Nyaya Health at ANMF 2010 Conference: Telemedicine

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Nyaya Health presents on Nyaya's experience with telemedicine at ANMF 2010 conference at Flagstaff, AZ.

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Nyaya Health at ANMF 2010 Conference: Telemedicine

  1. 1. Telemedicine as Collaborative Medicine:The Case for Global Health Delivery 2.0 in Rural Nepal<br />Sushant Wagley | Nyaya Health<br />sushant@nyayahealth.org<br />America Nepal Medical Foundation, Annual Conference 2010Flagstaff, Arizona <br />
  2. 2. Outline of Presentation<br /> Achham and Nyaya Health<br /> Telemedicine as collaborative medicine: connecting ideas to impact lives, fight disease, and train clinicians<br />1<br />
  3. 3. Nyaya Health: Who We Are<br /><ul><li>501(c)(3) organization founded in 2006
  4. 4. Public-private partnership with Nepali Ministry of Health & Population (2009)
  5. 5. Managed by a volunteer Board of Directors and 26 full-time employed Nepali staff
  6. 6. Over 99% of all funds used directly in Nepal</li></ul>Mission: <br />To expand healthcare capacity in rural Nepal<br />To develop a scalable model of healthcare delivery in resource-poor settings throughout the world<br />2<br />
  7. 7. Achham District, Far Western Region, Nepal<br />
  8. 8. Where We Work<br />250,000<br />population of Achham<br />0<br />number of allopathic doctors in Achham before Nyaya<br />10+<br />hours in bus to reach the nearest airport and operating room<br />14<br />hours in bus to reach the nearest intensive care unit<br />6% & 54%<br />Female and male literacy rates, respectively<br />1 in 125<br />deliveries results in the mother’s death<br />64<br />number of stillborns for every 1,000 live births<br />50%<br />of men migrate to India for work; over 7% return with HIV<br />99.5%<br />of babies are born in homes and cattle sheds<br />50¢<br />average daily per capita income in Achham<br />60%<br />60%<br />of children are chronically malnourished<br />4<br />
  9. 9. History: Sanfe Bagar Primary Health Center<br />Opened for service April 6, 2008<br />Served over 17,000 patients between April ’08 and May ‘09<br />Services included:<br />Outpatient department<br />24 hour emergency services<br />Maternity suite with 24 hour-obstetric services<br />Diagnostic laboratory<br />Pharmacy<br />23 all-Nepali staff<br />All services completely free<br />
  10. 10. History: Transition to Bayalpata Hospital<br />6<br />
  11. 11. History: Transition to Bayalpata Hospital<br />Goal: infrastructure development, capacity building<br />Goal: to collaborate with the government in the development of pro-poor, rural health care development<br />Government contract for 5 years signed June 2009 – June 2014<br />Ministry of Health & Population to take over Bayalpata Hospital in 2014<br />
  12. 12. Current Services: Bayalpata Hospital<br /><ul><li>Services include (all free):
  13. 13. Inpatient & Outpatient services
  14. 14. 24-hour emergency and obstetric services
  15. 15. Laboratory & Pharmacy
  16. 16. Community Health Workers (CHWs)
  17. 17. Clean water supply for surrounding communities
  18. 18. 2010-2011 Expansion:
  19. 19. X-Ray Services
  20. 20. Surgical suite
  21. 21. Expanded CHW network
  22. 22. And to harness Solar energy for the hospital energy system </li></li></ul><li>Outline: Developing a Scalable Model of Healthcare Delivery<br />Nyaya’s Telemedicine Program: Connecting Ideas Globally for Collaborative Work<br />Telemedicine: Nyaya’s strategies for Global Health Delivery 2.0<br />Case example: Tiyatien Health <br />Challenges faced by Nyaya<br />
  23. 23. Telemedicine as Collaborative Medicine: Nyaya’s Approach<br /><ul><li>Telemedicine is not just about transmitting images or patient data to remote clinicians and experts
  24. 24. For Nyaya Health, it is more fundamentally about the desire to connect, to reach across oceans to impact lives, to fight disease and to train clinicians
