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Nyaya Health 2009
Nyaya Health: Foundations and Challenges
Ryan Schwarz, Director of Operations
Nyaya Health 2009
2006
…While I was staying there, I literally had 10 women a night knocking on my door asking for medical help for themselves or their children. All but one of their husbands had worked in India and half of them were widows at 25-40 years old. Among those that knew their [HIV] status, all were positive. There are no medical services available to them beyond the most basic primary care (and that is often geographically and financially inaccessible)… It was very difficult to talk with these women because there was nothing I could offer or recommend to them. The nearest facility providing HIV care (and doing so incredibly poorly) is a 12 hour bus-ride away. The women were talking about selling their houses to buy ARVs for themselves and their children, which we dissuaded them from doing, since that would buy them at most a year of meds and survival. Moving to the cities where care is available is not an option for them, due to the cost of living and having no employable skills… It's not just HIV that's a problem, of course. 95% of births (or more) take place in a home without a health worker present… Malnutrition is a major problem, with >60% of children in those two districts having moderate-to-severe malnutrition… One night I was sitting, having dinner in a room full of the women I had been providing my meager medical advice to and it struck me that they would almost all be dead within five years, given their symptomaticity and prospects for treatment. Since that moment, I’ve felt wholly compelled but completely adrift…
Jason Andrews, MD Nyaya Co-Founder3/12/2006
Nyaya Health 2009
Who We Are
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Mission: To expand healthcare capacity in rural Nepal To develop a scalable model of healthcare delivery
in resource-poor settings throughout the world
501(c)(3) organization founded in 2006 Public-private partnership with Nepali Ministry
of Health & Population (2009) Managed by a volunteer Board of Directors and
paid Nepali staff Over 99% of all funds used directly in Nepal
Nyaya Health 2009
Where We Work: Nepal – Achham District, Far Western Region
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
History: founding of Nyaya Health
Nyaya Health 2009
History: Sanfe Bagar Primary Health Center
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Nyaya Health 2009
History: Sanfe Bagar Primary Health Center
Opened for service April 6, 2008
Served over 17,000 patients between April ’08 and May ‘09
Services included: Outpatient department 24 hour emergency services Maternity suite with 24 hour-
obstetric services Diagnostic laboratory Pharmacy
23 all-Nepali staff
All services completely free
Nyaya Health 2009
History: Transition to Bayalpata Hospital
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Nyaya Health 2009
History: Transition to Bayalpata Hospital
Goal: infrastructure development, capacity building, not care provision
Goal: to collaborate with the government in the development of pro-poor, rural health care development
Government contract for 5 years signed June 2009 – June 2014 Ministry of Health & Population to take over Bayalpata Hospital in 2014
Nyaya Health 2009
Current Services: Bayalpata Hospital Services include
Inpatient & Outpatient services 24-hour emergency and obstetric services Laboratory Community Health Workers (CHWs) Clean water for community
Phased Expansion: Surgical suite X-Ray Services ( HIV ART program) Women’s Center (mental health/
reproductive education/ social services)
Expanded CHW network
Nyaya Health 2009
Achieving Nyaya Health’s Mission
Mission #1: Build Healthcare Infrastructure
Mission #2: Develop a Scalable Model
Nyaya Health 2009
Mission #1: Building Healthcare Infrastructure
An effective, responsive, community-driven healthcare system is the basis of public health and health justice.
Some key challenges: Human Resources Supply-chain management Telecommunications /energy Community outreach
Nyaya Health 2009
“Video X-ray” – the development of a healthcare system
Nyaya Health 2009
Building Healthcare Infrastructure: Human Resources
Nyaya Health 2009
Building Healthcare Infrastructure: Supply Chain Management
Supply Chain Challenges: Medicines Fuel Food General supplies Maintenance/ Repair Staff travel (trainings, KTM, expats)
Achham
Nyaya Health 2009
Building Healthcare Infrastructure: Supply Chain Management
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Nyaya Health 2009
Building Healthcare Infrastructure: Telecommunications
Reliable telecommunications systems is central to our ability to deliver: Patient quality (communities, referrals) Logistics planning (Achham/KTM/USA) Telemedicine (ultrasound; ?psych, ?X-ray) Fundraising (KTM & USA)
Nyaya Health 2009
Building Healthcare Infrastructure: Community Health Workers
CHWs play critical roles in creating critical linkage to community
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
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
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 Financial data
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
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:
Public access to enhance collaboration and transparency in the global health community
Revision of programmatic design and protocols according to regular data evaluation
Nyaya Health 2009
Building a scalable model: Tiyatien Health
Nyaya Health 2009
Nyaya Health: Summary and next steps
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
Expanded energy systems
Nyaya Health 2009
Thank You! Questions?
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135 College St, Suite 323New Haven, CT 06510Phone: +1.724.986.5050Fax: +1.630-604-8615
[email protected] http://www.nyayahealth.org http://wiki.nyayahealth.org
http://blog.nyayahealth.org
Bayalpata Hospital, Ridikot VDCAchham, Nepal
Phone: 977-94-690-404 (Achham)Phone: 977-9845236035(KTM)
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: 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
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: 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
What Frank Bia asked for…
“What would be of interest is:
1.how the organization was founded and staffed,
2.the implications of reopening the hospital
3.most importantly patient stories and needs.
4.Since we supply pharmaceuticals and medical supplies you might want to emphasize the shortfalls, sources of such and how the needs are currently met.
Photographs are better than death by PowerPoint, as all medicals students are already aware of. Let me know what works best for you and we can plan it from thereSincerelyFrank Bia”