Sehat Kahani: providing primary healthcare services to women in Pakistan
Sehat Kahani is a social impact initiative by Community Innovation Hub that aims to provide a basic health unit to underprivileged areas across Pakistan. In an interview, the initiative's Co-Founder and CBDO Dr. Iffat Zafar tells us about her personal story and how the initiative impacts the lives of women and girls.
What prompted you to start your business?
I was born into a ‘broken’ family and from early childhood was trapped between the different expectations of 2 different families: one being elitist and thinking I couldn't make it in life, the other one being conservative perceiving a woman's place to be in the kitchen. Therefore, when growing up, I was constantly trying to prove to myself and to the rest that I can achieve too, with a constant support from my father.
For as long as I can remember I knew I wanted to become a doctor - for what else could be more prestigious than being a doctor? So, I went to Medical School, which turned out to be one of the best experiences of my life. Back then, I realized the immense health gaps in my country. I wanted to help change this and initially moved over to the pharmaceutical sector for a few years. It became clear to me, however, that true impact can only happen through Public Health interventions. So, I started to work for a micro health insurance organization. At that time, I also met my future partners who were piloting an amazing and innovative idea of recruiting home-based female physicians and connecting them to marginalized communities. I fell in love with this idea instantly. As they say, life is unpredictable: I went with this business development idea and two months later, I was representing doctHERs as a cofounder.
In February 2017, based on mutual consent, doctHERs underwent an amicable demerger. Under the legal agreement of our demerger, all clinical operations, assets & team of doctHERs Pvt. Ltd were acquired by "Sehat Kahani"- co- founded by me and Sara Khurram so that we could continue the social impact we had created through the established clinics and partnerships.
The inspiration behind Sehat Kahani for me is my personal journey and my personal struggle. I know how difficult it is to become a doctor, particularly if you are coming from a middle-income family background with limited finances. To me, it feels very ironic and unfair that women shouldn’t work after acquiring a prestigious degree. It is a real dogma that a huge gender bias exists in Pakistan due to which women are not given the due rights. So while women in communities lack the basic right of good quality healthcare, female physicians lack the right of being able to practice medicine fully.
What does your business offer to your clients and what is the core value proposition?
As a health-tech social enterprise, Sehat Kahani creates social impact on an individual and holistic level. Ultimately, the goal is primary health service delivery all across Pakistan, specifically to the marginalized communities. More specifically, the scope of Sehat Kahani includes:
- Empowering female healthcare providers to deliver cutting edge healthcare to rural and low-income urban communities,
- Leveraging technology, such as video conferencing, transmission of still images, e-health, remote monitoring of vital signs, continued medical education, consumer-focused wireless applications and early referrals;
- Capacity building of nurses to transform them into micro-entrepreneurs;
- Improvement of maternal and neonatal health and water sanitation and hygiene indicators;
- Health market research to disseminate knowledge for the betterment of the health sector; and
- The creation of awareness campaigns pertaining to all genres of health.
What stage of operation have you reached?
Sehat Kahani is currently exploring avenues for expansion of its existing lines of work and also in the process of developing new business segments, such as a mobile application.
The organization currently operates fourteen tele-health clinics in Sindh, Punjab, and Khyber Pakhtunkhwa that have served more than 40,000 customers directly and 350,000 indirectly over the past two years. Meanwhile, Sehat Kahani continues to grow and expand these operations and their reach throughout Pakistan in collaboration with SPRING, an accelerator sponsored by the Department for International Development of the United Kingdom (DFID), the United States Agency for International Development (USAID), the Nike Foundation, and the Australian Department of Foreign Affairs and Trade (DFAT).
Currently, we are also collaborating with a number of other organizations to create additional innovative solutions for preventive and clinical health care, such as running a mobile clinic van, operating a psychiatry health drive in the central jail of Karachi, and conducting an extensive calcium awareness drive in communities, medical colleges and factories.
Why do you specifically focus on girls and women?
While working in communities for more than two years, we realized that girls are exposed to immense conservativeness. Based on our research, almost sixty million girls are being married in their childhood years worldwide. (World Association of Girl Guides and Girl Scouts) [1] Almost 21% of adolescent girls are married in Pakistan.[2] This is because social, religious and cultural barriers prevail in the country that don’t grant girls equal status to boys from the time they are born. They are often pulled out of school as soon as they reach menarche and are wedded off as they turn sixteen or seventeen. According to UNICEF, the primary school induction of girls in Pakistan is around sixty-five percent which falls to twenty-nine percent once a girl reaches secondary school. Puberty further hinders girls’ personal growth because they are often restricted by the boundaries of their home.
