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How Praava Health Was Created

Praava Health, the healthcare startup that describes itself as “a network of Family Health Centers” and provides family doctors and diagnostics services in Dhaka, started its full-fledged operation in Dhaka on February 2018 with one center in Banani.

It has since expanded as a team and as a business. The company has six labs that can do 250-unique tests and has built Bangladesh’s first PCR lab for molecular cancer diagnostics. Praava also offers a handful of membership plans and has a home care service where doctors and nurses visit patients at home.

Praava claims that it has the first-ever fully integrated hospital information system in Bangladesh. It means Praava keeps all medical records of a patient, which patients can access anytime from anywhere using Praava mobile app. Once you are registered with Praava, you can connect your app with your Praava registration number and access your records online from anywhere. You can also make appointments and communicate with Praava using the app.

The story of Praava Health is a fascinating one. Praava Founder Sylvana Quadir Sinha has an illustrious career and worked multiple sectors from law to development sector to politics spanning multiple countries from the US to Afghanistan.

The founding story of Praava is personal and serendipitous and offers an insight into how the minds of founders works and what it takes to follow your calling.

In an interview with Future Startup in 2018, Ms. Sylvana explained how Praava Health was founded. This is the story of the creation of Praava Health.

The Inspiration and Idea

After my graduation, for many years I worked in international law and international development, including at The World Bank and major international law firms, and in US foreign policy as an advisor to then-Senator Barack Obama.

I worked on Obama’s campaign primarily because I wanted to learn from the incredible minds he had pulled together – including Susan Rice, Samantha Power, and Denis McDonough.

When it looked like he would win, I considered pursuing a role in his administration, but I had always believed that a big problem with US foreign policy was that policy setters hadn’t spent enough time abroad. I decided I shouldn’t be part of that problem, so I moved to Afghanistan with the World Bank at the end of 2008.

I spent four years in Afghanistan, with the World Bank and the US Institute of Peace, along with other UN agencies in the Middle East and South Asia. My work was the perfect confluence of my interest in law and development and US foreign policy.

After working closely with the people in Washington in jobs I thought I wanted, I found myself craving the accountability and pace of the private sector. I also wasn’t feeling as directly connected to the impact of my work.

I went back to a “big law firm” in NYC, working on some fascinating international disputes, but I was still craving more.

I always had this yearning to create something of my own – to touch people’s lives directly – but my career has taken me in a very different direction than I had expected.

I was feeling a little lost at that point. I started thinking seriously about the Bangladesh market, and what I might be able to do to create impactful change in the country. I knew there was a dire need for quality health care services.

A few years prior to that, in 2010, my mother was hospitalized at one of Bangladesh’s top hospitals for a basic operation. We expected that the routine procedure would go smoothly, yet she suffered such dramatic complications that we nearly lost her. It was one of the top hospitals in Bangladesh. They diagnosed her with cancer which was later dismissed when we consulted doctors in Thailand.

It was really an eye-opening experience that brought me in direct contact with the healthcare system and how it was failing – for the first time. That’s just one example. I would soon come to realize that many people in this country have a story to share about the negligence they have experienced from hospitals and the broader healthcare system.

My mother was lucky to be treated at one of the best hospitals in the country. Not everyone can afford such treatment or go abroad, for that matter. I spent a great deal of time thinking about the tremendous need to change the health sector in Bangladesh.

In 2014, I made a conscious decision that I wanted to be part of a needed change in the way healthcare was delivered in Bangladesh. The idea of Praava was still a seed, and I had no idea what it would blossom into. I went on a mission to understand the reality in the healthcare space in Dhaka. I began to listen to everyone who would talk to me about their experiences with the healthcare system in Bangladesh.

Since everyone has been a patient at some point in their life, everyone has a story and a perspective to share. I would listen to anyone who would talk to me. When I would ask people to share with me their experiences, usually they would start talking and floodgates would open up. There are good doctors in Bangladesh, and not all the stories were bad. But there are some systematic issues which are failing the patients.

I had also met with doctors and others working in the healthcare industry – not just in Bangladesh but also in the region and a lot of time internationally in the US, in Asia, and in India. It is an incredibly exciting time to be working globally in healthcare – some of the richest countries in the world are failing to serve their citizens, and everyone is trying to understand these problems and offer solutions.

Consistently, I heard Bangladeshi patients complain about a lack of trust in their healthcare system. In fact, anyone who can afford to travel abroad for healthcare does, often at substantial personal expense and sacrifice.
I thought this might be because there was only one internationally accredited lab in the country resulting in a high percentage of diagnostic errors. But in fact, the #1 reason patients are traveling abroad is an absence of trust – they feel the doctors in Bangladesh don’t spend enough time answering their questions or listening to them.

