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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.

51 comments

Join the conversation:

Comment
Photo of NaSeem Usmani
Team

Things are moving in right direction and hope soon you will start using EMR and collaborate with others doing the same kind of effort

Photo of Zakiuddin Ahmed
Team

After having a hands on experience of working in telemedicine for around 20 years now both in Pakistan as well as globally, I am convinced that this solution, which is needs based, offers a meaningful value proposition and has a strong potential to address & solve the healthcare problems which we face especially in the rural areas. It is focused around the patient and not around technology hence ensuring the success of any Telemedicine solution.
The team of Sehet Kahani not only has the relevant expertise, experience & conviction which is required for making such projects successful & sustainable, they also possess state of the art technology allowing a seamless & patient-centric teleconsultation process.
Pakistan with a population of 220 million, rural-urban disparity, lack of healthcare professionals & facilities, poor quality of care, and other challenges need such an integrated and unique solution which leverages upon the huge resource of female Physicians who not only possess the required training & expertise but also the zeal & passion to contribute while enjoying the luxury of remaining at home and taking care of their families. This concept of connecting professionals without having them to leave their homes will play a major role in the sustainability of this solution.
I have launched quite a few Telemedicine projects and Digital Health initiatives both locally as well as globally and hence can confidently endorse this idea of Sehat Kahani which has most of the ingredients for a successful & sustainable patient-centric Telemedicine solution.
I wish Dr. Sara and her team all the best and hope that their solution will alleviate some of the misery of our patients in Pakistan.
Dr. Zakiuddin Ahmed
Past President, eHealth Association of Pakistan
President, Healthcare Quality & Safety Association of Pakistan
Program Director, Digital Health, King Saud University, Ryadh
Project Director, Riphah Institute of Healthcare Improvement & Patient Safety
President, Healthcare Paradigm
Director, Digital Health, Pharmevo
Secretary, Health Research Advisory Board
CEO, Digital Care
www.drzaki.org

Photo of Aisha Mir
Team

I would like to congratulate the team involved in the sehat kahani success. Working in a public sector tertiary care setup for the last 5 years in Pakistan and having seen all problems faced by patients getting quality healthcare i would say they need all the support needed. Women in general are more health conscious but are left without means to access facilities due to various reasons. They have indentified a novel way to over come hurdles and I wish them success as they have a very long road ahead even though have come up at the speed of light.
Best wishes
Dr Saifullah Mir MD.

Photo of Umar Farooq
Team

We have been working with Sehat Kahani team from couple of years in KP region. As we all know that Primary healthcare infrastructure in KP province is mostly concentrated in urban areas. There’s a pressing need to provide the rural population with access to quality and affordable services
Sehat Kahani is trying to bridge this gap with the help of technology . They are they are the pioneers of the health care revolution in KP . Sehat Kahani is reaching out the remote areas of Pakistan where finding quality health care is almost impossible. Being said getting face to face real time consultation with qualified female doctors is the real game changer for these rural communities and huge blessing. We wish these guys all the best for their future endeavors and looking forward to offer our full support and cooperation to extend their foot print in the region.
Umar Farooq
Founder Tech Valley Abbottabad

Photo of Dr. Sara Saeed Khurrum
Team

Umar Farooq we are fortunate to have supporters like you that enable us to pursue our passion!

Photo of Mohsin Mustafa
Team

I have seen Sehat Kahani and the team evolve over the years. They've grown by leaps and bounds as individuals and have grown the business in parallel. They get full marks for dedication, commitment and passion
 What I would like to see more of (if it's not happening already) is integration of these telemedicine centers with the local health systems be it private clinics, dispensaries or hospitals. While business focuses on and benefits from growth, healthcare outcomes however are improved through collaboration with the local health system. Embedding it into the DANA from the outset would build the right kind of growth trajectory.

I hope you guys win this one. All the best,
Mohsin

Photo of Dr. Sara Saeed Khurrum
Team

Mohsin Mustafa we appreciate your unconditional support towards our mission and team!

Photo of Rahmatullah Turk
Team

Sehat Kahani is working on great project to serve rural community because majority of our country still lives there and have no facilities as urban people are enjoying specially health is great problem for them as transport and other infrastructure issues. Sehat Kahani is providing easy access of health care for them. And through this initiative Sehat Kahani has got a committed and result oriented team.

