Recently I had the pleasure of meeting Asher Hasan and Irum Musharraf and learning about their remarkable enterprise, Naya Jeevan (www.njfk.org).  Asher is the Founder and CEO while Irum is Vice President of Finance and Strategic Planning.

As its logo simply states, Naya Jeevan provides micro insurance for the urban, working  poor - household staff such as drivers, cooks, maids, guards, etc or low-income labor employed in the corporate/academic or SME sectors such as school teachers, waiters, administrative assistants, etc.  Nurturing “new” life in the emerging world, Naya Jeevan is the developing world’s first “HMO for the poor”.   Conceived with the idea of promoting social justice and reducing economic disparity, it seeks to provide a safety net for the poor who remain vulnerable to catastrophic medical events throughout their lives – events that have the potential to decimate them financially and crush them spiritually. 

While the idea is noble and quite simple, its implementation in a country like Pakistan is a challenge, one we hope our readers will take upon themselves to embrace and support. 

I spoke to these two remarkable ‘social entrepreneurs’ about their life’s journey and about Naya Jeevan. 

Asher Hasan: 

Q: Let’s start at the beginning and give our readers some background on you 

A: Well, I grew up in England and came to Pakistan as an 11 year old child.  Following the completion of my ‘A’ Levels at Karachi Grammar School, I moved to the US for college at Oberlin, where I completed my bachelors in neuroscience and international relations.  After College, I spent a couple of years doing research with a group of vascular surgeons at Harvard Medical School and Mass General hospital in Boston.

Q: What was the research about?

A.: The research focused on a disease process called atherosclerosis - a disease in which arteries get clogged with cholesterol plaques that reduce the flow of blood to the heart or the brain - we studied how that process takes place.  We conducted our research on animal models like rabbits and rats (in those days I was fondly referred to as “choohon ka baadshah”).  We performed balloon angioplasty on these animals to observe how blood vessels can get injured and re-clog after angioplasty. This is a phenomenon called restenosis and we were trying to understand why this occurs and how can we mitigate or even reverse it. It was cutting-edge research at that time and I was very fortunate to be part of it.

I went on to attend medical school and after graduating in 1999, I married and started my surgery residency shortly thereafter.  Surgery residency, which was at Beth Israel, was a relentless nightmare. It was during my surgery residency that I realized I did not want to pursue this path as a career - I wasn’t really using my brain cells and I was degenerating fast - both mentally and physically, working over 100 hours per week. The residency was brutal and called for many sacrifices and its impact on my family was far too great.  So I decided to move into the pharmaceutical/biotech industry and joined sanofi-aventis as a medical director and stayed with them for nearly 6 years.

While working in the pharma-biotech world, I decided to spread my wings a little and hone my business aptitude with an MBA from NYU Stern, attending their part-time, evening program. It was during this time that I also managed to get divorced (for those aspiring MBA students out there the MBA had nothing to do with it). So newly single and armed with an amalgamation of scientific and business acumen, I decided to head west and transitioned into a more entrepreneurial role in biotech with Amylin in San Diego, CA. The Company focuses on the development of obesity and diabetes drugs.

My role at Amylin was very exciting: it enabled me to work in a very cross-functional, ‘matrixed’ environment in which I had to make many leadership decisions. It was also during my Amylin tenure that I came to an important crossroads in my life: I could either continue living a superficial, spiritually barren,  ‘good life’ while being a small fish in a huge ocean in the US or I could actually take a deeper plunge and do something potentially transformational for Pakistan and its people.  I wanted to do something that would engineer and  institutionalize a major change in our society and that is what led to the genesis of Naya Jeevan.  The time was right for me to start a social venture - I was single, able to work long hours and I could take a huge financial risk.

Q: Could you elaborate on the inspiration and thought process behind Naya Jeevan?

A: As I mentioned, I grew up in England where the health care system is considered socially egalitarian, at least on paper: a system where everyone has access to health care.  As a kid traveling to Pakistan on vacations and then actually relocating to Pakistan at the age of eleven, what really struck me and disturbed me at the same time was that children my own age, were either running around half-naked on the streets or working as child labor in shops or various house holds. Many of the poor children I got to know on a personal basis were equally, if not more intelligent than I was but they just didn’t have the same opportunities as I did to excel in life. So, that was something that really played on my psyche. 

