sloan ghd course final project bodell, debroy, miller, nanni
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Nyaya HealthDecember 6, 2010 – Board of Directors Report
15.965 Global Health Delivery and Management
Molly 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
1
Deliver free community-based health care in rural
Nepal
2
Establish & 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- Become teaching model for delivery of quality health care
- Be known and serve as a model for open source organizations
Other Goals:
Mission 3
•Geography:̵9 Mountainous terrain̵9 Poor road conditions
•History:̵9 Civil war̵9 Lack of existing medical care in district
• Poverty:̵9 Median household income <$1 / day
• Government:̵9 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 employees100% 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
• 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 employees100% Nepali
Nyaya Health Employs Unique Model for Free, Quality Care Delivery
Nyaya Health
Model 9
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
Model 10
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
Model 11
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
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 offers unique value proposition for four key audiences
Achham Valley
• 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 Nyaya blog
Population 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 CONS
Brand and charge for materials/documents
• Materials already exist on website
• Not aligned with mission• Not significant source of revenue
Membership fees for website access
• Organizations may be willing to pay for access to information
• Not aligned with mission
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
21
Q&A
22
Works Cited
• 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/
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Appendix
24
Nyaya Org Chart
25
Nyaya budget is expected to increase by more than 250% in 2 years
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 – $400,0002012 (Projected) $500,000
26
Nyaya’s Organizational Model
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
27
History of Nyaya
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
28
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
29
UNUSED SLIDES
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
Similar organizations lack reinforcing feedback loop created by wiki