Photo of Dr. Sara Saeed Khurrum
Team

Rahmatullah Turk thankyou for your appreciation!

Photo of Salima Mithani
Team

I have worked with Sehat Kahani very closely and have seen the impact through the stories unfolded by the community people. Not just it provides access to health care but it is touching these communities through empowering local people by providing capacity building workshops and hands-on experience with technology. In a community where people do not know about the laptop, Sehat Kahani has introduced them to telemedicine. As a team, I have been with them when they were facing one of the toughest times of their journey and I must say they possess the consistency, grit, and fierceness to achieve their goals. With this determination and passion, I am sure they will achieve more than what they aim for. Good luck super amazing team!

Photo of Dr. Sara Saeed Khurrum
Team

Thankyou Salima Mithani  for your love and support!

Photo of Hiba Ikram
Team

Hello Dr.Sara,
I would like to bring this into your notice that Sehat Kahani has used RingMd's picture in its user experience map. This picture is solely RingMD's property which was taken during their telemedicine camp at Haran Mera Rawalpindi.
I was RingMD's PR&Communications Manager at that time and have lead this project myself, so I am the concerned person to notify you about this issue, which I think violates the true spirit of intellectual property.

Please take notice of this as soon as possible.
Thank you!

Photo of Dr. Sara Saeed Khurrum
Team

Hi Hiba,

Thank you for your comment and bringing my attention to this matter. I want to first start off with appreciating RingMd for their innovative approach to improving access to health care in Pakistan. When my R& D team was designing the user experience map, we searched online search engines [open source] for pictures that would best describe our process. While using the pictures we ensured not to remove any apparent logo from any pictures that depicted their source. We specifically did not intentionally use Ring Md picture nor we were aware of the picture source at the time. We even made the picture blur and sketchy so it could have depicted the wholistic viewpoint. In the user map, we nowhere claimed that these pictures were the exclusive property of Sehat Kahani. If you also view our media gallery you will see that all pictures depict Sehat Kahani mechanism and no third-party images are used. The same goes for the content as well. However, we would like to acknowledge your work and would love to give credit for the image that has been used. We would also like to thank you for helping us learn to always mention picture source while using a third party image. We will incorporate this in our future endeavors. The end goal is to co-exist and support each other mission to make healthcare accessible and bridge health inequality for all.

If there are any other reservations, I am happy available on my email at sara@sehatkahani.com

Photo of Shehzad Saleem
Team

It all stated few centuries ago when people used to discuss there everyday problems in the form of storytelling or "Kahani". I feel that the issue of rural health has so far been hidden from the storytellers and now Sehat Kahani has taken up the cause of rural health . As afirst step by using ,modern technology and combining it with age old tradition , their initiative will make health delivery possible to the over 60% rural population of Pakistan where even diagnosis of various chronic illnesses is not available and thus the patient is not able to reach the tertiary health care centres for treatment.
The availability of telehealth will be a great help to a huge population of the country.

Photo of Dr. Sara Saeed Khurrum
Team

Shehzad Saleem Thankyou for understanding the dire need of quality healthcare service in Pakistan. At Sehat Kahani we are aiming to bring back the female health workforce and connect them to deprived areas for the provision of accessible, affordable and quality healthcare.

Photo of Fa Salahuddin
Team

Great idea and execution to date: bringing much wasted medical potential back into practice, and serving the unmet medical needs of the BOP communities. Bravo!

Photo of Dr. Sara Saeed Khurrum
Team

Fa Salahuddin Thankyou for your love and support!

Cheers (:

Photo of Zia Imran
Team

This is a needed service to bring healthcare to BOP and small rural communities. Thousands of patients already served. Very impressive.

Photo of Dr. Sara Saeed Khurrum
Team

Zia Imran It is the supporters like you who are continuously motivating us to bring the health services closer to the Women, girls, and children in Pakistan. Thank you for showing your support and commitment towards our vision!

Photo of Syed Haider
Team

Great Work !
We need more such initiatives to bring about positive change in our country

Photo of Dr. Sara Saeed Khurrum
Team

Syed Haider Thankyou for your support! Stay Connected to see the amazing initiative Sehat Kahani team is bringing for the marginalized communities in Pakistan! If there is any other feedback let us know!

