An interview with Sylvana Q. Sinha, Founder, Managing Director, and CEO of Praava Health

Sylvana Quader Sinha

Founder, Managing Director, and CEO, Praava Health

Praava is a network of Family Health Centers where patients come first. They are providing a better patient experience enabled by technology. Patients are offered consultations with family doctors and a full range of diagnostics services including lab and imaging. MBR had an opportunity of an interview with Sylvana Quader Sinha, Founder, Managing Director, and CEO of Praava Health to learn more about her vision regarding the advancements of the Bangladeshi healthcare industry.

Tell us a bit about your formative years and the way it shaped you into becoming the successful entrepreneur that you are today.

I was born in the United States and visited Bangladesh often as a child. As an American visiting Bangladesh, I was very affected by my visits – by the energy and humor and pace of life, by the spirit of joy in the Bangladeshi people, despite the immense wealth contrasting with the poverty. I was also always impressed at the resourcefulness and creativity of the people. Necessity is the mother of invention, and because of scarce resources, Bangladeshis have always been exceedingly creative. I knew someday that I wanted to do something for Bangladesh, but honestly, I had no idea what that would be.

I was always very curious as child and was, and still am occasionally, criticized for asking too many questions. I still believe that my inquisitive nature is one of the main drivers of my path – I am always learning. The fact is that every single other person in the room knows something that you don’t. It is up to you to be willing to learn from them, and listen to them. The one who asks the most questions learns the most. Asking questions is not a sign of weakness. It takes confidence to ask questions, and admit what you don’t know. With the rate at which knowledge is being created, it is impossible for anyone to know everything that is knowable. Ignorance is a state of humility. It was this curiosity that led me to found Praava Health – when I started out, I knew there was a profound need for change in the delivery of healthcare in Bangladesh, but I only learned from others what the biggest challenges are facing patients and healthcare professionals in the system.

What drove you to focus your work on health-care? And why in Bangladesh?

Six years ago, 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. The most harrowing part of the experience was the doctor’s cavalier attitude. On my mother’s worst day, my sister and I desperately needed to understand why our mother was vomiting bile, but the doctor ignored our queries and walked out of the room. I distinctly remember chasing him up two flights of stairs to demand answers to our simple questions. His indifference to our mother’s suffering made us feel completely helpless. Eventually, our family had no choice but to take my mother to Bangkok, where she had a second surgery. A year later, she had to have a third surgery, all because of complications arising from the original operation.

After my mother’s experience, I spent a great deal of time thinking about the tremendous need to revolutionize the health sector in Bangladesh. I wanted to be part of that revolution. So, I moved to Bangladesh to found Praava Health.

What were the initial challenges that you faced and how did you overcome them?

The first challenge I faced was that I was a completely unknown person in Bangladesh, since I was born and raised abroad and had never lived here. However, I politely reached out to everyone possible in my networks to try to learn more deeply about Bangladesh’s health sector as well as what was happening globally in terms of innovations and models for improved healthcare delivery. I was sometimes relentless in trying to secure meetings with particular individuals or organizations, and through this persistence, I was able to meet a lot of incredible individuals, some of whom eventually became part of the founding team of Praava Health.

How does Praava Health differentiate itself from other health-care providers in the market? Is/are there any definitive cause/s Praava is dedicated towards?

We are bringing back the family doctor, who has a personal relationship with you and knows your entire medical history and works together with you to manage your health. We personally guarantee you that our family physicians will spend a minimum of 10 minutes with you for each appointment.

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. The HIS also allows us to also collect data that will help us to better understand the communities we are serving.

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.

Praava Health has built Bangladesh’s first PCR lab for molecular cancer diagnostics. What is your vision regarding this segment?

Other facilities in Bangladesh offer Molecular Cancer Diagnostics tests, but the samples are sent abroad for analysis. We have our own PCR lab which is why we are calling it the first PCR lab. By doing these tests in Bangladesh, we minimize error rates that can be caused while transporting samples abroad and substantially reduce the cost to the patient.

