Gm 2011 032711

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  • Friday, 915-1030: Global Health at the Grassroots:In this session participants will understand how the communities we work with are mobilizing for the larger movement for global health equity. An emphasis will be placed on exploring the advantages and opportunities for growth between our partner organizations and our chapters. Timeline: Mark for 15m, Ryan for 15-20m, 30m for q&a
  • - Begin talk w/ visceral story to get their interest; transition from this slide in to the outline slide where we give general overview. Then mark talks about achham’s changes, and ryan then discusses NH’s changed
  • Identify where Achham is, and point out that most development, funding, tourism is in the KTM valley/east of the country – i.e. NOT the FW. Can also mention Achham (FW generally) was epicenter of Maoist conflict => even more destitution. Don’t spend more than 90 secs on this slide though, our goal is not to give a history of Nepal heheDon’t talk much about Achham in detail on this slide as you will give stats and more depth on slides 6 and 7 – contextualize Achham here, explain it later
  • This slide should be a 2-minute deeper articulation of NH’s mission (expanding from slide #3) but again will only scratch the surface. Think elevator pitch for slide #3, and elevator gets stuck for 2 extra minutes for this slide ;)
  • Goal of slides 6-8 is to offer audience an understanding of where we work and what changes/progress we’ve seen there over the last 5 years. Slides 6 & 7 will offer general numbers, divided into People and Infrastructure, with slide 8 offering a summary of where we are in 2011.
  • “ICU” = intensive care unit (we should spell this out for the college audience as many people likely won’t know what that is)
  • (Mark’s last slide)Thesis of first section is that this is not something that is a short-term project, not something that can be handled by a quick in-and-out NGO org – need sustainability and long-term approach (as a lead-in to discussing the changing of the INGO structure AVO => professionalizing). While we’ve seen some changes, to see real change we need to think about long-term work.Use as transition into Ryan discussing NH as evolving from an AVO to a professional org
  • (Ryan takes over on this slide)Frame this next part of the talk as offering the audience a look into how NH as an org has evolved and adapted to the needs of Achham – as we worked more it became obvious that the need was enormous and an AVO simply wasn’t enough to develop a truly local, long-term, sustainable solution to healthcare. more infrastructure/reliability/consistency was needed on the US side (in addition to the increasing capacity in Achham). This section will talk about that evolution as NH has just recently gone through (continues to go through) as we believe the lessons we’ve learned as an org offer are relevant for GM students to consider their role in the gh movementAfter framing this section of the talk (as above) this slide is a quick history of NH’s inception, setting the stage to discuss evolution
  • Ryan rants about pros/cons of AVO model highlighting HR in USA as limiting factor for organizational work
  • As written on slide – a discussion of what we learned and why we decided to hire full-time ED and move towards a more centralized team structure
  • Point of this slide is to begin to discuss the importance of back-office work and that orgs must have advocates AND implementers, and not all the work that is required for GHD is the “sexy” work on the groundPic of the staff to highlight that after a few years we have a whole team of people who know Achham better than we do, but they do not have access to the resources we do to build a health system for Achham. We’re starting to get the local HR and infrastructure, but in order to make this long-term we have to transition from a mindset of daily operations management to an Advisory Board that spends more of its time bringing resources to bear and guiding the organization at a 20k feet level
  • Point of this slide is delve deeper into the challenges of redefining our roles, and also the great benefits we can gain by doing soPoint generally that these slides are aimed at highlighting (next slide) is that it takes all types to do GHD work and we cannot forget or ignore the critical importance of advocates pounding the pavement and making possible what goes on on the ground
  • Theme of conference is leveraging history to build a movement including civil rights, lgbtq, etc –note that NH’s experience is a lesson in history to offer perspective for the development of the movement and the importance of advocatesin that movementAs Nyaya grew it became increasingly irresponsible/impossible to meet the challenges we needed to for our patients without creating more structure and reliability for our team to leverage advisory and collaborative opportunities=> students/activists like GM chapters are uniquely positioned to be advocates in a field that desperately needs them
  • Gm 2011 032711

