Praava Health Founder, Managing Director, and CEO Sylvana Quader Sinha on what inspired her to start a healthcare company in Bangladesh, the challenges of building a healthcare company, the challenges she had to overcome in the early days of Praava Health, her lessons in life and entrepreneurship, the single most important tip for raising investment, how having a group of supportive mentors and advisers has helped her in personal and organizational growth, Praava’s future plan, why management is all about people, why the ability to relentlessly resourceful is the most important quality of a founder, how she designs her reading list, and much more.
This was a much longer interview, so we had to break it up into two parts. This is the second and final part of the interview, you can find the part one here. subscribe to our weekly newsletter to get our stories directly in your inbox.
Future Startup
Why did you decide to start a family health center? Why focus on family doctors? You could have solved other problems in the healthcare space.
Sylvana Quader Sinha
80-90% of healthcare needs can be addressed by a family doctor – and I saw an opportunity to rebuild trust in the system starting with the basic relationship between the family doctor and the patient. That, coupled with a lab established according to international standards, I believed could be hugely impactful.
Additionally, we are aiming to change the way people think about healthcare. Currently, the system in Bangladesh is a very hospital-centric system, but the trend globally is toward de-hospitalization. Most healthcare needs can be addressed in an outpatient setting like Praava’s.
Future Startup
What were your challenges in the early days? What are the challenges now?
Sylvana Quader Sinha
Well, healthcare is a capital-intensive business. Primarily, we had to set up six laboratories, bring in machines, and other expensive equipment. It is not like traditional startups – It's hard to create a systematic change in healthcare with an asset-light approach. Still, we have bootstrapped as much as we could with a creative, scrappy team.
Moreover, for us to scale, human capital is a fundamental challenge. There aren't enough doctors, nurses, or technicians in this country. Globally, if you look at the healthcare industry as a pyramid, you see there are the most number of technicians, then nurses, and then doctors. But in Bangladesh, it's just the opposite – a reverse pyramid.
So, in order to build this up and scale it, we will have to develop our in-house training capacity. We already have a robust training program in partnership with Harvard University and other organizations. We also have plans to build our own training institute in the longer run.
I believe there's no limit to our capacity as human beings. To see this team come together and what we have been able to achieve has really taught me a great deal. We have faced so many challenges, big and small, and we have managed to overcome those challenges which give me a sense of hope and resilience that there is nothing beyond our intentional capacity when we really focus on something.
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Future Startup
Could you touch upon the challenges of building a healthcare company in Bangladesh?
Sylvana Quader Sinha
If you look at the pharmaceutical industry in Bangladesh, you'll see that this rapidly growing industry has a huge cadre of professionals. Healthcare not has gotten to such a level yet. You don't have as much of a pool of professional talents as some of the other sectors have to offer. That's a really big challenge.
In that regard, we have been very fortunate to be able to attract some of the most prominent professionals in this country. But despite that, it remains difficult to find people who have talent and, at the same time, whose values also align with ours, as we are trying to build a values-based organization.
Future Startup
There is a huge resource-constraint in the healthcare industry. Doctors - patients ratio is painfully low in Bangladesh, it is somewhere 4 doctors for every thousand patients. You mentioned earlier that human resource is the biggest challenge for you and you have taken initiative around training and all. But that training would not essentially solve doctors scarcity problem, at least in the near future. How do you plan to tackle this challenge in your business?
Sylvana Quader Sinha
We have started in an urban setting very intentionally. It's because the best doctors in the country don't want to leave the cities and visit the rural areas. As a result, the shortage is not as acute in the urban setting as it is outside of the cities. We have also been very lucky to attract some really very good doctors. I think we would face the human resource challenge more and more as we scale which is why I want Praava to bolster and build up its in-house training capacity, including with its own training institute eventually.
Just don’t give up. It (fundraising) requires a lot of patience and a really thick skin. You can't take anything too personally although you've devoted your blood, sweat, and tears into building your company. Because other people's choices aren't necessarily a rejection of you. An investor may choose not to invest in your business for a lot of reasons. Their money might be tied up somewhere else or the timing might not be right on their end. It is really about persistence and not giving up in the face of rejection. I think that’s the name of the game, whether fundraising or any other aspect of the daily challenges of building a company.
Future Startup
Again, going back to the previous question, what are some lessons you’ve learned?
Sylvana Quader Sinha
I believe there's no limit to our capacity as human beings. To see this team come together and what we have been able to achieve has really taught me a great deal. We have faced so many challenges, big and small, and we have managed to overcome those challenges which give me a sense of hope and resilience that there is nothing beyond our intentional capacity when we really focus on something.
For example, the construction of our facility was ongoing last summer. It was flooding badly at that time too. The wet weather made it difficult for us to build the laboratory. The lab requires special kind floor and it has to dry which was very difficult due to the humidity and rain. Incessant raining had also delayed the arrival of construction materials from the port.
Our team stood strong through these intense moments. Some people say that it is a miracle that we opened our doors in August 2017. But it was no miracle, it was because of this incredible team that it happened - everyone came together with laser focus to make sure that we opened up the facility as planned.
Every day we fight and overcome these challenges.
One other thing I always say is that the people who ask more questions always learn more. It is critical that we maintain our curiosity and nurture our sense of intellectual inquisitiveness. That is how we will continue to grow every day. There’s a quote from Pepsico CEO Indra Nooyi: “Every morning, you’ve got to wake up with a healthy fear that, to win, you have to change faster and be agiler than anyone else.”
I came up with the idea of Praava by asking questions. And every day by asking questions, we get feedback for our existing services and ideas for new products. When a patient leaves our premises, s/he has to answer four question at the exit regarding her/his experience here. We also ask them to review our service on a scale of 1 to 5. I believe you have to ask a lot of questions if you want to grow.
