"How to Start a Hospital" Nyaya Health Presented by: Bibhav Acharya, Executive Vice-President April 15, 2011

1. NYAYA HEALTH: WORKING FOR HEALTH EQUITY IN
RURAL NEPAL
Bibhav Acharya, Execu8ve Vice‐President
bibhav@nyayahealth.org
April 15, 2011
Yale University
Nyaya Health 2011

2. Outline
 Introduc8on to Nepal and Achham
 Birth of Nyaya Health
 Key features of the NGO
 Current services provided by Bayalpata Hospital
 Next Steps
 GeOng involved
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3. Where is Nepal?
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4. Where is Nepal?
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5. Where is Nepal?
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6. Nepal: Key sta4s4cs
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7. Nepal: Key sta4s4cs
• Per Capita GDP (PPP): $1100 (169/182)
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8. Nepal: Key sta4s4cs
• Per Capita GDP (PPP): $1100 (169/182)
• Life expectancy: 59.8 yrs (male: 60.9, female: 59.5)
Nyaya Health 2011 5

9. Nepal: Key sta4s4cs
• Per Capita GDP (PPP): $1100 (169/182)
• Life expectancy: 59.8 yrs (male: 60.9, female: 59.5)
• Fer8lity rate: 4 children/women
Nyaya Health 2011 5

10. Nepal: Key sta4s4cs
• Per Capita GDP (PPP): $1100 (169/182)
• Life expectancy: 59.8 yrs (male: 60.9, female: 59.5)
• Fer8lity rate: 4 children/women
• Literacy rate: 48.6% (male: 62.7%, female: 34.9%)
Nyaya Health 2011 5

11. Nepal: Key sta4s4cs
• Per Capita GDP (PPP): $1100 (169/182)
• Life expectancy: 59.8 yrs (male: 60.9, female: 59.5)
• Fer8lity rate: 4 children/women
• Literacy rate: 48.6% (male: 62.7%, female: 34.9%)
• Number one cause of death of women aged 15‐50: Suicide
Nyaya Health 2011 5

12. Nepal: Key sta4s4cs
• Per Capita GDP (PPP): $1100 (169/182)
• Life expectancy: 59.8 yrs (male: 60.9, female: 59.5)
• Fer8lity rate: 4 children/women
• Literacy rate: 48.6% (male: 62.7%, female: 34.9%)
• Number one cause of death of women aged 15‐50: Suicide
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13. Nyaya Health 2011 6

14. West in the middle?
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15. West in the middle?
Kathmandu
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16. West in the middle?
Kathmandu
Achham
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17. Achham
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18. Achham
250,000 popula8on of Achham
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19. Achham
250,000 popula8on of Achham
0 allopathic doctors before Nyaya
>80% of healthcare from private prac88oners
Nyaya Health 2011 7

20. Achham
250,000 popula8on of Achham
0 allopathic doctors before Nyaya
>80% of healthcare from private prac88oners
2 allopathic doctors hired by Nyaya
Nyaya Health 2011 7

21. Achham
250,000 popula8on of Achham
0 allopathic doctors before Nyaya
>80% of healthcare from private prac88oners
2 allopathic doctors hired by Nyaya
12 Hours to nearest airport and opera8ng room
Nyaya Health 2011 7

22. Achham
250,000 popula8on of Achham
0 allopathic doctors before Nyaya
>80% of healthcare from private prac88oners
2 allopathic doctors hired by Nyaya
12 Hours to nearest airport and opera8ng room
16 hours to nearest ICU
Nyaya Health 2011 7

23. Achham
250,000 popula8on of Achham
0 allopathic doctors before Nyaya
>80% of healthcare from private prac88oners
2 allopathic doctors hired by Nyaya
12 Hours to nearest airport and opera8ng room
16 hours to nearest ICU
1 in 125 deliveries results in the mother’s death
Nyaya Health 2011 7

