Nyaya health generic 062009


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  • Annotations in the Notes section for each slide follow and should guide the presenter as to the key points meant to cover throughout the presentation. Title slide; introduction.
  • Nyaya's first project in Achham was the Sanfe Bagar Primary Health Center, which: COVER POINTS ON SLIDE
  • Bayalpata hospital is the big next step that Nyaya is taking to build the health system in Achham. The hospital is slated to open in 21 June, 2009. COVER POINTS ON SLIDE
  • Nyaya Health's two key missions are complementary of each other. Together with local communities and the Nepali government, Nyaya is working to build a health care system for the Achham district. In parallel, and directly through our experiences in this setting of severe deprivation, we aim to provide a model that other providers can utilize in expanding access to health services in similar areas affected by remoteness, poverty, isolation and war.- The rest of the presentation will be structured in two parts, as per Mission #1 and #2.
  • This slide is an outline of the aspects of Mission #1 Building Healthcare Infrastructure we will now discuss.
  • Nyaya uses data and regular evaluation to drive our services improvements and expansion. Providing data-driven health care is a key component of Nyaya's efforts to ensure its services are directly responsive to the needs of our patients, incorporating both their quantitative and qualitative feedback. COVER POINTS ON SLIDE Some details: The initial Nyaya Rapid Health Assessment was overseen be co-founder and epidemiologist Dr. Duncan Maru in April, 2007. The RHA covered the essential aspects of health infrastructure available to the communities served by the future Sanfe Bagar Medical Clinic http://wiki.nyayahealth.org/CommunitySurveys
  • 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'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 takes a pragmatic approach to energy that we believe can be used effectively by other rural providers. The flow diagram describes how each system component of Nyaya's current energy system relates [quickly review flow diagram]. Most importantly to the Nyaya energy system are the key factors of affordability and conservation. As we expand services to Bayalpata Hospital, and as financing permits, we aim to add on more costly, but ultimately more environmentally friendly, solar power solutions, which can be incorporated into our current system. DISCUSS PHASED IMPLEMENTATION AND SCALE-UP OF ENERGY PROGRAM AS OUTLINED
  • Water is plentiful in Achham; water access and safe water, however, often are not. At our hospital site at Bayalpata, Nyaya has worked out an agreement for reliable water access provided for free by local community members in a partnership to benefit the larger community. In the past, Nyaya has used in the electric water filters based on reverse osmosis technology to effectively filter our clinical water supply.  At the new hospital site, we will deploy a system that couples the electric water filters with on-site chlorine production units that are being procured through a collaboration with Antennae Technologies and Environmental Camps for Conservation Awareness. Additionally, excess chlorine will be distributed via our community health workers to local communities to educate the public about the importance of clean water, at the same time decreasing significant morbidity and mortality caused by water-born diarrheal illnesses.
  • Nyaya Health operates in a region where patients often have to walk over four hours to access our services. Roads and cell phone towers are minimal. To achieve screening and follow-up, we utilize community health workers who meet the patients in their own villages, enhancing the quality of our care and accessibility to our patients. Background: http://wiki.nyayahealth.org/CHWs
  • This slide is an outline of the aspects of Mission #2 Developing a Scalable Model we will now discuss.
  • The wiki is the core technology behind our collaborative and transparency objectives. COVER POINTS ON SLIDE
  • The Nyaya Health Blog is another component in our efforts to share our work with key stakeholders, including other organizations working in similar situations, as well as the lay public and our supporters. The Blog offers stories of our work, our patients, and our challenges, in a journal-esque format.
  • To effectively provide the services our patients need, and to implement them in the most effective, efficient, and cost-effective manner, Nyaya relies on rigorous data monitoring, continued evaluation, and consequent programmatic revision. Furthermore, to ensure continued critical feedback and collaboration amongst our colleagues and supporters, all of our data is available online through our wiki in easily accessible format. COVER POINTS ON SLIDE This page provides an overview of Nyaya's data strategies: http://wiki.nyayahealth.org/DataManagement
  • 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's mission is to advocate for increased transparency throughout the global health community. Nyaya's wiki offers us an easy and readily exportable model to achieve further transparency in this type of work.
  • COVER POINTS ON SLIDE INCLUDING IMPORTANT CHALLENGES/NEXT STEPS - This is a good place in the presentation for an updated slide discussing particular needs.
