As COVID-19 strains Pakistan's health system, tens of thousands of women doctors are sitting at home, their talents squandered in a country where millions have no access to medical care. Many families encourage their daughters to study medicine not for a career, but to bolster their marriage prospects. The phenomenon even has a name – "doctor-brides".
Appalled by the waste of expertise, entrepreneur Sara Saeed Khurram has set up a telemedicine platform enabling female medics to provide e-consultations from their homes to patients in rural communities. "Half the population in Pakistan – 100 million people – never get to see a doctor in their lifetime," Khurram, CEO of Sehat Kahani, told the Thomson Reuters Foundation.
"At the same time we have another big challenge which is very close to my heart – more than 60% of our doctors are women, but most don't work." Sehat Kahani is among a myriad of social enterprises – businesses seeking to build a better world – that are innovating to plug healthcare gaps in developing countries, a task given added urgency by the COVID-19 crisis.
On Friday, G20 countries, health organisations and other experts will meet for an online summit to share lessons from the pandemic and brainstorm on how to bolster health systems. Khurram, who has seen patient numbers increase ten-fold during the pandemic, believes her model could be replicated in other developing countries with doctor shortages.
Since launching in 2017, Sehat Kahani has established 35 rural telemedicine clinics across Pakistan where, for a small fee, a patient can see a nurse who will link them via the platform to a doctor. The nurse is trained to carry out examinations guided by the doctor who may be sitting at home hundreds of miles away.
Patients with a smartphone can also contact a doctor directly via an app. Khurram, herself a doctor, said the doctor-bride phenomenon, compounded by a brain-drain, meant only 90,000 of Pakistan's 200,000 trained doctors were practising in the country.
"A female doctor gets the best hand in marriage so everyone wants their daughter to become a doctor, but not everyone wants their daughter-in-law to work," she said. "Our platform opens up opportunities. Now they can suddenly create a whole virtual clinic in their home."
DOUBLE MISSION In neighbouring India, where an escalating COVID crisis has left the health system on its knees, entrepreneur Kunaal Dudeja said the country needs about 30 million more healthcare professionals to support doctors and nurses.
In 2018, he co-founded Virohan Institute to train young people, many from lower income backgrounds, in dozens of paramedical roles from laboratory technicians to operating theatre assistants. "Our social mission is two-fold – to significantly improve the quality of healthcare in India, and to improve the lives of youth," Dudeja said, adding that student numbers had more than doubled during the pandemic.
"We're providing an aspirational career and helping them cross socio-economic barriers." After qualifying, a trainee can quadruple what they would earn in the sorts of jobs typically open to them, Dudeja said.
Most of Virohan's 5,500 graduates are now working on the frontlines of the COVID crisis. The start-up, which operates across five states, is looking to expand across the country and potentially to Sri Lanka.
Across Asia, Africa and Latin America, many social enterprises are working at a grassroots level, using everything from rickshaws to drones to deliver medical supplies to poorer communities.
Yunus Social Business, which invests in Virohan and other social businesses tackling poverty, said the pandemic has underlined the crucial role such ventures can play in bridging health gaps. CEO Saskia Bruysten said social enterprises were often better placed than the government to respond fast in a crisis because they already worked with the most vulnerable.
"They are just closer to where the need is biggest. They're usually the ones that can come in first because they see the need directly," she said. "Often government is very far removed, a little bit in an ivory tower, and doesn't necessarily have the infrastructure to reach that last person somewhere in a rural area."
Bruysten described social enterprises as the "beautiful shining star" of a new type of capitalism, motivated by engendering social change rather than enriching shareholders. Many have quickly adapted their operations during the COVID-19 crisis.
With the pandemic making travel harder, Uganda's Kaaro Health, which runs solar-powered container clinics, is sending nurses to treat patients at home, and putting its technicians on motorbikes to collect medical samples and deliver prescriptions. Kenyan business Solar Freeze, which has pioneered the use of solar-powered chest freezers to help farmers cut post-harvest waste, is repurposing its units to store COVID-19 vaccines and other medicines requiring cold temperatures.
It has supplied scores of freezers to rural clinics lacking electricity and to Kakuma Refugee Camp in northwest Kenya – home to 160,000 refugees from more than half a dozen countries. Social enterprises are also collaborating with governments and businesses.
In Liberia, Last Mile Health has partnered with the government to vaccinate health workers including a network of rural community health workers created after the 2016 Ebola crisis who have been trained to spot COVID-19 symptoms. VillageReach is using drones to speed up diagnosis of COVID-19 test samples and deliver protective medical equipment in Malawi and Democratic Republic of Congo, and will use them to fly vaccines to remote areas when immunisations get under way.
In Pakistan, Sehat Kahani's Khurram said they had liaised with the federal government to provide free consultations to all patients during the first wave of COVID-19. They also installed apps in hospital intensive care units treating COVID patients, allowing junior doctors to get immediate advice from critical care experts based elsewhere.
"In a pandemic, solutions like these can be crucial." Khurram said. "This has already saved many lives." ($1 = 410.0000 naira)