DoctHERS-in-the-House: Improving health care for low-income women in Pakistan

Dr Sara Khurram is a young doctor from Karachi. In 2012, she got pregnant, and this led her to quit her residency and stop her medical career.

Sara’s story is common among Pakistani female doctors. While 80 percent of medical school graduates are women, only 25 percent ever practice medicine. Pakistan being a conservative country, many have to stop working once they get married or start having babies. That’s how an estimated 9,000 trained female physicians end up staying at home.

Pakistan’s medical crisis

This home restriction phenomenon puts an additional pressure on Pakistan’s collapsing medical system. With only 0.74 doctors for 1,000 people, active physicians are overwhelmed, and of course, this has a negative impact on the population’s well-being.

Pakistan is still struggling with poliomyelitis as well as with a high rate of stillbirth and tuberculosis cases. Moreover, the examples of malpractice and medical negligence are numerous. In Lahore, for instance, a toddler with a small burn on her hand passed away after a doctor injected her with too much anesthesia. A teenager had his appendix removed when in fact he was suffering from colon cancer. And every day, newborns with jaundice symptoms are misdiagnosed, making them either deaf or brain-damaged.

The main victims of this predicament are the 56 million Pakistani who earn less than three dollars per day. Whenever they get sick, they are left with three choices: get no treatment, go to an insalubrious public hospital, or visit the often unskilled local doctor. For pregnant women living in poverty, the situation is even more dramatic, as many refuse to be examined by a male doctor. Therefore, 95 percent cannot access quality health care; and in the countryside, 1 in 5 mothers dies every day, because she delivers at home, in an unsafe environment.

Bridging the gap between female doctors and female patients

While expecting her baby, Dr Sara Khurram had to spend most of her time on bed rest, and she was doing a lot of thinking. In particular, she thought about her own situation and the current medical crisis.

One day, she came up with a clever idea to circumvent Pakistan’s main socio-cultural barriers: she would open a telemedicine clinic! Thus, female physicians could stay at home, and yet, provide poor women with primary and OB/GYN cares. To lower the risk of misdiagnosis and enhance the human interaction, the young woman decided to rely on Lady Health Workers.

In Pakistan, there are about 90,000 of these community-based women, and they play a key role in preventive health care. Dr Khurram, therefore, thought she could hire some of them and train them further to assist the physicians.During an ante-natal visit, for instance, the nurse would conduct the patient’s examination, and since the entire consultation would be video-conferenced, the doctor would not only supervise her assistant. She would also see in real time what appears on the monitor, and thus, give accurate medical counsel.

At the time, considering opening a virtual clinic was a bold idea. For sure, telemedicine had been spreading across the world for a while. But it was far from having reached Pakistan, and it is well known that many people in the country are wary of ICTs. On the other hand, mobile penetration was already high (85 percent), and Dr Khurram believed mobile and video consultations were workable in most regions.

“On the seventh day, one patient came in”

It did not take long for the young woman to take the leap and give her ‘DoctHERS-in-the-House’ project a try. To test its feasibility and sustainability, she decided to start a pilot in Naya Jeevan‘s health center of Sultanabad, a conservative slum of 250,000 people in Karachi.

In May 2013, everything was ready, and Dr Khurram could open her virtual clinic, the first telemedicine facility in Pakistan. “For six days, she said, not even one patient came in; […] but on the seventh day, one patient came in.” Since then, the clinic has always been full, encouraging the young woman to hire more doctors and replicate her model throughout Pakistan.

It has turned out that video-conferencing is not an obstacle for the female patients. In fact, since DoctHERS-in-the-House started, women have been thrilled by this new type of consultation. For sure, they are happy to pay 50 percent less than they would do for an in-person visit. But what satisfies them the most is the good quality of the care they receive. In Sultanabad only, DoctHERS-in-the-House have provided 500 women with ante- and post-natal care. For 14 percent, they anticipated medical complications and sent their patients to a hospital, where they could get a safe delivery.

And this has certainly saved a few lives!

