Nyaya Health 2010

Nyaya Health: A public-private partnership

to develop healthcare in rural NepalJhapat Thapa, Medical Director

director@nyayahealth.org

Nyaya Health 2010

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.

501(c)(3) organization founded in USA in 2006 Public-private partnership with Nepali Ministry

of Health & Population. Managed by a volunteer Board of Directors and

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

1 in 125 deliveries results in the mother’s death

64 number of stillborns for every 1,000 live births

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

6% & 54% Female and male literacy rates, respectively

50% of men migrate to India for work; over 7% return with HIV

60%

Nyaya Health 2010

First stage: 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

14 all-Nepali staff

All services completely free

Nyaya Health 2010

Second stage: Transition to Bayalpata Hospital

The Hospital was constructed by Nepali government 30 years ago but never came into operation

Nyaya Health has renovated and opened the services in June 2009 in collaboration with Nepali Ministry of Health. Ministry of Health & Population to take over Bayalpata Hospital in 2014

Nyaya Health 2010

Current Services: Bayalpata Hospital Services include (all free):

Adult and pediatrics Ambulatory services. 24-hour emergency and obstetric services. In patient services. Laboratory & Pharmacy. Community Health Workers (CHWs) Ultrasound services. ART and DOTS clinic Ambulance services. Ambulance services.

2010-2011 Expansion: X-ray service. Surgical suite for emergency C-

section and general surgery. Expansion of inpatient and maternity

ward. Solar energy

Nyaya Health 2010

Achieving Nyaya Health’s Mission in Achham

Mission #1: Build Healthcare InfrastructureMission #2: Develop a Scalable Model

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Nyaya Health 2010

Mission #1: Build Healthcare Infrastructure

Key components: Needs assessment Clinical Facilities

Development Human Resources:

Recruitment Human Resources:

Continuing Medical Education

Telecommunications Reliable energy Clean water

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Nyaya Health 2010

Building Healthcare Infrastructure: Needs Assessment

Needs assessment is a key component of delivering locally effective community-driven healthcare services

Rapid health assessment, 2007 Reviewing clinical service data Community health worker

surveys

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Nyaya Health 2010

Building Healthcare Infrastructure: Clinical Facilities Development

Nyaya Health incorporates principles of social justice and community-driven development into all design processes

Facilities designed to enhance patient dignity and healing

Sanfe Bagar Health Center: Before

Sanfe Bagar Health Center: After

Nyaya Health staff participate in the process, further developing human resource capacity

Local community members engage in the process through voluntary and paid engagements

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Nyaya Health 2010

Building Healthcare Infrastructure: Staff Recruitment

Focus on local talent

Open, advertised process

Structured and qualitative components to the interview

Salaries on par with the Nepali government

Opportunities for career advancement

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Nyaya Health 2010

Building Healthcare Infrastructure: Continuing Medical Education

Developing new competencies among staff is key to building health systems.

Strategies include: Reviewing evidence-based clinical

protocols Ultrasound data reviewed by Yale. On-site clinical consultants. Computer literacy

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Nyaya Health 2010

Building Healthcare Infrastructure: Telecommunications

Reliable telecommunications system is central to our ability to deliver:

Quality medical care. Logistics planning. Telemedicine. Fundraising.

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Nyaya Health 2010

Building Healthcare Infrastructure: Community Health Workers

Community health workers play critical roles in ensuring timely access to essential medical care

Effectively deliver care in rural regions with little access to transportation

Provide follow-up care of chronic conditions

Help raise awareness and educate their fellow citizens

Offer continual feedback to Nyaya about community needs and concerns

Phased scale-up of CHW network

1. Outreach

2. Medical adherence support

3. Paramedical services

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Nyaya Health 2010

Developing a Scalable Model: Nyaya Health Wiki

Wiki is an searchable repository of: Management policies and contracts Clinical protocols clinical data Clinical engineering details

All pages viewable to the public

A forum to share lessons-learned from our patients in Achham with organizations in similar settings around the world

http://wiki.nyayahealth.org

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Nyaya Health 2010

Developing a Scalable Model: Nyaya Health Blog

Staff and volunteers write journal-type stories to share and reflect on our programs

Forum for discussing: Patient cases Clinical operations details Organizational challenges and successes

Colleagues throughout the world can use these experiences to guide their own work and provide us with feedback or questions http://blog.nyayahealth.org

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Nyaya Health 2010

Developing a Scalable Model: Data Monitoring

Effective healthcare must be driven by data monitoring and evaluation

Collaboration between Nepal- and US-based data team is critical: Monthly uploading and analysis Public access to enhance

collaboration and transparency in the global health community

Revision of programmatic design and protocols according to regular data evaluation

http://wiki.nyayahealth.org/DataManagement

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Nyaya Health 2010

Developing a Scalable Model: Financial Transparency

Nyaya’s wiki offers ready accessibility to: Line-by-line expenditures Month-by-month budgets summaries Timeline of expenditures Accounts balances

Benefits More engaged donors Organizational culture of honesty

and openness More effective management

http://wiki.nyayahealth.org/Budget

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Nyaya Health 2010

Nyaya Health – Bayalpata Hospital celebrates 1st Birthday

• Whole community was invited

• Tree planting as a symbol of sustainable development and a green future.

Nyaya Health 2010

Nyaya Health and Yale New Haven/Waterbury Hospital

Started off by Yale Medical Students

Several residents from Yale have rotated at Bayalpata Hospital

Future program for interested residents to rotate at the hospital.

Hospital equipment donation

Nyaya Health 2010

Nyaya Health –

Nyaya Health 2010

Thank You! Questions?

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135 College St, Suite 323New Haven, CT 06510, USAPhone: +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)