24. Achham
250,000 popula8on of Achham
0 allopathic doctors before Nyaya
>80% of healthcare from private prac88oners
2 allopathic doctors hired by Nyaya
12 Hours to nearest airport and opera8ng room
16 hours to nearest ICU
1 in 125 deliveries results in the mother’s death
90% of deliveries in homes and ca`le sheds
Nyaya Health 2011 7

25. Achham
250,000 popula8on of Achham
0 allopathic doctors before Nyaya
>80% of healthcare from private prac88oners
2 allopathic doctors hired by Nyaya
12 Hours to nearest airport and opera8ng room
16 hours to nearest ICU
1 in 125 deliveries results in the mother’s death
90% of deliveries in homes and ca`le sheds
60% of children are chronically malnourished
Nyaya Health 2011 7

26. Achham
250,000 popula8on of Achham
0 allopathic doctors before Nyaya
>80% of healthcare from private prac88oners
2 allopathic doctors hired by Nyaya
12 Hours to nearest airport and opera8ng room
16 hours to nearest ICU
1 in 125 deliveries results in the mother’s death
90% of deliveries in homes and ca`le sheds
60% of children are chronically malnourished
50¢ average daily per capita income in Achham
Nyaya Health 2011 7

27. Achham
250,000 popula8on of Achham
0 allopathic doctors before Nyaya
>80% of healthcare from private prac88oners
2 allopathic doctors hired by Nyaya
12 Hours to nearest airport and opera8ng room
16 hours to nearest ICU
1 in 125 deliveries results in the mother’s death
90% of deliveries in homes and ca`le sheds
60% of children are chronically malnourished
50¢ average daily per capita income in Achham
50% of men migrate to India for work;
Nyaya Health 2011 7

28. Achham
250,000 popula8on of Achham
0 allopathic doctors before Nyaya
>80% of healthcare from private prac88oners
2 allopathic doctors hired by Nyaya
12 Hours to nearest airport and opera8ng room
16 hours to nearest ICU
1 in 125 deliveries results in the mother’s death
90% of deliveries in homes and ca`le sheds
60% of children are chronically malnourished
50¢ average daily per capita income in Achham
50% of men migrate to India for work;
over 7% return with HIV
Nyaya Health 2011 7

29. Outline
 Relevant health sta8s8cs of Nepal and Achham
 Birth of Nyaya Health
 Current services provided by Bayalpata Hospital
 Key features of the NGO
 Next Steps
 GeOng Involved
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30. Birth of Nyaya Health
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31. Sanfebagar Primary Health Center
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32. Sanfebagar Primary Health Center
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33. Bayalpata Hospital
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34. Bayalpata Hospital
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35. Bayalpata Hospital: Then and Now
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36. Bayalpata Hospital: Then and Now
*No water buffaloes were harmed
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37. Bayalpata Hospital: Then and Now
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38. Bayalpata Hospital: Then and Now
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39. Outline
 Relevant health sta8s8cs of Nepal and Achham
 Birth of Nyaya Health
 Current services provided by Bayalpata Hospital
 Key features of the NGO
 Next Steps
 GeOng Involved
Nyaya Health 2011 15

40. Bayalpata Hospital: Current Services
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41. Bayalpata Hospital: Current Services
 Outpa8ent department
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42. Bayalpata Hospital: Current Services
 Outpa8ent department
 24‐hour emergency services
Nyaya Health 2011 16

43. Bayalpata Hospital: Current Services
 Outpa8ent department
 24‐hour emergency services
 24‐hour birthing center
Nyaya Health 2011 16

44. Bayalpata Hospital: Current Services
 Outpa8ent department
 24‐hour emergency services
 24‐hour birthing center
 15‐bed Inpa8ent ward
Nyaya Health 2011 16

45. Bayalpata Hospital: Current Services
 Outpa8ent department
 24‐hour emergency services
 24‐hour birthing center
 15‐bed Inpa8ent ward
 Laboratory with point of care
tests
Nyaya Health 2011 16