In fact, a British Medical Journal study published in 2017 ranked Bangladesh at the bottom of 67 countries surveyed in terms of the amount of time doctors are spending with patients – the average primary care doctor in Bangladesh spends 48 seconds with each patient – compared to 2 minutes per patient in India, and 5-22 minutes per patient in more developed countries. That was very interesting. There is this huge trust gap in the system but it really starts with the relationship between patients and their medical service providers.

I decided there were 2 major problems that I wanted to fix –

1) I wanted to improve trust in the system, and help patients feel that they were being heard and taken seriously, and
2) I wanted to offer quality diagnostic testing so that people didn’t have to double, triple and quadruple check their test results for accuracy, even sometimes traveling abroad in order to do so.

That was the inspiration for the core concept of Praava. At Praava, we take this relationship between patients and doctors very seriously. Our doctors spend a lot of time with the patients and there is a real relationship between these two parties. We actually guarantee 15-minute appointment slots for every patient.

The birth of Praava Health

I came with the concept in 2014 and I hired my first employee in February 2016, almost 18 months later.
In between, I conducted the research, I built a 10-year financial model, I raised funds from investors, and put together many other bits and pieces of the business.

Building the initial operation

Our medical director was my first employee in February 2016. The lab director and the IT director joined us on April 2016. We also have a senior medical director who I had met in January and who joined with us in April as well.

I built the team by being very honest about my values and vision, and it helped to attract like-minded people who shared my values and believed in our team’s capacity to create positive change.

By the end of the summer, we had about 12 people on-board. In November 2016, we signed a lease for our first facility in Banani, and within a year, we launched our first facility in August 2017, with more than 100 employees present for the ribbon-cutting.

One of the hardest parts of setting up the initial operation facility was finding the right building. Because we needed a spacious premise with ground-floor access that is affordable. We had to invest a significant amount of time in finding the right space. I myself spent time in scoring places.

We opened our doors in August 2017. It was a soft launch period for the initial five months. We went into full-fledged operation in February 2018 – hard launch we call.

A sneak peek into Praava Health

So what does Praava do? Basically, Praava is defined by its tagline: family doctors and diagnostics. We have a group practice of family health professionals that include family doctors who have advanced training in family medicine.

In Bangladesh, people have a tendency to go directly to a specialist even when the situation doesn’t demand so.
Our group of family health professionals also includes women’s health specialists, pediatrics, dentistry, physiotherapy, nutritionists, psychological counseling, and health coaching. We have a particular focus on helping patients in managing chronic diseases.

On the backend, we have six labs that can do 250 unique tests. The lab has been set up according to international standards and we are proud to challenge anyone to find variation between our lab reports and any other internationally accredited lab. I get my blood work done here, my mother gets her blood-work done here, so I need it to maintain that standard. We have started the application process for international accreditation, which takes a couple of years to complete.

Also, I’m very proud of the fact that Praava Health has built Bangladesh’s first PCR lab for molecular cancer diagnostics. Molecular cancer diagnostics, including liquid biopsy, can reduce cancer mortality based on early detection as well as develop a better understanding of the patient’s disposition to various treatment options and disease management. This latest technology only recently became available even in the west.

Before we existed in Bangladesh, other facilities were sending patients’ samples abroad for analysis. By doing these tests in Bangladesh, we minimize error rates that can be caused during transport of samples abroad, substantially lessening the cost to the patient, and reducing turnaround time for reports.

Rapid turnaround times are crucial when making decisions regarding targeted therapies for cancer patients. We have already conducted hundreds of molecular cancer diagnostic tests at Praava Health. We also offer a full range of imaging services.

We have also introduced membership plans which are first of their kind in this market. We have annual membership plans ranging in price from BDT 4,500 to BDT 28,000.

We are marketing it directly to the consumers as well to the corporates for our corporate membership plans. We will gradually introduce more attractive individual customer and corporate plans.

In fact, the concept of our membership plan is actually a values-based health care concept. It’s an idea that healthcare companies shouldn’t make more money when we keep getting sick. But that’s what happens. So what we are doing is that we are basically betting on the opposite. We don’t more money if you get sick.

We are saying to our customers that by paying a flat rate, which is buying a Praava membership, you can come to Praava every single day of the year. But we believe that you won’t have to because we are going to keep you healthy.

We have an assumption that you may come twelve times a year. For every member-patient, we predict how many times s/he is likely to visit us for check-ups and then try to lower the figure by providing her/him better health care because if you visit us less, which means if you get sick less, it is good for our business.

By this, we are trying to align our values with the ones of our patients. And this is how we operate from a values-based perspective at every level of our operation. Our decisions are made not to merely maximize our business, but to ensure an excellent experience for our patients.

Ayrin Saleha Ria works at Future Startup as a full-time Research Associate. She has a background in Applied Sociology. Before joining the FS team, she worked and volunteered with a number of social organizations. As someone who comes from a social science background, she takes a deep interest in research around important social-economic challenges in our society. A voracious reader, Ayrin is passionate about working for the betterment of society, takes a deep interest in human society and behavioral science, and loves books.

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