ANMF and Nyaya Health: Providing free healthcare in the Far West


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ANMF and Nyaya Health: Providing free healthcare in the Far West

  1. 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. 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 Nyaya Health 2009 1
  3. 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 Nyaya Health 2009 2
  4. 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 Nyaya Health 2009 3
  5. 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 Nyaya Health 2009 4
  6. 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 Nyaya Health 2009 5
  7. 7. Achieving Nyaya Health’s Mission in Achham Mission #1: Build Healthcare Infrastructure Mission #2: Develop a Scalable Model Nyaya Health 2009 6
  8. 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 Nyaya Health 2009 7
  9. 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 Nyaya Health 2009 8
  10. 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… Nyaya Health 2009 9
  11. 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 Nyaya Health 2009 10
  12. 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 Nyaya Health 2009 11
  13. 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 Nyaya Health 2009 12
  14. 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 Nyaya Health 2009 13
  15. 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 Nyaya Health 2009 14
  16. 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 Nyaya Health 2009 15
  17. 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 Nyaya Health 2009 16
  18. 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 Nyaya Health 2009 17
  19. 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 Nyaya Health 2009 18
  20. 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 privacy DataManagement Nyaya Health 2009 19
  21. 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 Nyaya Health 2009 20
  22. 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 Nyaya Health 2009 21
  23. 23. Thank You America Nepal Medical Foundation! 135 College St, Suite 323 Bayalpata Hospital, Ridikot VDC New Haven, CT 06510 Achham, Nepal Phone: 203-687-8615 Phone: 977-94-690-404 (Achham) Fax: 630-604-8615 Phone: 977-9845236035(KTM) Nyaya Health 2009 22