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Globe Med Presentation, Dan Schwarz, March 2010
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Globe Med Presentation, Dan Schwarz, March 2010

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This presentation was delivered as one of the "Partnerships in Global Health Equity" workshops at the 2009 GlobeMed Summit (http://www.globemedsummit.org/) on March 6th, 2010.

This presentation was delivered as one of the "Partnerships in Global Health Equity" workshops at the 2009 GlobeMed Summit (http://www.globemedsummit.org/) on March 6th, 2010.

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  • Animate slide so maps show up together, then circles appear kathmandu, everest, achham~450k/ 275 miles (as crow flies) KTM to Achham(do NOT discuss)geography has played an important role in historic socio-politics with the recent civil conflict$65k to climb Everest
  • Ultimately, our goal is to reduce maternal mortality at a population level.  This is expressed commonly as the Maternal Mortality Ratio (MMR), which is a public health outcomes measure that describes the risk of pregnancy in a population.  Its units are deaths per 100,000 live births.  The current best estimate of MMR in Achham is 800.  This is 200x higher than the MMR of 4 in many communities in the United States.   The most precise data on MMR are taken from facilities data.  These, however, are typically not very accurrate since they grossly underestimate MMR in areas such as Achham where only a small number of pregancies actually take place in medical facilities.  In Achham, for example, the number is 0.5%, or 1 in 200.    Greater details regarding the methodology for our mortality assessments are provided on our Mortality Data page.
  • Stress the “success” of being approached by the gov’t for collaboration – this slide should really just be “a few months after opening the clinic, we were approached by the government and local community, and offered to join in a public-private partnership to re-open the Bayalpata HospitalBridge to next slide where meat of the discussion is (with text bullets)
  • Stress the importance of our philosophy in how we approach our work
  • After discussing importance of transitioning to Bayalpata, this should be a quick overview of basic services
  • This slide is an outline of the aspects of Mission #2 Developing a Scalable Model we will now discuss.
  • Background:Historic lack of transparency and collaboration between non-profits, especially in health field2008 Global Accountability Report revealed that many non-profits scored even worse than for-profit multinational corporations on accountability metrics1Implications: Lack of transparency decreases accountability and results in missed opportunities for collaborationParticularly in the health sector, collaboration is needed to develop best practicesTransparency can facilitate accountability and collaboration in health delivery
  • Transcript

