"When your goal is impact, you may have to build from scratch"
Sinha speaking to a group of healthcare professionals and policymakers
Sinha speaking to a group of healthcare professionals and policymakers.Sylvana Q. Sinha, founder, and CEO of Praava Health spent over a decade in international law and development pursuing her long-time intent to do work that leveraged her American education to make an impact in the world. She's American by birth, Bangladeshi by blood, and highly educated, with degrees from Columbia Law School, Harvard's Kennedy School, and Wellesley College. She always wanted to use this world-class education to improve the conditions she knew first hand in her family's country of origin and other emerging markets.
But she found that the international law and even on-the-ground roles with the World Bank and other international development organizations weren't providing the satisfying sense of the life-changing impact that she sought. So, following one of her favorite quotes: "Stay close to anything that makes you glad to be alive," by Hafiz, and started Praava Health in 2014.
Tell me about your professional path leading to your current role.
I worked in international law and international development for years, at The World Bank and major international law firms, and as a foreign policy advisor to then-Senator Barack Obama. I worked on Obama's campaign primarily to learn from the incredible minds he had attracted - including Susan Rice, Samantha Power, and Denis McDonough. When it looked like he would win, I considered a role in his administration, but I had always believed that a big problem with US foreign policy was that policymakers hadn't spent enough time abroad.
I decided I had to act in line with this belief, so I moved to Afghanistan to work for the World Bank in-country. I spent about four years in Afghanistan, and elsewhere in the Middle East and South Asia working for the World Bank and other UN agencies. My work was the perfect blend of my interests in law, development, US foreign policy. Still, I found myself hungry for the accountability and pace of the private sector, and even in the field, I didn’t feel as connected to the impact of my work as I had always craved. I returned to New York to work for a law firm resolving international disputes. That work too was fascinating, but it was taking me in a very different direction, and I was left with the yearning to create something of my own that would touch people's lives directly.
And what do you do now?
I am the Founder & CEO of Praava Health, which is building a network of Family Health Centers in Bangladesh where patients come first. We are creating a better patient experience enabled by technology. We opened our first facility in August 2017. I am an American by birth and Bangladeshi by blood. From a young age, I had always wanted to do something for Bangladesh, but I didn’t know what that would be, or when I would do it.
Firsthand experience showed me the dire need for quality healthcare in Bangladesh. Six years ago, my mother had a basic operation at one of Bangladesh’s top hospitals, and nearly died. Several other relatives with cancer were wrongly diagnosed. These experiences made me wonder about the millions of people in Bangladesh who didn’t have my family’s privilege to get second opinions and treatment abroad.
I saw an opportunity to fix a big problem. The country was hitting a sweet spot in terms of economic growth and demographic indicators. The rapidly growing middle class was changing the entire economy. I believe that some of the most exciting business opportunities today are in countries like Bangladesh where the infrastructure isn’t able to keep up with the pace of economic development. That context provides real opportunities for social enterprises like Praava to provide services that the emerging middle class needs and is now able to pay for.
When did you decide that you wanted your work to contribute more specifically to social impact? What led to that decision?
To be honest, I always wanted my work to contribute to social impact, but I didn't know what that would look like. Many of my jobs had a social impact component, and yet on several occasions, I was stuck in jobs I didn’t love. There were mornings when I wanted to throw my alarm clock across the room, and I remember asking myself, “Why are you so unhappy? Hundreds of generations of human beings before you spent their entire lives growing rice – Who are you to crave joy and larger meaning in your work?”
But I had this feeling that all the opportunities I had been afforded, and this hunger for a deeper connection to my work’s impact, were not for nothing. If I had access to this massive privilege to be able to create a job for myself and for others, and a life that feels meaningful, the question was, “Who am I not to take full advantage of it?” I do believe it is my responsibility as a human being to stay ambitious and seek a larger purpose, dedicating the resources, talents, and time I have on this earth to solving important problems.
Tell me about the journey to integrating your work with a larger sense of purpose or social impact specifically.