Early marriages take an extensive toll on the health of the girl child, she becomes anaemic, lacks access to proper nutrition and hygiene. The tender years where girls should read books and be carefree is spend in child bearing, child rearing and fulfilling household responsibilities. Most girls become mothers of one or two children by the time they are eighteen, resulting in malnourished and stunted children. The women themselves are often severely anaemic, lack calcium and other essential nutrients. Due to responsibilities of child rearing, they completely ignore themselves. Pregnancy and childbirth complications are the 2nd leading of death amongst girls aged 15 to 19 worldwide [3](WHO)
Through SPRING we were able to conduct research on the needs and the kind of healthcare access these young mothers require while maintaining their cultural barriers.
As a result, we have developed an innovative E-Spoke model where community health workers equipped with pre-fed tablets go from door to door to young mothers who are unable to come to the clinics. They provide them with access to online physicians through the ICT enabled tablets and also do counselling through pre-fed healthcare awareness materials, video tutorials and e-magazines.
Ultimately, we at Sehat Kahani want to ensure that every adolescent girl and young mother has access to the best quality healthcare not only within the vicinity of her community but also within the vicinity of her home.
How do you measure the impact of your work on girls?
We measure impact by analysing the reach of our programs to direct and indirect beneficiaries.
Direct beneficiaries include adolescent girls who have come to our clinics and received consultations through the E-Spokes, as well as girls and young mothers who have accessed some form of healthcare facility or the ones who participated in community health awareness sessions at our medical camps.
Indirect beneficiaries are family members of direct beneficiaries. We estimate that for every direct beneficiary, five other family members are being impacted indirectly through the marketing, mobilization and awareness sessions that we conduct regularly in target communities.
What challenges did you face while developing the business and how did you overcome them?
Working in communities in the healthcare space particularly for women is challenging in itself. Conservative communities often find it difficult to understand what women are going through in terms of healthcare and the women keep on suffering in despair. This is why we aim to develop community elders into our advocates. This enables us to create trust in otherwise difficult communities.
Another challenge has been developing and creating synergies with the local governments for projects, which require ICT-enabled platforms. Most local governments still follow the usual redundant pathway and are often reluctant to adopt digital platforms. However, by meeting the right individuals, particularly younger ones, it has become easier to adapt to government policies.
Also, healthcare is an ignored segment within Pakistan, with hardly 2.6 percent of GDP spent on it in 2014[4](World Health Organisation). However, change has begun to happen. With potential donors and investors coming into the space of health tech within Pakistan, we are slowly overcoming this issue as well.
Where do you see the business in 5 years’ time?
Life has become very exciting and there is a lot in store for us as an organisation and also for me in my personal capacity. At Sehat Kahani we are in the process of seeking funds to scale up. We are also developing an innovative mobile application to ensure a doctor is just a click away for the middle and upper income segment. People like me when in need of a doctor can then easily chat or have a video consultation with a doctor from their smartphones only. We hope to launch this for the masses by the beginning of 2018.
Our ultimate vision for 2020 is two expand to 50 E-Hubs and 200 E-Spokes, impacting six million lives through the clinics and spokes and to impact more than 3 million lives through the mobile application. We also envision to create a female health care provider network which can work collaboratively to bring about quality primary health care in our country at the same time ensuring sustainability while we scale up our unique business model.
I also received a Commonwealth scholarship just recently to do my MSC in Global E-Health from University of Edinburgh and I believe this will play an instrumental role in the expansion of my business.
Do you have any advice for businesses looking to have a positive impact on the lives of women and girls?
Running a social enterprise is not an easy task. Me and my business partner Sara Khurram are often working 24/7 and sometimes even that seems not enough. Also, the financial gain is very limited or comes at a later stage of the organisational development. So the first advice for anyone wanting to step into the social impact business is to be extremely passionate and resilient. Secondly, a personal connection makes the bond stronger, which keeps the drive up even in difficult times. My third advice would be to do extensive study and research in whatever segment you want to dive into. For example, if it is healthcare or education or hygiene, do a deep dive to analyse the missing links. Realize the grey areas and then begin developing products, services or strategies around how to fill these grey areas. I would also strongly recommend doing demos and trials with customers to actually analyse what works and what doesn’t work. Running human-centered design techniques often helps to reach the actual depth of the issues and makes the business more holistic and more customer friendly.
Lastly I Would say “have a cause that you truly believe in and you will never feel lost!”
Thank you so much. Feel free to reach out to me for advice, mentorship or any other information at iffatzafar@sehatkahani.com
Do you want to know more about Sehat Kahani's work in Pakistan? Have a look at this short BBC documentary
[1] https://www.wagggs.org/en/what-we-do/stop-the-violence/about-campaign/f…
[2] http://www.girlsnotbrides.org/child-marriage/pakistan/
[3] http://www.who.int/mediacentre/factsheets/fs364/en/
[4] http://www.who.int/countries/pak/en/
This blog is a part of the September 2017 series on Empowering women, in partnership with SPRING.
Read the full series for insights on business models that empower girls and women, a new analysis of gender impacts of value chain interventions, tips on gender-lens investing and many inspiring personal stories from women.