Pakistan’s healthcare system is marred by multifarious problems, not least of which has been consistent government neglect. According to the Pakistan Economic Survey (2016-17), the country spent only between 0.5 and 0.8% of its GDP on health over the last 10 years, with per capita health spending standing at $36.2, well below the World Health Organisation’s low-income countries benchmark of $86.

Recently, a handful of health start-ups are attempting to bring a modicum of relief to this situation. On the back of factors such as growth in ICT, increased internet penetration, availability of cheaper smartphones and increasing trust in the ‘online’ medium, entrepreneurs and doctors are attempting to make possible the provision of an array of quality and affordable healthcare facilities to people far and wide and in real-time. Although each start-up offers unique services via their websites and mobile apps, the common aim is to make quality healthcare services available to patients across Pakistan, as conveniently and easily accessible as it is to book an Uber or Careem.

Aurora interviewed three start-ups that are attempting to reshape healthcare delivery as we know it in Pakistan.

Find My Doctor

Saad Siddiqui, an economics graduate from SZABIST, founded Find My Doctor in August 2015, with an investment of one million rupees. The demise of his mother in 2012 due to doctors’ negligence motivated him to find solutions to Pakistan’s health management problems by starting a proper review and rating system for doctors. Find My Doctor was launched as a (for profit) company in January 2016.

So far, Find My Doctor has about 1,800 doctors and 20,000 patients on its database – and all the major hospitals in Karachi are on board. The credentials of all the doctors are verified with the Pakistan Medical and Dental Council (PMDC). To be included on the panel, it is mandatory for a doctor to have at least four years of experience.

Although the target market is SEC B and C, the service is available to everyone looking for affordability and convenience in healthcare. “Healthcare is a very difficult market; you can sell clothes or food, but with healthcare you have to build trust.”

This year, Find My Doctor introduced two new services; a ‘lab tests at home’ service, offering convenience to patients by sending phlebotomists (people trained to draw blood and take samples) to their residence. For this service, the start-up has four labs on-board: National Institute of Blood Disease and Bone Marrow Transplantation (NIBD), Chughtai Lab, Essa Laboratory and National Medical Centre. After the test is carried out, patients receive, within 24 hours, an SMS or email alert notifying them that the results are ready, after which they can log in to their account on Find My Doctor to access the results or request their delivery at home. The other service is ‘doctor at home’; here, a general physician (GP) will visit a patient’s home for consultation on request. Once checked, patients are sent a prescription via SMS which can be accessed on the system record.

Find My Doctor charge Rs 1,000 a month from the doctors on the panel. Patients are encouraged to rate and review a doctor. The company charges a 40% commission on all lab tests and patients are charged only for consultation and lab tests. In July, Find My Doctor have secured a further funding worth Rs 20 million and are now planning to expand the service to Faisalabad, Hyderabad, Islamabad, Lahore, Multan, Rawalpindi and Sukkur. There are also plans to launch a pharmacy and a health insurance partnership with TPL Life.

Sehat Kahani

This tele-health platform was founded by Dr Sara Khurram and Dr Iffat Zafar in February 2017. The objective is to connect at-home or out-of-workforce women doctors to underserved patients in low and middle-income segments. The platform is a ‘for profit’ (SECP registered) company and was initially funded by the Spring Accelerator [UK’s Department For International Development (DFID)] and the Nike Foundation.

According to Dr Khurram, Sehat Kahani is based on three pillars: access, prevention and efficiency. The first aims to provide clinical care for patients in low-income areas via E-Health Hubs or clinics (14 in number) throughout Pakistan. This is done by partnering with nurses and clinics in different communities. According to Dr Khurram, there are already clinics run by nurses in the communities they serve, but there is no medical protocol, doctors are unavailable and there is no sanitation. “We take over these clinics as operation partners and also incentivise nurses.”

Sehat Kahani imparts training to the nurses (medical, pharmaceutical, software and soft skills) to enable them to carry out video consultations with women doctors through a laptop. The clinics also act as lab collection points and provide ultrasound and specialised consultation.

Out of a network of 500 doctors, about 30 are directly involved with the clinical services. On average, there are two to three doctors at a clinic at one time and consultation fees range between Rs 50 to 500 (30% goes to the nurse and 70% to Sehat Kahani). For services such as lab tests and ultrasound, the charges are divided equally between Sehat Kahani and the nurse. The doctors are given a stipend, based on the number of hours they give to a clinic, and this ranges from Rs 12,000 to 24,000. Sehat Kahani say that so far, they have treated over 40,000 women.

To carry out preventive care campaigns, Sehat Kahani has entered into collaborations with companies such as Engro Corporation, GlaxoSmithKline (GSK) and Unilever as well as with the Benazir Income Support Programme (BISP). The objectives here are to create awareness about hygiene, sanitation, communicable and non-communicable diseases, mental and child health.

To improve efficiencies and increase outreach, Sehat Kahani recently launched an app aimed at engaging the 440 women doctors who are not yet involved in any clinical activity. Through the app, these doctors can accept a consultation call or an appointment. As a result of this app, the target audience has moved beyond the low-income segments to reach to anyone requiring access to healthcare.

Sehat Kahani is planning to set up 100 E-Health Hubs nationwide, train 5,000 women physicians and a 1,000 nurses and community health workers to impact more lives and provide 500,000 consultations per year by 2020.

Sehatyab

This healthcare service was launched by Nadeem Nasir, a chartered accountant with experience in hospital management from Kuwait. Co-founders are Yaqub Ahsan, an IT architect; Farrukh Sohail, a corporate strategist; and Murtaza Hussain, who has extensive experience in IT project management.

Sehatyab was launched with initial funding from the founders, amounting to Rs 30 million, a staff of 14 people and 11 doctors; it currently has 24,000 registered patients across Pakistan. The start-up offers online video consultation in dermatology, family medicine, nutrition, psychiatry and psychology.

According to Nasir “what makes us different is that we do not have any hospitals on our panel as we are healthcare providers ourselves.” He says that the start-ups offering healthcare services are mostly engaged in arranging doctor appointments online and providing text-based medical advice. “They are technology companies providing a marketplace for patients and doctors; we are a health company, which outsources technology.”

About 30% of Sehatyab’s patients are from Karachi, 29% from Lahore, while Islamabad and Rawalpindi constitute 25% of the patient pool, with the rest coming from other cities. All 11 doctors working are employed by Sehatyab. Patients pay Rs 750 for a consultation and the doctors receive a regular salary.

The start-up is website-optimised for smartphones and an app is under development. According to Nasir, 80% of patients access the service through their smartphones, Facebook subscribers number 45,000 and increasing every day. Sehatyab is competing with traditional clinics and the objective is to move more patients towards online clinics. “We want more companies to enter the healthcare arena so that awareness of online health services increases.”

In Nasir’s opinion, in Pakistan, approximately 50% of healthcare service providers are not licensed, “‘which is why the biggest challenge is the absence of telemedicine regulations and awareness among patients.”

Future plans include investing in an awareness campaign and establishing tele-health centres in rural and remote areas.