  • We appreciate the opportunity to present at your conference, and are excited to work with you more in 2009. Best wishes - The Nyaya Health Team
  • Nyaya health generic 062009

    1. 1. <ul><li>Nyaya Health: 2009 update </li></ul><ul><li>Ryan Schwarz, Director of Operations </li></ul><ul><li>[email_address] </li></ul>
    2. 2. Who We Are <ul><li>501(c)(3) organization founded in 2006 </li></ul><ul><li>Channel over 99% of all donations directly to Nepal </li></ul><ul><li>Managed by a volunteer Board of Directors and paid local Nepali staff </li></ul><ul><li>Mission: </li></ul><ul><ul><li>To provide free community-based healthcare in rural Nepal </li></ul></ul><ul><ul><li>To develop a scalable model of healthcare delivery in resource-denied settings throughout the world </li></ul></ul><ul><li>Strategies: </li></ul><ul><ul><li>To facilitate resource distribution to resource-denied areas </li></ul></ul><ul><ul><li>To expand human resource capacity and foster local grassroots collective action </li></ul></ul><ul><ul><li>To apply evidence-based medicine principles and rigorous data monitoring and evaluation to all programs </li></ul></ul><ul><ul><li>To involve the central government in the development of pro-poor health infrastructure </li></ul></ul><ul><ul><li>To utilize innovative technologies aimed at improving transparency and collaboration in global health delivery </li></ul></ul>
    3. 3. 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
    4. 4. Current Services: Sanfe Bagar Primary Health Center <ul><li>Opened for service April 6, 2008 </li></ul><ul><li>Served over 17,000 patients in the course of 14 months </li></ul><ul><li>Facilities include: </li></ul><ul><ul><li>Outpatient department </li></ul></ul><ul><ul><li>Maternity suite </li></ul></ul><ul><ul><li>Treatment rooms for 24-hour emergency and obstetric care </li></ul></ul><ul><ul><li>Laboratory </li></ul></ul><ul><ul><li>Pharmacy </li></ul></ul><ul><li>20 all-Nepali staff </li></ul><ul><li>All services completely free of charge to patients </li></ul>
    5. 5. Current Services: Bayalpata Hospital <ul><li>Built by the government but subsequently abandoned </li></ul><ul><li>45 minutes from Sanfe Bagar </li></ul><ul><li>5-year contract signed with the Nepali Ministry of Health and Populations to renovate and operate the hospital </li></ul><ul><li>Services will include (summer, 2009): </li></ul><ul><ul><li>Outpatient department </li></ul></ul><ul><ul><li>24-hour emergency and obstetric services </li></ul></ul><ul><ul><li>Inpatient ward </li></ul></ul><ul><ul><li>Laboratory & blood transfusion </li></ul></ul><ul><ul><li>Testing and treatment for HIV, tuberculosis, and malnutrition </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>Women’s Center (mental health/ reproductive education/ social services) </li></ul></ul><ul><ul><li>Surgical suite </li></ul></ul><ul><ul><li>Digital X-Ray Services </li></ul></ul><ul><ul><li>Expanded CHW network </li></ul></ul>
    6. 6. Achieving Nyaya Health’s Mission in Achham Mission #1: Build Healthcare Infrastructure Mission #2: Develop a Scalable Model
    7. 7. Mission #1: Build Healthcare Infrastructure <ul><li>An effective, responsive, community-driven healthcare system is the basis of public health and health justice. </li></ul><ul><li>Key components: </li></ul><ul><ul><ul><li>Needs assessment </li></ul></ul></ul><ul><ul><ul><li>Clinical Facilities Development </li></ul></ul></ul><ul><ul><ul><li>Human Resources: Recruitment </li></ul></ul></ul><ul><ul><ul><li>Human Resources: Continuing Medical Education </li></ul></ul></ul><ul><ul><ul><li>Telecommunications </li></ul></ul></ul><ul><ul><ul><li>Reliable energy </li></ul></ul></ul><ul><ul><ul><li>Clean water </li></ul></ul></ul>
    8. 8. 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>
    9. 9. Building Healthcare Infrastructure: Clinical Facilities Development <ul><li>Nyaya Health incorporates principles of social justice and community-driven development into all design processes </li></ul><ul><li>Facilities designed to enhance patient dignity and healing </li></ul><ul><li>Nyaya Health staff participate in the process, further developing human resource capacity </li></ul><ul><li>Local community members engage in the process through voluntary and paid engagements </li></ul><ul><li>Developing Bayalpata Hospital is Nyaya’s next step in this process… </li></ul>Sanfe Bagar Health Center: Before Sanfe Bagar Health Center: After