What aspects do you think the stakeholders in the industry need to collaboratively work on to improve healthcare as a whole in this country?

A major area that healthcare organizations need to collaborate on is collection of data and interoperability. Interoperability means the ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities. Bangladesh has a unique opportunity given that most hospitals are currently not using technology to store medical records. When public and private hospitals finally decide to use electronic health records, if we as a community of healthcare providers can commit to storing data in a manner that is interoperable, we will be at a substantial advantage at a systems level in terms of understanding the changing health profile of the Bangladeshi people.

We at Praava are also committed to empowering patients to manage their health in a manner that is aligned with their values. This means introducing value-based concepts to the delivery of healthcare. It isn’t appropriate, for example, that health care providers tend to make more money when patients keep getting sick. Rather, it makes more sense if we as providers can be incentivized for keeping our patients healthy. Value-based health care delivery, based upon the research of Harvard Business School Professor Michael Porter, is a framework for restructuring health care systems with the overarching goal of achieving the best value for patients.

What are the major issues surrounding health-care in this region and how does Praava Health plan to address them?

Consistently, we hear patients complain that the biggest problem with healthcare in Bangladesh is a lack of trust. The #1 reason patients are traveling abroad is an absence of trust – that they feel the doctors in Bangladesh don’t spend time answering their questions or listening to them. In fact, a British Medical Journal study published in 2017 ranked Bangladesh #67 out of 67 countries surveyed in terms of the amount of time doctors are spending with patients. The average primary care doctors 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.

In fact, patients actually feel better when their doctors spend time getting to know them. “Patient-centered care” actually improves patients’ clinical outcomes and satisfaction by enhancing the quality of the doctor-patient relationship, while at the same time decreasing overall health care costs and wastefulness of diagnostic testing, prescriptions, hospitalizations, and referrals.

It is this notion of patient-centered care that Praava is bringing to Bangladesh. We aim to be your partner in health. There are many medical professionals in Bangladesh who share these values, and we are actively bringing some of them onto our team to help achieve our vision.

How has the response been so far; in terms of both the medical professionals and the clients?

The response has been overwhelmingly positive. I believe that human capital is one of our biggest challenges, but we have been really gratified to identify some incredibly talented professionals who are excited to be part of a revolution in healthcare in Bangladesh. In terms of patients, we are actively collecting feedback from every patient who steps into Praava. So far, we have gotten very positive feedback regarding patients’ experiences, as well as some really useful suggestions regarding how we can make the patients’ experiences even better. To be honest, I personally am more welcoming of the constructive negative feedback because it gives us the best opportunity to learn and improve.

Do you believe health-tech is the future? How do you think Bangladesh scales up against neighboring countries in providing tech-based solutions?

Absolutely, the future of healthcare is technology – though I believe that technology can never replace the family doctor, it can enable improved diagnostic accuracy, clinical outcomes, and patient experiences. Like our neighbors, I believe Bangladesh is close to the beginning of its journey of technology innovations for healthcare. The future is wide open for all of us to introduce and adapt technology based solutions – from lifestyle management solutions to drug adherence applications to teleradiology, this is just the beginning.

How do you as leader stay connected with your peers and employees?

Last year, Praava organized an event to bring together some of the other health innovators in Bangladesh, and we hope to convene additional gatherings along these lines in the coming year as well. There are so many challenges to take on in our health sector and we believe that collaboration can only help us to improve health outcomes for our country.

Within the company, we organize weekly lunches with the CEO in which I get a chance to know some of our team members better, whom I don’t otherwise get a chance to interact with on a daily basis. I really look forward to these lunches because they give me a chance to see a different side of my colleagues and also to hear from them about how they feel about what we are doing – what are some of the things they think we can do better? What questions do they have for me about the direction of the organization? Our employees are our most important asset and I really try to learn from our team as much as possible.

What are your long term plans for the company?

We plan 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 in the coming months.

Any advice for aspiring leaders hoping to work for healthcare?

Go for it! We need more creative thinkers in this space and hope to be able to learn from other innovators who are trying to create positive change in Bangladesh’s health sector.