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Ameri cares nyaya_health_120309


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Ameri cares nyaya_health_120309

  1. 1. <ul><li>Nyaya Health: Foundations and Challenges </li></ul><ul><li>Ryan Schwarz, Director of Operations </li></ul><ul><li>[email_address] </li></ul>
  2. 2. 2006 … While I was staying there, I literally had 10 women a night knocking on my door asking for medical help for themselves or their children. All but one of their husbands had worked in India and half of them were widows at 25-40 years old. Among those that knew their [HIV] status, all were positive. There are no medical services available to them beyond the most basic primary care (and that is often geographically and financially inaccessible)… It was very difficult to talk with these women because there was nothing I could offer or recommend to them. The nearest facility providing HIV care (and doing so incredibly poorly) is a 12 hour bus-ride away. The women were talking about selling their houses to buy ARVs for themselves and their children, which we dissuaded them from doing, since that would buy them at most a year of meds and survival. Moving to the cities where care is available is not an option for them, due to the cost of living and having no employable skills… It's not just HIV that's a problem, of course. 95% of births (or more) take place in a home without a health worker present… Malnutrition is a major problem, with >60% of children in those two districts having moderate-to-severe malnutrition… One night I was sitting, having dinner in a room full of the women I had been providing my meager medical advice to and it struck me that they would almost all be dead within five years, given their symptomaticity and prospects for treatment. Since that moment, I’ve felt wholly compelled but completely adrift… Jason Andrews, MD Nyaya Co-Founder 3/12/2006
  3. 3. Who We Are <ul><li>Mission: </li></ul><ul><li>To expand healthcare capacity in rural Nepal </li></ul><ul><li>To develop a scalable model of healthcare delivery in resource-poor settings throughout the world </li></ul><ul><li>501(c)(3) organization founded in 2006 </li></ul><ul><li>Public-private partnership with Nepali Ministry of Health & Population (2009) </li></ul><ul><li>Managed by a volunteer Board of Directors and paid Nepali staff </li></ul><ul><li>Over 99% of all funds used directly in Nepal </li></ul>
  4. 4. Where We Work: Nepal – Achham District, Far Western Region
  5. 5. Where We Work 250,000 population of Achham 0 number of allopathic doctors in Achham before Nyaya 2 number of allopathic doctors in Achham hired by Nyaya 10 hours in bus to reach the nearest airport and operating room 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 in 1,000 children don’t survive past the age of five 83 99.5% of babies are born in homes and cattle sheds 50 ¢ average daily per capita income in Achham 60% of children are chronically malnourished 14 hours in bus to reach the nearest intensive care unit
  6. 6. History: founding of Nyaya Health
  7. 7. History: Sanfe Bagar Primary Health Center
  8. 8. History: Sanfe Bagar Primary Health Center <ul><li>Opened for service April 6, 2008 </li></ul><ul><li>Served over 17,000 patients between April ’08 and May ‘09 </li></ul><ul><li>Services included: </li></ul><ul><ul><ul><li>Outpatient department </li></ul></ul></ul><ul><ul><ul><li>24 hour emergency services </li></ul></ul></ul><ul><ul><ul><li>Maternity suite with 24 hour-obstetric services </li></ul></ul></ul><ul><ul><ul><li>Diagnostic laboratory </li></ul></ul></ul><ul><ul><ul><li>Pharmacy </li></ul></ul></ul><ul><ul><li>23 all-Nepali staff </li></ul></ul><ul><ul><li>All services completely free </li></ul></ul>
  9. 9. History: Transition to Bayalpata Hospital
