Growing up in the UK and coming of age in Pakistan, TEDIndia Fellow Asher Hasan observed a vast discrepancy: those with and without access to basic healthcare, and the devastating social consequences of this disparity. He tells TED Blog the story of how he witnessed a single health disaster ruin the hopes of his childhood friends, and how this compelled him to attempt to transform a broken healthcare system with his Pakistan-based health micro-insurance company, Naya Jeevan, which offers not only quality, affordable healthcare to the urban poor, but also the financial and social inclusion the rest of us take for granted.
What does your organization do, and why?
The name Naya Jeevan traces its roots from Sanskrit, and means “new life” in modern Hindi and Urdu. We are committed to bringing low-income families in the emerging world out of poverty by providing them with affordable access to quality healthcare, financial inclusion and socio-economic opportunity. This is important because in many developing countries, catastrophic medical events trigger financial shocks that can decimate low-income families, Titanium welding tubing suppliers especially as they have no public support system or safety net.
We collaborate with large, multinational corporations, and cascade our health plan up and down their value chains, essentially targeting low-income businesses and workers — mainly informal workers, domestic workers, factory workers and so on — who are either on the supply side or on the distribution/retail side. We encourage corporate executives and managers to enroll their informal domestic employees. So, for example, you could be a small-hold farmer supplying milk to a dairy company. You could be a retailer — or a micro-retailer, in some rural village — who happens to be selling a basket of products that includes products by Unilever, P&G, and so on.
For example, Unilever, which is re-launching our domestic worker plan this year, encourages its officers and managers to enroll their domestic staff — their drivers, maids and those workers’ families — in our healthcare program. The premiums are deducted from the payroll of the Unilever manager or executive. Or a corporation might directly finance the healthcare of micro-retailers who are selling their products.
The beneficiary can make co-payments, typically by mobile phone, using mobile financial services now widely available in South Asia. Enrollment in a mobile bank account will soon be part of the health plan we offer, because the people we typically serve are also Titanium Wire unbanked. This way, they get the additional benefit of building up a financial transactional history that serves as a de facto credit report for them.
Naya Jeevan addresses socio-economic empowerment as well, tackling the informal system of what I call socio-economic apartheid in many developing countries, where there’s a rich, elitist class, and then there’s the other 90% that serves them. The rich get so used to this social dynamic that they almost start treating those who work for them like subhumans. I’ve seen many instances where even friends and family, in certain instances, have abused their domestic staff — yelled at them, beaten them, and so on. It’s absolutely disgusting, and it has to stop. Because this master-servant mindset is still pervasive, employee benefits of any type have never before been extended to these informal employees. Prior to Naya Jeevan, nobody ever considered the possibility of giving health insurance to their maid, or to their driver, or to their driver’s child, for example.
There’s a personal hook to this story…
There’s very much a personal hook to the story. My father was born in India, but some of his family members were raised in Pakistan. As a young man, he went to the UK, so I was born and raised there until I was 11, when my dad passed away from cancer. My mom, who was also born in India but raised in Pakistan, brought us back to Karachi, and I finished my schooling there.
When I first travelled to Pakistan, I was really shocked to see the tremendous disparity between rich and poor — between the elites who had unlimited access to resources and opportunity, and everybody else, who didn’t. I was especially shocked about the lack of access to healthcare in comparison to the UK, where everyone, regardless of income, has access to a national health insurance system, and where, relatively speaking, people of varying incomes have a fairly comparable quality of life.
I had direct exposure to this disparity between rich and poor. My mother had a maid with six kids, who were all within my age range, between 8 and 14. I was 11 when I first moved to Pakistan, and grew very close to these kids. Essentially, they were like my siblings. These kids were brilliant, dynamic — and I’m convinced that if they had the opportunity or had they been born in a different country, they could have become leaders of our country. They were far more intelligent than I was, that was for sure. And even though their parents — the maid and her husband, who was a mechanic — were very committed to educating them, there was a glass ceiling, a predefined trajectory that their lives seemed to be taking.
The year I left for the US for college, their father had a stroke. He’d had many, many years of uncontrolled blood pressure. Typically, in the lifestyle of low-income laborers, there’s no concept of preventive health care. It’s very much crisis management. He was taken to a public hospital, not diagnosed in time, not treated in time, and ended up paralyzed and completely incapacitated.
This had a devastating effect on the family. The kids’ mother, a very proud lady, did not want to depend indefinitely on charity, so she made the rather titanium welding wire fateful decision to pull all six kids out of school and place them in different child labor situations. Two ended up in houses working as maids, two ended up on the street selling candy, two ended up working in apprenticeships. All six of them ended up being sexually, physically and psychologically abused.
When I returned to Pakistan during my sophomore year for a visit, I was really disturbed to see the profound impact their father’s incapacitation had on their lives. These once dynamic, bubbly kids who were full of life were completely jaded and disillusioned. It was almost like their lives had been sucked out of them and they had simply given up. Rabia, who is three years older than me, said, “You know, I’m the daughter of a maid and I’m destined to be a maid. This is my ‘kismet’ (fate). We can’t expect to be treated like royalty, or to come out of poverty.” Her father’s stroke was the first trigger event that put me on the path of doing what I do.
What happened next?
I went to medical school in the US, spent a couple of years at Harvard Medical School and Mass General Hospital tinkering around in the research labs, and then moved on to Beth Israel for surgery residency. I then transitioned into the pharma-biotech industry, which ultimately took me to San Diego, land of the cushy lifestyle, during which time I also completed an MBA from NYU. By the summer of 2007, I had acquired scientific acumen and learned some business skills. Materially and intellectually, I guess I was quite enriched, but I felt spiritually bankrupt. I think my spirit was very restless at that time and craved something more meaningful. I got another jolt in 2005, when my mother, a diabetic for many years, also ended up having a massive stroke. She was taken to one of the best hospitals — in fact, she only lived about 10 minutes away from one of the best hospitals in the country — but she died on the way there.
My mother’s death was another powerful trigger event for me. It was like someone drilling a message into my brain: “Wake up, stupid! You have lived and witnessed socio-economic apartheid, you have accumulated all this technical expertise, you understand the healthcare system, you understand the Desi culture, you speak the language, so what are you doing about changing the system?” I had to look deep inside myself in search of an answer to that question.
I started thinking seriously about what I needed to do to change the direction of my self-centered life and to do something to tackle this issue head-on. Ultimately, if we want to get both people and developing countries out of vicious cycles of poverty and aid dependency, we need to do everything we can to create the scaffolding that will enable them to build their own way out. Given my background, I thought, “Okay, I need to come up with a healthcare model that’s sustainable, scalable, replicable, and will help to transform or catalyze the transformation of the healthcare system in Pakistan and subsequently in other emerging nations.”
I left the biotech industry, took a quantum leap of faith and and plunged full time into tackling this issue. I took a bunch of graduate students with me to Pakistan and India, and we did a fairly thorough, three-month landscape analysis of the health systems there to understand the nature of the beast. We looked at the health care systems, the stakeholders, the role of the private sector, the role of the corporations, the role of the public sector, public health systems. It was a fairly rigorous assessment of what the status quo was, what the unmet needs were. We interviewed a lot of our potential customers — low-income beneficiaries — to better understand their needs.
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