1. ANMF & Nyaya Health:
Providing free health care in the Far West
Duncan Maru, MD, PhD
13th Annual ANMF Conference, 19-21 June, 2009
Nyaya Health 2009

2. ANMF and Nyaya Health: Shared Values & Mission
 Building health infrastructure in Nepal
 Providing healthcare to Nepal’s most
vulnerable and impoverished citizens
 Training healthcare professionals in
resource-poor settings
 Achieving meaningful collaboration
between professionals within and
outside of Nepal
 Engaging the Nepali diaspora
 Developing models for rural healthcare
delivery and access
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3. Who We Are
 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
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4. Where We Work
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
14 hours in bus to reach the nearest intensive care unit
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
83 in 1,000 children don’t survive past the age of five
99.5% of babies are born in homes and cattle sheds
50¢ average daily per capita income in Achham
60% of children are chronically malnourished
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5. Current Services: Sanfe Bagar Primary Health Center
 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
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6. Current Services: Bayalpata Hospital
 Built by the government but
subsequently abandoned
 45 minutes from SanfeBagar
 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
 Phased Expansion:
 Inpatient ward
 Women’s Center (mental health/
 Laboratory & blood transfusion reproductive education/ social services)
 Testing and treatment for HIV,  Surgical suite
tuberculosis, and malnutrition
 Digital X-Ray Services
 Community Health Workers (CHWs)
 Expanded CHW network
 Clean water for community
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7. Achieving Nyaya Health’s Mission in Achham
Mission #1: Build Healthcare Infrastructure
Mission #2: Develop a Scalable Model
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8. 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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9. 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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10. 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
 Nyaya Health staff participate in the
process, further developing human
resource capacity
 Local community members engage in the
process through voluntary and paid
engagements
Sanfe Bagar Health Center: After
 Developing Bayalpata Hospital is Nyaya’s
next step in this process…
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11. 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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12. 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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13. 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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14. 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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15. 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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16. 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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17. 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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18. 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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19. 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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20. 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
privacyhttp://wiki.nyayahealth.org/
DataManagement
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21. 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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22. ANMF and Nyaya Health: Shared Values and Mission
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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23. Thank You America Nepal Medical Foundation!
135 College St, Suite 323 info@nyayahealth.org Bayalpata Hospital, Ridikot VDC
New Haven, CT 06510 http://www.nyayahealth.org Achham, Nepal
Phone: 203-687-8615 http://wiki.nyayahealth.org Phone: 977-94-690-404 (Achham)
Fax: 630-604-8615 http://blog.nyayahealth.org Phone: 977-9845236035(KTM)
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