Photo of Zara Hussain
Team

I have been personally watching this initiative grow from the ground up and I must say it's commendable how the founders and the entire team have developed this idea into a reality. This truly puts technology in the correct use in Pakistan. Healthcare is a necessity that alot of Pakistanis can't afford or don't have access to. Sehat kahani is striving and are achieving goals which were thought to be impossible. They have tapped potential talent the female doctors and gave them the power to use their abilities while maintaining their personal lives. They are promoting women empowerment while building a better healthcare system. I think their ideas and purpose of existence is exemplary and should be supported because they are capable of achieving what they have outlined as they have been doing so far. Good luck team sehat kahani!

Photo of Dr. Sara Saeed Khurrum
Team

Zara Hussain  thank you for your support and kind words! Its supporters like you that drives our passion to bridge health equality gap in Pakistan via utilizing technology!

Photo of Rabea Sarwar
Team

Hi! I'm a student at Liaquat National Hospital and Medical College. Members of our college's philanthropic committee, Helping Hands, recently accompanied the Sehat Kahani team and worked in close proximity with them at a camp revolving around provision of maternal and child health care. We first hand witnessed how this project is a huge step towards providing quality healthcare to our rural communities.
It was truly remarkable to see how, at the end of just a one day camp, over 300 women had undergone free health checkups, including free ultrasonography.
Your leadership skills,organizational abilities and channelization of different duties in the most demanding of environments greatly attribute to your success. We as young philanthropists someday wish to instill similar characteristics within our work frame.
Thank you for the opportunity and we hope our collaboration reaches higher milestones through future endeavors. :)

Photo of Dr. Sara Saeed Khurrum
Team

Rabea Sarwar it was truly a privilege to work with students of Liaquat National Hospital and Medical College! We as a team aspires to evolve continuously to deliver the best possible solutions to underserved beneficiaries. Making healthcare accessible in such resource constraint area is a constant challenge and can not be executed by one person or team only. We believe that collaboration and cocreation are the keys to our success! Thank you for all your love and support!

Photo of Maha Rehman
Team

Hi. Much needed initiative to reach the under served communities across the country.

I am specifically interested in your expansion plans in Punjab. The BHUs here, in particular, are understaffed. Can you please elaborate on this aspect a bit more?

Photo of fareha
Team

This sounds like a great initiative by the sehat kahani team. We definitely need projects like these to run and help better our community. To cover the remote areas of the country where there is little to no help of doctors in thr matters of health, I think this initiative will prove viable and important!

Photo of Dr. Sara Saeed Khurrum
Team

Thankyou Fareeha for your support and feedback!

Photo of OpenIDEO
Team

Hi Sara and Team! We’re excited to share with you feedback and questions from our expert reviewers. We encourage you to think about this feedback as you continue to improve and refine your idea. You are welcome to respond in the comments section and/or to incorporate feedback into the text of your idea. Your idea and all associated comments will all be reviewed during the final review process.

Based on expert career, previous work and field experience, is this a new approach or bold way of answering the challenge question:
• I really like the connection here between different marginalized groups. Creative and bold in that sense. The attention to nuance and local embededness also supports the strength of this proposal. I think the amount they lean into the user-centric nature of design thinking and this refinement process will support how much more innovative they may call their model relative to other telehealth initiatives.
• I’m curious about the decentralized model of change – curious about how Sehat Kahani manages so many different agents of change, and tracks their impact/influence accurately. The mobiletech phenomenon, esp as it applies to connecting underresourced populations to health resources, is not so new. Though if the impact can be created and tracked in the context of this project and urgent issue, I definitely would categorize it as bold.

Desirability and Viability of proposal:
• Would categorize as desirable. The prototypes and success seen to date help with confidence here. Viability wise, I am interested for more granular details about how they plan to scale as mentioned in the proposal – and what risks they are keeping top of mind in this growth (in regrads to sustainability).
• Would love to see more context around the end users and what they see as an ideal solution, as well as how included/discluded they feel from a community, given the mobile aspect of this solution. Is there some aspect of co-creation that might strengthen this work and ensure local/community sustainability for the women? How can empowerment continue on past initial engagement with the product/service?

Feasibility of proposal (is this an idea that could be brought to life?):
• Certainly seems feasible. They’ve done a great job of capturing learning/impact to date, though more granular information on what it took to reach the current level of impact would strengthen proposal. This could be used to accurately predict resources/energy needed to scale feasibily as scoped.
• I love that they have illustrated a willingness to grow/evolve eventually with user needs – was impressed by their identification of what has changed due to beneficiary feedback and quick integration.

