Author: Anmol Irfan
In 2020, amidst lockdown in Pakistan, primary health care physician Dr. Sadia Khalid consulted with a young 16-year-old patient over a tele-clinic. Her patient was complaining of breathlessness, fever and cough. “Her mother seemed reluctant to give me her history, and kept insisting that she had covid and that I give her the necessary treatment.” Khalid adds that it wasn’t until the third consultation over a period of a couple of months that the young girl opened up about the fact that her parents were separating and because of that her home life had been quite stressful.
Khalid notes the reluctance of the mother to reveal this information, and chalks it up to the taboos around mental health and the lack of awareness that we see in our society. Khalid works with Sehat Kahani, a health tech platform that has both an app for telehealth appointments and remote clinics in low income communities in Pakistan. As part of Sehat Kahani’s team, Khalid was able to connect the patient with a mental health professional on the team who could provide the necessary help. Awareness is just one part of Sehat Kahani’s approach, and the platform extends that resource further to provide health care and resources to those who are unable to access it otherwise. The remote nature of their work has meant that it’s particularly benefited the country in times of crisis like the pandemic and the recent flooding disaster - both of which meant limited mobility and travel, and an increased need of medical resources. But co-founders Dr Iffat Zafar and Dr Sara Saeed are focused on catering to a more long-term gap - women’s access to healthcare.
It’s particularly interesting that the same needs that were catered to in the pandemic had always existed in Pakistan, but because they were issues faced mostly by women, they’d never really been addressed. Zafar and Saeed launched their app in 2019, but Zafar says it didn’t pick up till the pandemic in 2020. “Many women we’d met had never met a qualified MBBS doctor in their lives,” Zafar says, adding that on the other hand, “40% of doctors in Pakistan are women and yet most never come back to work after their degree. In fact even Sara and I felt like we had to choose between our careers and our family,” she said. In 2019 it was reported that 85000 women doctors who had completed their routine were not part of Pakistan’s medical system. This particular phenomenon, which is called doctor brides, is quite common in the country. It’s why the team wanted to bridge the gap between disconnected doctors and patients who can’t physically access clinics. The platform allows doctors to work exclusively in telehealth, using the app and the remote clinic functions and therefore work from home. We’ve had women who weren't working, and now with us, they’ve given post-grad exams, and we’ve brought doctors back to work who are now joining other multinationals,” Zafar adds.
Even with bringing more female doctors into the workforce - which in itself is a two-way solution because it creates work opportunities for doctors and brings more female doctors into the fold for women who might prefer that - there’s still a lot of health care barriers that women face. Mahnoor Farishta, the founder of Khair - a health tech platform focused on women’s menstrual and reproductive health points to a lack of leveraging data and creating tech-based solutions as a reason for Pakistan’s struggling health care system. “I don't think we realize our female upward mobility is increasing, as is smartphone penetration. Yet most women don't have access to a doctor but everyone has TikTok,” Farishta says. Women have long struggled with healthcare access for multiple reasons. Misinformation around women’s health is rife. Women don't understand the importance of why we need to show it to a doctor. Even if they do understand, there’s a lot of cultural taboos and a lot of weird embarrassment. Women know they have issues, but there are so many gatekeepers, for eg, not everyone may have a smooth delivery, but everyone says, itna kya ho gaya har kisi ne tau paida kiye hain,” Zafar shares. Sexual and reproductive health in particular is an aspect that’s extremely ignored. Certain traditions are prioritised over good health care. Zafar shares how she heard of someone who delivered a risky birth at home simply because that was the done thing in their family. When asked why the family said “ everyone in our family has delivered at home what’s the big deal? She can do it too.”
Farishta also points out that there’s a lot of focus on tertiary care in Pakistan but not enough on preventative tech. She hopes that Khair becomes a way for women to take charge of their bodies and to be in touch with themselves way before they need emergency or serious medical intervention. Getting women to be more aware of their bodies through the information and with an easy-to-use interface on the app is the first step.
“We try to make health care fun. We use social media to provide information. Literacy and awareness is very low,” Farishta says when talking about the gaps that need to be filled before health tech can truly impact Pakistani women.
“A lot of startups in Pakistan have missed the mark in investing in useful and efficient tech. 1000s of women signed up before we even launched our app, shared information about themselves and that was on the opposite end of what usually happens,” she says adding, “Everyone knows how hard it is to get a lead on an app but this made it clear that women needed this.”
It’s why Khair launched Pakistan’s first period and pregnancy tracking application, which allows users to access it in English, Urdu and Roman Urdu. Along with tracking your cycle, the platform has a menstrual hygiene subscription service as well as connecting them with doctors online. For Farishta, the goal is to leverage the tech that is available to make health care for women as efficient and accessible as possible.
