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

1. Telemedicine as Collaborative Medicine:The Case for Global Health Delivery 2.0 in Rural Nepal Sushant Wagley | Nyaya Health sushant@nyayahealth.org America Nepal Medical Foundation, Annual Conference 2010Flagstaff, Arizona

2. Outline of Presentation Achham and Nyaya Health Telemedicine as collaborative medicine: connecting ideas to impact lives, fight disease, and train clinicians 1

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 NepalMission: To expand healthcare capacity in rural Nepal To develop a scalable model of healthcare delivery in resource-poor settings throughout the world 2

7. Achham District, Far Western Region, Nepal

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. 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

10. History: Transition to Bayalpata Hospital 6

11. History: Transition to Bayalpata Hospital Goal: infrastructure development, capacity building 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

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. X-Ray Services

20. Surgical suite

21. Expanded CHW network

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. 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

28. Telemedicine: Technological Platform for Global Health Delivery

29. Wiki

30. Aggregate Patient Database

32. Management policies

33. Clinical & operational protocols

34. Financial data

35. Changes to the wiki seen immediatelyPromote real-time collaboration on programs as they evolve to meet the changing needs of communities

36. Nyaya Health: Wiki

38. Tables, charts and graphs of classical epidemiological indicators

39. Social indicators to evaluate social equity of our programs

40. Outcomes data necessary monitoring and evaluation of global health delivery programs

43. TH and NH face similar challenges in effective health delivery practices

44. Via transparent operations and inter-team collaboration, TH and NH have been able to enhance work in both Liberia and Nepal

45. Successful collaborations including:

46. Financial accounting protocols

47. Pharmacy and inventory management

49. Thank You… Questions? 19