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Martin chautari talk shefali 060509


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Martin chautari talk shefali 060509

  1. 1. Nyaya Health:Providing healthcare in rural Nepal Shefali Oza
  2. 2. The Sanfe Bagar Medical Clinic (April 2008 – June 2009) Outpatient department (OPD), maternity suite, 24-hour emergency care, laboratory, and pharmacy Community health worker network No user fees 20 all-Nepali staff, including one doctor Treated over 17,000 patients in 14 months
  3. 3. Bayalpata HospitalAbandoned hospital in Achham built 20+ years ago5-year contract signed with MOHP to renovate and operatethe hospitalServices will begin mid-June 2009 Current goal (2009- 2010): OPD, 24-hour emergency, inpatient maternity care, VCT, PMTCT, DOTS, X-Ray, expanded CHW network 2-5-year goals: ARVs, surgical services with blood transfusion, inpatient ward
  4. 4. Our model: 5 key pillarsFree healthcare for all patientsFull Transparency– All data, line b line expenditures, and protocols are - -y available at http://wiki.nyayahealth.orgWorking together with community and governmentClinical services and community care/outreach mustbe integratedEvidence-based medicine through rigorous datacollection and evaluation
  5. 5. Monthly expenditure Operational budget Breakdown by categoryFrom our wiki:
  6. 6. Current key prioritiesMaternal and child healthCommunity-based initiativesHIV/AIDS and tuberculosisTechnology
  7. 7. Maternal and child health Maternal Mortality Ratio (deaths per 100,000 live births) in Achham: 800 – 200x that of areas in USA Nearest C-section facility is 5 hours by bus 99.5% of deliveries occur outside a health center 60% of children are chronically malnourished in Achham Nyaya Health patient data: – 68% chronically malnourished – 35% severely malnourished
  8. 8. Our maternal and child health programSafe delivery and abortion servicesMaternal inpatient and pre-delivery bedsAntenatal and post-natal servicesCommunity and clinic-based monitoringOutcome tracking and evaluation Targeting malnutrition at the clinic and community level – Pregnant women and young children Community health workers provide education, treatment, referrals and follow-up
  9. 9. Some of our community- based initiatives Paid Community Health Worker network for multiple programs Reducing indoor air pollution through clean stove technology (planned) Providing clean water by distributing hospital-generated chlorine solution (planned) Community accountability structures for improved health care
  10. 10. Our Community Health Workers (CHWs)Main reasons for CHW network – limited transportation but long distances – high prevalence of chronic diseases requiring long-term medication adherence – social challenges in accessing existing healthcare services, especially among the vulnerable – lack of highly trained healthcare personnelNyaya’s CHW program – monitoring community for illnesses, pregnancy, and malnutrition – general patient follow-up and antenatal/postnatal follow-up – directly observed treatment (DOTS) for TB patients – community-based malnutrition program – health education and awareness outreach
  11. 11. HIV/AIDS and Tuberculosis Migrant labor to India leading to rapid rise in Achham’s HIV incidence Risk of multi-drug resistant TB increasing due to prescribing practices and incomplete TB treatmentRoll-out of VCT, PMTCT, and ARVs at Bayalpata HospitalCommunity-based education and nutritional support programs throughCHWsCHW-based Directly Observed Treatment (DOTS) for TBStrengthening TB diagnostic capacity, including drug sensitivityPiloting active TB case finding in the community
  12. 12. Our use of technologyDiagnostics– Ultrasound– X-ray (by 2010)– Laboratory equipment (I-Stat machine, QBC machine)Data collectionConnectivity– Telemedicine– CHW networking
  13. 13. Some key challenges Transportation – Hilly region with one road that ends in Sanfe Bagar – Restricts access to health facilities and patient follow-upCommunication– No area-wide cell phone tower, internet, or landlinesUnreliable electricity gridDeficits in water quantity and quality
  14. 14. Our funding sourcesPrivate donorsFoundation grantsNepali governmentIn-kind donations of equipment andsuppliesCollaborations with NGOs
  15. 15. Our online presenceWebsite (– Provides general information about our organization and directs visitors to contacts and/or further informationWiki (– All of our data, line-by-line budget expenditures, protocols, and expansion plansBlog (– Up-to-date posts about our work, including news events, patient stories, and logistical/management issues
  16. 16. Thank you from Nyaya Health