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)