Odd Jobber: Connecting Lahore’s Rickshaws with Mobile

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Lahore, a bustling metropolis of over 9 million people, is nestled just inside Pakistan’s Eastern border with India. For Lahore’s unskilled laborers, finding work on a consistent basis can pose a daily challenge. Often times that challenge has nothing to do with desire, ability, or work ethic, but simply a lack of available work. Despite boasting one of Pakistan’s stronger regional economies, hundreds of thousands of people in Lahore live well below the poverty line. Pakistan, as a nation, ranks 177th out of 228 with a GDP per capita of only $3,100 per person per year.

Ideacentricity, a tech-startup located in Lahore’s impressive Arfa Software Technology Park, has created an SMS based marketplace called Odd Jobber to help directly connect this workforce with the consumers who need their services. Ideacentricity’s founder Adnan Khawaja describes the Odd Jobber platform as a combination of oDesk for odd jobs and Uber for rickshaws.

Currently, Odd Jobber is primarily focusing on their rickshaw capacity. The average rickshaw driver in Lahore, of which there are over 120,000, spends a large part of their day actively searching for fares. During this period the rickshaw drivers aren’t generating any revenue, and are expending cash on fuel and other costs. This is period of inactivity is what Odd Jobber is designed to alleviate.

Consumers have three ways to interact with Odd Jobber. They can call, send an SMS to 8001 with a pick- and drop-off address, or book online here. Once the request has been submitted, an SMS in Urdu goes out to rickshaw drivers who are close by, and they respond via SMS with a bid. The consumer chooses their preferred bid, which will soon be accompanied by driver rating, and the rickshaw should be on-site within 10 minutes. The Odd Jobber interface empowers drivers with direct access to customers, enabling them to generate revenue for the entirety of their shift.

Utilizing an SMS based platform instead of smartphone technology (think Über) is critical to the potential success of Odd Jobber. The mobile penetration rate in Pakistan is approaching 80%, while only 7-10% of the population have a smartphone. Ideacentricity is working to incorporate a rapidly expanding mobile-banking service called easypaisa (Telenor) into the Odd Jobber platform. This will facilitate easy transaction flow, and allow consumers to pre-pay for services.

Ideacentricity is attempting to expand Odd Jobber organically within Lahore. On their website, the company is encouraging consumers to request areas in which they’d like service. Expanding in this manner ensures that they are offering services in high-traffic areas, leading to optimal utilization of the rickshaw driver’s time.

This efficiency also carries over into the Odd Jobber business model. While Odd Jobber was launched with the goal of creating positive impact for Pakistan’s unskilled labor force, Ideacentricity is a for-profit company. On every ride they organize, or job they coordinate, Odd Jobber charges an 8% fee. The fee is added in addition to the bid that the rickshaw driver places, and is carried over to the consumer, allowing the driver to take home the entirety of their bid. Khawaja estimates that within 3 years, Odd Jobber will provide 40,000 rickshaw drivers with a combined additional income of $86 million (5:30 mark in linked video). For a workforce averaging $5-$7 a day, that increase is significant.

If you are in the Washington, D.C. area and want to learn more about Odd Jobber, Adnan Khawaja will be giving a talk with Uber president Travis Kalanick at the Annual Fulbright Conference and Prize Ceremony on October 17.

You can also check out Odd Jobber on Facebook.

Can E-learning Solve the Education Crisis in Pakistan?

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In Pakistan, school is compulsory for every child between 5 and 16. In reality, the law is not enforced, and the country will not meet the Millennium Development Goal of achieving universal primary education by 2015.

Pakistan’s Education Crisis

Over the past decade, education has been a low priority for the Pakistani governments; and economic poverty, natural disasters and religious extremism have further worsened the situation. With 5.5 million out-of-school children, Pakistan has the second worst performance in the world when it comes to enrollment (after Nigeria). Of course, disadvantaged girls are first to drop out: in 2013, 66 percent did not receive any education at all…

For children enrolled in government schools, the prospects for the future are almost as bleak. Public education is in a disastrous state, and student achievement is outrageously low. 36 percent of the 10-year-old pupils cannot read a sentence in English, which they are supposed to learn at 7; and, in the underdeveloped Balochistan province, only 45 percent of the primary school graduates can solve a two-digit subtraction.

