Nyaya Health: A public-private partnershipto develop healthcare in rural Nepal<br />JhapatThapa, Medical Director<br />dir...
Who We Are<br />Mission: <br />To expand healthcare capacity in rural Nepal<br />To develop a scalable model of healthcare...
Public-private partnership with Nepali Ministry of Health & Population.
Managed by a volunteer Board of Directors and employed Nepali staff
Over 99% of all funds used directly in Nepal</li></ul>1<br />
Where We Work: Nepal – Achham District, Far Western Region<br />
Where We Work<br />250,000<br />population of Achham<br />0<br />number of allopathic doctors in Achham before Nyaya<br />...
First stage: SanfeBagar Primary Health Center<br />Opened for service April 6, 2008<br />Served over 17,000 patients betwe...
Second stage: Transition to Bayalpata Hospital<br /> The Hospital was constructed by Nepali government 30 years ago but ne...
Current Services: Bayalpata Hospital<br /><ul><li>Services include (all free):
Adult and pediatrics Ambulatory services.
24-hour emergency and obstetric services.
In patient services.
Laboratory & Pharmacy.
Community Health Workers (CHWs)
Ultrasound services.
ART and DOTS clinic
Ambulance services.
Ambulance services.
2010-2011 Expansion:
X-ray service.
Surgical suite  for emergency C- section and general surgery.
Expansion of inpatient and maternity ward.
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Nyaya Waterbury Hospital Presentation

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Dr. Thapa's presentation at the noon conference for attendings and residents.

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  • Good afternoon everybody. My Name is jhapat and today I want to share my experience of working in Rural Nepal.
  • This slide is a brief overview of who Nyaya is, including our two-fold mission and basic stats about the organization An important aspect of the organization is that Nyaya does not pay any expatriate consultants and only employs Nepalis in all work
  • - This slide simply meant to show the audience where Nepal is, and that Nyaya works in the Achham district in Nepal (circled in red)
  • This slide is designed to offer the audience a quick understanding of the poverty of rural Nepal These stats are for the Achham district where Nyaya works. It’s not necessary to discuss all of them, however focusing on a few stats will help the audience understand how poor the district is, and some of the barriers to delivering healthcare. These stats include a large district (250,000 population) with no doctors and nearest health care facilities far away (10-14 hours by bus). Education is very poor (low literacy) and also highlights the disparity between men and women’s access to education. Many women and children die in birth, and the high migration of men to India for work results in a high prevalence of HIV (men working in India will have sex and bring HIV back to their wives in Nepal). Children are unhealthy (60% malnutrition) and the average salary is very low.
  • - This slide summarizes the Sanfe Bagar Primary Health Center, which was Nyaya’s first project in Achham. Nyaya opened the health center in April of 2008, bringing the first doctor to the district and providing completely free care to patients. The clinic operated for 13 months and treated over 17,000 patients, and then in June of 2009 Nyaya moved services to the Bayalpata Hospital in partnership with the Nepali Ministry of Health and Population.
  • After operating the Sanfe Bagar Health Center for a year, Nyaya joined in a partnership with the Nepali Ministry of Health and Population to open the abandoned Bayalpata Hospital, only a few kilometers from Sanfe Bagar. Nyaya’s goals are to develop infrastructure and health care capacity in partnership with the public sector. Nyaya does not seek to develop a parallel health care system and believes strongly that working with the government will ensure sustainable health care system development. As a result, Nyaya focuses on training of health workers and development of infrastructure.Nyaya has signed a 5 year contract with the Ministry after which time the Ministry will assume control of the Hospital During the 5 year period of the contract the Ministry will supply 40% of costs for the Hospital, and Nyaya will provide 60%. All services offered at the hospital are completely free.
  • This slide summarizes the services currently offered at Bayalpata Hospital and our planned expansion over 2010 and 20111. Out patient clinic.2. in patient services 3. Laboratory and pharmacy services 4. emergency and obstetric services 5. ultrasound 6. Ambulance service 7. Community health workers. 8. ART and DOTS clinic.
