Sylvana Q. Sinha is the Founder, Chair, and CEO of Praava Health, a groundbreaking community health organization in Dhaka, Bangladesh. After a personal experience with her mother’s own health needs, Sinha summoned the innovative model and funding required to offer high-quality care as well as the diagnostics to support it.
The business model is described in a Harvard Business School case, and well worth reading about. We discussed Sinha’s purposeful approach to creating, leading, and growing Praava, including the trust and relationships she’s needed to build. And the challenges of doing that as a sole female founder of color.
Nell Derick Debevoise: What inspired you to start your company, and how is Praava connected to your individual purpose?
Sylvana Q. Sinha: In the 5 years since we opened our doors, we’re privileged to have served nearly half a million patients with world class healthcare in Bangladesh with our click-and brick outpatient healthcare model.
More than a decade ago, my mother needed an emergency appendectomy in Dhaka, Bangladesh. We rushed her to the very best hospital, where her surgery was delayed, and after many post-op complications, she was airlifted abroad to another hospital for another emergency surgery — the first of many. Poor quality of care in the first hospital almost took my mother’s life.
If we had been in New York or Bangkok, the situation would have been shocking. But we were in Dhaka, so it was completely normal. Despite Bangladesh’s vibrant economy, every day thousands of people, and every year billions of dollars, leave the country in search of quality healthcare.
Unmet demand, ability to pay, and lack of supply is an obvious business opportunity. But I started Praava Health as more than a way to fill a market gap — I wanted to fill a gap in dignity and trust, to create a world where quality care is available to everyone. The power dynamics of health are so skewed; doctors and hospitals hold all the information and patients easily feel powerless. I started Praava to show patients they deserve better quality and dignity in their health, and in their lives.
Derick Debevoise: How did you enroll the right supporters and advisors to support your vision?
Sinha: When I had the idea for Praava Health almost a decade ago, I had no professional healthcare experience and was a first time entrepreneur. I hadn’t even lived in Bangladesh before. What I did have was a global network of contacts from my diverse career in law, US foreign policy, and international development. I spent about a year on a “global listening tour” talking to as many people as I could about the systems and the business of healthcare - in Bangladesh and around the world.
Sinha in conversation with global health leaders and investors.
I also spent a lot of time in Bangladesh, listening to patients and Bangladeshi healthcare professionals to learn from their experiences and pain points. Through all of these meetings, I started to better understand both what I should be building and the kinds of people I wanted to build it with. I even met some of our founding team members and earliest investors and advisors through these conversations.
The most important thing I learned during this time was to be open - to put the time in to share my motivations and inspiration, and to learn from the people who were willing to teach me. I also was very self aware of the gaps in my own experience and knowledge, and within that first year, I brought together healthcare entrepreneurs, investors, medical professionals, and digital health experts convening a “Global Advisory Council” that continues to help us bring the lessons of the global healthcare community to our model in Bangladesh.
Derick Debevoise: How did your identity, including elements of both privilege and underrepresentation, influence that process?
Sinha: My identity informs every aspect of my business. My parents were born in Bangladesh, so while I was born and grew up in the United States, I was raised as culturally bilingual. I studied at some of the best universities in the world, and have worked at some of the most prestigious global organizations. I have never taken these experiences for granted; I have always been aware that that privilege opened doors for me that otherwise would have remained shut. In Bangladesh, I was unknown, having never lived there before. However, the pedigrees of my education and professional experiences, coupled with the fact that my family runs a successful business founded in 1954 by my grandfather, also helped to open certain doors for me - I did have enormous advantages.
At the same time, I am a woman of color. Less than 2% of venture dollars go to female-founded businesses, and even less to solo female founders of color. And despite my privileges of education, financial resources, family ties, and social access, as a woman of color building a business in an emerging market, I have had numerous experiences that I would describe as sexist or condescending.
The data backs up Sinha's experience.
In multiple conversations, men in the room have questioned my experience, my business plan, even my commitment. After one meeting with a potential investor, a male colleague who I’d invited to join told me that he’d never seen that depth of grilling in his many years of capital raising. It’s hard not to take such experiences personally. I lean on the privilege of confidence in my past experiences and education for the strength to remain steadfast in my vision.
