 13% go on to pursue medicine as a career. Many women opt out of pursuing medicine due to limited mobility after marriage and childbirth, due to social and cultural barriers towards working women in Pakistan. As a result these rural and marginalized communities are devoid of female physicians depriving female patients from very conservative backgrounds (who are often not comfortable in seeking healthcare from male physicians) to reach out to any healthcare services.

Sehat Kahani is an all female health provider network including that is working to create quality health care solutions for communities where health access, quality, affordability of health care is still a dream, using cost effective E-Health [&] ICT enabled solutions. In the low income communities, where majority of the population is uneducated with limited exposure to technology, Sehat Kahani upgrades existing basic health centers within the community to “Sehat Kahani E – Health Hubs”, by developing telemedicine services in these marginalized communities. This is facilitated by a licenced telemedicine software equipped with EMR (Electronic Medical Records), Live video consultation, E-PRescriptions as well as essential diagnostic tools enabling proper diagnostic facilities with the support of an intermediary nurse. The Hubs act as a one stop shop for primary health care services in the target communities and are then run by our network of trained and trusted intermediary- a front line female worker (Lady Health visitors, Nurse, Community Midwife). The intermediary connects all walk in patients to an online female home based doctor (general physician and Specialists) using a specialized software that records medical information of the patients secured via a unique medical record(MR)number, enable a video consultation, uploads relevant medical documentation including diagnostic reports and images, can connect to point of care diagnostic tools for carrying out extensive examination, generates an E- Prescription and Invoice after the consultation, records feedback of the patients as well as aids in educating and counselling the patients through various preventive and curative health care tutorials. Each intermediary is provided with online and in-person 5 step training with modules on leadership, soft skills, business acumen, medical and pharmaceutical protocols, peripheral point of care diagnostics tools and best service delivery practices. Along with providing access, Sehat Kahani conducts preventive health care messaging to work on community health patterns as well as provides digital health efficiency through its health Tech platform that can provide a female doctor to anyone in just 3 clicks on their mobile phone.