46. Bayalpata Hospital: Current Services
 Outpa8ent department
 24‐hour emergency services
 24‐hour birthing center
 15‐bed Inpa8ent ward
 Laboratory with point of care
tests
 Tes8ng and treatment for HIV,
tuberculosis, and malnutri8on
Nyaya Health 2011 16

47. Bayalpata Hospital: Current Services
 Outpa8ent department
 24‐hour emergency services
 24‐hour birthing center
 15‐bed Inpa8ent ward
 Laboratory with point of care
tests
 Tes8ng and treatment for HIV,
tuberculosis, and malnutri8on
 In‐house pharmacy
Nyaya Health 2011 16

48. Bayalpata Hospital: Current Services
 Outpa8ent department
 24‐hour emergency services
 24‐hour birthing center
 15‐bed Inpa8ent ward
 Laboratory with point of care
tests
 Tes8ng and treatment for HIV,
tuberculosis, and malnutri8on
 In‐house pharmacy
 Ambulance service
Nyaya Health 2011 16

49. Bayalpata Hospital: Current Services
 Outpa8ent department
 24‐hour emergency services
 24‐hour birthing center
 15‐bed Inpa8ent ward
 Laboratory with point of care
tests
 Tes8ng and treatment for HIV,
tuberculosis, and malnutri8on
 In‐house pharmacy
 Ambulance service
 X‐ray
Nyaya Health 2011 16

50. Bayalpata Hospital: Current Services
 Outpa8ent department
 24‐hour emergency services
 24‐hour birthing center
 15‐bed Inpa8ent ward
 Laboratory with point of care
tests
 Tes8ng and treatment for HIV,
tuberculosis, and malnutri8on
 In‐house pharmacy
 Ambulance service
 X‐ray
 Ultrasound
Nyaya Health 2011 16

51. Bayalpata Hospital: Current Services
 Outpa8ent department
 24‐hour emergency services
 24‐hour birthing center
 15‐bed Inpa8ent ward
 Laboratory with point of care
tests
 Tes8ng and treatment for HIV,
tuberculosis, and malnutri8on
 In‐house pharmacy
 Ambulance service
 X‐ray
 Ultrasound
 Safe abor8on
Nyaya Health 2011 16

52. Bayalpata Hospital: Current Services
 Outpa8ent department
 24‐hour emergency services
 24‐hour birthing center
 15‐bed Inpa8ent ward
 Laboratory with point of care
tests
 Tes8ng and treatment for HIV,
tuberculosis, and malnutri8on
 In‐house pharmacy
 Ambulance service
 X‐ray
 Ultrasound
 Safe abor8on
 Community Health Workers
(CHWs)
Nyaya Health 2011 16

53. Bayalpata Hospital: Current Services
 Outpa8ent department
 24‐hour emergency services
 24‐hour birthing center
 15‐bed Inpa8ent ward
 Laboratory with point of care
tests
 Tes8ng and treatment for HIV,
tuberculosis, and malnutri8on
 In‐house pharmacy
 Ambulance service
 X‐ray
 Ultrasound
 Safe abor8on
 Community Health Workers
(CHWs)
 Telemedicine
Nyaya Health 2011 16

54. Outline
 Relevant health sta8s8cs of Nepal and Achham
 Birth of Nyaya Health
 Current services provided by Bayalpata Hospital
 Key features of the NGO
 Next Steps
 GeOng Involved
Nyaya Health 2011 17

55. Nyaya Health: Unique Features
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56. Nyaya Health: Unique Features
 “Jus8ce in Health”
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57. Nyaya Health: Unique Features
 “Jus8ce in Health”
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58. Nyaya Health: Unique Features
 “Jus8ce in Health”
 Collabora8on with the Government
Nyaya Health 2011 18

59. Nyaya Health: Unique Features
 “Jus8ce in Health”
 Collabora8on with the Government
 Managed by a volunteer Board of Directors, 29 full‐8me employed Nepali staff and many
volunteers around the world
Nyaya Health 2011 18

