Indus Hospital Delivering Free Health Care in Pakistan

1. The Indus Hospital
Delivering Free Health Care in
Pakistan

2. Group Members
• Jawaher Chaudhary
• Nazia Kulsoom
• Annum Younus

3. Reason for starting this project
“Working in the government medical system,
most of my energy was being misdirected,
and life is too short. So I said, lets Build a
hospital where our energies are better
utilized.”
(Dr. Abdul Bari Khan, CEO of Indus hospital.)

4. Reason for Starting this Project
• Hospital was stared with mission of providing
“exceptional care without exception”
• In 2007 it was started with only 150 beds but later in 2011 , nearly
1000 patients visit daily.
• Which increase annual operating budget 5 times.
• Donations was support for repaid growth.

5. • So, Mr. Bari was thinking to build 750 beds, full-service tertiary
hospital which include;
o Medical college
o Nursing school
o Clinical research
o Other linked to primary healthcare for diagnosis and treatments
Reason for Starting this Project

6. Overview of Pakistan
• Islamic Republic of Pakistan is
located in south Asia .
• Country is divided into five
provinces
1. Punjab
2. Sind
3. Khyber Pakhtunkhwa
4. Balochistan
5. Gilgit Baltistan

7. History
• After partition of subcontinent into two nations Pakistan was
developed in 1947.
• Dispute ownership of Jammu and Kashmir caused two to three wars
after partition.
• Bangladesh was also part of Pakistan until 1971.
• Government rule.
o Civilian rule
o Military rule
• Natural disasters
o 2005 earthquake
o 2010 flood

8. Demographics
• Pakistan is sixty most populous country in the world.
• Total Population is nearly 184 million.
• 95% are Muslim & divided into different sects.
• National language is Urdu and official speaks English.
• Karachi is the largest city and national economic hub.
• Pakistan is a lower-middle-income country with a high rate of
poverty.

9. Economic
• Neuromas internal political disputes cause the low level of foreign
investment and underdevelopment.
• Between 2001 to 2007 Pakistan economy grow rapidly, staring in
2007 global economic crises and in wake of domestic political
destruction economic growth slowed.

10. Zakat
• Zakat is 2.5% of the surplus wealth you have owned for one lunar
year.
• It is indented to promote redistribute wealth, create social security
and keep money circulated in economy.
• Government withdrew 2.5% of zakat from people saving accounts
before Ramadan.

11. Health in Pakistan
• In 2010 Pakistan faced high rate of diseases and increasing
prevalence of non-communicable diseases.
• Average age of person in Pakistan is 67.
• Vaccinated people is 73%.

12. Leading Causes of Mortality &
Morbidity

13. Health Care Workforce
• Pakistan had shortage of health care workforce.
• Majority of health services are located in urban areas.
• Private traditional healers are the main source of care in ruler areas.
• Earning of government physicians is about 145 to 212 USD per
month.

14. Public Health System
• Pakistan inherited centralized healthcare from British.
• MOH provide free health care and hospital services to public.
• Rapid changes in administration health leadership and policies.
• Less than 30% of people uses public healthcare services.
• Issues in public healthcare.
• Government allocates less than 4% to health care sector.

15. Public Health Sector
Infrastructure

16. Private Health Sector
Infrastructure

17. The Private Health Sector
 Private services included traditional healers, for-profit clinics, high-
tech specialty hospitals, not-for-profit clinics and hospitals that
provided free or discounted care to poor.
 82% was funded through individual out-of-pocket payments.
 Poor and wealthy alike relied on private system.

18. The Private Health Sector
 Middle class families struggled to pay for health care, pushing them
deeper into poverty by forcing them to sell assets.
 The government and major private business provided health care
for their employees and retirees.
 Funding channeled through the ministry of Zakat & similar Govt.
Department called Bait-Ul-Maal accounted for 0.32% of formal
health financing in 2008.

19. Charity Medical Care
• 1800 NGO’s provided health care in Pakistan.
• Trust Hospitals (Provide free medical care to poor).
• Overtime many charity hospitals closed or began charging fee to
cover expenses.
• Reasons for failure included not hiring professional hospital
management, departure of founding champion etc.
• One charity hospital Dr. commented
“There are real issues with charity hospitals. It’s not as if they are the
final answer. They are trying to fill the huge gap that the Gov. should be
filling.”

20. Indus Hospital Mission
To provide health and excellence driven
comprehensive unconditional medical
services to the humanity—free of charge only
to please Allah SWT.

21. Indus Hospital Vision Statement
The Indus Hospital is a state of the art tertiary care
center accessible to the public free of charge. Local
and expatriate professionals provide specialized
medical care in accordance with Good Clinical
Practices, with an emphasis on innovation and
research. The tertiary care facilities at the hospital
will be complemented by community outreach
programs focused on prevention and early
detection of disease, encouraging community
involvement and ownership.