The Whole System is in Danger of Collapse

Pakistan is confronting an acute education crisis, and the whole system is to blame. The curriculum does not meet international standards; and the lack of investment is blatant at both the federal and state levels. In 2013, total allocations for education amounted to just 1.9 percent of the country’s GDP. This was the lowest rate in South Asia, and only seven other countries put less money in their education system.

In practical terms, this means that the teachers are not paid enough, neither are they well-trained. It is not surprising, then, that Pakistan has to deal with a massive shortage of teaching staff. To make the public education system work, there should be at least 100,000 extra instructors…

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Britannica SmartMath

Bilal Shahid is a Director at Tech Implement, an innovative IT company founded in 2005 in Lahore. For this e-learning specialist, the country’s education crisis is a shame because it affects the least fortunate — those who cannot afford to go to private school.

In 2012, he decided to take action and approached the CARE Foundation, the largest education NGO in the country. Shahid intended to carry out an experiment to improve the children’s skills in mathematics. The Tech Implement team would take the Encyclopedia Britannica’s e-learning tool called SmartMath, map it to the Pakistani syllabus and use it to train the students.

Displaying the questions as a game with stars to reward every right answer, this tool is especially appealing to the youth. Furthermore, SmartMath is adaptive and driven by the students’ actual progress. When they are consistent at answering questions correctly, they move to the next level. But if they don’t reach the proficiency target, they spend more time on the topic. SmartMath can even suggest remediation.

Leaning Against the Wind

In 2012, Shahid’s idea to bring an e-learning tool to the classroom was bold, as many people in Pakistan were still wary of ICTs. But the CARE Foundation that manages 225 public schools throughout the country welcomed the initiative. In August 2012, they started a pilot in five Lahore schools; by April 2013, they had expanded the project to 23 other institutions.

However, the teachers were not thrilled. They did not take e-learning seriously and were concerned that SmartMath would replace them in the future. Tech Implement spent a lot of time explaining that the tool was actually designed to assist them in their teaching practice. It took a while, but eventually everyone agreed to play the game. And, once the schools’ computer labs were properly equipped, the project could begin.

Or so they thought…

“They Were Scared of Holding the Mouse”

The beneficiary students were aged 8 to 13, and they all came from low-income families. With no computer at home, they had no idea how to use it. Some were even scared of holding the mouse! Again, Shahid and his team put the project on hold, this time to train 2,500 children in the basics of computer literacy.

Soon, the students were able to take their hour-long SmartMath session. And it was only a matter of weeks before they showed significant improvements. By the end of the academic year, they scored 8.73 in math, whereas other students got an average of 4.25. Moreover, the majority passed their final exam!

After two years of experimentation, SmartMath has therefore proven to be a viable solution to Pakistan’s learning crisis. And today, Tech Implement wants to scale up the project and train 15,000 additional students by 2015!

What do you think? Could e-learning solutions really help enhance students’ performances in a country like Pakistan? Are they sustainable in the long run?

Will Wikipedia Zero Inspire Local Language Content?

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The Wikimedia Foundation has launched Wikipedia Zero in Bangladesh, India Indonesia, Pakistan, Sri Lanka, and Thailand over the last two years. Wikipedia Zero is a “zero-rate” program that allows users to browse Wikipedia entries on their mobile phones for free thanks to a partnership between Wikimedia and the mobile carrier.

Wikimedia’s goal is to enable access to free knowledge for every single person on the planet, leveraging the ubiquity of the mobile phone. However, that information currently exists mainly in English. There are just 109,404 posts in Hindi for the 295 million native Hindi speakers, while the 365 million English speakers get 4,413,036 Wikipedia articles (and counting) to learn from.

And while I enjoy the benefits of English language domination on the public Internet, I feel we should pause a moment and think a bit about the pros and cons of yet another bastion of English being offered as a gift to the world.

Might it be better if Wikipedia Zero came with social cues and gamification that inspired more Hindi posts? Its not like the Indian government’s Vikaspedia will succeed by itself.

We need to recognize and empower all languages equally, so that the Internet can truly reflect the diversity that is our reality. We need a Wikipedia Plus that adds local knowledge, not just disseminates others’ distant information.