  10. 10. History: Transition to Bayalpata Hospital <ul><li>Goal: infrastructure development, capacity building, not care provision </li></ul><ul><li>Goal: to collaborate with the government in the development of pro-poor, rural health care development </li></ul><ul><li>Government contract for 5 years signed June 2009 – June 2014 </li></ul><ul><ul><ul><li>Ministry of Health & Population to take over Bayalpata Hospital in 2014 </li></ul></ul></ul>
  11. 11. Current Services: Bayalpata Hospital <ul><li>Services include </li></ul><ul><ul><li>Inpatient & Outpatient services </li></ul></ul><ul><ul><li>24-hour emergency and obstetric services </li></ul></ul><ul><ul><li>Laboratory </li></ul></ul><ul><ul><li>Community Health Workers (CHWs) </li></ul></ul><ul><ul><li>Clean water for community </li></ul></ul><ul><li>Phased Expansion: </li></ul><ul><ul><li>Surgical suite </li></ul></ul><ul><ul><li>X-Ray Services (  HIV ART program) </li></ul></ul><ul><ul><li>Women’s Center (mental health/ reproductive education/ social services) </li></ul></ul><ul><ul><li>Expanded CHW network </li></ul></ul>
  12. 12. Achieving Nyaya Health’s Mission Mission #1: Build Healthcare Infrastructure Mission #2: Develop a Scalable Model
  13. 13. Mission #1: Building Healthcare Infrastructure <ul><li>An effective, responsive, community-driven healthcare system is the basis of public health and health justice. </li></ul><ul><li>Some key challenges: </li></ul><ul><ul><ul><li>Human Resources </li></ul></ul></ul><ul><ul><ul><li>Supply-chain management </li></ul></ul></ul><ul><ul><ul><li>Telecommunications /energy </li></ul></ul></ul><ul><ul><ul><li>Community outreach </li></ul></ul></ul>
  14. 14. “ Video X-ray” – the development of a healthcare system
  15. 15. Building Healthcare Infrastructure: Human Resources
  16. 16. Building Healthcare Infrastructure: Supply Chain Management <ul><li>Supply Chain Challenges : </li></ul><ul><ul><ul><li>Medicines </li></ul></ul></ul><ul><ul><ul><li>Fuel </li></ul></ul></ul><ul><ul><ul><li>Food </li></ul></ul></ul><ul><ul><ul><li>General supplies </li></ul></ul></ul><ul><ul><ul><li>Maintenance/ Repair </li></ul></ul></ul><ul><ul><ul><li>Staff travel (trainings, KTM, expats) </li></ul></ul></ul>Achham
  17. 17. Building Healthcare Infrastructure: Supply Chain Management
  18. 18. Building Healthcare Infrastructure: Telecommunications <ul><li>Reliable telecommunications systems is central to our ability to deliver: </li></ul><ul><ul><ul><li>Patient quality (communities, referrals) </li></ul></ul></ul><ul><ul><ul><li>Logistics planning (Achham/KTM/USA) </li></ul></ul></ul><ul><ul><ul><li>Telemedicine (ultrasound; ?psych, ?X-ray) </li></ul></ul></ul><ul><ul><ul><li>Fundraising (KTM & USA) </li></ul></ul></ul>
  19. 19. Building Healthcare Infrastructure: Community Health Workers <ul><li>CHWs play critical roles in creating critical linkage to community </li></ul><ul><ul><li>Provide follow-up care of chronic conditions </li></ul></ul><ul><ul><li>Help raise awareness and educate their fellow citizens </li></ul></ul><ul><ul><li>Offer continual feedback to Nyaya about community needs and concerns </li></ul></ul>
  20. 20. Mission #2: Develop a Scalable Model <ul><li>Developing a scalable model is central to building the field of global health delivery </li></ul><ul><li>Nyaya Health uses several tools: </li></ul><ul><ul><li>Wiki </li></ul></ul><ul><ul><li>Blog </li></ul></ul><ul><ul><li>Data monitoring and evaluation </li></ul></ul><ul><ul><li>Open-access clinical and financial data </li></ul></ul>
  21. 21. Developing a Scalable Model: Nyaya Health Wiki <ul><li>Wiki is an searchable repository of: </li></ul><ul><ul><li>Management policies and contracts </li></ul></ul><ul><ul><li>Clinical protocols </li></ul></ul><ul><ul><li>De-identified clinical data </li></ul></ul><ul><ul><li>Financial data </li></ul></ul><ul><li>All pages viewable to the public </li></ul><ul><li>A forum to share lessons-learned from our patients in Achham with organizations in similar settings around the world </li></ul><ul><li>Opportunity for critical feedback and collaboration </li></ul><ul><li> </li></ul>