  • Constructing effective healthcare facilities requires planning and community involvement. COVER POINTS ON SLIDE
  • Human resources form the core backbone of a health system.  Additional point re: physicians: In Nepal, the overall physician: citizen ratio is 1 in 70,000; in Kathmandu, the capital city, that number is 1:5,000. In Achham, prior to the arrival of Nyaya Health, it was 1:500,000
  • COVER POINTS ON SLIDE Additional point re: Continuing medical education (CME): Expatriate physicians and other experts are critical to our CME efforts. Nyaya has established relationships with external universities to improve our overall delivery of care. The broader focus is to build the skills and competencies of the local staff on-site who form the foundation of the Nepali health system.
  • Telecommunications is an integral component to Nyaya&apos;s ability to offer health care services in the rural and impoverished Achham district. Both our clinical and administrative capacities are reliant upon consistent and reliable communication technologies. COVER POINTS ON SLIDE
  • Nyaya Health has all financial information publicly available on our wiki to ensure full transparency. Our team has extensive experience in the non-profit sector, and a key compomnent of Nyaya&apos;s mission is to advocate for increased transparency throughout the global health community. Nyaya&apos;s wiki offers us an easy and readily exportable model to achieve further transparency in this type of work.
  • With expansion of services, shortage of human resourcesResidents can provide training to staff
  • Born and brought up in Darna, Accham a 5 hour walk from Bayalpata HospitalPursued medicine in Eastern Nepal and got involved with Nyaya during 2007 through my senior. Came as the medical director in March 2008. Oversaw clinical services and community health worker programGot the chance to give back to the community I was from.
  • Nyaya Waterbury Hospital Presentation

    1. 1. Nyaya Health: A public-private partnershipto develop healthcare in rural Nepal<br />JhapatThapa, Medical Director<br />director@nyayahealth.org<br />
    2. 2. Who We Are<br />Mission: <br />To expand healthcare capacity in rural Nepal<br />To develop a scalable model of healthcare delivery in resource-poor settings. <br /><ul><li>501(c)(3) organization founded in USA in 2006
    3. 3. Public-private partnership with Nepali Ministry of Health & Population.
    4. 4. Managed by a volunteer Board of Directors and employed Nepali staff
    5. 5. Over 99% of all funds used directly in Nepal</li></ul>1<br />
    6. 6. Where We Work: Nepal – Achham District, Far Western Region<br />
    7. 7. 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 />3<br />
    8. 8. First stage: SanfeBagar 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 />14all-Nepali staff<br />All services completely free<br />
    9. 9. Second stage: Transition to Bayalpata Hospital<br /> The Hospital was constructed by Nepali government 30 years ago but never came into operation<br />Nyaya Health has renovated and opened the services in June 2009 in collaboration with Nepali Ministry of Health.<br />Ministry of Health & Population to take over Bayalpata Hospital in 2014<br />
    10. 10. Current Services: Bayalpata Hospital<br /><ul><li>Services include (all free):
    11. 11. Adult and pediatrics Ambulatory services.
    12. 12. 24-hour emergency and obstetric services.
    13. 13. In patient services.
    14. 14. Laboratory & Pharmacy.
    15. 15. Community Health Workers (CHWs)
    16. 16. Ultrasound services.
    17. 17. ART and DOTS clinic
    18. 18. Ambulance services.
    19. 19. Ambulance services.
    20. 20. 2010-2011 Expansion:
    21. 21. X-ray service.
    22. 22. Surgical suite for emergency C- section and general surgery.
    23. 23. Expansion of inpatient and maternity ward.