Other questions or suggestions our experts felt would support the assessment or success of your idea:
• Good work. Has thought been put behind what is a Plan B, should partnerships, local adoption, etc become insecure? Great proposal, but I’d like to see more of an address of risks/potential challenges. What are the dangers that you’ve considered, and how do you plan to respond to these proactively should they arise? A critical lens is so important in this work.
• We’d be interested to learn more about if/how the organization is considering challenges from the governmental/policy lens (How might the proposal be influenced from this perspective? Are there additional strategic partnerships that may, at some point in the roadmap, need to be put into place?)

In case you missed it, check out this Storytelling Toolkit for inspiration for crafting strong and compelling stories: http://ideo.to/DXld5g Storytelling is an incredibly useful tool to articulate an idea and make it come to life for those reading it. Don’t forget - June 16 at 11:59PM PST is your last day to make changes to your idea on the OpenIDEO platform.
 
Have questions? Email us at bridgebuilder@ideo.com.
 
Looking forward to reading more!

Photo of Dr. Sara Saeed Khurrum
Team

Hi OpenIDEO Team,
We are very grateful for your valuable feedback! Continuous mentorship and support are what makes us improve our services and fuel our passion for making quality and affordable healthcare accessible for all in Pakistan.

How Sehat Kahani tracks impact/influence on the different change of agents as well as the role of m-health innovation?

Sehat Kahani believes that the ultimate purpose of any medical care is to maintain or improve health and well-being. Thus, how Sehat Kahani telemedicine platform affects the quality of care and its outcomes is a central evaluative question—as it is for any health service. To track the impact of services following dimensions are the included by our monitoring and evaluation team.
• Technical capacity—whether the deployed technology is safe, accurate, and reliable (e.g., how do transmit digital images compare to films?);
• Diagnostic accuracy—whether the deployed technology contributes to a correct diagnosis (e.g., was an initial dermatology diagnosis by a primary care clinician corrected after review by a dermatologist?);
• Diagnostic impact—whether the deployed technology provides diagnostic information that is useful in making a diagnosis (e.g., after the telemedicine consult, is a face-to-face consultation still necessary?);
• Therapeutic impact—whether the deployed technology influences patient management or therapy
• Patient outcome—whether the deployed technology improves patients' health and well-being

At Sehat Kahani, the impact on beneficiary or patients are generally considered to include not just desired endpoints of health care (e.g., reduced mortality, improved functioning) but also a broad range of immediate and intermediate results (e.g., reduced blood pressure, higher vaccination rates, fewer hospital readmissions). We track these indicators on a monthly, quarterly and annual basis and compare them with the National Statistics or reports available to gauge the overall impact. Our on-ground community health workers are actively engaged with community beneficiaries who are now transformed as local influencers and help to increase awareness in the area. Conventionally, we aim to mitigate and prevent the three broad types of quality problems during our monitoring and evaluation process. They are (1) overuse of care (e.g., unnecessary telemedicine consultations); (2) underuse of care (e.g., failure to refer a patient for a necessary consultation); and (3) poor technical or interpersonal performance (e.g., inattention to patient concerns).

Increasing access to new health technologies that leverage the power of mobile communications—both in emerging and developed markets—promises to deliver better health solutions around the globe. Recent research shows that emerging countries are adopting mobile phones at a very fast pace. Although, in Pakistan, only 3% of the population owns a smartphone, while the remaining 50% still use feature phones. Sehat Kahani believes that as mobile devices become increasingly sophisticated, they can be used to do more than simply transmit information and advice. Smartphones and broadband enabled devices can become medical devices, used for monitoring vital signs and body functions or as video conferencing equipment, facilitating remote consultations. The penetration of telehealth services in Pakistan is not as high as in other developing countries. The concept of accessing a doctor on a broadband-enabled service in rural communities is still very novel contributed by low literacy and awareness level. Sehat Kahani unlike its other contemporary telehealth project is working exclusively in rural communities and is striving to integrate telehealth into primary health care services for more cost effective, accessible and quality healthcare service delivery.

Photo of Dr. Sara Saeed Khurrum
Team

What is the scale up and sustainability plan of Sehat Kahani?

