Nyaya Health - global health at...

Nyaya HealthDecember 6, 2010 – Board of Directors Report

15.965 Global Health Delivery and ManagementMolly Bodell, Pompa Debroy,

Sophie Cain Miller, & Evvie Nanni

Outline

Mission Statement1

2

3

4

Background

Model

Recommendations

Nyaya Health has a two-pronged mission

Overarching Mission: Quality Health Care Delivery

1Deliver free community-based health

care in rural Nepal

2Establish & disseminate a scalable

model of healthcare delivery worldwide

- PIH model of delivery: • No one is denied care• Use CHWs (Community Health Workers)• Permanent on-the-ground care

Other Goals:

Mission 3

• Geography: Mountainous terrain Poor road conditions

• History: Civil war Lack of existing medical care in district

• Poverty: Median household income <$1 / day

• Government: Unreliable provision of healthcare

Main challenges to delivering Healthcare in Achham, Nepal

Source: 2009 Annual ReportImage Source: Roof of Nyaya Health Clinic; Wikipedia Background 4

Key health status indicators in Achham prior to Nyaya Health

INDICATOR STATISTIC

Health Care Staff 0 Doctors

Nearest Operating Room 10 hours by bus

Maternal Mortality Ratio 740 deaths per 100,000 live births

Stillbirths 64 per 1,000 live births

Under-5 Child Mortality 83 deaths per 1,000

Migration 50% of men migrate to India for work7% return with HIV

Chronic Malnutrition rate 60% of children

Source: 2009 Nyaya Health Annual Report Background 5

High maternal mortality ratio (MMR) in district

United States: 17

Nepal: 240Achham: 740

Source: IHME 2010, Maternal Mortality (Global), Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5, Institute for Health Metrics and Evaluation, Online, viewed 13th April, 2010. Note: numbers are per 100,000 live births

Italy: 4

Background 6

VALUES ORGANIZATION

GOVERNMENT PARTNERSHIP TECHNOLOGY

• Free care• Egalitarian• Transparency• Accountability

• Owns facility• Provides 38% of funding• 5 year agreement with Nyaya Health

• Trains and hires CHWs

• Open-source• Information sharing• Documentation and data collection

• Website, blog & Wiki

US-based StaffHistorically unpaidvolunteerHired first US-based ED

Nepal-based Staff28 employees82% Nepali

Nyaya Health Employs Unique Model for Free, Quality Care Delivery

Nyaya Health• Comprehensive health care delivery

• 24/7 service• 25 doctors and staff• 36,000 patients per year• 67% women• 50% of patients travel 1-3 hours by foot

• Top 2 diagnoses: gastritis and upper respiratory infections (URIs)

• Multiple sources of funding

Model 7

Nyaya Funding Comes From Multiple Sources

Donors

Private Donations

Grants from US students’ research

Nepali Government

Staff salaries

Pharmaceuticals

Medical supplies

MaintenanceOffice expenses & telecom

Sources of Funding Spending

59%

29%

12%

c 57%

c 32%

c 11%

Model 8

VALUES ORGANIZATION

GOVERNMENT PARTNERSHIP

TECHNOLOGY






US-based StaffHistorically unpaidvolunteerHired first US-based ED

Nepal-based Staff28 employees82% Nepali


Nyaya Health

Model 9

VALUES ORGANIZATION


TECHNOLOGY






US-based Staff•Historically unpaid•volunteer•Hired first US-based ED

Nepal-based Staff•28 employees•82% Nepali


Nyaya Health

Model 10

VALUES ORGANIZATION


TECHNOLOGY









Nyaya Health

Model 11

VALUES ORGANIZATION


TECHNOLOGY









Nyaya Health

Model 12

At the End of the World: The Cutting Edge of Health IT

• Advanced software to track medicine supply• Connection to directors, located in five countries across the world• Five areas of information made possible through IT

Information Technology

• Developed supply chain for medicines where none existed before• Expect to double medicine procurement in the next year, with only

120% increase in cost

Supply Chain

• All budgets and internal data available on open source Wiki• Organizations can provide feedback on Nyaya’s operations

Completely Open-source Operations

Model 13

Nyaya Wiki

http://wiki.nyayahealth.org

Model 14

http://wiki.nyayahealth.org

Nyaya offers unique value proposition for four key audiences

AchhamValley

• Free healthcare to 250,000 people

• Comprehensive healthcare

• Malpractice mechanisms

• Education

Nepali Health System

• To serve as model for other facilities in Nepal

• Medicine supply chain to rural area

• Model for sourcing local doctors and medical workers

• Model for utilizing gov’t trained CHWs

Global Health Community

• Provide information, examples and templates for other facilities

• IT gold standard for rural healthcare

• Information and data completely accessible and open source

Donors

• Information completely accessible and open source, including budget, reach and evaluative data

