Nyaya Health 2009

Nyaya Health: 2009 update

Ryan Schwarz, Director of Operations

info@nyayahealth.org

Nyaya Health 2009

Who We Are

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501(c)(3) organization founded in 2006 Channel over 99% of all donations directly to Nepal Managed by a volunteer Board of Directors and paid local

Nepali staff

Mission: To provide free community-based healthcare in rural Nepal To develop a scalable model of healthcare delivery in

resource-denied settings throughout the world

Strategies:

1. To facilitate resource distribution to resource-denied areas

2. To expand human resource capacity and foster local grassroots collective action

3. To apply evidence-based medicine principles and rigorous data monitoring and evaluation to all programs

4. To involve the central government in the development of pro-poor health infrastructure

5. To utilize innovative technologies aimed at improving transparency and collaboration in global health delivery

Nyaya Health 2009

Where We Work

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250,000 population of Achham

0 number of allopathic doctors in Achham before Nyaya

2 number of allopathic doctors in Achham hired by Nyaya

10 hours in bus to reach the nearest airport and operating room

1 in 125 deliveries results in the mother’s death

64 number of stillborns for every 1,000 live births

50% of men migrate to India for work; over 7% return with HIV

in 1,000 children don’t survive past the age of five8399.5% of babies are born in homes and cattle sheds

50¢ average daily per capita income in Achham

60% of children are chronically malnourished

14 hours in bus to reach the nearest intensive care unit

Nyaya Health 2009

Current Services: Sanfe Bagar Primary Health Center

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Opened for service April 6, 2008 Served over 17,000 patients in the

course of 14 months Facilities include:

Outpatient department Maternity suite Treatment rooms for 24-hour

emergency and obstetric care Laboratory Pharmacy

20 all-Nepali staff All services completely free of

charge to patients

Nyaya Health 2009

Current Services: Bayalpata Hospital

Built by the government but subsequently abandoned

45 minutes from Sanfe Bagar 5-year contract signed with the Nepali

Ministry of Health and Populations to renovate and operate the hospital

Services will include (summer, 2009): Outpatient department 24-hour emergency and obstetric

services Inpatient ward Laboratory & blood transfusion Testing and treatment for HIV,

tuberculosis, and malnutrition Community Health Workers (CHWs) Clean water for community

Phased Expansion: Women’s Center (mental health/

reproductive education/ social services) Surgical suite Digital X-Ray Services Expanded CHW network

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Nyaya Health 2009

Achieving Nyaya Health’s Mission in Achham

Mission #1: Build Healthcare Infrastructure

Mission #2: Develop a Scalable Model

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Nyaya Health 2009

Mission #1: Build Healthcare Infrastructure

An effective, responsive, community-driven healthcare system is the basis of public health and health justice.

Key components: Needs assessment Clinical Facilities

Development Human Resources:

Recruitment Human Resources:

Continuing Medical Education Telecommunications Reliable energy Clean water

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Nyaya Health 2009

Building Healthcare Infrastructure: Needs Assessment

Needs assessment is a key component of delivering locally effective community-driven healthcare services

Rapid health assessment, 2007

Reviewing clinical service data

Community health worker surveys

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Nyaya Health 2009

Building Healthcare Infrastructure: Clinical Facilities Development

Nyaya Health incorporates principles of social justice and community-driven development into all design processes

Facilities designed to enhance patient dignity and healing

Sanfe Bagar Health Center: Before

Sanfe Bagar Health Center: After

Nyaya Health staff participate in the process, further developing human resource capacity

Local community members engage in the process through voluntary and paid engagements

Developing Bayalpata Hospital is Nyaya’s next step in this process…

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Nyaya Health 2009

Building Healthcare Infrastructure: Staff Recruitment

Focus on local talent

Open, advertised process

Structured and qualitative components to the interview

Salaries on par with the Nepali government

Opportunities for career advancement

Meeting the challenges of physician recruitment

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Nyaya Health 2009

Building Healthcare Infrastructure: Continuing Medical Education

CME is a key benefit that Nyaya can provide to retain workers

Developing new competencies among staff is key to building health systems

Strategies include: Reviewing evidence-based clinical

protocols CME sessions w/ Medical Director

and clinical staff Ultrasound On-site clinical consultants Computer literacy

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Nyaya Health 2009

Building Healthcare Infrastructure: Telecommunications

Reliable telecommunications systems is central to our ability to deliver: Patient quality Logistics planning Telemedicine Fundraising

