Post on 12-Nov-2014
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Nyaya Health 2011
Nyaya five years on:Finding our role in the
movement Mark Arnoldy, Executive Director
&Ryan Schwarz, VP of US Operations
Nyaya Health 2011
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… 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-Founder3/12/2006
Nyaya Health 2011
Outline of Presentation
1. Nyaya Health introduction
2. Achham: 2006-2011
3. Nyaya: 2006-2011
4. Reflections on building the movement
Nyaya Health 2011
Nyaya Health: Who We Are
Social justice-oriented mission:
1. To provide free community-based healthcare in rural Nepal that strengthens the public sector
2. To develop and disseminate effective strategies of health delivery in resource-poor settings throughout the world
Founded in 2005; public-private partnership with Nepali Ministry of Health & Population in 2009
Partners In Health (PIH) Partner Project Nyaya Team:
27 full-time employed Nepali staff + ~50 CHWs
1 full-time US-based Executive Director Volunteer Executive Team, Board of
Directors and Board of Advisors
Nyaya Health 2011
Where We Work: Nepal – Achham District, Far Western Region
Nyaya Health 2011
Nyaya Health: Mission and operations Goal: infrastructure development, capacity building, not only care
provision
Goal: collaborate with the government in development of pro-poor, rural health care
Government partnership contract for 5 years June, 2009 – June, 2014
Nyaya Health 2011
Achham: People
~270,000 people
99.6% Hindu
60% agricultural
>80% of men migrate to India, and 35% of families rely on remittances from India
33% literate: 54% men, 14% of women
<$1USD is daily per capita income
Nyaya Health 2011
Achham: Infrastructure 2006: >90% of houses have did
not have electricity 45% had access to clean
water – 2.5x worse than national average
Hydroelectric plant functioning <50% capacity
Extremely limited landline telephone capacity, one cell phone tower
Paved road ended in Sanfe Bagar
Airport destroyed during war
Hospital 5 hours, surgery 6 hours, ICU 14 hours
Nyaya Health 2011
Achham: Progress and challenges, 2006-2011
0 => 4 doctors & enhanced services
Increased health spending per capita ($5) (USA = ~$6,956 in 2007)
Road has been extended ~ 5 miles
Further development post-war
Landline phones a little more common, cell reception a bit better
Other statistics difficult to predict due to lack of good data
Lack of development relative to country
Roads dismal and dangerous, no airport
Continually limited electricity
Still > 6 hours for surgery, >14h to ICU
MMR: ?600-600? vs 251 Nepal avg vs 17 in USA (per 100,000)
HIV burden ?highest? in country
A long way to go…
Progress Continued Challenges
Nyaya Health 2011
Nyaya’s founding and the “all-volunteer” organization (AVO)
Founded by students and residents
Ability to leverage resources for resource-poor settings
No high-paid NGO consultants; instead a “lean, nimble and innovative” volunteer model
Full-time Nepali staff (locally hired when possible; >80%)
“Part-time” volunteer USA staff – “All-volunteer organizational” model
Nyaya Health 2011
Benefits & limitations of the AVO model
Pragmatic no one else working in
Achham no money to hire anyone harness student excitement
for GH >99% funds to programs
Philosophic volunteers > high-paid
consultants
Strength: innovative use of HR
PROS CONS
Pragmatic “sexy” work vs “grunt”
work “sin wave” model of
reliability lack of centralized
structure no accountability limited (no) expertise
Weakness: HR = limiting factor
Nyaya Health 2011
Lessons-learned and transitioning to a professional organization
HR outside of Achham became a limitation to expansion of our work in Achham (funding in particular)
We lacked:1. Reliability in operations, capacity for opportunities, and funding2. Infrastructure to obtain enhanced advisory capacity – “we are supremely
unqualified to do this work”3. Infrastructure to expand partnerships and enhance effectiveness
We need to professionalize – providing healthcare for hundreds of thousands of people is not a part-time job
AVO model
Nyaya Health 2011
Lessons learned: “Managing Board” to “Advisory Board”
Goal: “to create a long-term and sustainable solution to health delivery in Nepal” requires:local HR and local infrastructureneed for expanded networking, fundraising, partnership
developmentless need for day-to-day on-the-ground operations management
transition from “Managing Board” to “Advisory Board”
Nyaya Health 2011
Challenges of organizational change: “Founder’s Curse” – inability
to let go “Sexy” vs “grunt” work (field
vs back-office)
Impact of organizational change: Reliability and consistency Budget $160k (2010) $400k
(2011) Enhanced networking and
partnership opportunities for improved operations
Realization of local solutions to health delivery
Utilization of diaspora and expatriate team to leverage resources to Achham
Lessons learned: “Managing Board” to “Advisory Board”
Nyaya Health 2011
Reflections – finding our place in the movement
Critical role for volunteers in the movement, and an equally critical role for us to recognize our limitations
Students and activists can access resources our colleagues in resource-poor settings cannot
As leaders of the movement we need to be cognizant of where we can add value – sometimes that is in the field, sometimes in the back-office
Grassroots work relies on both advocates and implementers
Nyaya Health 2011
We can do better for our patients.
Nyaya Health 2011
…thoughts, questions, concerns, feedback?
135 College St, Suite 323
New Haven, CT 06510Phone:
+1.724.986.5050Fax: +1.630-604-8615
info@nyayahealth.org http://www.nyayahealth.org http://wiki.nyayahealth.org http://blog.nyayahealth.org
Bayalpata Hospital, Ridikot VDCAchham, Nepal
Phone: 977-94-690-404 (Achham)Phone: 977-9845236035(KTM)