Globe med presentation, dan schwarz, march 2010
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Nyaya Health 2010 The challenges of transparency, accountability, and collaboration in global health Dan Schwarz Executive Director | Nyaya Health [email protected]
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Transcript of Globe med presentation, dan schwarz, march 2010
Nyaya Health 2010
The challenges of transparency, accountability, and collaboration in
global healthDan Schwarz
Executive Director | Nyaya Health
Nyaya Health 2010
Outline of Presentation
1) Nyaya Health Overview
2) Developing a scalable model for health care delivery
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Nyaya Health 2010
Nyaya Health: Who We Are
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Mission: 1) To expand healthcare capacity in rural Nepal2) To develop a scalable model of healthcare delivery
in resource-poor settings throughout the world
501(c)(3) organization founded in 2006 Public-private partnership with Nepali Ministry
of Health & Population (2009) Managed by a volunteer Board of Directors and
26 full-time employed Nepali staff Over 99% of all funds used directly in Nepal
Nyaya Health 2010
Where We Work: Nepal – Achham District, Far Western Region
Nyaya Health 2010
Where We Work
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250,000 population of Achham
0 number of allopathic doctors in Achham before Nyaya
10+ hours in bus to reach the nearest airport and operating room
14 hours in bus to reach the nearest intensive care unit
1 in 125 deliveries results in the mother’s death
64 number of stillborns for every 1,000 live births
6% & 54% Female and male literacy rates, respectively
50% of men migrate to India for work; over 7% return with HIV
99.5% of babies are born in homes and cattle sheds
50¢ average daily per capita income in Achham
60% of children are chronically malnourished60%
Nyaya Health 2010
Achham District, Far Western Region, Nepal
Nyaya Health 2010
History: Sanfe Bagar Primary Health Center
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Nyaya Health 2010
History: Sanfe Bagar Primary Health Center
Opened for service April 6, 2008
Served over 17,000 patients between April ’08 and May ‘09
Services included: Outpatient department 24 hour emergency services Maternity suite with 24 hour-
obstetric services Diagnostic laboratory Pharmacy
23 all-Nepali staff
All services completely free
Nyaya Health 2010
History: Transition to Bayalpata Hospital
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Nyaya Health 2010
History: Transition to Bayalpata Hospital
Goal: infrastructure development, capacity building, not care provision
Goal: to collaborate with the government in the development of pro-poor, rural health care development
Government contract for 5 years signed June 2009 – June 2014
Ministry of Health & Population to take over Bayalpata Hospital in 2014
Nyaya Health 2010
Current Services: Bayalpata Hospital Services include (all free):
Inpatient & Outpatient services 24-hour emergency and obstetric services Laboratory & Pharmacy Community Health Workers (CHWs) Clean water supply for surrounding communities
2010-2011 Expansion: Surgical suite X-Ray Services Expanded CHW network Solar energy
Nyaya Health 2010
Outline: Developing a scalable model of health care delivery
Background: accountability, transparency and collaboration
Health sector approaches to collaboration
Nyaya’s Approach
Case example: Tiyatien Health
Challenges
Nyaya Health 2010
Background: Importance of transparency, accountability, collaboration
Questions:
1. What are best practices for health care delivery in resource-poor settings?
2. How can NGO’s ensure accountability to stakeholders in global health delivery?
Background:
Historic lack of transparency and collaboration between NGO’s, especially in health
2008 Global Accountability Report (One World Trust) revealed that many non-profits scored even worse than for-profit multinational corporations
Implications:
Lack of transparency decreases accountability and misses opportunities for collaboration
Particularly in health sector, collaboration is needed to develop best practices
Transparency, accountability and collaboration can aid the development of a scalable model for health delivery
Nyaya Health 2010
Attributes of a scalable model of healthcare delivery
Transparency
Collaboration
Accountability
Nyaya Health 2010
Take-home message
A lack of transparency not only reduces the accountability of individual programs, it also misses an opportunity to advance global health delivery by establishing best practices in the field and collaboration between partners in these efforts to create best practices.
Nyaya Health 2010
Nyaya’s Approach to transparency, accountability, & collaboration
• Data-driven health care delivery• Clinical, financial and managerial
• Open-access data fostering:• inter-team communication, and• collaboration with global health delivery community
• Fully transparency aimed at accountability to stakeholders• Patients, public sector, partner org’s
Nyaya Health 2010
Nyaya Health: Wiki
Wiki is a searchable repository of: Management policies Financial data Clinical protocols De-identified clinical data
All pages viewable to the public
A forum to share lessons-learned from Achham with organizations in similar settings around the world
Opportunity for critical feedback and collaboration
http://wiki.nyayahealth.org
Nyaya Health 2010
Nyaya Health: Inter-team communication
Intra-team communication• Nyaya is a collaboration between Nyaya Health INGO (USA) and
Nyaya Health Nepal (Nepal) • Fluid communication is critical to a collaborative model • Nyaya uses low-bandwidth, user-friendly, open-access, free
technologies to communicate and facilitate work among team members
Gmail ArchiveGoogle Docs EverNote
Nyaya Health 2010
Challenges and barriers to effective communication
Two locales & two teams Discontinuous communication Details of day-to-day life lackingContext for decision-making lacking
Uncomfortable tensions: Micro-management vs. “hands-off”
approach Empowerment vs. “letting go” of control
Deferral to local authority
…An imperfect system
Nyaya Health 2010
Current approaches to collaboration in health delivery
– Recent initiatives have utilized online communities to enhance collaboration among global health practitioners
– Initiatives aimed at enhancing collaboration to facilitate development of sector-wide best practices
Nyaya Health 2010
Collaboration with partner organizations: Tiyatien Health
Case Study in Collaboration: Tiyatien Health
• TH: similar organization in Liberia
• TH and NH face similar challenges in effective health delivery practices
• Via transparent operations and inter-team collaboration, TH and NH have been able to enhance work in both Liberia and Nepal
• Successful collaborations including:• Financial accounting
protocols• Pharmacy and inventory
management• Fundraising strategies
Low-cost, transparent,
scalable model
Collaboration with health delivery
community
Costs of Nyaya transparent operations model USDCapital expenses for IT infrastructure 3,700.00$ Laptop computers 650.00$ Internet monthly costs 140.00$ Website domain monthly costs 10.00$ PB Wiki software FreeGoogle Docs software FreeEvernote software Free
Nyaya Health 2010
Limitations of model
Such tools do not replace local, community-level transparency and accountability structures, especially in resource-poor settings Need for CABs, CHWs, partnerships w/ regional stakeholders
Model is not accessible to our patients and staff due to poverty and illiteracy
Model requires internet technologies, not available in many settings High amount of start-up and maintenance capital ($)
M&E dependent on epidemiological and data management experience Difficult skill set to recruit in many settings
“Evidence-based medicine” is a pedagogical culture not shared by all health care systems/practitioners Need for education, training and incentives for staff
Nyaya Health 2010
Thank You… Questions?
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135 College St, Suite 323New Haven, CT 06510Phone: +1.724.986.5050Fax: +1.630-604-8615
[email protected] 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)