By 2020, we plan to establish 50 E-Hubs and 100 E-Spokes across Pakistan. The plan is to induct 500 community health workers and a network of 2000 at home female physicians. The breakup of expansion plan on provincial level is given below:
1. Khyber Pakhtunkhwa [KPK]- Expansion to 15 E-hubs and 30 E-spokes in collaboration with Medibank Pakistan, TechValley Abbottabad, Sungi Foundation, DKT Pakistan and KPK government by creating public-private partnerships and collaborations.
2. Punjab- Expansion to 10 E-Hubs and 20 E-Spokes in collaboration with Punjab Government, Kawish Trust and Medibank Pakistan
3. Sindh- Expansion to 20 E-Hubs and 40 E-Spokes in collaboration with SPRING [DFID], MNCH, DKT, Rotary International and BISP Pakistan.
4. Balochistan- Expansion to 5 E-Hubs and 10 E-Spokes in collaboration with Rotary International and BISP Pakistan and Institute for Development Studies and Practices (IDSP)

Sehat Kahani aims to provide and an average of approx. 500,000 patient consultations per year. This would result in a cumulative impact of approx. 8.1 million lives through all the services. In the next 6 months, we are already on schedule with funding and partnerships in place to open 8 new E-Hub clinics and are in the process of seeking funding as well as partners for further expansion. In addition, Sehat Kahani continues to explore other partnership/collaboration avenues to introduce telehealth services in underutilized primary healthcare centers.

Sehat Kahani strives to be sustainable in communities by exhibiting strong collaboration within the rural health institution, with the local community, and with external partners. In addition, Sehat Kahani establishes well-functioning, in-person outreach clinics within primary health care specialties, hence making an early move toward adoption of telehealth in under-served areas. Furthermore, the champions and managers of Sehat Kahani exhibits visionary leadership and adopted facilitating tactics to cultivate participation and generative capability.

In terms of financial sustainability, Sehat Kahani aims to develop a mechanism whereby E-Hubs [Clinics converted as telehealth centers], as well as the E-spokes [community health worker equipped with a tablet to provide telehealth consultations to users on a door to door basis], become sustainable after a period of 1-year deployment. The numerous revenue generation streams of a Sehat Kahani health services include consultation with a telehealth online physician, teleconsultations with a Specialist, Value added services, which include (but are not limited to) Drips, Injectable, Nebulization, Glucose strips etc., ultrasound services and subsidized referral mechanisms for tertiary care services.

At E-Hub level, at Month 6 to ensure sustainability, we aim to have approx. 350 telemedicine consultations and around 160 specialist consultations. Whereas, at 12 months the telemedicine consultations will cap at 450 patients while the Specialist patients will cap at 200 patients. Total Revenue from the above-mentioned streams along with the perceived value-added services is going to be around 1,069USD per clinic per month. After deduction of the expenses, this becomes roughly 784USD per clinic per clinic. At E-Hub level, the CHW will charge 1 USD to the beneficiary for teleconsultation with an online physician at home. Value Added services will be charged at 1.5 USD. During the 12-month timeline [1st year of E-Hub deployment] includes 12 visits per day. On an average; one Spoke will be able to generate 360 USD after 12 months after deduction of the CHW’s incentive, Online Physician’s incentive as well as the expenses needed to incur for the E-Spoke Model. Looking at 2 spokes per clinic; this essentially means a Net Profit of 720 USD per Hub for 2 spokes after a period of 12 months. Reaching sustainability ensures that the Sehat Kahani E-Hub and E-Spoke model is self-dependent and does not require any external funding ensuring a sustainable growth for the company as well.

Some risks that may hinder Sehat Kahani growth and expansion includes inadequate funding, local community adoption, laws and regulations and failure of partnership collaboration [discussed in detail in further responses.]

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Team

Is there some aspect of co-creation that might strengthen this work and ensure local/community sustainability for the women? How can empowerment continue on past initial engagement with the product/service?

When a patient/ beneficiary first enters through a health care provider’s intake system, telehealth can enable immediate assessment and triage. Based on our user and community research we have found that that the ideal solution for community beneficiary is the in-house availability and accessibility of all health care services ranging from a primary health consultation to laboratory and ultrasound services. As our beneficiaries [women and children] residing in rural areas are unable to access health services from far flung areas.

