Bangladesh’s recent economic growth, equivalent to some of the best-performing Asian economies, has contributed to a substantial decrease in poverty from 40 percent in 2005 to 18.7 percent today. Today, Bangladesh is growing at a faster pace over a longer period of time than even China and boasts a GDP per capita higher than India’s and a GDP of more than US$459 billion, putting it on track to be one of the world’s 30 largest national economies by 2030.

Remarkably, Bangladesh is one of a few countries that meets almost all of the Millennium Development Goals. On social development indicators, in fact, Bangladesh is doing better than any other country in South Asia. Infant and maternal mortality rates have fallen by at least half since 1990, and life expectancy has risen by 13 years to 72, four years more than in India and three more years than in Indonesia. Bangladesh has also outperformed similar countries in terms of female primary and secondary schooling.

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

I moved to Bangladesh for the first time in my life when I realised this problem presented a massive opportunity, and founded Praava Health. For countries that are growing as quickly as Bangladesh, health spending grows even faster than incomes – as incomes rise, families invest disproportionately in healthcare and education.

Unfortunately, Bangladeshis who want world-class health care, international-standard diagnostics or speciality and tertiary care often feel that they need to travel outside of the country. Even the most expensive facilities in Dhaka do not consistently maintain international standards –  so the rich travel to Bangkok, Singapore or beyond. The middle class most often travels to India, which is a relatively more affordable trip, but it remains a stretch for many. The reason a Bangladeshi middle-class family falls back into poverty is a health incident. Each of us will pay any price possible to access healthcare for our loved ones. Every single day, India’s embassy in Dhaka issues thousands of medical visas. It is estimated that $500 million leaves the country for healthcare every year, also contributing to forex challenges for the economy.

Consistently, patients complain that they don’t trust Bangladesh’s healthcare system. When founding Praava Health, we originally hypothesised that so many middle-class Bangladeshis were travelling to neighbouring India, which may be due to the lack of tertiary care locally. However, when we actually asked people why they were travelling abroad, we were somewhat surprised to learn that the primary response was that doctors in Bangladesh generally do not spend adequate time with their patients, or answer their questions, or even look them in the eyes. Many Indians who hear this scoff, as they feel similarly about their own health care system. However, we are pushing up against certain margins. The British Medical Journal published a study in November 2017 in which it surveyed 67 countries to find out how much time doctors were spending with patients, on average, globally. Bangladesh ranked #66 at 48 seconds per patient, in contrast to two minutes per patient in India.

Moreover, Bangladesh’s healthcare system is often focused on episodic care, and driven by incentives that push doctors to hospitalize patients and order unnecessary tests and drugs. Our system is overly hospital-centric, and in the words of Dr. Omar Ishrak (Former CEO and Chair of Medtronic, and Former Chair of Intel), “hospitalization is the failure of healthcare.”

In this spirit, we founded Praava Health, a “click-and-brick” health system where patients come first: a one-stop outpatient network of health centers with family doctors as well as quality, reliable diagnostics, and Bangladesh’s first patient app. Because between 80 and 90 percent of all health care needs can be addressed by a family doctor, Praava’s care is centered on high-quality primary care and family medicine—the bedrock for patient trust—while including secondary and specialist care; outpatient procedures; in-house, world-class lab and imaging diagnostics; and a pharmacy that procures only directly from manufacturers.

Proper care depends on accurate diagnosis. The diagnostics services we offer in-house include six world-class laboratories for basic and advanced pathology, including Bangladesh’s first molecular cancer diagnostics lab in certain cancers like breast, cervical and colon cancer; and imaging services. Praava maintains international standards for our laboratories as one of 7 international standard labs in Bangladesh today.

We launched our first family health center in 2018 and the full network will be rolled out in the coming years based on a “hub and spoke” concept, with hubs and spokes spread between Dhaka and Chittagong and spokes focused in the cities and beyond to peri-urban and rural areas. Our model aims to bring care to the community level and offer an array of services under one roof. Over time, harnessing technology and data, and creative alternative financing models, Praava Health expects to be able to offer world-class health care to tens of millions of Bangladeshis. The future of healthcare is technology, and Praava has already brought Bangladesh its first patient app, placing health literally in the palm of patents’ hands. We are further harnessing technology to improve diagnoses. Today more than 600,000 patients trust Praava Health for their care. Through our “click-and -brick” platform, we guarantee 15-minute appointments in a country where 48 seconds is the average for a consultation. Our Net Promoter Score is consistently over 80, higher than that of most Fortune 500 companies.

However, we do not believe that technology will ever replace the family doctor. Post-pandemic, consumers are increasingly adopting digital solutions to various needs, including healthcare. However, our belief is that digital health alone can never meet the full spectrum of a patient’s needs. There is today much discussion about reconfiguring entrenched healthcare systems into a hybrid concept, incorporating a single channel for accessing healthcare virtually or in-person – via “click-and-brick” models such as Praava Health, which has been studied by Harvard Business School, the Bill & Melinda Gates Foundation, and others, for this reason. We have also seen globally that pure play digital health models, including healthcare marketplaces, telemedicine, and e-pharmacy – such as PharmEasy and Halodoc in the region, or Babylon internationally – have failed to solve the problems of patients and also failed to generate returns to investors. These businesses were sexy categories in the last decade but have demonstrated little evidence of success (except for a few isolated examples in the U.S.), largely because the problems of healthcare cannot be solved by technology alone. This is especially true in low and middle income countries like Bangladesh, where we lack basic infrastructure.

We aspire to play a small part in Bangladesh’s development story, based on our belief that private sector infrastructure investment is essential to alleviating poverty, and that a healthy populace is a precondition to achieving and maintaining a sustainable growth trajectory. ■