Next-generation healthcare systems and telehealth

As one of the fastest-growing economies globally, recently exceeding India's GDP per capita two years in a row, Bangladesh has been dubbed the next Asian tiger by the World Economic Forum, The Economist, and others. This is a far cry from the "basket case" that Henry Kissinger labelled the country on its birth in 1971. This rapid economic growth has contributed to a substantial decrease in poverty from 40 percent in 2005 to less than 30 percent today. A dynamic, growing middle class of forty million has already propelled Bangladesh to "middle-income" status, according to the World Bank. Bangladesh is now projected to be among the top 30 economies globally by the end of this decade.

This incredible growth trajectory is predicated on tremendous progress in health and education in the last decade. Bangladesh is performing better than every other country in South Asia on social development indicators. Infant and maternal mortality rates have fallen by at least half since 1990. Life expectancy has also risen by 13 years to 72, four years more than India and three more years than Indonesia. Bangladesh has also outperformed similar countries in female primary and secondary schooling, although it still lags at the tertiary level. Between 2006 and 2010, Bangladesh enrolled over seven percent more girls in primary education than other economies at the same level of income.

Against this backdrop of rapid growth and progress, social infrastructure and specifically healthcare are still lagging dramatically. In June 2018, the International Monetary Fund (IMF) recommended further public investment in infrastructure, including healthcare service delivery. The urgent need for investment in healthcare in Bangladesh is twofold: 1) there is too much demand in the market for healthcare and not enough supply to match the growing needs of a population that has more disposable income to spend on more and better healthcare, and 2) Bangladesh's continued growth as a nation depends on a healthy, resilient population.

I founded Praava Health after first-hand witnessing the limitations of medical care in Bangladesh. Today, Praava Health is transforming the healthcare experience in Bangladesh with our "click and brick" healthcare platform that integrates digital health and in-clinic experiences convenient to where everyone lives, works, and clicks. The platform seamlessly combines technology with traditional health services — meaningful doctor-patient relationships and high-quality diagnostics and medications — to improve patient experiences and outcomes. Praava's digital products include Bangladesh's first patient app launched in 2018, as well as telemedicine, e-pharmacy, and virtual primary care. Praava is also the first in the region to introduce value-based healthcare concepts, aligning patient values with our incentives.

A few thoughts come to mind as we think about next-generation healthcare systems and telehealth.

First of all, in markets such as Bangladesh - across Low and Middle-Income Countries - more people are dying due to lack of access to quality healthcare than lack of access alone. As such, any next-generation models in these markets must critically invest in underlying quality infrastructure to build impactful healthcare models. Telemedicine alone, for example, does a lot to solve the problem of access but is often not equipped to address the quality challenge. At Praava, our core focus on quality care and our integrated approach allows us to holistically best serve our patients and have the biggest impact on patient outcomes and improvement in patient quality of life.

Secondly, telemedicine can become a meaningful triage tool to improve efficiency in the process of accessing care, allowing patients to share their complaints via video consults and providers to determine whether that is enough to diagnose the patient or whether a follow up in-clinic visit is required. In some cases, an in-person examination is still necessary, but many cases can be diagnosed from a telemedicine visit alone.

Finally, the impact of telemedicine can be maximised in the context of tools that allow for ongoing care management that will ultimately improve patient outcomes and lives - above all, keeping patients out of the hospital. Indeed, when we as providers can align our incentives in a way that allows us to invest in better health for our patients, everyone wins. Our early investment in technologies placed us in a fortunate position of being able to respond quickly when the global Covid-19 pandemic arrived in Bangladesh. Today, Praava offers a suite of technologies that allow us to serve and protect patients in a variety of ways. We are building a proprietary application, Praano, a digital concierge tool that provides patients, families, and caretakers at home management for chronic diseases. During the Covid-19 pandemic, we utilised this tool so that many patients could be treated at home, protecting both themselves and healthcare providers. The benefits to our technology quickly became apparent– hospitalisation rates for our patients were reduced by a third compared to the national average, and 86 percent of our patients could recover at home successfully. This reduced out-of-pocket costs for patients, decreased hospital-acquired infection rates, and lowered healthcare system costs. Moreover, with the virus constantly evolving, healthcare providers also benefit as access to the latest guidance on diagnosing, testing, and treating patients most effectively is continuously updated on the platform.

At Praava, we firmly believe that telehealth is most impactful when it's effectively integrated with in-clinic services in meaningful ways. There is a strong interplay between telemedicine, remote monitoring, and virtual primary care. Today, as a silver lining of the terrible public health crisis we have braved over the last two years, patients and providers alike have grown accustomed to accessing and delivering healthcare through virtual and remote channels. This is a very positive development that will help improve the efficiency of healthcare systems. The future of healthcare promises even more evolution of such offerings in the form of remote monitoring, gathering data and information to improve patient outcomes, and offering an integrated approach to achieve value-based care that is holistic, affordable, and measurable.

As we look to the future at Praava Health, we're excited and inspired by the opportunities we see to improve the lives of our patients. Bangladesh's continued growth as a nation depends on a healthy, resilient population – we are privileged to be able to contribute to that journey in a small way.

Sylvana Quader Sinha is the Founder, Chair & CEO of Praava Health.