Tech penetration in Pakistan has a long way to go and faces quite a few challenges, especially when it comes to women’s access. 6 in 10 women still face restrictions when it comes to internet access despite extensive research showing how women’s increased access to tech can improve their influence and accessibility both within workforces and personal lives. Still, despite the restrictions on usage, access to smartphones is becoming a lot more common and yet it’s not actually improving lives. “ I don't think we realize our female smartphone penetration has increased a lot and there is upward mobility,” says Farishta while adding, “yet most women don't have access to a doctor but everyone has TikTok.” Even used in the smallest ways the connectivity that digital access can help women build far more confidence and awareness around their bodies and their health. It’s just a matter of making them realize that their health is important enough to be cared about.
The lack of holistic understanding around the impact of technology and its usage has affected the growth of health tech in Pakistan as well. So many organizations that started out - despite having good goals have failed to take off. Another big reason for that is that health tech is seen as a risky investment. Sehat Kahani co-founder Dr Sara Saeed shares that “Investors have repeatedly said health tech and ed tech is not on our radar.” She also adds that digital health is a very technical field and so we don’t have appropriately skilled workers which makes progress harder.
“As cliche as this sounds, being a female founder in tech is difficult - but that’s an issue that’s always been there and will always continue,” Saeed says. Farishta echoes her sentiments. Male investors, it seems, continue to be skeptical of female founders and their expertise, and the two have often gotten questioning responses. Having to prove your with constantly can be added as an emotional labour in an already stressful environment.
Their experience creates a bit of a paradox because women are best placed to work on empowering women and can better understand their lived experiences - and yet women are often seen as unserious or risky investments by investors, making it that much harder for female founders to leave a mark. Most of the female founders here expressed concerns about how men expect them to focus more on their home lives, and think they won’t be as committed to their organisations as compared to men, which is why they’re reluctant to invest in them. Some also say that men don’t see them as capable of being experts on tech related matters
It’s why Ayesha Amin, founder of Baithak wanted to introduce a solution that would work on tech already familiar to the communities she wanted to serve. Baithak originally started as an organization aimed at creating sexual and reproductive health awareness in rural Pakistan with what Amin describes as focus group discussions. Very soon the communities she had involved started calling the gatherings Baithaks, and for many of these women, this became an important activity in their regular routine, because it created a safe space for them to ask questions they never thought they were allowed to ask before.
Through her research, Amin realized that what she was seeing in her discussions was a country-wide problem, and knew she needed a unique solution to cater to that kind of mass need. This year, Baithak is launching GUL - an AI-powered voice assistant that will use Whatsapp as a tool to help educate users on sexual and reproductive rights. This year will be the first year GUL will be in action. “I realized that the kind of need there was we just couldn’t physically reach as we could only do 2-3 sessions a month,” she says, adding, “That’s why we created somewhat of a virtual safe space on a platform that users in Pakistan are already familiar with so it won’t be new to them.” Whatsapp is commonly used across the country and so using a voice message-powered chat bot will be familiar to users who may be skeptical of unfamiliar tech. The idea is to allow women to ask questions they might have around their health, menstrual issues and other taboo topics while feeling safe and also without being misinformed.
GUL is available in all regional languages, which makes it one of the only tech-based solutions in Pakistan available to such a broad audience since much of the population feels more comfortable in rural languages as compared to Urdu and even fewer in English.
“The idea is to give women information and access to resources. We engage women in the whole process of consuming that information and then let them make their own decisions,” Amin says.
For those still who have little to no access to smartphones or internet browsing, Sehat Kahani works in another way. They’ve worked with Basic Health Units and midwife clinics in rural areas where women are most cut off from internet access to create tele-health clinics. By partnering with the local health workers at that clinic, Sehat Kahani has set up a teleclinic system where locals can come into the clinic and get an online consultation with experienced doctors from all across Pakistan. The midwife or nurse in the clinic is trained to help with the physical examination and provide medications or prescriptions as needed.
“90% of our footfall in these clinics is women and children. These are women who’ve always had to wait for a male chaperone to take them to a hospital far away or simply not go at all. Now they can access these clinics themselves because they are close by,” Saeed says.
Zafar further adds that by making some of these clinics in existing Basic Health Units, they’ve also made this model more cost-effective for the government.
Women in Pakistan have long struggled with healthcare access, and Amin notes that progress - particularly when it comes to tech solutions has been slow. That has been due to a variety of factors - social taboos around women being online, lack of digital healthcare policy and poor digital penetration to name a few. But as more creative solutions come up where the tech works with systems that already exist that may just be a first step into getting more women the healthcare they’ve long deserved.
Published by: Digital Rights Foundation in Digital 50.50, Feminist e-magazine