The women of the yesteryears have always shown dynamism long before the time of progression. Hence we’ve had the likes of Begum Rokeya, Sufia Kamal as well as Zohra Begum Kazi paving the way for many more pathfinders like themselves to lead the way for others. Their indomitable spirit and contribution to the society served as guidance for many generations of women despite the age-old gender banter. But much has changed over the years; women are now more actively involved in the corporate front braving complex fields of work that are often considered to be a male-driven territory. Sylvana Quader Sinha too belongs to this generation of women leaders. A 360-degree view of foreign policy, emerging markets, and development has informed her vision for the healthcare industry in Bangladesh. With the establishment of Praava Health, Sylvana aims to introduce a systemic change to the way healthcare is delivered.
As a female CEO specialising in health, what challenges have you faced upon establishing a medical facility like Praava Health in Bangladesh?
Every day is an adventure and a challenge; I have learned to expect the unexpected. Specifically, I think human capital is our biggest challenge in building a world-class healthcare system in Bangladesh, but honestly, it hasn’t been quite as difficult as I had expected. Praava has been very lucky and humbled to attract some incredibly talented individuals to help us build this dream.
In a PwC’s Strategy & report, it showed that the share of incoming women CEOs in the world’s 2,500 largest public companies dropped to 2.8%. Among healthcare companies, the rate was even lower-1.6%.How do you think they can be motivated to pursue authoritative roles in the healthcare industry?
There are certainly systemic and institutional roadblocks to women accessing power globally and locally. Still, Bangladesh is doing better than many of our peers regarding women in positions of power, starting with our Prime Minister, Speaker of the House, and former Prime Minister, as well as influential female leaders in the business community. Despite that, women are often underestimated in theory. That doesn’t bother me too much – in some ways, I prefer to be underestimated and to let my work speak for itself. Frankly speaking, I think that socio-economic barriers are more difficult to overcome than those relating to gender in Bangladesh.
In Bangladesh, women in medicine often choose to specialise in women’s health and pediatrics, but I hope we will start to see women branching out into other fields as well. We are proud at Praava Health that our Senior Medical Director Dr. Simeen Akhtar has been working in the field of quality and hospital administration for many years and she also has practiced all over the world in her area of specialty, internal medicine. So, the tide is starting to shift, and I hope that will continue.
Service wise, what standards do you endorse at Praava Health? How is it different from those that are being provided by local private companies as well as international chains?
Praava Health envisions a world-class health care system that puts patients first. Every process is designed to get patients the solutions they need faster. We are bringing back the family doctor, who has a personal relationship with you, is aware of your entire medical history, and cooperates with you to manage your health. We guarantee that our family physicians will spend a minimum of 10 minutes with you for each appointment. The fact is that family doctors can address 80-90% of the issues that come up for most people. Only in a few instances will a referral to a specialist or hospital be required.
Consistently, we hear Bangladeshi patients complain about a lack of trust in our healthcare system. In fact, anyone who can afford to travel abroad for healthcare does, often at substantial personal expense and sacrifice. When surveyed, patients who are traveling abroad cite lack of trust in the system as the number one reason they are leaving Bangladesh to seek healthcare. Trust is indeed the core of any effective healthcare system. Patients feel better when their doctors spend time getting to know them. Patient-centred care is a holistic approach to health care. It goes beyond educating patients about their diagnosis and potential treatments by involving them in critical decisions about their health, taking into account their circumstances and preferences. There is substantial evidence that patient-centered care improves clinical outcomes and satisfaction by enhancing the quality of the doctor-patient relationship, while at the same time decreasing overall healthcare costs and wastefulness.
Praava Health was founded upon this core value of patient-centric care, also supported by in-house quality diagnostics and enabled by technology. Our lab and facility have been designed according to the standards of the College of American Pathology (CAP) and the Joint Commission of Inquiry (JCI), both international accreditation bodies from whom we hope to secure accreditation within a couple of years. We have brought Bangladesh its first fully integrated HIS (Hospital Information System), including EHR (Electronic Health Records) and featuring the first Patient Portal available on the internet or an app on your phone, for patients to download medical records, make appointments, and communicate with doctors and medical professionals. We want to enable patients to have every tool imaginable to empower them to manage their own health.
What inspired you to focus on healthcare in particular? To what extent has your academic background helped you better understand the health industry in the Global South and Bangladesh?