Delivering effective systems requires: Working with public and private partners Institutional investment Flexibility to adapt to rapidly changing

technologies

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Nyaya Health 2009

Building Healthcare Infrastructure: Rural Energy Systems

Effective rural healthcare demands reliable energy supply

Nyaya Health’s phased approach: Phase 1: Transfer existing

energy system to Bayalpata Hospital

Phase 2: Preliminary expansion of energy capacity

Phase 3: Integrating a small-scale solar-powered system

Phase 4: Larger-scale energy capacity expansion via solar power

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Nyaya Health 2009

Building Healthcare Infrastructure: Water Systems

Reliable clean water supply crucial to health care delivery

Bayalpata Hospital

Access to water donated via community collaboration

Working with community members to protect the water supply lines

On-site chlorination treatment through the support of Antennae Technologies and Environmental Camps for Conservation Awareness

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Nyaya Health 2009

Building Healthcare Infrastructure: Community Health Workers

Community health workers play critical roles in ensuring timely access to essential medical care

Effectively deliver care in rural regions with little access to transportation

Provide follow-up care of chronic conditions

Help raise awareness and educate their fellow citizens

Offer continual feedback to Nyaya about community needs and concerns

Phased scale-up of CHW network

1. Outreach

2. Medical adherence support

3. Paramedical services

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Nyaya Health 2009

Mission #2: Develop a Scalable Model

Developing a scalable model is central to building the field of global health delivery

Nyaya Health uses several tools:

Wiki

Blog

Data monitoring and evaluation

Open-access clinical and financial data

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Nyaya Health 2009

Developing a Scalable Model: Nyaya Health Wiki

Wiki is an searchable repository of: Management policies and contracts Clinical protocols De-identified clinical data Clinical engineering details

Provided in real-time, as they are developed, evaluated, and revised

All pages viewable to the public

A forum to share lessons-learned from our patients in Achham with organizations in similar settings around the world

Opportunity for critical feedback and collaboration

http://wiki.nyayahealth.org

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Nyaya Health 2009

Developing a Scalable Model: Nyaya Health Blog

Staff and volunteers write journal-type stories to share and reflect on our programs

Forum for discussing: Patient cases Clinical operations details Organizational challenges and successes

Colleagues throughout the world can use these experiences to guide their own work and provide us with feedback or questions

http://blog.nyayahealth.org

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Nyaya Health 2009

Developing a Scalable Model: Data Monitoring

Effective healthcare must be driven by data monitoring and evaluation

Collaboration between Nepal- and US-based data team is critical: Monthly uploading and analysis Public access to enhance

collaboration and transparency in the global health community

Revision of programmatic design and protocols according to regular data evaluation

Rigorous attention to patient privacy http://wiki.nyayahealth.org/DataManagement

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Nyaya Health 2009

Developing a Scalable Model: Financial Transparency

The Global Accountability Report: non-profits fared dismally

Nyaya’s wiki offers ready accessibility to: Line-by-line expenditures Month-by-month budgets summaries Timeline of expenditures Timeline of revenue Accounts balances

Benefits More engaged donors Organizational culture of honesty

and openness More effective management

http://wiki.nyayahealth.org/Budget

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Nyaya Health 2009

Nyaya Health: Summary and next steps

Nyaya Health and Bayalpata Hospital:

Achieving healthcare access to Nepal’s most vulnerable citizens

Training and expanding healthworker capacity in rural Nepal

Developing models for rural healthcare delivery

Next Steps:

Larger community health worker network

Surgical capacity

X-Ray services

Improved telecommunications capacity

Expanded energy systems

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Nyaya Health 2009

Thank You!

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135 College St, Suite 323New Haven, CT 06510Phone: 203-687-8615Fax: 630-604-8615

info@nyayahealth.orghttp://www.nyayahealth.orghttp://wiki.nyayahealth.orghttp://blog.nyayahealth.org

Bayalpata Hospital, Ridikot VDCAchham, Nepal

Phone: 977-94-690-404 (Achham)Phone: 977-9845236035(KTM)