    24. 24. Solar energy</li></li></ul><li>Achieving Nyaya Health’s Mission in Achham<br />Mission #1: Build Healthcare Infrastructure<br />Mission #2: Develop a Scalable Model<br />7<br />
    25. 25. Mission #1: Build Healthcare Infrastructure<br />Key components:<br />Needs assessment<br />Clinical Facilities Development<br />Human Resources: Recruitment<br />Human Resources: Continuing Medical Education<br />Telecommunications<br />Reliable energy <br />Clean water<br />8<br />
    26. 26. Building Healthcare Infrastructure: Needs Assessment<br /><ul><li>Needs assessment is a key component of delivering locally effective community-driven healthcare services
    27. 27. Rapid health assessment, 2007
    28. 28. Reviewing clinical service data
    29. 29. Community health worker surveys</li></ul>9<br />
    30. 30. Building Healthcare Infrastructure: Clinical Facilities Development<br />Nyaya Health incorporates principles of social justice and community-driven development into all design processes<br />Facilities designed to enhance patient dignity and healing<br /><ul><li>Nyaya Health staff participate in the process, further developing human resource capacity
    31. 31. Local community members engage in the process through voluntary and paid engagements</li></ul>Sanfe Bagar Health Center: After<br />Sanfe Bagar Health Center: Before<br />10<br />
    32. 32. Building Healthcare Infrastructure: Staff Recruitment<br />Focus on local talent<br />Open, advertised process<br />Structured and qualitative components to the interview<br />Salaries on par with the Nepali government <br />Opportunities for career advancement<br />11<br />
    33. 33. Building Healthcare Infrastructure: Continuing Medical Education <br />Developing new competencies among staff is key to building health systems.<br />Strategies include: <br />Reviewing evidence-based clinical protocols<br />Ultrasound data reviewed by Yale.<br />On-site clinical consultants.<br />Computer literacy<br />12<br />
    34. 34. Building Healthcare Infrastructure: Telecommunications<br />Reliable telecommunications system is central to our ability to deliver:<br /> Quality medical care.<br /> Logistics planning.<br /> Telemedicine.<br /> Fundraising.<br />13<br />
    35. 35. Building Healthcare Infrastructure: Community Health Workers<br /><ul><li>Community health workers play critical roles in ensuring timely access to essential medical care
    36. 36. Effectively deliver care in rural regions with little access to transportation
    37. 37. Provide follow-up care of chronic conditions
    38. 38. Help raise awareness and educate their fellow citizens
    39. 39. Offer continual feedback to Nyaya about community needs and concerns
    40. 40. Phased scale-up of CHW network</li></ul>Outreach<br />Medical adherence support<br />Paramedical services<br />14<br />
    41. 41. Developing a Scalable Model: Nyaya Health Wiki<br /><ul><li>Wiki is an searchable repository of:
    42. 42. Management policies and contracts
    43. 43. Clinical protocols
    44. 44. clinical data
    45. 45. Clinical engineering details
    46. 46. All pages viewable to the public
    47. 47. A forum to share lessons-learned from our patients in Achham with organizations in similar settings around the world</li></ul>http://wiki.nyayahealth.org<br />15<br />
    48. 48. Developing a Scalable Model: Nyaya Health Blog<br /><ul><li>Staff and volunteers write journal-type stories to share and reflect on our programs
    49. 49. Forum for discussing:
    50. 50. Patient cases
    51. 51. Clinical operations details
    52. 52. Organizational challenges and successes
    53. 53. Colleagues throughout the world can use these experiences to guide their own work and provide us with feedback or questions</li></ul>http://blog.nyayahealth.org<br />16<br />
    54. 54. Developing a Scalable Model: Data Monitoring<br /><ul><li>Effective healthcare must be driven by data monitoring and evaluation
    55. 55. Collaboration between Nepal- and US-based data team is critical:
    56. 56. Monthly uploading and analysis
    57. 57. Public access to enhance collaboration and transparency in the global health community
    58. 58. Revision of programmatic design and protocols according to regular data evaluation</li></ul>http://wiki.nyayahealth.org/DataManagement<br />17<br />
    59. 59. Developing a Scalable Model: Financial Transparency<br />Nyaya’s wiki offers ready accessibility to:<br />Line-by-line expenditures<br />Month-by-month budgets summaries<br />Timeline of expenditures<br />Accounts balances<br />Benefits<br />More engaged donors<br />Organizational culture of honesty and openness<br />More effective management<br />http://wiki.nyayahealth.org/Budget<br />18<br />
    60. 60. Nyaya Health – Bayalpata Hospital celebrates 1st Birthday<br /><ul><li>Whole community was invited
    61. 61. Tree planting as a symbol of sustainable development and a green future. </li></li></ul><li>Nyaya Health and Yale New Haven/Waterbury Hospital <br />Started off by Yale Medical Students<br />Several residents from Yale have rotated at Bayalpata Hospital <br />Future program for interested residents to rotate at the hospital. <br />Hospital equipment donation<br />
    62. 62. Nyaya Health – <br />
    63. 63. Thank You! Questions?<br />22<br />

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