    10. 10. Building Healthcare Infrastructure: Staff Recruitment <ul><li>Focus on local talent </li></ul><ul><li>Open, advertised process </li></ul><ul><li>Structured and qualitative components to the interview </li></ul><ul><li>Salaries on par with the Nepali government </li></ul><ul><li>Opportunities for career advancement </li></ul><ul><li>Meeting the challenges of physician recruitment </li></ul>
    11. 11. Building Healthcare Infrastructure: Continuing Medical Education <ul><li>CME is a key benefit that Nyaya can provide to retain workers </li></ul><ul><li>Developing new competencies among staff is key to building health systems </li></ul><ul><li>Strategies include: </li></ul><ul><ul><ul><li>Reviewing evidence-based clinical protocols </li></ul></ul></ul><ul><ul><ul><li>CME sessions w/ Medical Director and clinical staff </li></ul></ul></ul><ul><ul><ul><li>Ultrasound </li></ul></ul></ul><ul><ul><ul><li>On-site clinical consultants </li></ul></ul></ul><ul><ul><ul><li>Computer literacy </li></ul></ul></ul>
    12. 12. Building Healthcare Infrastructure: Telecommunications <ul><li>Reliable telecommunications systems is central to our ability to deliver: </li></ul><ul><ul><ul><li>Patient quality </li></ul></ul></ul><ul><ul><ul><li>Logistics planning </li></ul></ul></ul><ul><ul><ul><li>Telemedicine </li></ul></ul></ul><ul><ul><ul><li>Fundraising </li></ul></ul></ul><ul><li>Delivering effective systems requires: </li></ul><ul><ul><ul><li>Working with public and private partners </li></ul></ul></ul><ul><ul><ul><li>Institutional investment </li></ul></ul></ul><ul><ul><ul><li>Flexibility to adapt to rapidly changing technologies </li></ul></ul></ul>
    13. 13. Building Healthcare Infrastructure: Rural Energy Systems <ul><li>Effective rural healthcare demands reliable energy supply </li></ul><ul><li>Nyaya Health’s phased approach: </li></ul><ul><ul><ul><li>Phase 1: Transfer existing energy system to Bayalpata Hospital </li></ul></ul></ul><ul><ul><ul><li>Phase 2: Preliminary expansion of energy capacity </li></ul></ul></ul><ul><ul><ul><li>Phase 3: Integrating a small-scale solar-powered system </li></ul></ul></ul><ul><ul><ul><li>Phase 4: Larger-scale energy capacity expansion via solar power </li></ul></ul></ul>
    14. 14. 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>
    15. 15. Building Healthcare Infrastructure: Community Health Workers <ul><li>Community health workers play critical roles in ensuring timely access to essential medical care </li></ul><ul><ul><li>Effectively deliver care in rural regions with little access to transportation </li></ul></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><ul><li>Phased scale-up of CHW network </li></ul><ul><ul><ul><li>Outreach </li></ul></ul></ul><ul><ul><ul><li>Medical adherence support </li></ul></ul></ul><ul><ul><ul><li>Paramedical services </li></ul></ul></ul>
    16. 16. 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>
    17. 17. 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>Clinical engineering details </li></ul></ul><ul><li>Provided in real-time, as they are developed, evaluated, and revised </li></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>http:// wiki.nyayahealth.org </li></ul>
    18. 18. 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> http:// blog.nyayahealth.org </li></ul>
    19. 19. 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>Monthly uploading and analysis </li></ul></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><ul><li>Rigorous attention to patient privacy http:// wiki.nyayahealth.org/DataManagement </li></ul>
    20. 20. 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>http:// wiki.nyayahealth.org /Budget </li></ul></ul></ul>
    21. 21. Nyaya Health: Summary and next steps <ul><li>Nyaya Health and Bayalpata Hospital: </li></ul><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>Improved telecommunications capacity </li></ul><ul><li>Expanded energy systems </li></ul>
    22. 22. Thank You! 135 College St, Suite 323 New Haven, CT 06510 Phone: 203-687-8615 Fax: 630-604-8615 [email_address] http://www.nyayahealth.org http://wiki.nyayahealth.org http://blog.nyayahealth.org Bayalpata Hospital, Ridikot VDC Achham, Nepal Phone: 977-94-690-404 (Achham) Phone: 977-9845236035(KTM)