First published on Acumen Fund’s Blog
Often we are so inclined towards action, starting something to make a difference in the world around us, that we forget to take the first step – to spark discussion about the issues we want to solve, and encourage debate and dissent necessary to determine the best way to create change.
I realized this when I attended the last of a series of “Java Jolt” coffee chats organized by the Acumen Fund Pakistan office in Karachi a few weeks ago. The initiative, designed and implemented by Huma Haque (Business Development Summer Associate) and Sadaf Rehman(Pakistan Business Development Associate), raised awareness of Acumen Fund’s patient capital approach to investing as well as different social enterprise models in Pakistan, particularly those working in the fields of healthcare and education.
“Sustainable Solutions to Healthcare Delivery” was the topic of discussion that day. Representatives from three prominent healthcare non-profits in Pakistan, LRBT (Layton Rahmatulla Benevolent Trust), Naya Jeevan and The Aman Foundation, gave us a snapshot of the different (mainly donation-based) models their organizations adopt.
All these non-profits are doing some amazing work in Pakistan. LRBT runs state-of-the-art hospitals providing quality and free eye care to the underprivileged. Naya Jeevan provides micro health insurance for the urban poor, and The Aman Foundation offers an ambulance service, community health workers and tele-health services for mother-and-child hospitals.
From the discussion that ensued, I learnt that Pakistan is amongst the most charitable nations, a fact which is rarely highlighted in mainstream media. This altruistic tradition of giving is one reason why donation-driven models dominate the social sector in Pakistan. But this also becomes a barrier to further growth of social enterprises as their work is restricted to the size of the donation pool.
The healthcare sector in Pakistan is still largely underserved even by the development community. The discussion highlighted the following aspects which need to be considered if we want to come up with sustainable solutions:
- Changing attitudes – Beneficiaries often lack awareness regarding the benefits of services like health insurance – even when it is offered at very low or subsidised rates. This becomes a major hindrance to rolling out that service and making large-scale change. Convincing people to opt for it is the first challenge one needs to overcome.
- Providing choice, not charity – There is a large number of people in Pakistan who don’t need charity. But their low income (between PKR 8,000 to 20,000) means that they have a poor standard of living, especially with respect to healthcare, housing and water facilities. What they need is more choice and an opportunity to improve their lives. Currently these needs are being met by what was described as ‘a vast often usurious informal sector’. We need different players to participate and provide a fair system of access to all.
- Reducing dependency – In order to scale up initiatives to reach millions of people, it is worth exploring how social enterprises can be made financially viable and thus less dependent on donations or pure philanthropy. We need to think in the long-term and on a larger scale.
All in all, this informal discussion was a huge success, serving as a starting point for new ideas and a great platform for identifying socio-cultural barriers that are restricting development. Having looked at these issues from a holistic perspective, I look forward to the follow-up discussions that will further drive the momentum created by this event to find actionable answers and solutions.
Ayesha Hoda is a member of Pakistan for Acumen, a volunteer chapter supporting Acumen Fund.