Future Startup
What are some major goals for Praava for the next couple of years?
Sylvana Quader Sinha
At present, we are laser-focused on achieving profitability and, by the end of 2019, rolling out a couple of additional spokes (medical centers).
We are trying to make our IT infrastructure more streamlined. We have already brought in some state-of-the-art healthcare technology systems for the first time in Bangladesh, such as our hospital information system and Bangladesh’s first patient portal, and we have partnered with Life Track, which allows patients to have second opinions on their scans from US board-certified radiologists, and others. But again, tech is only an enabler of our better services and a better patient experience.
Future Startup
In terms of raising money, what tips would you give to other founders who are trying to raise money? What kind of negotiation goes into when you raise investment? ?
Sylvana Quader Sinha
Just don’t give up. It requires a lot of patience and a really thick skin. You can't take anything too personally although you've devoted your blood, sweat, and tears into building your company. Because other people's choices aren't necessarily a rejection of you.
An investor may choose not to invest in your business for a lot of reasons. Their money might be tied up somewhere else or the timing might not be right on their end.
It is really about persistence and not giving up in the face of rejection. I think that’s the name of the game, whether fundraising or any other aspect of the daily challenges of building a company.
Future Startup
Have you found anything particularly helpful or advantageous such as a tool or mentorship or a program in the process of building Praava?
Sylvana Quader Sinha
I have had so much help while building this company. I have a team of local and international advisers and others who I turn to for advice and support often. Specifically, we have a local board of directors and team of international advisors with varying experience in healthcare service delivery, medical technology, healthcare technology, and business.
I think it is wonderful and an honor for people like you to want to interview me, but I'm only the face of this organization; there are so hundreds of people behind me who hold me and Praava up and have helped Praava to come this far. I'm deeply grateful to every single one of them.
Future Startup
What is your take on Bangladesh's healthcare industry in terms of opportunities and challenges?
Sylvana Quader Sinha
Opportunities are tremendous in Bangladesh. My predictions say that Bangladesh’s healthcare industry will more than double in the future. To get the local industry to the level of India's alone would require $17b-$20b of investments.
Less than 10% of the healthcare industry in Bangladesh is structured compared to that of India which is at least 20% structured. That’s the opportunity. If we can structure our industry that will help to grow the trust among the patients. In Bangladesh, there are not many chains in Bangladesh that are brands that people know and trust, and there are few institutions that monitor and implement standards.
Future Startup
What is your management philosophy?
Sylvana Quader Sinha
I think my job as a CEO is ensuring accountability and inspiration – that is, to hold people accountable to goals that we have set for ourselves and make sure that we moving toward them in a timely manner.
I also want to keep our employees inspired and motivated to stay focused and connected to the mission of this organization which is to be the best healthcare company in Bangladesh.
Nobody can build a company all by yourself. Ultimately, building a company is a very lonely journey, and in some ways as a founder, ultimately you are alone and it can be hard to communicate with others about what you go through as a founder. But you can’t do it alone. It takes a village to build anything. You have to use every resource available to you, whether it's emotional support, or strategic or technical advice or an introduction or otherwise. Don't shy away from reaching out to people. I’m relentless in following up with people who offer introductions or help.
Future Startup
Building a company from scratch is extremely challenging. Some people say it is like eating glasses. It comes with a lot of challenges and many entrepreneurs go through short-term bipolar mood changes. As an entrepreneur, how do you deal with the challenges and stress that comes being a founder?
Sylvana Quader Sinha
Entrepreneurship is a roller-coaster ride. You can experience euphoric successes and disappointing failures, several times in a day, or even an hour! Sometimes the hardest thing to do is to wake up on the next day and keep going. You just keep going. That’s all you can do.
Because I believe in this service that we are trying to bring to Bangladesh. I don’t think my belief in this has ever wavered, although I do go through the highs and lows of entrepreneurship. I would not say that I never felt hopeless, I did probably a few times, but giving up never came to mind as an option.
I deal with stress by staying connected to the people who I care about the most, and by trying to exercise regularly. It’s also important to have enough sleep. Although I wouldn’t say I’m a very good example of doing that. I trying to be more committed to having better sleep.
Future Startup
What’s your advice for other entrepreneurs who are trying to build a business?
Sylvana Quader Sinha
Nobody can build a company all by yourself. Ultimately, building a company is a very lonely journey, and in some ways as a founder, ultimately you are alone and it can be hard to communicate with others about what you go through as a founder. But you can’t do it alone. It takes a village to build anything.
You have to use every resource available to you, whether it's emotional support, or strategic or technical advice or an introduction or otherwise. Don't shy away from reaching out to people. I’m relentless in following up with people who offer introductions or help. And I think you have to be if you want to build a business. Because this is something that requires so much more of everything you need than what you can imagine. And many people genuinely want to help someone who is doing something worthwhile. If you reach out to people, most of them would like to support.
Future Startup
A couple of books you have been reading lately.
Sylvana Quader Sinha
One of my favorite books about healthcare is If Disney Ran Your Hospital: 9 1/2 Things You Would Do Differently. It’s about how to create a service culture and a patient experience that is unparalleled, based on the lessons from the Disney model, which is a different kind of an experience than healthcare, but an experience nonetheless.
We are living in an experience economy and I think understanding that is key to understanding the needs of 21st-century consumers.
I deal with stress by staying connected to the people who I care about the most, and by trying to exercise regularly. It’s also important to have enough sleep. Although I wouldn’t say I’m a very good example of doing that. I trying to be more committed to having better sleep.
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(Interview by Ruhul Kader, Transcription by Sabiba Benta Habib | Photos by Praava)