22. The Indus Hospital
• Non-Profit Hospital, opened in July 2007, located in Korangi.
• The five-story, 150 beds Indus Hospital was the tallest building.
• Indus 20 acre campus included walk in filter clinic, an open-air TB
clinic, a Pharmacy, a nursing hospital.

23. The Indus Hospital

24. Background
• In the 1980s a group of medical students at Dow Medical College in
Karachi formed an organization called the Patients Welfare
Association to raise funds for the poor patients at Civil Hospital.
• When a devastating terrorist bomb blast occurred in Karachi after
the Russian invasion of Kabul in 1984, Civil Hospital was unprepared
to cope with the catastrophe. In response, a group of young,
idealistic Patients Welfare Association members led by Abdul Bari
Khan, raised money to refurbish the emergency department and
build a blood bank at Civil Hospital.
• Over the next two decades, Bari dedicated his career to building a
cardiac surgery department at Civil Hospital.

25. Background
• After 20 years and 3,000 bypass surgeries, Bari came to believe that
there were two ways to improve health care in Pakistan—fight the
government system or create external delivery models of
high‐quality, efficient care.
• Bari said, “I was very clear from day one that the hospital had to be
free. The people we see are the poorest of the poor. They don’t
have money for transport, let alone to top off their care. I know
these patients from my work in the public sector.”

26. Background
• Dr. Zafar Zaidi, Indus Hospital Medical Director.
• He said all patients had a right to high‐quality care, regardless of
ability to pay.
• The chairman of the hospital’s board of directors, wrote in a
quarterly hospital newsletter, “In my eyes, it is not enough to help
provide health care to the poor. It is essential that this health care is
of the same quality that we would want for ourselves and our
family.”

27. Planning and Building
 Bari turned to his donor network for financial support. He secured
USD 2 million in seed funding from a Pakistani industrialist.
Construction began in 2005.
 Zaidi estimated that buying a prebuilt electronic record system
would have cost USD 6 million. Instead, his team of software
engineers built a custom‐ designed system for the cost of their time
and hardware. The computers linked to a backup power supply that
prevented workflow interruptions and data loss during frequent
power outages, and remote servers backed up all information

28. Planning and Building
 “Pakistan’s first paperless hospital.”
 In July 2007, Indus Hospital treated its first patient. Bari, Zaidi, and
other founding physicians Akhtar Aziz and Muhammad Chinoy—
reported to a nine‐member board of directors composed largely of
Karachi businessmen.
 The founding physicians worked for free for the first six months.

29. Planning and Building
 The founders did not offer maternal health services, believing the
high demand would overwhelm the hospital
 With donor funding, the hospital opened a 10‐bed dialysis center,
recruited a gastrointestinal specialist, opened an endoscopy suite,
and offered ophthalmology services

30. Patient Services
• Patients could be admitted to the hospital in three ways: through
the emergency department, by a hospital consultant, or from the
outpatient filter clinic.
• New patients received a unique patient identification number and
an electronic medical record.
• All staff signed into the medical information system with a
biometric scan of their hands.
• Once registered, patients received a white card listing their name,
age, and patient ID number. This card became their passport within
the hospital.

31. Patient Services
• The first 300 patients to arrive at the filter clinic each day received
tokens guaranteeing them an appointment that day. Patients began
lining up as early as 5 a.m. to receive tokens.
• Filter clinic doctors included young medical officers and
pediatricians. They ordered basic diagnostic tests, such as x‐rays,
blood analysis, or urine cultures, through the computer system.
• Doctors and nurses made their rounds with mobile computers and
entered patient notes, ordered tests, and scheduled appointments
directly through the computer system.

32. Patient Services
• Doctors and nurses made their rounds with mobile computers and
entered patient notes, ordered tests, and scheduled appointments
directly through the computer system.
• The electronic system eliminated the need for nearly all paper
forms, except legal consent forms, surgical checklists, outpatient
prescriptions, and patient discharge summaries
• Treatment were provided at no cost to all patients. There were “no
cash counters in Indus Hospital.”

33. Tuberculosis Programs
• Indus began treating TB patients in 2007.
• Interactive Research and Development (IRD) worked with Indus
staff to become one of the National Tuberculosis Program’s TB drug
distribution centers.
• Indus raised private money to purchase the expensive second‐line
drugs** for MDR‐TB, and leaders travelled to Peru, Turkey, and
Geneva to learn about building a MDR‐TB program that met the
World Health Organization’s Green Light Committee†† standards.
• In November 2008 Indus became the first and only TB treatment
site in Pakistan to receive Green Light Committee approval.

34. Tuberculosis Programs
• Global Fund awarded Pakistan USD 153 million for TB, including USD
136 million specifically for MDR‐TB treatment.
• To support the expanded TB program, Indus built a high‐tech
laboratory capable of safely diagnosing MDR‐TB and an open‐air TB
clinic. It had its own pharmacy and X‐ray machine.
• If TB patients had to be hospitalized, Indus referred them to a
government hospital that specialized in TB services.

