Nyaya Health operates a clinic in Achham District, Nepal that provides free, high-quality healthcare using a unique model. Their model employs community health workers, is open-source and transparent, and relies on multiple sources of funding. They aim to become a teaching model for healthcare delivery and serve the underserved population. However, Nyaya Health faces challenges of growing their scale and scope while strengthening resources for replicability and creating sustainable revenue streams.

1. Nyaya HealthDecember 6, 2010 – Board of Directors Report 15.965 Global Health Delivery and Management Molly Bodell, PompaDebroy, Sophie Cain Miller, & Evvie Nanni

2. Outline 1 Mission Statement 2 Background 3 Model 4 Recommendations

4. No one is denied care

5. Use CHWs (Community Health Workers)

6. Permanent on-the-ground care- Become teaching model for delivery of quality health care - Be known and serve as a model for open source organizations Mission 3

8. Mountainous terrain

9. Poor road conditions

10. History:

11. Civil war

12. Lack of existing medical care in district

13. Poverty:

14. Median household income <$1 / day

15. Government:

16. Unreliable provision of healthcare Source: 2009 Annual Report Image Source: Roof of Nyaya Health Clinic; Wikipedia Background 4

17. Key health status indicators in Achham prior to Nyaya Health Background 5 Source: 2009 Nyaya Health Annual Report

18. High maternal mortality ratio (MMR) in district Italy: 4 United States: 17 Nepal: 240 Achham: 740 Source: IHME 2010, Maternal Mortality (Global), Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5, Institute for Health Metrics and Evaluation, Online, viewed 13th April, 2010. Note: numbers are per 100,000 live births Background 6

20. Egalitarian

21. Transparency

22. Accountability

23. Open-source

24. Information sharing

25. Documentation and data collection

26. Website, blog & Wiki

27. Owns facility

28. Provides 38% of funding

29. 5 year agreement with Nyaya Health

31. 24/7 service

32. 25 doctors and staff

33. 36,000 patients per year

34. 67% women

35. 50% of patients travel 1-3 hours by foot

36. Top 2 diagnoses: gastritis and upper respiratory infections (URIs)

37. Multiple sources of fundingModel 7

38. Nyaya Funding Comes From Multiple Sources Sources of Funding Spending c 57% 59% c 32% 29% c 12% 11% Model 8

40. Egalitarian

41. Transparency

42. Accountability

43. Open-source

44. Information sharing

45. Documentation and data collection

46. Website, blog & Wiki

47. Owns facility

48. Provides 38% of funding

49. 5 year agreement with Nyaya Health

50. Trains and hires CHWsNyaya Health Employs Unique Model for Free, Quality Care Delivery Nyaya Health Model 9

52. Egalitarian

53. Transparency

54. Accountability

55. Open-source

56. Information sharing

57. Documentation and data collection

58. Website, blog & Wiki

59. Owns facility

60. Provides 38% of funding

61. 5 year agreement with Nyaya Health

62. Trains and hires CHWsNyaya Health Employs Unique Model for Free, Quality Care Delivery Nyaya Health Model 10

64. Egalitarian

65. Transparency

66. Accountability

67. Open-source

68. Information sharing

69. Documentation and data collection

70. Website, blog & Wiki

71. Owns facility

72. Provides 38% of funding

73. 5 year agreement with Nyaya Health

74. Trains and hires CHWsNyaya Health Employs Unique Model for Free, Quality Care Delivery Nyaya Health Model 11

76. Egalitarian

77. Transparency

78. Accountability

79. Open-source

80. Information sharing

81. Documentation and data collection

82. Website, blog & Wiki

83. Owns facility

84. Provides 38% of funding

85. 5 year agreement with Nyaya Health

86. Trains and hires CHWsNyaya Health Employs Unique Model for Free, Quality Care Delivery Nyaya Health Model 12

87. At the End of the World: The Cutting Edge of Health IT Model 13

88. Nyaya Wiki http://wiki.nyayahealth.org Model 14

89. Nyaya offers unique value proposition for four key audiences Population served by traditional NGOs Stakeholders not traditionally served by global health community Model 15

90. Business model success dependent on feedback loop between two sides of mission Operations are transcribed directly to website Demand increase through publicity and word-of-mouth Quality of Information available on wiki Quality of care delivered in Achham Valley Awareness and use of Nyaya resource by other NGOs Key reinforcing feedback loop Feedback on care delivery model Operational & service delivery improvements More users will provide diversity of input & expertise Model 16

91. Despite successful model, Nyaya Health currently faces three key challenges Model 17

92. Recommendation 1: Growth in scale & scope Recommendations 18

93. Recommendation 2: Strengthen available resources for model replicability Nyaya Health currently maintains website, blog & wiki Recommendations 19

94. Recommendation 3: Create sustainable revenue streams; monetize services Recommendations 20

95. Q&A 21

97. Email correspondence with Ryan Schwarz, Director of Operations (Ryan@NyayaHealth.org)

98. 2009 Nyaya Health Annual Report

99. Nyaya Health Wiki: http://wiki.nyayahealth.org

101. Nyaya Org Chart 24

102. Nyaya budget is expected to increase by more than 250% in 2 years 25

103. Nyaya’s Organizational Model 26

104. History of Nyaya 27

105. At the End of the World: The Cutting Edge of Health IT 28

109. Quality training for health care workers

110. Support for rural health workers

111. Scholarships for health leadersUNUSED SLIDES