    • 1. The challenges of transparency, accountability, and collaboration in global health
      Dan SchwarzExecutive Director | Nyaya Health
      dan@nyayahealth.org
    • 2. Outline of Presentation
      Nyaya Health Overview
      Developing a scalable model for health care delivery
      1
    • 3. Nyaya Health: Who We Are
      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
      • 4. Public-private partnership with Nepali Ministry of Health & Population (2009)
      • 5. Managed by a volunteer Board of Directors and 26 full-time employed Nepali staff
      • 6. Over 99% of all funds used directly in Nepal
      2
    • 7. Where We Work: Nepal – Achham District, Far Western Region
    • 8. Where We Work
      250,000
      population of Achham
      0
      number of allopathic doctors in Achham before Nyaya
      10+
      hours in bus to reach the nearest airport and operating room
      14
      hours in bus to reach the nearest intensive care unit
      6% & 54%
      Female and male literacy rates, respectively
      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
      99.5%
      of babies are born in homes and cattle sheds
      50¢
      average daily per capita income in Achham
      60%
      60%
      of children are chronically malnourished
      4
    • 9. Achham District, Far Western Region, Nepal
    • 10. History: Sanfe Bagar Primary Health Center
      6
    • 11. 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
    • 12. History: Transition to Bayalpata Hospital
      8
    • 13. 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
    • 14. Current Services: Bayalpata Hospital
      • Services include (all free):
      • 15. Inpatient & Outpatient services
      • 16. 24-hour emergency and obstetric services
      • 17. Laboratory & Pharmacy
      • 18. Community Health Workers (CHWs)
      • 19. Clean water supply for surrounding communities
      • 20. 2010-2011 Expansion:
      • 21. Surgical suite
      • 22. X-Ray Services
      • 23. Expanded CHW network
      • 24. Solar energy
    • Outline: Developing a scalable model of health care delivery
      Background: accountability, transparency and collaboration
      Health sector approaches to collaboration
      Nyaya’s Approach
      Case example: Tiyatien Health
      Challenges
    • 25. Background: Importance of transparency, accountability, collaboration
      Questions:
      What are best practices for health care delivery in resource-poor settings?
      How can NGO’s ensure accountability to stakeholders in global health delivery?
      Background:
      Historic lack of transparency and collaboration between NGO’s, especially in health
      2008 Global Accountability Report (One World Trust) revealed that many non-profits scored even worse than for-profit multinational corporations
      Implications:
      Lack of transparency decreases accountability and misses opportunities for collaboration
      Particularly in health sector, collaboration is needed to develop best practices
      Transparency, accountability and collaboration can aid the development of a scalable model for health delivery
    • 26. Attributes of a scalable model of healthcare delivery
      Transparency
      Collaboration
      Accountability
    • 27. Take-home message
      A lack of transparency not only reduces the accountability of individual programs, it also misses an opportunity to advance global health delivery by establishing best practices in the field and collaboration between partners in these efforts to create best practices.
    • 28. Nyaya’s Approach to transparency, accountability, & collaboration
      • Data-driven health care delivery
      • 29. Clinical, financial and managerial
      • 30. Open-access data fostering:
      • 31. inter-team communication, and
      • 32. collaboration with global health delivery community
      • 33. Fully transparency aimed at accountability to stakeholders
      • 34. Patients, public sector, partner org’s
    • Nyaya Health: Wiki
      • Wiki is a searchable repository of:
      • 35. Management policies
      • 36. Financial data
      • 37. Clinical protocols
      • 38. De-identified clinical data
      • 39. All pages viewable to the public
      • 40. A forum to share lessons-learned from Achham with organizations in similar settings around the world
      • 41. Opportunity for critical feedback and collaboration
      http://wiki.nyayahealth.org
    • 42. Nyaya Health: Inter-team communication
      Intra-team communication
      • Nyaya is a collaboration between Nyaya Health INGO (USA) and Nyaya Health Nepal (Nepal)
      • 43. Fluid communication is critical to a collaborative model
      • 44. Nyaya uses low-bandwidth, user-friendly, open-access, free technologies to communicate and facilitate work among team members
      Gmail Archive
      Google Docs
      EverNote
    • 45. Challenges and barriers to effective communication
      Two locales & two teams
      Discontinuous communication
      Details of day-to-day life lacking
      Context for decision-making lacking
      Uncomfortable tensions:
      Micro-management vs. “hands-off” approach
      Empowerment vs. “letting go” of control
      Deferral to local authority
      …An imperfect system
    • 46. Communication challenges
      Nyaya is a collaboration between Nyaya Health INGO (USA) and Nyaya Health Nepal (Nepal)
      Fluid communication to facilitate inter-team collaboration is critical to model
      Nyaya uses low-bandwidth, user-friendly, open-access technologies to communicate among team members
    • 47. Current approaches to collaboration in health delivery
      • Recent initiatives have utilized online communities to enhance collaboration among global health practitioners
      • 48. Initiatives aimed at enhancing collaboration to facilitate development of sector-wide best practices
    • Building a scalable model: Tiyatien Health
    • 49. Collaboration with partner organizations: Tiyatien Health
      Case Study in Collaboration: Tiyatien Health
      • TH: similar organization in Liberia
      • 50. TH and NH face similar challenges in effective health delivery practices
      • 51. Via transparent operations and inter-team collaboration, TH and NH have been able to enhance work in both Liberia and Nepal
      • 52. Successful collaborations including:
      • 53. Financial accounting protocols
      • 54. Pharmacy and inventory management
      • 55. Fundraising strategies
    • Limitations of model
      Such tools do not replace local, community-level transparency and accountability structures, especially in resource-poor settings
      Need for CABs, CHWs, partnerships w/ regional stakeholders
      Model is not accessible to our patients and staff due to poverty and illiteracy
      Model requires internet technologies, not available in many settings
      High amount of start-up and maintenance capital ($)
      M&E dependent on epidemiological and data management experience
      Difficult skill set to recruit in many settings
      “Evidence-based medicine” is a pedagogical culture not shared by all health care systems/practitioners
      Need for education, training and incentives for staff
    • 56. Thank You… Questions?
      24

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