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Building Bridges: deliver quality healthcare to undeserved communities by utilizing E-Health solutions

Connect rural communities for provision of quality healthcare, employment opportunities and health education by telehealth avenues

Photo of Dr. Sara Saeed Khurrum

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*Please Upload User Experience Map (as attachment) and any additional Beneficiary Feedback in this field

Explain your project idea in two sentences.

Improve accessibility of quality health services by connecting rural low income beneficiaries [women & children] with home based female doctors through E-Hub and E-Spoke telehealth model in Pakistan.

What is your organization name? Explain your organization in one sentence.

Sehat Kahani provides affordable health care to low income families in rural Pakistan via telehealth

Is this project idea new for you or your organization? If no, how much have you already executed on?

In February 2017 “Sehat Kahani” acquired all of doctHERs' clinical operations, assets, team, and partnerships, which constitutes an acquisition of operations with a proven track record of 2 years. We have currently impacted 30,000 directly and 250,000 beneficiaries indirectly through 9 telehubs.

What is the problem you aim to solve with this idea? How would you define this problem as urgent and a priority in your target community?

Pakistan provides healthcare to 51% of its population. 30% lack access to even primary health care. Nearly 50% of the female workforce does not pursue medical career after graduation. Sehat Kahani has developed a cost effective replicable model that bridges the health inequality gap in Pakistan.

What is the timeline for your project idea? What are the key steps for implementation in the next 1-3 years?

As a part of of our 1 to 3 year project, we would expand to 40 E- Hubs and 80 E- Spokes all across Pakistan. E-Hubs would cater to in clinic services that will contain clinical consultations via an E- Hub specialist as well as provision of door to door health services through our E-Spoke model. Collectively we aim to reach out to 1.5 million beneficiaries. Along with this , we will be employing over 200 females doctors and 150 primary health care provider back into the medical workforce.

Describe the individual or team that will implement this idea (if a partnership, please explain breakdown of responsibility).

Dr. Sara: Co-founder & CEO – Community & Clinical Operations, Development & scale-up. Dr. Iffat: Co-founder & CBDO – Collaborations, Sponsorships, Investment Opportunities. Mahek Merchant- Lead research, Grant proposal writing. Makkiya: Monitoring and evaluation, collaborations & partnerships

What do you need the most support with in this project idea?

  • Program/Product/Service Design

What is your primary goal over the next 6 weeks of Refinement?

  • Learn to measure and grow project results

How do you currently measure (or plan to measure) results for this project?

Our impact metrics includes (i)Increased employment opportunity and capacity building for health workers. (ii)# of Community Midwives trained to facilitate online consultation by a specialist via telemedicine.(iii)Number of patient visits [initial and followup] for general and specialist consultations at home and at clinics. (iv) Number of patients availing Value Added Services. (v) Number of households covered by hub and spokes. (vi) # of our of home based female specialist inducted in network

How has your project proposal changed due to your user research during the Beneficiary Feedback Phase?

We realized that we need to make the project more user need centric. Therefore, we have added a feedback call mechanism in our system to analyze the user experience as well as realize the customization to the system expected by the users. Our community health workers also perform door to door mobilization to better understand user need and add it in the system as required.

During this Improve Phase, please use the space below to add any additional information to your proposal.

During improvement phase, we reached out to our beneficiaries for their user experience, feedback and stories. Bashira decided to narrate her story and shared her experience of accessing health services in her community like never before.

"I am a 50-year-old mother of five children, who work as a house cleaning lady. Without the support of my husband, I am the sole bread earner of the family. I tried to ignore her illness for a long time but as my condition worsened, and prevented my from doing further work, I finally decided to seek help."

Bashira was admitted at SehatKahani E-Health Centre [E-Hub} in Karachi, Pakistan, a few months ago. Her condition on arrival was 'alarming' recalls Nurse Tabinda. She was 'dehydrated, wasted, feverish' and on examination, she also had 'chest congestion and a debilitating cough'. On taking detailed history it was found that Bashira was in fact diagnosed with Tuberculosis many years ago and had also sought treatment back then. However due to financial constraints and lack of awareness she never completed her treatment.
She was connected to our E-Hub Specialist, who further concluded that Bashira was suffering from Multiple Drug Resistance Tuberculosis (MDR -TB). This form of T.B. was not only a danger to Bashira, but also her family and her employers, whom she was in close contact with. She was initially given a prompt anti-tuberculosis treatment, but due to the severity of her disease, a more intense treatment was required for faster recovery.

