“A man was having severe heart problems in Loralai, Balochistan,” narrates Dr Sara Saeed Khurram, co-founder of Sehat Kahani. “It was during the peak of the pandemic when the country was under lockdown and access to medical advice, tricky at the best of times in remote areas of Pakistan, had become all the more challenging. But he was able to connect to a doctor through Sehat Kahani and got prescribed the required medicine that helped save his life.”

With a ratio of one doctor for every 1,200 patients, half the population of Pakistan does not have access to basic primary healthcare services. Hand-in-hand is the phenomenon of doctor bahus: women who train medically but for a myriad of reasons are unable to practice in a country that desperately needs more doctors.

Born out of Dr Khurram’s personal experience, Sehat Kahani is a health tech social enterprise that provides a solution to both problems. “I was practicing when I had to shift cities. By chance, I connected to the nurse on duty at my old desk who told me patients were still coming to the clinic but no doctor was available. I started consulting on the phone and eventually got a webcam. Over time the chance encounter evolved into Sehat Kahani,” says Dr Khurram.

Operating through a network of 37 clinics, to date Sehat Kahani has offered 850,000 consultations and employs 7,000 doctors of which 85 per cent are females.

While various startups addresses a spectrum of challenges, till the net is cast wider and deeper, health tech will not be a panacea for all healthcare problems in Pakistan

According to the global health security index 2021, Pakistan is ranked 130 out of 195. From being able to access medical advice to the purchase of genuine medicine to recognising the presence of a disease, there are challenges across the entire process. Digitisation has stepped in to address many of the gaps of which Sehat Kahani is a case in point.

“We have saved six people from committing suicide in Pakistan,” says Syed Naseh, CTO of Saaya Health, a mental health platform. Available in seven languages globally and Urdu, Punjabi, Pashto and Sindhi in Pakistan, Saaya Health has conducted over 4,000 counselling sessions and its social-emotional learning content has reached about 100,000 children.

One in four people in Pakistan suffer from mental health issues. In Karachi, where multi-generational families live in small apartments, one in three suffer from depression and anxiety. And yet, there is a taboo around mental health with those seeking it as perceived to be ‘mad’, explains COO Alizeh Valjee who has a background in psychology.

During the pandemic, relationship issues were exacerbated, increasing domestic violence. The rate of disability and dysfunction increased in those with existing mental health issues along with burnout rates. Stress related to financial insecurities, rise in unemployment and poverty, lack of access to social support and recreational outlets, inability to access the health system during the lockdown and overall anxiety due to uncertainty together made an environment highly conducive to debilitating mental health and holistic wellbeing.

But things are improving, says Mr Naseh. Mental health is becoming less of a taboo, more literature is being produced and more universities are offering psychology cases, he said while giving the example of the recently held Karachi Wellness Festival.

However, all access to healthcare becomes meaningless if the medicines bought to address the illnesses are fake. And Pakistan’s problems with counterfeit drugs is endemic, with some research statistics indicating that 40-50pc of medicine sold are fake.

“We are trying to connect the pharma companies directly to the patient to help eliminate fake medicines from the system,” says Furquan Kidwai, founder and CEO of online pharmacy Dawaai.

There are 500-plus pharmaceutical companies in the country that are manufacturing drugs distributed by 1000-plus distributors through 45,000-plus licensed pharmacies, he explains using numbers to explain how fragmented the market is. This has resulted in the creation of many layers between the pharma company and the end consumer that has allowed one of the biggest counterfeit medicine markets in the world to flourish.

Because of the cryogenic nature of the market, there are about 20,000 unique SKUs (stock-taking units) available for about 500-600 medicines — each medicine is sold under 10-15 different names. “Take Paracetamol as an example. It is sold under 30 different names — Panadol, Paramol, Parasol etc,” he says.

An average shop has say about 200 SKUs so patients have to go through the hassle of visiting multiple pharmacies to get their prescription fulfilled. The pandemic pushed Dawaai’s user adoption rate to 5x-6x, leading to a current growth rate of 9x.

The health tech numbers are impressive. One source says there are 331 health tech startups in Pakistan, another says telehealth companies grew by 900pc during the pandemic. But this picture is skewed. While various health tech addresses a spectrum of challenges, from menstrual health to setting up appointments with doctors, the ease of access is limited to the relatively affluent that have access to the internet and a basic understanding of technology. Till the net is cast wider and deeper, health tech will not be a panacea for all healthcare problems in Pakistan.

Published in Dawn, The Business and Finance Weekly, March 21st, 2022

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