anmf and nyaya health: providing free healthcare in the far west
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Nyaya Health 2009
ANMF & Nyaya Health: Providing free health care in the Far West
Duncan Maru, MD, PhD13th Annual ANMF Conference, 19-21 June, 2009
Nyaya Health 2009
ANMF and Nyaya Health: Shared Values & Mission
Building health infrastructure in Nepal
Providing healthcare to Nepal’s most vulnerable and impoverished citizens
Training healthcare professionals in resource-poor settings
Achieving meaningful collaboration between professionals within and outside of Nepal
Engaging the Nepali diaspora
Developing models for rural healthcare delivery and access
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Nyaya Health 2009
Who We Are
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501(c)(3) organization founded in 2006 Channel over 99% of all donations directly to Nepal Managed by a volunteer Board of Directors and paid local
Nepali staff
Mission: To provide free community-based healthcare in rural Nepal To develop a scalable model of healthcare delivery in
resource-denied settings throughout the world
Strategies: 1. To facilitate resource distribution to resource-denied areas2. To expand human resource capacity and foster local
grassroots collective action3. To apply evidence-based medicine principles and rigorous
data monitoring and evaluation to all programs4. To involve the central government in the development of
pro-poor health infrastructure5. To utilize innovative technologies aimed at improving
transparency and collaboration in global health delivery
Nyaya Health 2009
Where We Work
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250,000 population of Achham
0 number of allopathic doctors in Achham before Nyaya
2 number of allopathic doctors in Achham hired by 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
50% of men migrate to India for work; over 7% return with HIV
in 1,000 children don’t survive past the age of five8399.5% 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
Nyaya Health 2009
Current Services: Sanfe Bagar Primary Health Center
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Opened for service April 6, 2008 Served over 17,000 patients in the
course of 14 months Facilities include:
Outpatient department Maternity suite Treatment rooms for 24-hour
emergency and obstetric care Laboratory Pharmacy
20 all-Nepali staff All services completely free of
charge to patients
Nyaya Health 2009
Current Services: Bayalpata Hospital
Built by the government but subsequently abandoned
45 minutes from Sanfe Bagar 5-year contract signed with the Nepali
Ministry of Health and Populations to renovate and operate the hospital
Services will include (summer, 2009): Outpatient department 24-hour emergency and obstetric
services Inpatient ward Laboratory & blood transfusion Testing and treatment for HIV,
tuberculosis, and malnutrition Community Health Workers (CHWs) Clean water for community
Phased Expansion: Women’s Center (mental health/
reproductive education/ social services) Surgical suite Digital X-Ray Services Expanded CHW network
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Nyaya Health 2009
Achieving Nyaya Health’s Mission in Achham
Mission #1: Build Healthcare InfrastructureMission #2: Develop a Scalable Model
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Nyaya Health 2009
Mission #1: Build Healthcare Infrastructure
An effective, responsive, community-driven healthcare system is the basis of public health and health justice.
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 2009
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 2009
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
Developing Bayalpata Hospital is Nyaya’s next step in this process…
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Nyaya Health 2009
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
Meeting the challenges of physician recruitment
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Nyaya Health 2009
Building Healthcare Infrastructure: Continuing Medical Education
CME is a key benefit that Nyaya can provide to retain workers
Developing new competencies among staff is key to building health systems
Strategies include: Reviewing evidence-based clinical
protocols CME sessions w/ Medical Director
and clinical staff Ultrasound On-site clinical consultants Computer literacy
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Nyaya Health 2009
Building Healthcare Infrastructure: Telecommunications
Reliable telecommunications systems is central to our ability to deliver: Patient quality Logistics planning Telemedicine Fundraising
Delivering effective systems requires: Working with public and private
partners Institutional investment Flexibility to adapt to rapidly changing
technologies
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Nyaya Health 2009
Building Healthcare Infrastructure: Rural Energy Systems
Effective rural healthcare demands reliable energy supply
Nyaya Health’s phased approach: Phase 1: Transfer existing
energy system to Bayalpata Hospital
Phase 2: Preliminary expansion of energy capacity
Phase 3: Integrating a small-scale solar-powered system
Phase 4: Larger-scale energy capacity expansion via solar power
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Nyaya Health 2009
Building Healthcare Infrastructure: Water Systems
Reliable clean water supply crucial to health care delivery
Bayalpata Hospital
Access to water donated via community collaboration
Working with community members to protect the water supply lines
On-site chlorination treatment through the support of Antennae Technologies and Environmental Camps for Conservation Awareness
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Nyaya Health 2009
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 network1. Outreach2. Medical adherence support3. Paramedical services
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Nyaya Health 2009
Mission #2: Develop a Scalable Model
Developing a scalable model is central to building the field of global health delivery
Nyaya Health uses several tools:
Wiki
Blog
Data monitoring and evaluation
Open-access clinical and financial data
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Nyaya Health 2009
Developing a Scalable Model: Nyaya Health Wiki
Wiki is an searchable repository of: Management policies and contracts Clinical protocols De-identified clinical data Clinical engineering details
Provided in real-time, as they are developed, evaluated, and revised
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
Opportunity for critical feedback and collaborationhttp://wiki.nyayahealth.org
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Nyaya Health 2009
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 2009
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
Rigorous attention to patient privacy
http://wiki.nyayahealth.org/DataManagement
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Nyaya Health 2009
Developing a Scalable Model: Financial Transparency
The Global Accountability Report: non-profits fared dismally
Nyaya’s wiki offers ready accessibility to: Line-by-line expenditures Month-by-month budgets summaries Timeline of expenditures Timeline of revenue 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 2009
ANMF and Nyaya Health: Shared Values and Mission
Bayalpata Hospital:
Achieving healthcare access to Nepal’s most vulnerable citizens
Training and expanding healthworker capacity in rural Nepal
Developing models for rural healthcare delivery
Next Steps:
Larger community health worker network
Surgical capacity
X-Ray services
Improved telecommunications capacity
Expanded energy systems
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Nyaya Health 2009
Thank You America Nepal Medical Foundation!
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135 College St, Suite 323New Haven, CT 06510Phone: 203-687-8615Fax: 630-604-8615
info@nyayahealth.orghttp://www.nyayahealth.orghttp://wiki.nyayahealth.orghttp://blog.nyayahealth.org
Bayalpata Hospital, Ridikot VDCAchham, Nepal
Phone: 977-94-690-404 (Achham)Phone: 977-9845236035(KTM)
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