I started asking questions of anyone who would talk to me – patients, doctors, public health professionals, entrepreneurs, and investors, in Bangladesh, and across Asia and the world. I wanted to understand what was needed in healthcare in Bangladesh, and what was happening globally. The exciting thing about healthcare right now is that everyone is grappling with how to improve service delivery and outcomes. I started to imagine a new kind of healthcare in Bangladesh.
Any Bangladeshi patient who can afford to travel abroad for healthcare does, often at substantial personal expense and sacrifice. Their leading explanation is an absence of trust, rather than technical factors or treatment outcomes. They feel the doctors in Bangladesh don’t spend enough time answering their questions or listening to them. In fact, a 2017 British Medical Journal study ranked Bangladesh last of 67 countries in terms of the amount of time doctors spend with patients. The average primary care doctor in Bangladesh spends 48 seconds with each patient, compared to two minutes in India, and five to 22 minutes in more developed countries.
I decided there were two major problems that I wanted to fix. First, I wanted to improve trust in the system, and help patients feel that they were being heard and taken seriously. Second, I wanted to offer quality diagnostic testing so that people didn’t have to double, triple and quadruple check their test results for accuracy. Praava is a network of family health centers designed to solve those problems.
How’s it going? Connect the dots for us - how does your work make a better world?
We have been incredibly gratified by the feedback from patients in our first year. Many shared that they hadn’t imagined that a facility where doctors and other medical professionals build ongoing relationships with their patients could exist in Bangladesh. Recently a patient's daughter approached me to share that she only wishes we had opened our doors sooner, because of the support we provided her ailing father.
Also, Praava has built Bangladesh’s first lab for molecular cancer diagnostics, which can reduce cancer mortality with early detection and more personalized disease management. This technology is recent even in the West. Before Praava, other facilities sent patients' samples abroad for analysis. By doing these tests in Bangladesh, we minimize error rates, reduce the cost to patients, and reducing turnaround times. Praava has conducted hundreds of molecular cancer diagnostic tests, enabling patients to receive immediate treatment and results.
What has changed since you’ve better aligned your work with impact? Has anything changed in your personal life?
Work doesn't feel so much like work anymore. It is actually fun, and meaningful, to be working toward a goal that is value- and impact-driven. It’s also a joy to work with colleagues who share the same values and larger goal. Personally speaking, to be honest, I have less of a life than I once did! But, in some ways this work has deepened some of my most meaningful relationships.
It is difficult – probably impossible - for anyone to "have it all," but I consider myself truly lucky to be able to realize this dream with the extraordinary team we have assembled. The overwhelming feeling I have is one of gratitude: for the opportunity to build something that is impactful, to work with the professionals we have attracted in Bangladesh and globally; and for friends and family who support me unconditionally and believe in this work.
Are there ever conflicts between the impact you’re trying to create and your professional mandate or career goals?
My sense of purpose resonates every day, but it requires laser focus. Praava Health is here to change the way healthcare is delivered in Bangladesh. And there are seemingly endless levels at which we could pursue that goal. Several times a week, someone on our team, or a patient, comes to me with a "Praava should ....": some new service that we could bring to Bangladesh. I always respond, "Sure, we would love to. But we need to get this right first!"
The needs of Bangladesh’s healthcare system are tremendous - to get the system even to India’s level of development would require $17-20 billion US Dollars of investment - but we cannot take on every challenge at once. Before we build out dialysis, chemotherapy, or a cancer hospital, we need to ensure that we are able to run our first facility, and then a network of facilities, effectively and efficiently.
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 based on technology; however, we do not believe that technology can ever replace the family doctor. We are also introducing value-based concepts based on research from Harvard Business School, through outpatient subscription/insurance plans.
But the excess of opportunities for impact means that we have to make difficult choices about providing current offerings rather than expanding our offerings. The conflict between breadth and depth of impact is a theme that I’m always balancing.
What are the downsides of doing work that connects to a larger sense of purpose?
This work is a labor of love, and it fills my heart in ways I never could have imagined, that nothing I did before has ever done. But therein lies the conflict: I feel my work is always with me, and it can be very difficult to "turn off," which is necessary from time to time, in order to be productive leaders and professionals as well as loving daughters and sisters and aunties and friends! All that said, it is the best thing I am lucky to have ever done - and we still have so, so much work ahead of us - the future is incredibly exciting.