Sehat Kahani core work and impact is based on cocreation mechanism. For instance, the community health worker for E-Hubs and E-spokes is recruited from the respective beneficiary community only. In addition, local labs, pharmacies, and ultrasound services are included from the beneficiary community only. In order to make the community beneficiary feel more inclusive, the E-Hubs and E-Spokes are deployed within the target community only. Sehat Kahani bridges all these services and delivers it to beneficiaries in cost effective manner while ensuring quality and sustainability.

Sehat Kahani continues to empower beneficiaries by enabling them to improve self-management through education, remote monitoring, and treatment adherence, thereby, shifting the balance of power and transform the relationship between the user/beneficiary and health provider to one focused on co-creation. The aim is to empower women residing in under-served communities to engage in their own care. Furthermore, Sehat Kahani aims to financially empower female health workers who were underutilized in the past due to socio-cultural barriers, in communities by providing them employment opportunities for E-Hubs and E-spokes. In short, Sehat Kahani telehealth platform offers a flexible option for a wide variety of behavioral and physical health needs and treatment regimens, augmenting patients’ existing primary health resources and programs.

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Has thought been put behind what is a Plan B, should partnerships, local adoption, etc become insecure? Great proposal, but I’d like to see more of an address of risks/potential challenges. What are the dangers that you’ve considered, and how do you plan to respond to these proactively should they arise? A critical lens is so important in this work.
• We’d be interested to learn more about if/how the organization is considering challenges from the governmental/policy lens (How might the proposal be influenced from this perspective? Are there additional strategic partnerships that may, at some point in the roadmap, need to be put into place?)

Establishing E-Hub and E-Spokes in rural areas of Pakistan is a challenging task and requires a continuous behavior change support. Below are the following challenges Sehat Kahani anticipates in the growth and expansion of its E-Hub and E-Spoke model as well as proposes mitigation strategies.
1. Challenge: Failure of partnerships. Mitigation: Develop multiple partnerships to avoid any detrimental effect on the aimed impact.

2. Challenge: Affordability of Community Beneficiaries to access health services. Mitigation: (1) Device cost effective services for community beneficiaries to ensure maximum community participation and involvement. (2) Subsidization on health services availed by community beneficiaries. (3) Collaboration with local and international partners to support/sponsor telehealth services for beneficiaries.

3. Challenge: Technical Failure Risk [software risks] in remote areas of Pakistan. Mitigation: (1) Technical assessment performed during need survey of target communities. (2) Placement of Internet boosters or backup internet devices. (3) Usage of portable internet dongles to avoid internet disruptions in power failures. (4) Integration of work offline mode in the system to restore lost data saved. (5) The flexibility of switching from video to audio mode in case of low internet bandwidth. (6) The soft launch of the system in the community to assess any loopholes in the system. (7) Master training of software by technical respective to the project staff. (8) Collaboration with technological partners and National and International level.

4. Challenge: Community Uptake for telehealth services in rural Pakistan. Mitigation: (1) Weekly mahaulla [cohort] meetings and elder session to induce awareness and increase acceptability. (2) Live demo sessions with women cohorts. (3) Health awareness videos. (4) Confidence building measures to avail telehealth services.

5. Challenge: Political risks- Many political parties can influence the clinical activities in the targeted region to justify their political mandate. Mitigation: (1) Sehat Kahani strives to sustain a neutral relationship with political parties. (2) Sehat Kahani ensures that no endorsement of any political parties is being made at any beneficiary communities. (3) Sehat Kahani develops a steering committee including community leaders and political influencers to avoid any conflicts with the political culture of the targeted communities.

6. Challenge: Legal risk- No legal regulations or frameworks available in Pakistan for the telehealth service delivery model. Mitigation: (1) Sehat Kahani reviews all health legal acts to ensure transparency in the procedures. (2) Legal consultancy to mitigate any regulation issue. (3) Sehat Kahani before deploying any services in target communities seeks an approval from a local District Health Office [DHO] approval. (4) Sehat Kahani formulates partnerships with Governmental agencies to ensure compliance with regulations. For instance, currently Sehat Kahani has collaborated with Maternal and Child Health Pakistan [MNCH] – a government agency that monitors and ensures the quality of health services delivered by local community health workers and midwives.

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Team

Looking forward to talking to you!

