Designing Healthcare & Economic Opportunity for Women with Dr. Sara Saeed Khurram
Tell us the story behind Sehat Kahani.
In Pakistan, we have something called the doctor-bride phenomenon. This is middle class or upper middle class families that have money to send their daughters to medical college or teaching college – so that they can become doctors or teachers. There’s a focus on these professions because they’re viewed as noble or respectable. And respect is hugely important in Pakistan, especially for women, to be seen as noble and socially aligned, and to raise their social stature. What’s behind part of this intentionality is to secure the “best hand in marriage.” A beautiful female doctor is the “best possible package” in Pakistan for any bachelor, and this is the motivation for many parents behind sending their girls to medical college.
There are 200,000 doctors in Pakistan and 63% of them are women. I am also a doctor, and 80% of my medical college class was female. In the early years of college, we were all acing our exams and doing well, but as the final years approached, many of my classmates were getting married and getting pregnant. Their career was shifting towards being a homemaker – these families wanted their daughters and daughters-in-law to be doctors, but not be practicing or working.
There’s many professions in Pakistan where women don’t or aren’t encouraged to work — it’s a problem for all sectors. However, if the medical sector sits at home, it ultimately affects the people who need help. ~50% of the Pakistani population never gets to see a doctor in their lifetime, and as you move from urban to rural, or from men to women, this accessibility only gets worse – all because female doctors are not allowed to work.
I was also a doctor bride. Even though I continued working after marriage, I paused after my first pregnancy, and I struggled with postpartum depression. One day, a clinic I used to work for, who was understaffed, called me to consult on some of their patients. I began to see patients on calls and soon, video calls. When I started working again, I felt happier and better.
If I can be a female doctor and provide healthcare from my home, why can’t the rest of the female doctors do the same using telemedicine? In 2015, we started working on the idea of a female doctor working from home – by connecting her to low-income community clinics, where the nurses would help connect the patient to the doctor. We started creating clinics in 2 major provinces of Pakistan. To ensure financial sustainability of our service, we created an app to open up to retail customers and corporates through which employees could access telemedicine. By 2017, we had the app and 27 clinics. Then the pandemic came, and so many were going into healthcare misery. The Pakistani government reached out to us to help because so many physical clinics were shut down, they needed a telemedicine facility to help out the country.
Today we have 5000 female doctors in our network. And now, we are advocating for and working on a digital health policy with the President – which has been a huge win for us.
Today, Sehat Kahani is an all female doctor provider network that provides quality, affordable and accessible health care to all using a chat, audio video enabled telemedicine platform used in low income communities in clinics and through a mobile application for the masses. Sehat Kahani has a network of 35 clinics across Pakistan, has connected more than half a million patients with doctors globally and has overall impacted 7.2 million lives. Sehat Kahani focuses on SDG 3,5 and 10 with a focus on good health and wellbeing and reduced inequalities.
What have you learned about women and girls over the years?
Through building Sehat Kahani, a few themes and key pain points have emerged from the doctor's end and patient’s end: our doctor needs flexibility, empathy, belonging, financial independence, safety and reduction of guilt. The patients need to feel comfortable, and be heard about what they need.
Flexibility:
Our doctors always tell us what times work for them: part time, full time, on the weekends. This has been key for our success.
Empathy:
This is a place where a parent teacher meeting can be considered an emergency and there’s no eyebrows raised. Understanding that when an emergency comes up, there will be back up and they don't need to worry about it.
Belonging:
When we stop working, we get cut off from the doctor community. But through Sehat Kahani, many of our doctors have re-found their sense of belonging: to know that there’s someone who understands what you’re going through and they’re working together with you is such a big plus. We’ve been able to communicate that you can back each other up.
Financial Autonomy and Independence:
We pay all our doctors, and seeing money come into their accounts is motivating. Our doctors have joined us with histories of mental health issues, or having been abused by their husbands and financial independence helps to build back that sense of self worth, and self esteem.
Safety:
When we created the app, we didn’t anticipate the harassment that our female doctors experienced. Patients with fake identities would send them inappropriate content. We quickly amended this by putting in firewalls and having a strong cybersecurity system. Now, the app also has a small button through which a doctor can flag inappropriate behavior of a patient.
Policy also plays a huge role in creating a safe space – so when we do receive a flagged case, we deal with it and this gives the doctors a sense of comfort that they are being heard and taken care of. On the patient end, we’ve allowed for anonymity to be chosen if the patient likes – they have to disclose everything to their doctor, but not to our portal. But when/if we do come across patients who have shared a history of abuse, we assist them in making sure their case is registered after taking their consent.
No guilt:
They’re not leaving the house or their kids, so there is a reduction in guilt which arises otherwise.
