Fighting Diabetes and Cultural Constraints to Deliver Quality Care in Pakistan

What makes Fahad Hasan believe his program HealthOne is unique and innovative? He launched HealthOne in Pakistan to offer easier access to healthcare for the country’s low-income and vulnerable populations, with a particular focus on treating patients with diabetes. Today, HealthOne operates three clinics in Pakistan, each uniquely staffed with female doctors and male nurses. The clinic has two types of patients: paying and non-paying. As of this summer, the clinics have served a combined total of 7,000 patients.

The Center for Health Market Innovations spoke with Hasan recently about his organization’s key successes, challenges, and lessons learned, and how HealthOne has used CHMI to connect with other innovators in Pakistan.

What is HealthOne?

Pakistan currently has more than 15,000,000 people who suffer from diabetes and pre-diabetes. HealthOne responds to this large disease burden in Islamabad and Rawalpindi with high-quality and affordable healthcare for the poor with a focus on diabetes care. The program’s clinics also provide primary care services in high density, low income areas.

HealthOne targets diabetes patients at the primary care level through general practice doctors, not specialists. By using a primary care approach HealthOne is able to lower the burden on local government hospitals and offer patients lower cost healthcare.

Why was HealthOne created?

Pakistan suffers from a lack of basic healthcare, and many people are forced to endure excruciatingly long  waiting times (5 to 10 hours) at government hospitals, are unable to afford healthcare, or are faced with a stigma associated with seeking health care (in the case of many women).

To remove the burden of paying for health care, HealthOne has two types of patients: paying and non-paying. Paying patients have the ability to undergo several health tests, with the option of seeking additional treatment from a doctor at one of HealthOne’s clinics. Non-paying patients have the basic tests available.

HealthOne also maintains a basic pharmacy that runs lab tests and provides essential medicines for paying patients.

Staffing Model

The doctors at HealthOne’s clinics are exclusively female, while nurses are exclusively male. This is a new approach in Pakistan’s medical field to achieve gender equality.

“One of the biggest tragedies in the medical profession in Pakistan is that a lot of the women who become doctors are only doing it to enhance their wedding credentials,” said Hasan, citing that most medically-trained women become stay-at-home mothers.

Moreover, hiring female doctors has allowed HealthOne to break the social stigma associated with women seeking healthcare. Because many women only feel comfortable seeing female doctors, HealthOne has noticed a sharp increase in female patients. Currently, 60 percent of HealthOne’s patients are women.

The decision to hire male nurses was to raise awareness and visibility in the communities. In a country that has a lot of cultural constraints, Hasan thinks leveraging male nurses might be one way to break through the barriers.

“When we entered communities… we needed our nurses to be active in the community by talking to shop keepers and spreading awareness of HealthOne’s services,” he explained.  The clinics have also built trust in communities by providing nearly 6000 free random blood glucose tests to date.

Challenges

Unsurprisingly HealthOne, like many startups, has encountered a slew of challenges, including hiring and training health personnel, attracting patients to its facilities, and raising brand visibility and awareness. 

When they first launched HealthOne, Hasan says the clinics were located by high density roads. Although many cars drove past the clinics every day, people seldom walked inside. Since then, the clinics have been relocated to sites where there are more pedestrians.

In terms of staffing, the program experienced significant turnover in its early stages. Before HealthOne launched, Hasan and his colleagues recruited and interviewed around 300 to 400 medical schools graduates. However, it was difficult to convince many of these fresh graduates to stay once hired, and finding the doctors and nurses with the right commitment to the work was initially a struggle.

How has CHMI impacted HealthOne?

Through the Innovator’s Handbook for Primary Care, and through its “connector” role, CHMI has helped Hasan and his colleagues connect with other program managers who face similar challenges.

The handbook, which CHMI released in February 2015 as a culminating product from a year’s worth of activities by the Primary Care Learning Collaborative, is designed to support implementers of primary care organizations in improving their services. Hasan called it unique in capturing the experiences of leaders and implementers, reflecting on their learnings in their own voices.

“It is an extremely informative document. I share many of the same experiences as the businesses profiled. I would love to be part of future such CHMI projects so that I can learn from others and share my own experiences,” he said.

Moreover, CHMI recently introduced HealthOne to SughaVazhvu, an India-based program providing primary healthcare to remote Indian populations through the establishment of Rural Micro Health Centers. SughaVazhvu, which is familiar with some of the same challenges as HealthOne (such as engaging and building trust with the community, encouraging rational use of drugs, etc.) provided HealthOne with key best practices for adding more income generating services through pharmacies and labs, connecting with the community through Community Health Workers to encourage preventative care, and providing package deals to chronic care patients to encourage frequent use of services and meetings with doctors.

Looking to the future

Hasan is optimistic, and wants to expand his program to other parts of Pakistan by adding up to seven more clinics in Islamabad/Rawalpindi, the cities where HealthOne currently operates. When HealthOne goes nationwide, Hasan hopes to introduce at least 100 clinics. He is impressed by Access Afya’s street-facing pharmacies and diagnostic services—something he hopes to possibly replicate in his own program model. Hasan and his colleagues would like to populate cities with internally-generated revenues. Another desire is to build HealthOne’s visibility and brand recognition through extensive networking and marketing. For Hasan and the HealthOne staff, the future of HealthOne is strong.