I am an American-born Bangladeshi who moved to Dhaka for the first time in my life to build Praava Health, after a career in international law and development, including The World Bank and major international law firms, and the US foreign policy as an advisor to Obama. I was educated at Harvard, Columbia, and Wellesley. A few years ago, I realized that although I had been lucky to have some incredible professional experiences, I wasn’t finding the impact I craved. I had always wanted to do something for Bangladesh, but I didn’t know what that would be. I knew the need for quality healthcare in Bangladesh based on multiple experiences of loved ones, and the market opportunity at this stage of the country’s development acutely. The Bangladeshi economy has been built upon the growing strength of the middle class, and that requires a healthy population. Although tremendous progress has been made in Bangladesh’s rural health outcomes and social development indicators, in the urban setting, healthcare is not at the level it needs to be. The fact is that for anything beyond the most basic primary care needs, anyone who can afford to is accessing the private system or traveling abroad. It is inappropriate to need to leave one’s own country to access quality healthcare.
My work in development also taught me of the strong evidence that private sector investments in infrastructure actually alleviate poverty. This knowledge and my professional experiences drove me to build something homegrown based upon lessons from other markets – we don’t need to reinvent the wheel when it comes to healthcare – and what made sense for Bangladesh at this moment of its economic development.
“When surveyed, patients who are traveling abroad cite lack of trust in the system as the number one reason they are leaving Bangladesh to seek healthcare. Trust is indeed the core of any effective healthcare system. Patients feel better when their doctors spend time getting to know them. Patient-centred care is a holistic approach to health care. It goes beyond educating patients about their diagnosis and potential treatments by involving them in critical decisions about their health, taking into account their circumstances and preferences.”
What extensive treatment does Praava Health offer to cancer patients?
A DG Health document on National Cancer Strategy stated in 2015 that 200,000 develop cancer and 150,000 die of cancer every year. In 2015, the cancer load was 1,200,000 people. Bangladesh, unfortunately, has no cancer registry – something we hope to be part of the building – but we believe the incidence of cancer is in fact much higher than 1.2 million. WHO estimates that 196,000 have lung cancer alone.
Praava Health has built Bangladesh’s first PCR lab for molecular cancer diagnostics. Molecular cancer diagnostics can reduce cancer mortality based on early detection as well as a better understanding of patient’s disposition to various treatment options and disease management. Other facilities in Bangladesh offer molecular cancer diagnostics tests, but the samples are sent abroad for analysis. By doing these tests in Bangladesh, we minimize error rates that can be caused while transporting samples abroad, substantially lessen the cost to the patient, and reduce turnaround times for reports. Rapid turnaround times are crucial when making decisions regarding targeted therapies for cancer patients.
With issues like malpractice and misdiagnosis, private hospitals in Bangladesh are often subjected to critical reception. In a time like this, how does Praava aim to gain trust and goodwill among the consumers?
Many patients in Bangladesh complain about mistakes they have experienced in diagnostic testing – and honestly it isn’t fair for us to blame doctors for this when the underlying testing facilities aren’t necessarily producing reliable results. It is not uncommon to send out 5 samples of blood to various facilities across the country and return 5 different results.
At Praava, we are taking significant measures to minimize diagnostic error rates, including the use of checklists. As noted, our facility has been designed according to the standards of the College of American Pathology (CAP) and the Joint Commission of Inquiry (JCI).
That said, medicine is a not a perfect science. We are doing everything we can to track errors that may occur; including taking accountability when such errors take place – as well as to continually obtain and learn from patient feedback so we can improve every patient’s experience.
Could you elaborate on some of the projects you are currently working on and some that you have in the pipelines?
We are planning to roll out several dozen Praava Family Health Centers across Bangladesh in the coming years. We have also recently signed agreements with a few international partners, including Joslin Diabetes Center (Harvard Medical School) and Narayana Health, whereby patients can have their cases reviewed by doctors abroad, and several others which we are excited to share with the public in the coming months. The future of healthcare is technology – though we believe technology can never replace the family doctor, it can enable improved diagnostic accuracy, clinical outcomes, and patient experiences. Over time, harnessing technology and data and creative alternative financing models, Praava Health hopes to be able to offer world-class health care to tens of millions of Bangladeshis.
How successful have you been in minimizing cases of depression and anxiety through your counselors and psychologists? What more do you think needs to be done in the mental health forefront to eradicate issues like suicide, self-destructive behaviors or body image issues?
One of our psychologists, Dr. Shamim Firdaus Karim, is specifically trained in a psychotherapy treatment known as Eye Movement Desensitization and Reprocessing (EMDR), which was initially designed to alleviate the distress associated with traumatic memories. It has been tremendously effective for individuals who have suffered specific incidents of trauma. The biggest challenge in mental health services in this country is the scarcity of psychiatrists – there are only 200 psychiatrists for a population of more than 160 million. It would be wonderful to get the government’s support to develop this field further and to encourage young doctors to specialize in mental health. We are excited to learn of some strides other colleagues in the ecosystem are also taking to improve local capacity and access to mental health services.