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Team

You mention as one of your metric, "Number of households covered by hub and spokes." How much of a limitation on your growth is the access to affordable broadband Internet? Our solar-powered, satellite/wireless broadband solution works anywhere in the world. Please see our submission: https://challenges.openideo.com/challenge/bridgebuilder/improve/appalachia-empowerment-collaborative
Anne

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Dear Anne,

Thank you for your comment. Internet is absolutely vital for our tele-consultations via the hubs and spokes. We currently use wireless internet devices by local telecom providers. Absolutely inspired by your idea and this would be a great opportunity to explore. Lets talk more on email: sara@sehatkahani.com

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Team

Hi Sara,
This is an amazing initiative that you and your team are working on. What intrests me is what inspired you to work in remote areas? How succesful is your project so far? Also if you could enlighten me about the challenges of telehealth penetration in the community that has a low education and awarness. Wish you all the best!

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Team

Thank you Karim for our positive feedback and vote of confidence on our initiative! The real health need of Pakistan exists in the remote areas. 40 % Pakistanis lives in poverty and 30% Pakistanis are unable to access a primary health care facility in their villages. In these areas medical care is often provided by untrained quacks. This poses a severe threat to our already worsening health impact indicators.

Sehat Kahani has a portfolio of 9 clinics under its banner in Sindh, Punjab and KPK. We have seen over 30,000 patients till date. Over 150,000 have been seen through preventive health care initiatives.

Currently we are working with organisations such as Unilever, GSK, BISP, HCP group, Medibank, Tech Valley Abbottabad, MNCH, Spring, Elaj Trust,Zong, Engro Foods, DIFID, Momentum to create many innovative health solutions for preventive and clinical care of our beneficiaries.

There are a few challenges that we do come across working in these remote areas as following:

Technical Challenges: Internet connectivity issues in the marginalized populations can result in distorted real time consultations, loss of beneficiary data or increased consultation time.
Cultural Barriers: Culturally women are expected to follow the usual norms of fulfilling domestic expectations. They are expected to be the care givers. As an organization enabling the women with empowerment and financial inclusion by providing an opportunity to work from within their homes, Sehat Kahani is going against the norms and can create waves with the opposite gender (husbands, fathers) who might feel insecure.
Political risks: the communities are often time the hubs of various political parties which can influence the clinical activities in the targeted region to justify their political mandate requiring Sehat Kahani to support them or become their advocates. In case of non-cooperation, the political party can threaten the local community employees (nurses, midwives, health workers etc) hindering the activities of Sehat Kahani.
Trust Issues: Seeing a doctor through a video consultation may be a unique experience for many. While many will be thrilled and excited by the idea, there can still be individuals who are unable to accept seeking consultation from an online physician. Some may doubt her qualifications and expertise.

Through our team of qualified doctors, trusted nurses /community midwives, field staff of moblizers and coordinators, we are trying mitigate all above issues through innovative community mobilization techniques, increase feedback loop from the beneficiaries, refresher trainings of clinical and non clinical field staff and positive reinforcement through incentives.
You can check us out at www.sehatkahani.com or write to me for any other questions!

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Team

Hi, Team Sehat Kahani. Your initiative is brilliant! What was your inspiration to move forward with this cause?

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Team

Dear Nida,

Thank you for your feedback. As mentioned in our application, 51% of Pakistani population has no access to health care while 50% of our total medical work force, being female, does not continue their careers after graduation. I, being a female doctor, having faced the same socio- cultural barrier,can relate to the health need as well as the health provider gap that exists in Pakistan today.

Our inspiration to move forward comes when patients get treated in our clinics via a qualified female doctor rather than a quack, get quality medications, laboratory services, ultrasound facilitates and tertiary care referrals options in their communities. Our vision is provide wholistic primary health care to our communities members within their place of comfort.Ultimately this will act as the missing piece of the puzzle in bridging this huge health care burden that exists in Pakistan.

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Team

Hi Sara,
Rural people especially in remote places experiencing various things
Paths, no electricity, cross the river without a bridge, perig to school must travel a long distance on foot, but the most terrible is the unavailability of drugs and good health facilities. Your idea is helpful or many people will lose their lives without medical help.

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Team

Thankyou eldy for your feedback! We truly appreciate your support for our initiative. As a team our goal is to bridge the health inequality gap in Pakistan by bringing healthcare closer to homes of beneficiaries residing in low income communities. If there are any questions or suggestions feel free to comment or email me at sara@sehatkahani.com

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Am a medical doctor and ehealth researcher in nigeria. I think we can collaborate to bring this idea to nigeria

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Team

Hi Charles,
Hope you are doing well. We are always excited for collaborations to generate impact and bridge health inequality in the developing countries. Feel free to reach out to me at sara@sehatkahani.com

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I hv sent you email

Photo of Noble charles
Team

I hv sent you email

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Hi Sara,

Thank you for sharing your story and the great work you are doing.