60. Nyaya Health: Unique Features
 “Jus8ce in Health”
 Collabora8on with the Government
 Managed by a volunteer Board of Directors, 29 full‐8me employed Nepali staff and many
volunteers around the world
 Over 99% of all funds used directly in Nepal
Nyaya Health 2011 18

61. Nyaya Health: Unique Features
 “Jus8ce in Health”
 Collabora8on with the Government
 Managed by a volunteer Board of Directors, 29 full‐8me employed Nepali staff and many
volunteers around the world
 Over 99% of all funds used directly in Nepal
 Transparency
Nyaya Health 2011 18

62. Nyaya Health: Unique Features
 “Jus8ce in Health”
 Collabora8on with the Government
 Managed by a volunteer Board of Directors, 29 full‐8me employed Nepali staff and many
volunteers around the world
 Over 99% of all funds used directly in Nepal
 Transparency
 Priori8zing the most marginalized
Hospital Staff:
70% achhami
60% female
35% dalit
Nyaya Health 2011 18

63. Nyaya Health: Unique Features
 “Jus8ce in Health”
 Collabora8on with the Government
 Managed by a volunteer Board of Directors, 29 full‐8me employed Nepali staff and many
volunteers around the world
 Over 99% of all funds used directly in Nepal
 Transparency
 Priori8zing the most marginalized
Hospital Staff:
70% achhami
60% female
35% dalit
CHWs: 100% female
Nyaya Health 2011 18

64. Nyaya Health: Unique Features
 “Jus8ce in Health”
 Collabora8on with the Government
 Managed by a volunteer Board of Directors, 29 full‐8me employed Nepali staff and many
volunteers around the world
 Over 99% of all funds used directly in Nepal
 Transparency
 Priori8zing the most marginalized
Hospital Staff:
70% achhami
60% female
35% dalit
CHWs: 100% female
Pa8ents:65% female
Nyaya Health 2011 18

65. Outline
 Relevant health sta8s8cs of Nepal and Achham
 Birth of Nyaya Health
 Current services provided by Bayalpata Hospital
 Key features of the NGO
 Next Steps
 GeOng Involved
Nyaya Health 2011 19

66. Next Steps
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67. Next Steps
Con7nued Renova7ons
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68. Next Steps
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69. Next Steps
Surgical Services
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70. Nyaya Health 2011 22

71. Community Health Workers
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72. Next Steps
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73. Next Steps
Solar Power
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74. GeJng Involved
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75. GeJng Involved
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76. GeJng Involved
• Demand Transparency and
Accountability
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77. GeJng Involved
• Demand Transparency and
Accountability
• Spread the word
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78. GeJng Involved
• Demand Transparency and
Accountability
• Spread the word
• Volunteer/intern
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79. GeJng Involved
• Demand Transparency and
Accountability
• Spread the word
• Volunteer/intern
• $$$
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80. Acknowledgements
 Global Health Leadership Ins8tute
 The staff of Bayalpata Hospital & the people of Achham, Nepal
 The volunteers and individual donors of Nyaya Health
 The Nepali Ministry of Health & Achham District Health officials:
Dr. Deepak Gaylal, Mr. Sailendra Shrestha, Mr. Jhanak Dhungana
 Ins8tu8onal Supporters: Abbot Laboratories, AMD and the Open
Architecture Network, America Nepal Medical Founda8on
(ANMF), BWH COE in Quality and Safety, Buddha Air, Cents of
Relief, Child Health Founda8on, CIWEC Clinic (Menlha Nursing
Home), Ella Lyman Cabot Trust, EquityEditors Associa8on, Ford
Founda8on, Frederick Lovejoy Founda8on, Google Grants, Nepal
Ministry of Health and Popula8on (MOHP), New Aid Founda8on,
Partners in Health, QBC Diagnos8cs, Quidel Corpora8on,
Singapore Internet Research Center, Ten Friends, The Hunger
Site, The Interna8onal Founda8on, The Shelley and Donald
Rubin Founda8on, Un8l There's a Cure Founda8on, UpToDate,
William Prusoff Founda8on, Yale University
Nyaya Health 2011