  25. 25. Using telemedicine to build a broad-based social movement: utilizing simple, free, open-source technology to meaningfully engage professionals who want to contribute but cannot be based in Achham
  26. 26. Nyaya Health’s Data Program</li></li></ul><li>Telemedicine: Connecting Ideas Globally for Collaborative Work <br /><ul><li>Recent initiatives have utilized online communities to enhance collaboration among global health practitioners
  27. 27. Initiatives aimed at enhancing collaboration to facilitate development of sector-wide best practices</li></li></ul><li>Nyaya’s Approach to Telemedicine: Global Health Delivery 2.0<br /><ul><li>Using simple, free, open-source technologies, Nyaya Health’s telemedicine program aims to promote collaboration, improve transparency, receive critical commentary from outside experts and compare approaches for global health delivery – e.g. (organizing budgets, pharmaceutical procurement, medical treatment protocols, and public health programs)
  28. 28. Telemedicine: Technological Platform for Global Health Delivery
  29. 29. Wiki
  30. 30. Aggregate Patient Database
  31. 31. Blog</li></li></ul><li>Nyaya’s Approach to Telemedicine: Technological Platform<br />Nyaya Health Wiki – http://wiki.nyayahealth.org<br />Open-access portal of protocols and data describing health care delivery programs<br />Nyaya’s Wiki is a publicly accessible repository of:<br /><ul><li>De-identified clinical data
  32. 32. Management policies
  33. 33. Clinical & operational protocols
  34. 34. Financial data
  35. 35. Changes to the wiki seen immediately</li></ul>Promote real-time collaboration on programs as they evolve to meet the changing needs of communities<br />
  36. 36. Nyaya Health: Wiki<br />
  37. 37. Nyaya’s Approach to Telemedicine: Technological Platform<br />Aggregate Patient Database – http://wiki.nyayahealth.org/PharmacyData<br />De-identified, up-to-date aggregate patient data<br /><ul><li>Nyaya’s Database includes a publicly accessible repository of:
  38. 38. Tables, charts and graphs of classical epidemiological indicators
  39. 39. Social indicators to evaluate social equity of our programs
  40. 40. Outcomes data necessary monitoring and evaluation of global health delivery programs
  41. 41. Aim to improve organizational accountability andfacilitate research and collaboration on strategies for developing patient care protocols</li></li></ul><li>Nyaya’s Approach to Telemedicine: Technological Platform<br />Blog– http://blog.nyayahealth.org<br />Forum for discussing relevant de-identified patient cases, clinical operations details, and organizational challenges and successes <br />Other colleagues involved in global health delivery can use these experiences to guide their own work or provide feedback with useful suggestions for improvement to Nyaya Health <br />
  42. 42. Collaboration with partner organizations: Tiyatien Health<br />Case Study in Collaboration: Tiyatien Health<br /><ul><li>TH: similar organization in Liberia
  43. 43. TH and NH face similar challenges in effective health delivery practices
  44. 44. Via transparent operations and inter-team collaboration, TH and NH have been able to enhance work in both Liberia and Nepal
  45. 45. Successful collaborations including:
  46. 46. Financial accounting protocols
  47. 47. Pharmacy and inventory management
  48. 48. Fundraising strategies</li></li></ul><li>Challenges faced by Nyaya Health<br />Transition to Bayalpata Hospital<br />Logistical overload  Temporary halting of Data Program<br />Unreliable supply of electricity<br />Constant “load-shedding” (scheduled power cuts by the government)<br />No electricity  No internet<br />Electronic data input vs. standardized government paper recording system<br />Low computer literacy among staff<br />Time needed to complete paperwork<br />Staff training<br />Lack of a Monitoring and Evaluation<br />Lack of skill set and training programs<br />Lack of financial resources and successful models<br />
  49. 49. Thank You… Questions?<br />19<br />

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