    1. 1. Nyaya five years on:Finding our role in the movement<br /> Mark Arnoldy, Executive Director&Ryan Schwarz, VP of US Operations<br />
    2. 2. 2006<br />“…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… 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 <br />Nyaya Co-Founder 3/12/2006<br />
    3. 3. Outline of Presentation<br />Nyaya Health introduction <br />Achham: 2006-2011 <br />Nyaya: 2006-2011 <br />Reflections on building the movement <br />
    4. 4. Nyaya Health: Who We Are<br />Social justice-oriented mission: <br />To provide free community-based healthcare in rural Nepal that strengthens the public sector<br />To develop and disseminate effective strategies of health delivery in resource-poor settings throughout the world<br /><ul><li>Founded in 2005; public-private partnership with Nepali Ministry of Health & Population in 2009
    5. 5. Partners In Health (PIH) Partner Project
    6. 6. Nyaya Team:
    7. 7. 27 full-time employed Nepali staff + ~50 CHWs
    8. 8. 1 full-time US-based Executive Director
    9. 9. Volunteer Executive Team, Board of Directors and Board of Advisors</li></li></ul><li>Where We Work: Nepal – Achham District, Far Western Region<br />
    10. 10. Nyaya Health: Mission and operations<br />Goal: infrastructure development, capacity building, not only care provision<br />Goal: collaborate with the government in development of pro-poor, rural health care<br />Government partnership contract for 5 years June, 2009 – June, 2014<br />
    11. 11. Achham: People<br />~270,000 people<br />99.6% Hindu<br />60% agricultural<br />>80% of men migrate to India, and 35% of families rely on remittances from India <br />33% literate: 54% men, 14% of women<br /><$1USD is daily per capita income<br />
    12. 12. Achham: Infrastructure<br />2006:<br />>90% of houses have did not have electricity<br />45% had access to clean water – 2.5x worse than national average<br />Hydroelectric plant functioning <50% capacity<br />Extremely limited landline telephone capacity, one cell phone tower<br />Paved road ended in SanfeBagar<br />Airport destroyed during war<br />Hospital 5 hours, surgery 6 hours, ICU 14 hours<br />
    13. 13. Achham: Progress and challenges, 2006-2011<br /> Progress Continued Challenges<br />0 => 4 doctors & enhanced services <br />Increased health spending per capita ($5) (USA = ~$6,956 in 2007)<br />Road has been extended ~ 5 miles<br />Further development post-war<br />Landline phones a little more common, cell reception a bit better<br />Other statistics difficult to predict due to lack of good data<br />Lack of development relative to country<br />Roads dismal and dangerous, no airport<br />Continually limited electricity<br />Still > 6 hours for surgery, >14h to ICU<br />MMR: ?600-600? vs 251 Nepal avgvs 17 in USA (per 100,000)<br />HIV burden ?highest? in country<br />A long way to go…<br />
    14. 14. Nyaya’s founding and the “all-volunteer” organization (AVO)<br />Founded by students and residents<br />Ability to leverage resources for resource-poor settings<br />No high-paid NGO consultants; instead a “lean, nimble and innovative” volunteer model<br />Full-time Nepali staff (locally hired when possible; >80%)<br />“Part-time” volunteer USA staff – “All-volunteer organizational” model<br />
    15. 15. Benefits & limitations of the AVO model<br />PROS CONS<br />Pragmatic <br />“sexy” work vs “grunt” work<br />“sin wave” model of reliability<br />lack of centralized structure<br />no accountability<br />limited (no) expertise<br />Weakness: HR = limiting factor<br />Pragmatic <br />no one else working in Achham<br />no money to hire anyone<br />harness student excitement for GH<br />>99% funds to programs<br />Philosophic <br />volunteers > high-paid consultants<br />Strength: innovative use of HR<br />
    16. 16. Lessons-learned and transitioning to a professional organization<br />HR outside of Achham became a limitation to expansion of our work in Achham (funding in particular)<br />We lacked:<br />Reliability in operations, capacity for opportunities, and funding<br />Infrastructure to obtain enhanced advisory capacity – “we are supremely unqualified to do this work”<br />Infrastructure to expand partnerships and enhance effectiveness<br />We need to professionalize – providing healthcare for hundreds of thousands of people is not a part-time job<br /> AVO model<br />
    17. 17. Lessons learned: “Managing Board” to “Advisory Board”<br />Goal: “to create a long-term and sustainable solution to health delivery in Nepal” requires:<br /><ul><li>local HR and local infrastructure
    18. 18. need for expanded networking, fundraising, partnership development
    19. 19. less need for day-to-day on-the-ground operations management transition from “Managing Board” to “Advisory Board”</li></li></ul><li>Challenges of organizational change:<br />“Founder’s Curse” – inability to let go<br />“Sexy” vs “grunt” work (field vs back-office)<br />Impact of organizational change:<br />Reliability and consistency <br />Budget $160k (2010)  $400k (2011)<br />Enhanced networking and partnership opportunities for improved operations<br />Realization of local solutions to health delivery <br />Utilization of diaspora and expatriate team to leverage resources to Achham<br />Lessons learned: “Managing Board” to “Advisory Board”<br />
    20. 20. Reflections – finding our place in the movement<br />Critical role for volunteers in the movement, and an equally critical role for us to recognize our limitations<br />Students and activists can access resources our colleagues in resource-poor settings cannot<br />As leaders of the movement we need to be cognizant of where we can add value – sometimes that is in the field, sometimes in the back-office<br />Grassroots work relies on both advocates and implementers<br />
    21. 21. We can do better for our patients.<br />
    22. 22. …thoughts, questions, concerns, feedback?<br />

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