Health at Home is the fourth dimension to Health Care



“My clients are my assets. I saw that they were facing a problem, so I devoted myself and my team of dynamic and passionate professionals to solve their problem” says the cardiac surgeon and the founder of an innovative health care model, Dr. Bishal Dhakal.

For a decade now, Health at Home has been serving the people and the society through these unique health care services at ones’ doorstep model.

1. Can you tell us your journey of Health at Home?
When I was a residential doctor, I wondered if hospitals and clinics are the only way to serve people. we can serve the people? Yes, hospitals are essential and no other health service institution can have the infrastructures that a hospital has but  I wasn’t happy with the way hospitals were functioning. So I started looking for an alternative health care facility for general people which is accessible, affordable and high-quality. Hence, I started off with one idea- Health at Home, 10 years back with passion, dedication and a supporting wife. 

2. What was it like initially having health services at one’s doorstep as it is a new concept here in Nepal? How did people perceive getting health facilities at their doorstep?
Health at Home was established with a simple motive of giving accessible, affordable and quality medical facilities to the people at their doorstep. When we first started, there wasn’t much work. People initially felt weird and they still do. But gradually, with time, we have gained the confidence and trust of the people.

3. How did you get this idea of the health facility at the doorstep?
Like I said I wasn’t satisfied with the hospitals and their facilities. When working as a residential doctor, I understood that patients needed more, not just medical care. They had so many questions that were often not addressed. They needed counseling, support, and navigations. 

Likewise, it is an unnecessary burden for patients to come out of their bed and drive to the hospitals. Moreover, the medical facilities today are skyrocketing making it difficult for a significant part of our society to afford it, which surely shouldn’t be the case. So, I wanted to address these aspects. Thus, we reversed the model, instead of having patients come to us we now go to the patients.

Apart from this, I have always been fascinated to try and do new things. Further, I also come from a family of successful doctors and business people, so there is always this motivation to do something new and good. All these multiple co-factors led to the establishment of this new model of getting health facilities at one’s doorstep. 

4. Can you tell us more about the models of health facilities?
There are different health care models. An individual doctor can always open up a clinic and provide medical facilities. Then we have polyclinics where a group of doctors comes together to solve a set of problems like gynecologists, pediatricians and so on. Next, we have hospitals that have emergency services, ICUs, helipads, MRI and so on which is an industrial model.
And finally, we have the fourth tier in the health care model, the home health care model which is comparatively a new concept in Nepal but it has been flourishing all around the world. Nepal still lacks quality medical infrastructure but I can bet that Nepal has the best home health care model.

5. What different services and facilities does Health at Home provide?
We provide 7 different services. We have Doctor on Call where we send doctors to take care of people and check on them. But we only look after simple diseases and not an emergency or surgery cases.
Next, we have nursing placement and nursing visits where the nurses look after wound dressing, Ivs, antibiotics and so on. This facility is mainly used by patients who do not necessarily need to go to hospitals.
Then we have physiotherapy and rehabilitation services for low back pain, post-stroke pain medication and so on. We also have a lab on call facility where we collect the blood of our patients from their home and bring it to the lab, prepare the report and take it back to our patients. This also includes diagnosing diseases like EKGs, cardiac evaluation and so on.
We also have transportation facilities where we take patients to hospitals and bring them back. Then we have an equipment rental and selling facility where people can rent beds, oxygen cylinders, non-invasive ventilators and so on. Lastly, we also have pharmacies but in a very limited quantity. 

6. What do you think are the major driving forces for the success of Health at Home?
At Health at Home, we have a commitment to amazing individuals. My team works 365 days 24 hours. We are not only an enterprise or a model that makes money, but I and my team also have a double duty of making things right, helping the people and also letting people get inspired to do good things to make our society vibrant. 

In addition to this, Health at Home has been able to create an impact on society. Rather than spending time, money and effort visiting a clinic or a hospital, with Health at Home you can get all of these services at home. We have good doctors who can check on you and give you a good prescription at the comfort of your home.
Along with accessibility, we are affordable too. Our price is affordable for regular middle-class people. I believe that Health at Home has made sense because the regulated price for the last 10 years has been the same. Being a social enterprise, we are not those who increase the cost every now. Instead, we focus on increasing the volume.
In addition to this, quality is and has always been our primary concern. We believe that if you mess up the quality, you mess up everything in your health care. So our primary concern to our clientele, staff’s satisfaction, operational smoothness, and planned decision making is helping us grow. 

7. How do you get the professionals under one roof?
We have been in the market for the last 10 years. So invariably we are in the same place. Our market presence has been recognized by multiple generations of staff, nurses and doctors. So the professionals keep reaching us via emails. We also have different network platforms to make them part of health at home. So, it is an ongoing process and has no single specific formula for it. 

8. How many people are working here at Health at Home?
We have like 20 to 30 people working in the core team and around 300 people working on a contractual basis. 

9. How many patients are associated with health at home as of now?
We have around 5000 households and we have around 150 patients in bed. So basically we have 100 to 150 patients on a monthly basis.

10. What were the main challenges you faced when you started Health at Home 10 years back?
Everything was a challenge but I didn’t take it as a challenge. I took it as something that will be a solution for my community and for my people. What I believe is that if you are passionate about your jobs it is more rewarding than challenging. Sometimes there is pressure but it is part of life. 

11. What criteria do you look into apart from the degree when hiring the professionals?
I don’t personally look into all these things. I have my team working on it. But if I have to mention the criteria when hiring, we look into the ability to work in a team, presence of interpersonal skills so that they can communicate with the patients well.
We have been considering these things from the very beginning and it has almost been a decade so we are still working on a perfect model. Our quest for improvement is continuous.

12. Is health at home located only inside Kathmandu valley?
No, we have health at home in Chitwan, Pokhara, and Itahari. Health at Home is doing quite well in Kathmandu and Pokhara but it is facing some problems in Chitwan and Itahari. The problem is that people there are not very adaptive to the model, so we are coming up with a new model. In addition to this, other institutions delivering similar home health care services is increasing. 

13. What are your future plans for Health at Home?
Nothing much. Just to keep things stable, keep moving, embracing innovation, creating new solutions and just do what we are doing. And for this, we are planning to expand our services to other major cities by 2020. 

14. Any unique patient experience you had to have?
There are so many. My clients are my seed investors; they are my assets. These clients have been with us throughout our journey, they have seen us grow and every single experience with them is precious. If I have to share one I’d share about this young lady who was a Tibetan refugee. She had tuberculosis and was literally dying. None of the medical therapies for tuberculosis was working. And one fine day she got connected with us and we started looking after her. We delivered medicines and IVs three times a day at her place for nearly a year and fortunately, she got better and survived the deadly disease. She later sent us some gifts, lots of good wishes and a thank you note. This experience is really close to my heart.

15. How has your entrepreneurial journey been so far?
It has been amazing. I am very happy and proud of the place I am in right now. It certainly wasn’t easy as there was a huge risk factor. I decided to pack my bags from Pakistan as I learned more about entrepreneurship. Since I come from a medical background, it was a bit tough when I first founded Health at Home because I had to manage everything and run the enterprise smoothly. But at the end of the day, I was running a health care system and solving peoples’ problems. So, this keeps me motivated and also gives a sense of satisfaction.  

16. Any other thing you’d like to share with us?
Things are not always going to be good; they may go bad. So you need to have flexibility in your thinking in order to make good, rational and logical decisions in tough times. 

Also, you should build things when you are young. You should become an entrepreneur not because it is what everyone is doing but because you see a problem and want to solve it for your people, your society and your community. 

To know more about Health at Home do visit their website

Article by Trishna Shakya