My father passed away from cancer when I was eleven and my traumatized mother ended up being institutionalized in England for a few years. My two siblings and I, barely in our teens, were uprooted from a relatively affluent lifestyle in England to living essentially on the brink of poverty, entirely, at the mercy of family charity in Pakistan. The experience was very powerful and unforgettable. It helped me to really empathize with people such as my maid and her children. I felt first-hand what it must be like to be on the outside looking in – to be in close proximity to wealth and yet be deprived of any opportunity to prosper, to have all the dreams and aspirations and yet not have the resources or tools to realize them. 

I think intuitively we all understand that there needs to be more social protection and economic opportunity for millions of underprivileged Pakistanis but I think that often times we don’t identify with these people because we haven’t been in their physical situation or experienced what they have in life. So, for me it was really an important eye-opener to actually, physically experience what that must be like. I believe in divine intervention and there was definitely divine guidance that put me through this necessary empathy building experience.

Another lesson in empathy that stuck in my head was that of a former maid of ours in Pakistan, who had 6 children and a chronic hypertensive husband. She lost her husband to stroke and she ended up borrowing money from various ‘loan sharks’ at predatory interest rates while all 6 kids were pulled out of school and put to work in the labor market. The eldest of these kids, a 16-year old girl, ended up in our house as a helper for my mother. Again, that personal proximity to her tragedy, really informed me that an event that could have remained minor because of early medical intervention became a major generational catastrophe because of the lack of affordable access to catastrophic health care. It was really these two personal life experiences that laid the foundation for Naya Jeevan.

Irum Musharaff:  

It’s interesting that all through what Asher was saying, I felt myself identifying with a lot of what he was talking about. I grew up in a military family, moving every two years or so.  As a result, I have lived all over Pakistan – from Quetta, Multan, Peshawar, Islamabad, Pindi to Karachi.

I recall my personal experience, in line with that of Asher’s.  When we lived in Peshawar, we had the fellow that ran the entire Army Mess, his family used to live at the back of our house. I was quite close to the family, and would often eat with them.  As a child, and like most children, I was more sensitive and noticed the disparity more quickly than adults and this consciousness has stayed with me although it didn’t come out till later.

I left Pakistan at age 10, when my father, who is an engineer, came to the US to study.  He took his engineering courses at Berkley and I spent my junior high years and my entire high school in the US and then went back to Pakistan at the age of 16.  And this time when I went back, I became even more aware and sensitive to this disparity. 

So, I guess what I was relating to was the fact that when you have seen two very different worlds, you become even more sensitive to the differences and injustices that exist between the two.  Upon my return to Pakistan, I did my bachelors in Economics and Statistics from CB College in Pindi. I then interned at Citibank in their Corporate Finance group and got my first job in sales of their Credit Card launch.  It was an experience I truly hated.  It was a commissions based job where you earned based on the number of cards sold.  But I stuck to it, staying a year and a half, partly because I was going to apply to LUMS and partly because it paid well. 

When I think back though,  I realize that I learnt a lot from the experience: not only did I feel that I matured as a person, learning a lot about myself in the process, but that I committed myself to doing something even though I hated it.  I was the only female sales representative and I didn’t like the atmosphere at all.  So it gave me a lot of strength to know that I could survive and in fact do reasonably well, even under unfavorable circumstances. 

After this job, I went to LUMS and did my MBA.  At LUMS, I was drawn to finance courses.  It’s interesting that while math had been my strength growing up, at LUMS I found myself surrounded by serious engineers whose math was very much stronger than mine.  I realized how relative strengths and weaknesses can be!

Also helpful was that in my second year, I studied my favorite subject, consumer behavior and market research.  It was statistical based marketing research and analysis, something I had touched upon in my undergraduate studies.  We did questionnaires and surveys, and I remember being on the streets and shops of Lahore, doing surveys.  E.g. we did price sensitivity and market analysis for Khayali books that published low cost books.  I find us doing that a lot now, with Naya Jeevan and it thrills me that this class could have taught me so much and prepared me so well for my role with Naya Jeevan. 