35. Open Air TB Clinic

36. Research
• Partnership with IRD (Interactive Research & Development) to
establish Indus Hospital Research Center.
• Introduced Public Health Research as a new field in Pakistan.
• Two-year, USD 1.3 million research grant on childhood pneumonia
in 2007.
• Research Partnership helped Indus leaders to learn deeply about
surrounding communities.
• Importance of primary care & community-based prevention
services based on new data and understandings.

37. Hospital Staffing
• Dr. Abdul Bari, CEO of Indus Hospital, estimated work was 18 hours
a day & 6 days a week.
• 566 clinical & administrative employees in 2010-2011 with total
payroll of about USD1.86 million.
• Initially employees were paid less than commercial market rate,
relying on hospital’s mission to attract the staff.
• By year 3, challenges in recruiting & retaining qualified staff which
became a main growth-limiting factor.
• Hired a consulting firm for salary survey and raised salaries of
ancillary staff, nurses and residents to match local market rate.

38. Hospital Staffing
• Recruitment of Specialists, Indus looked for people with “an
innate desire to help those who cannot help themselves”.
• Dr. Mansoor Khan, Orthopedic surgery attracted by Indus
hospital’s leadership and its values.
• Dr. Mansoor focused on his impact, “If you salvage one
breadwinner, you looked after welfare of dozens of dozen
people”
• Performed newer hip replacement technique, called hip
resurfacing (scarcely available in Pakistan) on selected
younger patients.

39. Training Programs
• Indus’ emphasizing quality & access to newer technologies
attracted trainees.
• Developed staff training programs based on internally created
SOPs.
• In 2010, hospital matched nurse-to patient ratio to international
quality standards.
• Developed strict nursing guidelines and Internal training programs.
• In 2009, received an approval to train medical residents.
• 2011-2012 budgeted medicine residency program.
• Planned to build medical school on its campus.

40. Hospital Volume
• In less than four years, staff performed 18000 surgeries, seen more
than 600,000 patients and provided 800,000 diagnostic tests.
• Exponential growth in emergency departments patients, increased
from 1500 patients (2007-2008) to 100,000 patients (2010-2011).
• Indus hired part time orthopedic surgeons in evening to operate
trauma cases in evening when elective cases are finished.
• Surplus patients were referred to other government or charity
hospitals.
• 26 general ward beds for children after data showed that 50% of
patients were children.
• Walk-in clinic visits increased to 80,000 in 2010-2011.

41. Hospital Volume

42. Finances
• In 2010-2011, Indus hospital provided USD 5 million in free medical
care(5 times of 1st operational year).
• 43% revenue from Zakat
• 24% unrestricted cash donations from individuals & Corporations
• 34% in-kind donations of equipment, supplies &medications
• Data Management to show data to the donor that their donations
are being used for quality health care of poor community.
• Patients underwent financial interviews to assess if they qualify for
Zakat.

43. Finances
• 65% Muslim patients qualified for Zakat.
• 35% Non-Muslim patients received free care under hospital’s
general fund.
• In four years, the hospital always met funding targets.
• Formalized fundraising efforts by developing by creating
Communication & Resource Development Office to develop
donation collection system.

44. Expenses & Revenues

45. Future Challenges
• To best handle increased patient volume and continue to improve
quality of services.
• Justification for Indus hospital of Budget increases in 2011-2012

46. Competitive Edge
• Commitment to quality care set them apart from other charity
hospitals
• Prebuilt electronic record system
• Pakistan’s first paperless hospital.
• Medical information system.
• Issuance of white card.
• Digitized lab tests.
• Real‐time tracking.

47. • No cash counters in Indus Hospital.
• Treat patients with MDR‐TB, something the government didn’t do,
Indus built a high‐tech laboratory capable of safely diagnosing
MDR‐TB
• In November 2008 Indus became the first and only TB treatment
site in Pakistan to receive Green Light Committee approval.
• Open‐air TB clinic
• Access to newer technologies
Competitive Edge

48. SWOT Analysis
Strengths Weaknesses
• Medical school
• Facilities were clean; the staff was friendly
and fair.
• provided detailed accounting to major
donors to maintain the trust
• Hospital’s volume increased, the unit cost
for nearly all procedures decreased.
• Creation of Communications and Resource
Development Office
• Indus leaders did not create a detailed,
written strategic growth plan.
• Long waits in the filter clinic
• Indus did not offer obstetric services
• the emergency department was too small
• when the hospital was full, which was
often, patients had to go to another free
hospital and wait again
• Indus employees could not leave early for
Friday congregational prayers and had to
work on some Muslim holidays
Opportunities Threats
• Medical school
• Donations, funds and grants
• more outpatient procedures
• hired part‐time orthopedic surgeons
• Patient volume increased rapidly
• Extended waiting lists
• General ward beds were full 90% of the
time
• Lack of beds
• Uncertainty

49. Thankyou for watching
Any Question??