Looking back, Bashira recalls “I used to be so upset before the diagnosis had been made, as I couldn’t look after my house nor could I perform my job properly. I was so happy to see the genuine concern for me by the very competent nurse and doctor at the Sehat Kahani E-Health Centre. They explained what I had and that I would get better with proper care. I did not have to stand in long lines all day just to get a token, either. Reaching out to the doctor and sharing every little concern I had with her was also made easy for me by the Sehat Kahani staff, considering how crucial my condition was."

Pakistan ranks 5th amongst the TB-burdened countries and has the 4th highest prevalence of MDR-TB in the world. People like Bashira, who are alone, have an entire family depends on them, and are at the very end of the socioeconomic scale, are the people in whose lives Sehat Kahani aims to make the biggest difference. These are the people for whom it is impossible to take a break and seek in tertiary care, let alone have access to quality healthcare! To date, Sehat Kahani has impacted 250,000 lives through our 9 E-Health Centres across Pakistan!

Today, Bashira is on her way to recovery. She has returned to work, gained weight, her appetite has increased, and she is taking all her medicines on time as counseled by our E-Hub Specialist. Sehat Kahani looks forward to a happy and healthy future for Bashira!

Note that you may also edit any of your previous answers within the proposal. Here is a great place to note any big final changes or iterations you have made to your proposal below:

During our improvement phase, we designed a user feedback survey to make the experience more user-friendly and centric. Approximately 2,500 beneficiaries were inducted in this survey.

Why Now?

Pakistan, a population of 182 million and one of the fastest growing economies in the world still struggles to provide basic healthcare to 51% of its total population. Around 40 million people live below the poverty line. Almost 30% of the population lack access to even primary health care facilities.  The total GDP spent on healthcare in 0.9% and there is a recorded 30% penetration of counterfeit medicines. One child in ten dies before their 5th birthday. Simultaneously, 2016 statistics by PMDC state that each year the country produces nearly 170,000 general physicians and about 40,000 specialists. Nearly 50% of this entire workforce consists of female doctors. Yet 50 % of the female workforce does not pursue career options after their medical degree and basic registration. The primary reason for this high drop-out rate is that women are expected to stay at home after marriage and children. 

Our Drive- Our Motivation- Our Story!

Primary Health Centers converted as Sehat Kahani Telehealth Centers = Ehubs

 An example of beneficiary availing telehealth consultation at Sehat Kahani E-Hubs 


Community Health workers equipped with tablets----> Door to door provision of telehealth consultations to beneficiaries [users] = E-Spokes

Sehat Kahani All-Female Health Provider Network Mechanism

Financial Model and Sustainability


Our Impact till Date

How we reach to our beneficiaries [Users]Our Growth and Expansion plan!

Our Competitive Edge in Market!Our Supporters and Partners


Explain your idea

Access to quality health care represents a challenge in Pakistan, particularly for marginalized and disadvantaged populations where 20 percent live more than ten kilometers from a basic health facility and 46 percent live more than ten kilometers from a rural health center. The materrnal Mortality ratio (MMR) in Pakistan is 276 maternal deaths per 100,000 live births. Under-five mortality is also high in Pakistan at 89 deaths per 1,000 live births and 38 percent of women have no postnatal check-up.
To bridge the health inequity gap, based in Pakistan, Sehat Kahani (http://sehatkahani.com/) is a social impact initiative of Community Innovation Hub. Our spectrum of services includes but is not limited to a) Empowering the value-chain of female healthcare providers to leverage ICT to deliver leading edge healthcare (Hubs and Spokes) in rural and low income urban communities. b) Leveraging technology to use video conferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education, consumer-focused wireless applications and early referrals c) Capacity building of nurses to transform them into micro-entrepreneurs. d) Improvement of Maternal and Neonatal Health and Water Sanitation and Hygiene Indicators. e) Health Market Research to disseminate knowledge for betterment of the health sector. f) Awareness Campaigns pertaining to all health domains.
The purpose is to create a bridge between these out of practice female health workers with women in under-served region for the provision of quality affordable healthcare [planet] within the vicinity of their communities using a web based interface to have better health outcomes [propsperity] by deploying tele health hub and spokes in rural regions.
 With the establishment of 9 telemedicine clinics, Sehat Kahani institutes a consistent, well-organized and easily replicable remote patient health setup that is pivotal to ensure the provision of quality healthcare in underserved communities. This will enable the communities to reduce their travel time and costs to access a basic health unit. The telehealth initiative will be a low cost one stop solution for communities at their doorsteps within the vicinity of their communities. The Sehat Kahani hub and spoke model can alter the approach healthcare services are delivered to and accessed by over 250 million women and children in Pakistan. The ideology is to promote gender inclusion in the workforce as well as reduce health inequality in Pakistan. Sehat Kahani intends to empower female healthcare professionals value chain by utilizing ICT based solution- a tradition that has been disregarded in past in Pakistan.

