Since 2018, Creating Hope in Conflict: A Humanitarian Grand Challenge has leveraged funding to 75 innovations in over 20 countries. Our path has been a learning journey in understanding how innovation adoption and scale in can help solve some of the humanitarian sector’s biggest problems. This post is one of many SEED Stories, is a series of blogs reflecting on what HGC-funded innovators have learned during the duration of their grant periods.
Ongoing military insurgency in northwest Pakistan, combined with natural disasters, has displaced over 5.3 million people. In addition, Pakistan continues to receive displaced Afghans, creating one of the most protracted refugee crises in the world. It hosts 1.4 million officially registered refugees.[1] Poor refugee healthcare access is only set to rise as thousands of additional Afghans under the Taliban’s increasingly brutal rule seek refuge in Pakistan, taxing its already strained healthcare system. Public healthcare infrastructure developments are not at pace with the growing needs of an increasing number of vulnerable populations, including refugees. Underlying weaknesses in the healthcare system alongside ongoing healthcare provider shortages make it difficult for many, especially women and girls, to have access to affordable and quality primary health care. Gender inequities in healthcare are compounded by the dearth of female doctors in Pakistan; even though over 80% of medical students in Pakistan are women,[2] it is estimated that only half of these female students go on to practice medicine in the country, thus contributing towards Pakistan’s “doctor-bride” phenomenon.[3]
How Sehat Kahani Tackled this Challenge
To respond to the growing healthcare gap within Pakistan’s refugee-hosting communities, the Community Innovation Hub launched its project Sehat Kahani (an Urdu phrase that translates to ‘story of health’). Sehat Kahani is a holistic telemedicine solution founded by 2 female physicians Dr. Sara Saeed Khurram and Dr. Iffat Zafar Aga that consists of a mobile application, a 24/7 helpline, and nurse-assisted e-clinics for those without internet connectivity. The virtual health platform addresses the disparities in health care for conflict-affected and vulnerable host communities in Pakistan and leverages the existing capacities of women health physicians. Many of these professionals were previously unable to access employment opportunities outside of the home due to socio-cultural barriers and can now provide remote health services from home.
Under CHIC funding, the Sehat Kahani team further developed their mobile app technology and established five e-clinics. Recognizing that many women and girls in conflict-affected and low-income host communities in Pakistan lack access to smartphones or reliable internet connectivity, the team re-appropriated under-used clinical spaces in target communities to establish “brick and mortar” hubs where patients can access physicians on the mobile app through nurse-assisted “in-person” care. Nearly half of the 5,000 physicians in Sehat Kahani’s network provided 18,928 e-health clinic patients with better-quality and cost-effective care, while nearly 28,000 patients were able to access the mobile app from their smartphone.
The uptick in female medical providers paved the way for progress in countering the country’s “doctor bride phenomenon.” During the CHIC funding period, the Sehat Kahani team extended their network to a total of 2,251 female doctors. By enabling female health professionals to work remotely, Sehat Kahani represents a breakthrough in overcoming Pakistan’s socio-political barriers impeding equitable female representation in the medical workforce.
In addition to these successes, the Sehat Kahani team also leveraged an additional USD $1 million from private investors as a part of their Pre-Series A efforts, and a USD $250,000 MIT Elevate Award. The government of Pakistan has also demonstrated a keen interest in Sehat Kahani, with Sehat Kahani’s founders having met with government officials, including the President of Pakistan, at a roundtable discussion of the innovation’s growth and scaling potential across underserved populations nationwide. The government also recognized Sehat Kahani as a leading female-led telemedicine solution in Pakistan. At the same meeting, the first draft of a national telemedicine policy was presented, which will help create an enabling environment to scale telemedicine solutions in Pakistan.
Partnerships Built
The Community Innovation Hub has built a broad range of valuable partnerships with public and private actors. Public partnerships include collaborations with the Government of Azad Jammu and Kashmir (a self-governing state) to establish telemedicine centres within designated basic health units. They also launched a free Mental Health Helpline for students and teenagers, Darmaan, in collaboration with the Anti-Narcotics Ministry of Pakistan. With support from Yaran-e-watan (a government initiative to tackle COVID-19), the Sehat Kahani team further expanded access to its mobile telemedicine platform to medical professionals and frontline health workers in the diaspora during the COVID era who supported the delivery of healthcare services in Pakistan.
Sehat Kahani also engaged various private actors, including the following:
- Telenor and Zong, the country’s biggest telecom companies to further optimize telemedicine outreach services through innovative technologies.
- Jubilee Life Insurance and Adamjee Insurance to implement Sehat Kahani as a telemedicine solution across over 700+ corporations and organizations.
- Essalab and Chughtai Lab to provide quality, accessible diagnostics at patients’ doorsteps.
- Leading e-health solution provider Engro Fertilizers (a subsidiary of Engro Corporation) to promote quality healthcare for all amid the ongoing COVID-19 pandemic.
Lessons Learned
- Additional guidance, monitoring, and quality assurance protocols are needed to overcome the increased risks of clinical malpractice in telehealth;
- Privacy and confidentiality are particularly difficult to safeguard when transmitting electronic health records, necessitating increased data security precautions and health staff training;
- Health needs are often deprioritized amid larger economic, social, natural, and humanitarian crises, increasing the importance of health service affordability when encouraging community participation and involvement.
What’s Next?
Having achieved proof of concept, Sehat Kahani was selected for follow-on “graduation” funding through CHIC’s transition to scale program and awarded an additional CAD $750,000. Over 18 months, the new funding will be directed towards:
- Expanding their reach by opening 25 e-clinics in refugee-hosting areas
- Upgrading their software and mobile application to include language translation, e-pharmacy modules, and clinical modules for history-taking, diagnosis, treatment, and referral to specialized services.
To improve the platform’s pathway to scale and sustainability, an evaluation will be conducted to assess the effectiveness of the platform’s diagnosis and treatment services. The team’s hoped-for results will enable them to collaborate with both the provincial and federal governments, as well as other large stakeholders to bring in new investments and further progress towards financial self-sufficiency.
Sehat Kahani also envisions scaling up beyond Pakistan into similar countries where healthcare access continues to be a challenge. To enable this expansion, the Sehat Kahani team is looking for partnerships with governmental stakeholders that can support feasibility assessments for converting basic healthcare units and centres into telemedicine-based facilities. This search for new partnerships has been coupled with an ongoing expansion of public-private partnerships to support moving towards more inclusive, accessible, and affordable primary health care at the national level.
Finally, with the support of newly hired experts, the Sehat Kahani Team further hopes to improve their financial portfolios and mobile application, including enhancing preventative care through the introduction into the application of machine learning and artificial intelligence-enabled solutions. A research team has been established for two patient-centered research studies using data from clinical services provided through the platform. This will enable more robust assessments of the effectiveness of Sehat Kahani’s telemedicine modalities within both low-income communities and the urban market. If proven effective, this could produce valuable evidence for encouraging more widespread government interest and uptake of the innovation.
[1] https://www.unhcr.org/pakistan.html
[2] The missing doctors — An analysis of educated women and female domesticity in Pakistan
[3] Doctor Brides: A narrative review of the barriers and enablers to women practising medicine in Pakistan. https://pubmed.ncbi.nlm.nih.gov/34580521/