After graduating from LUMS, I got married and moved to Boston.  I temped for a year and a half because no one in US knew LUMS, while my classmates back in Pakistan had embarked on exciting careers. Again, I think that this period was humbling and built up great strength in me. 

I landed my first 'real' job at State Street Corporation, where I started as a temp in the Technology area.  This was 1998 or 1999, when you were able to get tech jobs relatively easily.  I was, however, fixated on working in finance, so I switched departments.  I remember my interviewers were surprised that I would want to move in reverse to the current trend towards IT.  So I got hired to do risk management at state street bank doing credit and financial analysis for large corporates and international financial institutions for 6 ½ years.

Q:  How did you balance your work and family life?

A: Well, luckily it was a 9 to 5 kind of job.  And so 4 years into the job, I had my son. I continued to work until he was two and two years later, my daughter was born.  Around that time, my husband also started business school on the West Coast so we moved, and I was a stay at home mom for about 2 years until I met Asher at my husband’s graduation from business school.  Naya Jeevan was just a concept then, and I think it was his energy, and passion, that was quite electric.  Definitely I also felt that his vision had potential, and so we decided to join up as a team.

Asher: 

Q: So what is Naya Jeevan?

A:  Naya Jeevan, meaning new life in Urdu, is the developing world’s first HMO for the poor.  It is a multi-national social enterprise that is dedicated to providing low income families throughout the emerging world with affordable access to high-quality, catastrophic health care.  That, in a nutshell, is our core mission.

First of all, we decided that we are not going to be an NGO that gives out ad hoc charity hand outs. We wanted to create a self-sustainable and therefore scalable, replicable and globalizable model with its roots in Pakistan that could branch out throughout the developing world and also impact the lower income strata of the developed world.

So Naya Jeevan is a social enterprise whose core product is a subsidized catastrophic health plan that is targeted towards low income employees who are either permanently, informally or contractually working in  (i) house holds, e.g. drivers, cooks, maids, security guards, baby sitters, (ii) corporations, small medium enterprises, (iii) academic sector, e.g. teachers, ground staff (iv) NGO sector.  These are the four major sectors that we are focusing on. 

Q. Obviously health care is an important issue, but a lot of folks place education for children as the number one priority.  So why focus on health care?

A. Obviously education is a noble and essential cause to focus on and there are approximately two hundred and fifty thousand children studying in NGO schools such as DIL, TCF and CARE throughout Pakistan.  We want to bring healthcare to these children and their families.  We believe that social protection by way of affordable access to health insurance is very important. Catastrophic medical event such as strokes, heart attacks, life-threatening pregnancy complications and major trauma can impose a severe burden on low income families – it can financially cripple them and put them at the mercy of either loan sharks or charities, neither of which is a sustainable or dependable system.

And this of course has serious repercussions - forcing kids to leave school, putting them on the streets, exposing them to drug abuse, prostitution, physical abuse, and all of the other social malaise that’s associated with poverty and illiteracy. So we felt that if we focus on healthcare while other excellent NGOs or non-profits work on education then together we can synergistically provide the core services which are needed by low income families through out Pakistan.

Q: What does your NGO partnership look like?

A: In our NGO partnership model, we are interested in collaborating with educational NGOs to: (i) Provide health care to the children, the teachers and their families (ii) Get NGO’s to integrate the Naya Jeevan health plan within the menu of services that they offer.  For example, there may be an NGO providing information on maternal health in an out patient setting.  Naya Jeevan could partner with them and provide social protection to their clients by enrolling them in the Naya Jeevan health plan.

Q: What is the Naya Jeevan health plan?

A: It basically provides annual catastrophic healthcare coverage, which is sufficient to cover the cost of cardiac bypass surgery at major private quality hospitals throughout Pakistan. What we decided to do is to leverage the existing infrastructure and distribution system that is employed by the private health insurance system.  There are six hundred thousand, mostly affluent, corporate employees who participate in this insurance system.  This insurance is underwritten by insurance companies like Allianz-EFU, Asiacare, IGI, etc.