Who Benefits?

There are four target populations that primarily benefit from Sehat Kahani: (i) female medical doctors who are not practicing medicine and are excluded from the healthcare workforce due to social pressures or family constraints Sehat Kahani intends to target those 60,000 female physicians out of work force to empower them to join the workforce through an interface with which not only will they be able to work while maintaining the cultural and social sensitivities but it also enables them to have some monetary benefits while providing them a constant hand on training; (ii) underpaid female nurses and CHWs who are under-­‐employed in marginalized, rural communities and/or urban slums, (iii) 108 million low-­‐income women and families in rural areas and urban slums of Pakistan who lack access to affordable, quality healthcare, provide quality (iv) stakeholders affiliated with corporate value chains such as factory workers.

How is your idea unique?

Sehat Kahani is an innivative platform in Pakistan that creates and utilizes a network of out of force female health workers and connect them to marginalized women who are unable to access healthcare due to socio-cultural barriers while leveraging technology. It offers to deliver a healthcare model that advances the traditional healthcare services in Pakistan as the model is (a) real time, (b) affordable and (c) accessible. Unlike other teleheath ventures in Pakistan, Sehat Kahani offers real time nurse assisted video consultation with doctors and specialists, provide a range of value-added services all within the vicinity of the community. Therefore, it creates a 360 health solution in Pakistan that delivers comprehensive quality care to beneficiaries irrespective of cast color, creed, and geographical barriers. Our idea will be more sustainable because it is an initiative created by women for marginalized women in Pakistan to combat health inequality.

Idea Proposal Stage

  • Full-scale roll-out: I have completed a pilot and analyzed the impact of that pilot on the users I am trying to reach with my idea. I am ready to expand the pilot significantly.

Tell us more about you

Sehat Kahani is a social initiative created by disruptive innovators, based on an all-women provider network that is more allied with the social and cultural preferences and acceptability of women and children to be consulted by female doctors and community midwives.Consequently, it addresses health inequality, increases health accessibility and decreases the human health burden in Pakistan.
Currently we are working with national and international partners and collaborators to create many innovative health solutions for preventive and clinical care of our beneficiaries. These initiatives include but are not limited to first ever telehealth setup in Pakistan, measuring calcium bone density in rural communities and interventions to prevent it, monitoring and improving health hygiene practices and mass capacity building activities for female health workers in Pakistan. Sehat Kahani has 9 E- health clinics under its banner in Sindh, Punjab and KPK, employed 50 doctors and 25 nurses and community health workers and has treated 28,000 patients directly and more than 200,000 patients in last 2 years. Our future initiatives include equipping community midwives with telehealth services for specialist consultation for maternal complications, online continuous medication education for female doctors and converting basic health units into telehealth centers. By the end of 2017, Sehat Kahani aims to generate 450 patients/month/clinic for the general physician model and 200 patients/month/clinic for the specialist model. Based on this projected forecast, along with a percentage of 30% of the total patients availing VAS, 20% availing Ultrasound and another 30% availing lab referrals, Sehat kahani will be able to generate a net revenue of approximately 78,000 PKR per clinic per month ($742 @105 conversion rates). At the stated estimated revenue; Sehat Kahani will be able to ensure sustainability at a per clinic unit structure at 11 clinics. By 2020, Sehat Kahani will expand its services to 50 telehealth clinics and 100 telehealth spokes across Pakistan, provide better health solutions to 8 million beneficiaries, create a network of out of practice 500 female doctors 1000 females nurses and community health workers. We also aim to decline the net maternal and neonatal morbidity and mortality by 30% by increasing health accessibility by 85 % across rural regions of Pakistan.

Expertise in sector

  • 3-5 years

Organization Filing Status

  • Yes, we are a registered company.

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Photo of madiha kulsoom
Team

Hi Sara and Team!
I would like to congratulate the team involved in the sehat kahani success.
I also read the article about Pliro at https://peeky.pk/pliro-new-online-healthcare-platform-connect-doctors-patients/ and its awsome,
When was doctHERs registered as a company?

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