• Frequent anecdotal reporting via NyayablogPopulation

served by traditional NGOs

Stakeholders not traditionally served by global health community

Model 15

Business model success dependent on feedback loop between two sides of mission

Quality of care delivered in

Achham Valley

Quality of Information

available on wiki

Awareness and use of Nyaya resource

by other NGOs

Feedback on care delivery model

Key reinforcing feedback loop

Operational & service delivery improvements

Operations are transcribed directly to website

Demand increase through

publicity and word-of-mouth

More users will provide diversity of input & expertise

Model 16

Despite successful model, Nyaya Health currently faces three key challenges

• How can and should Nyaya scale to meet demand? Multiple locations or countries?

• What is the appropriate scope of services Nyaya should offer?

GROWTH

• How can Nyaya Health ensure model is easily replicable for other global health organizations?

REPLICABILITY

• How can Nyaya Health ensure more consistent and sustainable funding?

• Is there opportunity to monetize services?SUSTAINABILITY

Model 17

Recommendation 1: Growth in scale & scope

GROWTH

• SCALE: Focus on ‘flagship’ hospital as gold standard

• SCOPE: Increase scope of services, expand preventative and post-clinic care

Recommendations 18

Recommendation 2: Strengthen available resources for model replicability

REPLICABILITY

• Build awareness of resources

• Create more robust input loop (from local and global community)

• Reorganize and streamline online resources so that information is easier to navigate

Nyaya Health currently maintains website, blog & wiki

Recommendations 19

OPTION PROS CONSBrand and charge for materials/documents

• Materials already exist on website

• Not aligned with mission• Not significant source of revenue

Small fees for service • May help create demand for essential services

• Not aligned with mission• May prevent patients from seeking and receiving care

Create unrelated product and sell on site

• Growing market• Job creation• Help with branding

• Not related to mission• Would require added infrastructure

Conduct voluntourism • Has been successful in other areas of Nepal

• Rural and remote area• Not core competency• Detracts from mission

Package and sell IT services

• Expertise already in house• Based on lessons learned

• Would require additional staffing• Possible mission creep

Consulting/training for other global health orgs

• Existing need in industry• Thought leader• Strengthen brand

• Would require additional staffing• Possible mission creep

Recommendation 3: Create sustainable revenue streams; monetize services

Recommendations 20

Q&A

21

Works Cited

22

• Phone interview with Dan Schwarz, Executive Director ([email protected])• Email correspondence with Ryan Schwarz, Director of Operations ([email protected]) • 2009 Nyaya Health Annual Report• Nyaya Health Wiki: http://wiki.nyayahealth.org• Nyaya Health Website: http://www.nyayahealth.org/

Appendix

23

History of Nyaya

24

1996 – 2006: Nepalese Civil War, Only hospital in district shuts down

2008: Nyaya runs a newly opened primary health center to deliver care in Achham Valley

2009: Partnering with Nepali MOHP, renovated dilapitated Bayalpata hospital

2010: April: Starts a 5-year contract with MOHP to run Baylpata Hospital. May: Transitioned community health center to local health authorities.

2015: Government Funding set to expire

Nyaya budget is expected to increase by more than 250% in 2 years

25

Source Financial Contribution Percent of Nyaya Budget

Nepali Government $22,500 12%

Individual Donors $59,838 32%

Privation Donations $53,184 27%

Grants from US Students ~$50,000 29%

2010 Total $185,522 100%

2011 (Projected) $350,000 – $400,000

2012 (Projected) $500,000

Nyaya’s Organizational Model

26

US-Based Staff

Unpaid: volunteer to support Nepal Staff

Board of Directors: 12 members,

Board of Advisors: 10 members

Currently Recruiting Full-Time US

Director

Hospital

28 Staff members (23 are Nepali)

Roles include doctors, medical

director, pharmacists, nurses,

administration

Nurses oversee CHW’s and FCHV’s

Nepali government

Owns Facilities

Funding: provides 38% of Nyaya’s

operating budget

Trains CHW’s and FCHV’s

Nyaya Org Chart

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UNUSED SLIDES

28

Himalayan Health

• Multiple locations• Donates to

orphanages and provides care to patients in clinics through medical tourism, arranging for trips for medical volunteers

Partners in Health

• Multiple countries• Access to primary

care, free health care and education, community partnerships, addressing basic and economic needs, serving poor through public sector

Nick Simons Institute

• Based in Nepal• Quality training for

health care workers• Support for rural

health workers• Scholarships for

health leaders

Organizations with similar missions lack reinforcing feedback loop created by wiki

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