Derick Debevoise: What have been your greatest challenges around rallying support for your vision?
Sinha: Access to institutional capital has been our biggest challenge to scale the business. Despite living through the greatest public health crisis of our lifetimes, global health investments have actually fallen in recent years, and remain predominantly U.S.-focused.
We have been fortunate to have raised $15M+ from angel investors to build Praava Health, with investments ranging from $10,000 to millions. Our angels have deep experience building and leading healthcare companies all over the world. Each and every one of them shares our values of quality, dignity, and trust.
But at the same time, we see opportunities to grow that are only available with institutional capital. I’m thrilled to have served such a large community of patients in Bangladesh already. And, I know we can do so much more, both within Bangladesh and across other emerging markets.
Derick Debevoise: Would you share some strategies you have used to establish trust and build strong connections within your network?
Sinha: Authenticity, consistency, and persistence must be at the heart of every interaction. I am transparent and open about values, milestones, successes, and failures with current and potential investors, and with my staff. And I never give up.
Derick Debevoise: Has your purpose-driven approach to the work helped or hindered those connections?
Sinha: Last year, I was asked a question on a panel - how do you balance people, profits, and purpose when you are pitching? My fellow panelists were American men with US-based businesses, and they answered first, both saying “it’s all about the story” or “...purpose”.
For me, the experience is different. I am a woman of color leading a business operating in Bangladesh - a country traditionally viewed as a poor country in need of charity, even though it has recently graduated to lower middle income status and GDP per capita has exceeded India’s two years in a row.
Dhaka is awash with business and impact opportunity.
For all these reasons, it’s my sense that investors usually assume I am driven by purpose. Praava’s gross margins are 60+%, and while scaled healthcare systems in the US trade at 5-15x EBITDA, in Asia they trade at 15-25x - still, I usually have to convince investors that I understand the economics of the business. I’ve even been told by investors that I’m so passionate about my work and its mission that it might be distracting or somehow unclear that I am building a business that is going to generate strong financial returns.
Once I was asked, you’re so passionate about this work; are you passionate, or do you want to make money? I am not sure why it has to be one or the other - and I don’t think a male entrepreneur would get a similar question. I wonder if anyone ever faulted Adam Neumann for being passionate!
In fact, I know that my passion for our patients and high quality healthcare is what drives us to do better, every day, and creates ambition for every level of our business. The impact is implicit - Praava’s purpose and profits benefit everyone. McKinsey estimates that low-middle-income countries achieve a $4 increase in GDP for each dollar of healthcare investment.
Derick Debevoise: Can you share a time when a connection from your network helped you achieve a significant goal? Was there a connection between the goal they helped you with and that person’s purpose?
Sinha: One of our investors was formerly a senior leader in the US government. When our company faced some local regulatory challenges, he used his contacts to escalate our issue to the US embassy in Bangladesh and even the Bangladeshi government to emphasize the importance of protecting US investments like ours in Bangladesh. I never would have expected such swift and focused action. For me, it was an incredible example of how someone in a position of power can choose to use their time and power - to help open doors, and in the case of Praava, ensure continued access to high quality, affordable healthcare services.
Derick Debevoise: Maintaining relationships can be challenging, especially as one's career or business grows. How do you manage to stay connected with your network, and what advice do you have for others looking to do the same?
Sinha: For me, maintaining relationships is not only a business imperative, it is a joyful endeavor. I really do believe we are stronger together. My advice is that if you don’t enjoy maintaining relationships, you should either partner with someone who does, or rethink your career path!
Derick Debevoise: In your experience, what are some common mistakes people make when it comes to networking or building relationships? How can these be avoided?
Sinha: When you are goal-oriented, it can be tempting to become transactional in relationships. This may yield results in the short term, but in the long run nobody wants to feel used. As a leader, I am focused on sustainability and impact for the long run, not only of my business, but of a new model of patient-centered health that is focused on quality, dignity and trust.
So I am always looking at the contact or the relationship in a holistic, long-term lens, not what I can get out of it in the short term. This is true not only for external stakeholders but even for our colleagues. I see sincere relationships with our team as critical to the success of our business - as demonstrated by research published in Firms of Endearment, engaged employees are willing to go the extra mile - for themselves, for our colleagues, and for our patients.
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