I look forward to seeing your user journey and beneficiary feedback questions. If you have any questions at all, please tag me using ‘@‘ and ‘Kate Rushton’ or send me an email - krushton@ideo.com

Would you consider including a link to your website - http://sehatkahani.com/?

Am I right in thinking that Sehat Kahani has been in operation for a few months but was part of doctHERs - https://propakistani.pk/2017/03/08/docthers-falls-apart-demerges-two-entities/? When was doctHERs registered as a company (month and year)?

What would you include as part of a 1 to 3-year-project?

Are there certain types of organisations or organisations working in specific geographies that you are keen to connect to?

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Team

Hi Kate- I have replied to all your queries via email. Thank you for all your feedback- we shall incorporate it immediately. Please do not hesitate to reach out with more questions!

Photo of Dr. Sara Saeed Khurrum
Team

Dear Kate,

Here is a detailed answer to your queries,

In February 2017 “Sehat Kahani” acquired all of doctHERs' clinical operations, assets, team, and partnerships, which constitutes an acquisiton of operations with a proven track record of 2  years. 
 
Sehat Kahani now operates the entire portfolio of clinics formerly operated by doctHERs constuting 9 clinics in Sindh, Punjab and KPK under its banner which has served to more than than 30,000 direct customers and 250,000 indirect lives in their tenures of the last 2 years, while continuing to grow and expand these operations and their reach throughout Pakistan. 

 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 along with provision of value added services, laboratory services, ultrasound specialist and tertiary care referral  while E- Spokes will focus on at home visit via lady health workers.This home visit will include video consultation via an E- Spoke specialist along with basic testing for diabetes, Hypertension and primary ailments.

Through these hubs and spokes we would collectively reach out to  600,000 beneficiaries via our E-hub ( 450 patients per E- Hub per month) and over 1.1 million beneficiaries through our E-Spokes (400 patients per E- Spoke)

Along with this , we will be employing over 200 females doctors into our provider network and employing over 150 primary health care providers back into the workforce. 150 male and 150 female mobilizers will also be economically empowered in these communities. This along with our network of 500 female doctors, 1000 health care providers and our preventive health care portfolio will enable us reaching to almost 4 million people to make them more aware about their primary health care issues.

Our major impact indicators will focus on primarily decreasing maternal and neonatal mortality by 30% in these target communities along with 20 % in our primary health care indicators as we firmly believe that healthy mothers can create a healthier happier community.

Moreover, to enhance capacity and provide career counseling, we comducted our first ever Power Discussion for Female Doctors, this month at the US Consulate. It sought to understand the barriers that are holding women back. We aim to conduct such sessions on a monthly basis to add value to the existing capacity of the female health workforce. 

We are eager to connect to successful social impact E - health organisations in south east asian or other developing countries that have similar health conditions or health provider deficiency, so we can learn from their feed back experience. There a quite few in Africa and India. We have already reached out to some and will be able to provide concrete details once partnerships mature. 

Also community organisations advocating for primary health care rights will be our key area of focus when looking for community based collaborations. At the moment, we are working in collaboration with DKT International, Sungi Foundation, IDSP and some other health focused organizations within Pakistan. 

For any further queries, please email me at sara@sehatkahani.com!

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This is a truly remarkable idea . I was wondering, what channels did you use for customer acquisition? Are you collaborating with other organizations/ companies right now? Our startup also works with rural communities in Pakistan (do check out our submission to find more about us) and I feel, we could definitely learn from each other. Good luck

Photo of Dr. Sara Saeed Khurrum
Team

Hi Annie,

Hope you are doing well. Our prime beneficiaries are women and children residing in underserved communities as well as those female doctors who are unable to practice healthcare due to socio-cultural barriers. We generally have a very extensive need assessment survey that determines the inclusion and exclusion factor for selecting a community for our process. Do share your submission link with us so I can definitely look at the amazing work your startup is doing. I am sure together we can definitely cater the necessities of population residing in rural areas. For further information do drop me a message here or email me at sara@sehatkahani.com