So in terms of implementation, we felt that we should leverage the low hanging fruit or the population that could be most easily included in the existing system.  So we targeted individuals that are affiliated with these six hundred thousand individuals - either they are employed as domestic house hold staff, low income staff of schools, restaurants or corporations, or through NGOs that they may be a part of. 

By making this population our springboard into the health insurance industry, we are able to amplify the system twenty or thirty fold which in turn benefits all stakeholders: in an insurance system the larger the risk pool of client beneficiaries, the lower the risk and therefore the lower the cost per capita to every single stakeholder across the board.  So, there is a financial incentive for corporations, and corporate employees to participate in this system because their bottom line is also positively impacted.

Naya Jeevan's plan however is beyond simply providing our members with health insurance.  We provide social protection to low-income individuals through various health education related initiatives, workshops, and patient advocacy services.

Q: How extensive is your network of participating health care service providers?

A: The network consists of over 100 hospitals - private, quality hospitals such as Shaukat Khanum, Liaquat National Hospital, National Medical Center, Islamabad International Medical Complex, Kidney Center and other such hospitals. As I mentioned earlier, the coverage is sufficient to cover cardiac bypass surgery.  The insurance is focused on inpatient hospitalization, which covers (i) emergency procedures that require inpatient admission (ii) elective inpatient procedures such as surgery or ambulatory procedures such as colonoscopy (iii) diagnostic procedures such as MRI (iv) outpatient procedures/consultations which are associated with inpatient hospitalization, e.g. post surgical rehabilitation, physiotherapy or pre-surgical consultations, pre-surgical diagnostics, labs, imaging test etc, etc. So anything that is associated with a hospital admission or hospitalization event is coverable.

Q: What about non-catastrophic events, every day medical ailments? Does the insurance cover any of that?

A: No, we are, at the moment, focused on catastrophic events that we feel would financially decimate most low income families.  We have, through our market research, discovered that most families are able to cover modest outpatient expenses. However, our health plan does include providing preventive healthcare education and we envision providing access to primary care at a later stage, probably over the next 5 to 10 years.  A pre-requisite to this step would be to build a network of quality outpatient clinics with certified doctors, and credential pharmacies because there are big question marks about the qualifications of unregulated healthcare providers and the source and genuineness of the medication that is currently available in the developing world. 

Q: What kind of premiums are we talking about?

A: The health insurance premium was designed in a way that the burden was shared across all the different stakeholders. In our domestic employee model, as an example, the bulk of the premium is taken care of by the primary employer.  E.g. if it’s my driver, I will pay the bulk of his premium, typically 80-90% and the driver who is also the beneficiary, will pay 10%. If the premium is 200 rupees a month the driver’s contribution is 20 rupees a month, which is very affordable for him.

Q: This Rs. 20 is a regular payment or his out-of-pocket payment when he actually goes to get medical service?

A: This is the driver’s ongoing contribution to his own health insurance.  What we have suggested to employers is to deduct the employee contribution from their employee’s salary at source.  So while the domestic employee’s contribution is nominal from a financial perspective, it is an important symbolic gesture – they feel as if they have a participatory stake in their own health care and the healthcare of their families.  Moreover, in order to incentivize employers to provide coverage for children, we have essentially eliminated our margin such that they are receiving this service at cost. 

In the corporate employee model, a portion of the premium can be paid in the form of a charitable tax deductible contribution by the corporation as part of its corporate social responsibility, both to incentivize corporate employees to provide healthcare for their own domestic staff as well as to directly cover its own low income employees or to indirectly cover third party contractual staff.  E.g. in the emerging world, a lot of multinationals will circumvent laws by contracting out their labor needs to third parties so that they don’t have to provide health care benefits to the contracted labor.  We feel that is a sham so we really want and are encouraging multinationals to look at this very carefully.  Be it Nike, Gap or whoever, we want to create an opportunity that is so cost effective and socially impactful, that these big corporations feel compelled to cover their low income contractual staff. 

The cost as I mentioned, is approximately $1.25 per child per month and $2.50 per adult per month, extremely affordable to the primary employer with minority partial contributions made by the beneficiary.