Hsph saso presentation, dan schwarz, april 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


  • 1. Developing a health system:The case of Nyaya Health in rural Nepal
    Dan SchwarzExecutive Director | Nyaya Health
  • 2. Nyaya Health: Who We Are
    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
    • 3. Public-private partnership with Nepali Ministry of Health & Population (2009)
    • 4. Managed by a volunteer Board of Directors and 26 full-time employed Nepali staff
    • 5. Over 99% of all funds used directly in Nepal
  • 6. Where We Work: Nepal – Achham District, Far Western Region
  • 7. Where We Work
    population of Achham
    number of allopathic doctors in Achham before Nyaya
    hours in bus to reach the nearest airport and operating room
    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
    number of stillborns for every 1,000 live births
    of men migrate to India for work; over 7% return with HIV
    of babies are born in homes and cattle sheds
    average daily per capita income in Achham
    of children are chronically malnourished
  • 8. Achham district, Far West Region, Nepal
  • 9. 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
    23 all-Nepali staff
    All services completely free
  • 10. History: Transition to Bayalpata Hospital
  • 11. History: Transition to Bayalpata Hospital
    Goal: infrastructure development, capacity building, not just 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
  • 12. Current Services: Bayalpata Hospital
    • Services include (all free):
    • 13. Inpatient & Outpatient services
    • 14. 24-hour emergency and obstetric services
    • 15. Laboratory & Pharmacy
    • 16. Community Health Workers (CHWs)
    • 17. Clean water supply for surrounding communities
    • 18. 2010-2011 Expansion:
    • 19. Surgical suite
    • 20. X-Ray Services
    • 21. Expanded CHW network
    • 22. Solar energy
  • Nyaya’s approach to transparency, accountability, & collaboration
    • Data-driven health care delivery
    • 23. Clinical, financial, and managerial
    • 24. Nyaya’s wiki: http://wiki.nyayahealth.org
    • 25. Open-access data fostering transparency of operations:
    • 26. Improves the accountability of individual organizations to stakeholders
    • 27. The 3P’s of accountability: Patients, Public sector, Partner organizations
    • 28. Opportunities for inter-organizational collaboration
  • Nyaya Health: Wiki
    • Wiki is a searchable repository of:
    • 29. Management policies
    • 30. Financial data
    • 31. Clinical protocols
    • 32. De-identified clinical data
    • 33. All pages viewable to the public
    • 34. A forum to share lessons-learned from Achham with organizations in similar settings around the world
    • 35. Opportunity for critical feedback and collaborationhttp://wiki.nyayahealth.org
  • Moving forward – the future
    Key challenges:
    Human resources
    Supply chain management
    Energy systems & telecommunications
    Community relationships, outreach (CHWs)
    Public sector relationships
  • 36. Thank You… Questions?