Comfort:
From the patient's end, we learned too. It was our first priority to make the patient feel comfortable. The way we are culturally brought up, women prefer a cordoned off area for their consultations, which we didn’t expect would play a role in video consultations, but it did. So we began to create sections where the patient could be consulted while her child is in a play area so that she feels comfortable.
Understanding of demand and expression:
We also learned which health services were underserved and began to create partnerships based on that, for example, in sexual reproductive healthcare and mental health. We learned how women expressed themselves in these areas. Mental health is so underserved that a woman would say that she’s in pain rather than telling us about her anxieties. Learning from the cases of our patients and their experiences proved so helpful when we rolled out our app – especially because these patients had also come from more marginalised communities. Then, we knew which disease experts we needed, how we should be taking the history and understanding symptoms, that we will experience drug hesitation etc.
What advice would you have for someone creating a product, service, or community for women?
Understand the cultural, religious and social context
I can build a product today that talks openly about family planning, but I am not sure that it will have the uptake. Family planning is a religiously sensitive topic, so I would have to build this product with a lot of consideration.
Balance long-term vision with short-term needs
In the middle of advocating for the gender mission and vision we might have, we have to understand the importance of working within current norms and contexts and continue to meet needs by bridging the gap. We might believe that a product that openly discusses contraception needs to exist, but if we’re not “there” yet, we need to continue meeting the needs of the current context. Or we might hope that one day women won’t feel guilty leaving their home behind to go and work – but today, we will design to make sure that they don’t have to experience guilt. We take that on instead of putting the onus on them.
Work in a financial autonomy element
Our clinic model was only successful when the nurse was incentivized as a woman on the same level as the doctor. Financial independence is key to truly designing for women.
What are some common misconceptions about designing for women?
When men think they can design for women, this is another form of gaslighting
Even with all the gender gap awareness, this still happens so much – where men think they know the best for women. Having female voices that are not just placeholders is really important.
That women are stupid
There are so many products for women that come with an undertone that women are either stupid, or that they’re not aware, or that they don’t have the IQ or EQ. I have seen women from all walks of life have the basic instincts to do anything. In Pakistan, they will talk to a group of women and at the end say: “samajh aaya?” (did you understand??) – they will never ask a group of men that, but they will also ask women, that too in a disciplinarian teacher’s tone. You don’t need to dumb anything down. Women are smart, trust their minds to understand.
Where else in the world do you wish to see more intentionally designed offerings for women?
There is a massive need for women in the legal sector. I wanted to become a lawyer, but a woman fighting – that too in court – was unheard of in Pakistan when I was growing up. Women don’t know their rights and they bear through so much because they believe that’s the norm. They don’t know where to go for help.
What are some examples you’re seeing that are truly designing for women?
Dot and Line Learning have built a platform to formalise the services of informal educators, or tuition teachers (as they are known in Pakistan). They’re helping women become financially independent and providing a service for the mothers who suffer from their kids struggling in education.
Circle is a platform promoting female tech specialists. A lot of women study computer engineering, but they can’t go out and work. Circle trains women and connects them with freelance gigs so they can work from home. Digital skills development is a huge focus here, but mostly for men. Circle is doing it for women.
About Dr. Sara Saeed-Khurram
Dr.Sara Saeed Khurram has over 7 years of experience in the field of Digital health care as the Co-Founder and Chief Executive Officer, Sehat Kahani. Previous to this role, Dr. Sara Saeed Khurram was a clinician training for a career in Radiology and has also worked in micro health insurance and community health care initiatives with USAID. Dr. Sara Saeed Khurram has won notable awards for her work such as the Rolex Awards 2019 as Associate Laureate, TIAW Award, CRDF Global Awards, Ashoka Changemakers, ISIF Asia, The Unilever Sustainable Living Young Entrepreneurs Awards, The UNICEF Global Goal Campaigner Award 2016 and Arpatech Young Entrepreneurs Award 2017 for her work. She is an IWLS Fellow by National Defence University (Pakistan), Rainer Arnhold Fellow by Mulago Foundation, Cartier Fellow 2018, Acumen fellow 2016, Tedx speaker and Cherie Blair Foundation alumnus. She is also the first Frontier Innovator from Pakistan in 2017.
Dr. Sara Saeed Khurram was born and bred in Karachi. She has done her MBBS from DOW University of Health Sciences in 2010 and her Master is Health Policy and Management from The Aga Khan University of Health sciences in 2018. She is also an ISEP Alum from INSEAD Singapore 2019. Dr. Sara Saeed Khurram loves turning ideas into reality on ground, she is an implementer and doer who loves Travel, Music, poetry but majority of her personal time is dedicated towards her 2 daughters that inspire her to fight for equal rights for women in every walk of life.