Access to equitable healthcare is a major challenge in pursuing universal health coverage (UHC) in Pakistan. According to the World Bank, 63% of the total population reside in rural areas where access to health services is severely limited. Barriers to quality healthcare includes a shortage of hospitals and qualified healthcare providers, poor infrastructure such as road networks, limited availability and affordability of life-saving medicines, and a lack of government investment.
In 2017 Commonwealth Alumnus Dr Iffat Zafar Aga co-founded Sehat Kahani (meaning “story of health”), a health-technology social impact initiative which aims to democratise access to healthcare by using technology to connect patients with online doctors through chat, audio and video consultations. The platform is available to general consumers, corporates and those from rural and low income urban communities.
Iffat is now the Chief Operating Officer of Sehat Kahani and responsible for scaling-up the platform’s delivery across Pakistan and globally.
Providing low-cost health-care through e-clinics
At the time of establishing the platform, Iffat embarked on a Master’s in Global eHealth at the University of Edinburgh through a Commonwealth Distance Learning Scholarship. This mode of study enabled her to directly apply her learning to develop the business in real time and ensure it would meet the needs of patients and doctors.
Through her studies, she learned how to create healthcare access using telemedicine platforms, and for her thesis she conducted a systematic review of the target market for telemedicine in Pakistan for the provision of mental health. Understanding the market enabled Iffat to design a sustainable and effective business model which led to the development of the mobile and web-based application.
One of the key goals of the platform is to provide low-cost healthcare to rural and low income urban communities through e-clinics. Iffat needed to deliver the e-clinics at subsidised rates to this group without impacting service delivery or creating financial pressure on the business. To do this, Iffat and her co-founder developed a sustainable revenue stream by targeting the mobile application at general consumers and corporates who can afford to pay higher rates.
To attract corporates to the platform, through the market research conducted for her thesis, Iffat discovered that most corporates only provide health insurance cover for hospitalisation and not consultations with doctors. She also discovered that health insurance companies were unaware of telemedicine and how these services can be included in corporate healthcare insurance policies.
Based on these findings, Iffat and her corporate team developed a unique strategy for corporates by which the platform provides unlimited consultations for all registered employees, regardless of their role and rank within an organisation.
As a result, corporates registered to the platform have seen a decrease in absenteeism due to illness as employees can easily access medical consultations and attend to their heath needs. To date, the consumer app has over 1.4 million general consumers and the corporate application is being used in around 850 corporation. Collectively, through the network of 63 E-health centres, the consumer and corporate application platforms have facilitated over 2.6 million consultations.
“Sehat Kahani’s unique selling point is to enable a consultation within 60 seconds, 24 hours a day, 7 days a week… Our consumer and corporate applications have grown exponentially with their usage in over 317 cities. This includes not only cities but also small towns across Pakistan.”
The platform now supports a network of more than 7,500 healthcare professionals and provides a support system for peer-to-peer engagements to share success stories and discuss medical cases.
Securing funding to improve health
The platform now provides affordable access to doctors through 63 online e-clinics, which are available in all 4 provinces in Pakistan. This includes remote and conflict affected communities such as the Federally Administered Tribal Areas (FATA) region in north-western Pakistan, Azad Jammu and Kashmir (AJK), and Balochistan. This enables these services to be accessible to refugees and displaced groups and users can also access services in Urdu.
With the support of seed investments and soft funding from international agencies, Sehat Kahani has been able to reach marginalised communities and provide a plethora of health services under one digital health platform. The next step for Sehat Kahani is to scale its operations globally.
“In terms of funding, we are very strategically placed. We raised our seed funding of around $500,000 in 2018, then a Pre-Series A round of 1.2. million USD, and very recently we have closed Series A Round of funding of 2.7 million USD.
‘Being a social impact business, we have also had the opportunity to partner with many international funding bodies, such as USAID and Grand Challenges Canada, which are focused on women’s empowerment and social development.
‘Within the current round of funding, we are now aiming to scale the product into the MENA region.”
Overcoming social barriers
The shortage of healthcare facilities and qualified healthcare providers in rural areas disproportionately affects women, who rely on facilities to provide maternal and child healthcare, as well as women’s healthcare. Iffat notes that this is compounded by a lack of female doctors and qualified medical professionals who can advocate for women’s healthcare.
Prior to establishing Sehat Kahani, Iffat worked as a doctor in the pharmaceutical industry where she had immediate exposure to the challenges women face in the profession.
Although 70-10% of medical students in Pakistan are female, only 40% practice as medical professionals after graduation. Being a patriarchal society, the phenomenon of ‘doctor bride’ is prevalent, where female doctors are preferred as potential brides but are expected to leave their work after marriage to prioritise family. Of those who continue to practice medicine, many prefer to work in cities or move abroad for better prospects.
Due to this, there are limited or no female doctors available to treat women’s health concerns, especially in remote communities. The doctor-to-patient ratio in Pakistan is 1:1300, significantly higher than the World Health Organization’s (WHO) recommended ration of 1:1000.
Iffat is committed to address this issue. Through Sehat Kahani, she advocates for career development opportunities for female doctors and qualified health professionals.
The development of e-clinics as well as the mobile app enables female doctors to practice remotely, allowing them to continue in the profession and maintain work-life balance. As a result, some have been able to break social barriers by becoming financially independent and undertake more senior roles in the healthcare sector.
“The first doctor that we [Sehat Kahani] hired, started working with us as a general physician. During her training, she passed her Membership of College of Physicians and Surgeons (MCPS) and Membership of Royal College of General Practitioners (MRCGP) exam. She later worked with us in a different role and led the Monitoring, Learning, and Evaluation Department. She eventually moved to another company and is now working as the Chief Medical Officer of that organisation.”
85% of Sehat Kahani’s doctors are currently female, which effectively supports the 75% demand for e-clinic consultations regarding women and children’s health. Iffat stresses that Sehat Kahani is a gender-inclusive employer and that the platform is seeing a rise in male patients for which they also recruit quality male doctors.
Award-winning social impact
Iffat’s work to improve access to healthcare through telemedicine has been recognised and acknowledged internationally.
In 2021, Sehat Kahani contributed to the drafting of the national digital healthcare policy, which was also presented to the then President of Pakistan. Unfortunately, due to the change in government, the draft could not be passed, however Sehat Kahani plans to continue to contribute to the implementation of the policy in the future.
As a result of her groundbreaking work in Pakistan, she has contributed to efforts of the WHO, Grand Challenges Canada, British Asian Trust, Amplify, and many others, to improve maternal and mental healthcare and access to health services in remove communities through digital platforms. In 2019 she was awarded the MIT Elevate Prize and in 2022 the Heroine of Healthcare Award and the GBH Provocateur Award for her work at Sehat Kahani.
Reflecting on the impact of her current work, Iffat is proud of what Sehat Kahani has achieved in the telemedicine industry in Pakistan, and the impact of her Master’s studies in setting up the award-winning social impact enterprise.
“I believe my Master’s contributed quite a bit in terms of allowing me to really think beyond different metrics and variables of telemedicine, through which we could create healthcare accessibility in a country like Pakistan while also giving me exposure to the best practices across the globe for telemedicine and health insurance.”
Dr Aga Zafar Aga is a 2017 Commonwealth Distance Learning Scholar from Pakistan. She completed her MSc in Global eHealth from University of Edinburgh.