  22. 22. Developing a Scalable Model: Data Monitoring <ul><li>Effective healthcare must be driven by data monitoring and evaluation </li></ul><ul><li>Collaboration between Nepal- and US-based data team is critical: </li></ul><ul><ul><li>Public access to enhance collaboration and transparency in the global health community </li></ul></ul><ul><ul><li>Revision of programmatic design and protocols according to regular data evaluation </li></ul></ul>
  23. 23. Building a scalable model: Tiyatien Health
  24. 24. Nyaya Health: Summary and next steps <ul><li>Achieving healthcare access to Nepal’s most vulnerable citizens </li></ul><ul><li>Training and expanding healthworker capacity in rural Nepal </li></ul><ul><li>Developing models for rural healthcare delivery </li></ul><ul><li>Next Steps: </li></ul><ul><li>Larger community health worker network </li></ul><ul><li>Surgical capacity </li></ul><ul><li>X-Ray services </li></ul><ul><li>Expanded energy systems </li></ul>
  25. 25. Thank You! Questions? 135 College St, Suite 323 New Haven, CT 06510 Phone: +1.724.986.5050 Fax: +1.630-604-8615 [email_address] Bayalpata Hospital, Ridikot VDC Achham, Nepal Phone: 977-94-690-404 (Achham) Phone: 977-9845236035(KTM)
  26. 26. Building Healthcare Infrastructure: Needs Assessment <ul><li>Needs assessment is a key component of delivering locally effective community-driven healthcare services </li></ul><ul><li>Rapid health assessment, 2007 </li></ul><ul><li>Reviewing clinical service data </li></ul><ul><li>Community health worker surveys </li></ul>
  27. 27. Building Healthcare Infrastructure: Water Systems <ul><li>Reliable clean water supply crucial to health care delivery </li></ul><ul><li>Bayalpata Hospital </li></ul><ul><ul><li>Access to water donated via community collaboration </li></ul></ul><ul><ul><li>Working with community members to protect the water supply lines </li></ul></ul><ul><ul><li>On-site chlorination treatment through the support of Antennae Technologies and Environmental Camps for Conservation Awareness </li></ul></ul>
  28. 28. Developing a Scalable Model: Nyaya Health Blog <ul><li>Staff and volunteers write journal-type stories to share and reflect on our programs </li></ul><ul><li>Forum for discussing: </li></ul><ul><ul><li>Patient cases </li></ul></ul><ul><ul><li>Clinical operations details </li></ul></ul><ul><ul><li>Organizational challenges and successes </li></ul></ul><ul><li>Colleagues throughout the world can use these experiences to guide their own work and provide us with feedback or questions </li></ul><ul><li> </li></ul>
  29. 29. Developing a Scalable Model: Financial Transparency <ul><li>The Global Accountability Report: non-profits fared dismally </li></ul><ul><li>Nyaya’s wiki offers ready accessibility to: </li></ul><ul><ul><ul><li>Line-by-line expenditures </li></ul></ul></ul><ul><ul><ul><li>Month-by-month budgets summaries </li></ul></ul></ul><ul><ul><ul><li>Timeline of expenditures </li></ul></ul></ul><ul><ul><ul><li>Timeline of revenue </li></ul></ul></ul><ul><ul><ul><li>Accounts balances </li></ul></ul></ul><ul><ul><li>Benefits </li></ul></ul><ul><ul><ul><li>More engaged donors </li></ul></ul></ul><ul><ul><ul><li>Organizational culture of honesty and openness </li></ul></ul></ul><ul><ul><ul><li>More effective management </li></ul></ul></ul><ul><ul><ul><li> </li></ul></ul></ul>
  30. 30. What Frank Bia asked for… <ul><li>“ What would be of interest is: </li></ul><ul><li>how the organization was founded and staffed, </li></ul><ul><li>the implications of reopening the hospital </li></ul><ul><li>most importantly patient stories and needs.  </li></ul><ul><li>Since we supply pharmaceuticals and medical supplies you might want to emphasize the shortfalls, sources of such and how the needs are currently met.  Photographs are better than death by PowerPoint, as all medicals students are already aware of.  Let me know what works best for you and we can plan it from there Sincerely Frank Bia” </li></ul>