BAYALPATA HOSPITAL बयलपा�टा� अस्पता�लNCASC, FHD, FHI, UNICEF PresentationAchham, 8 Chaitra 2068

Bayalpata Hospital RepresentativesDan Schwarz, Executive DirectorDr. Amir Bista, HIV Program DirectorMs. Megha Giri Bista, Nurse In Charge Ms. Ranju Sharma, Community Health Director

Outline of Presentation

1. Nyaya Health – Bayalpata Hospital, Overview (Dan Schwarz)

2. Maternal Health Programs Review (Ms. Megha Giri Bista)

3. HIV Services Review (Dr. Amir Bista)

4. Community Health Services Review (Ms. Ranju Sharma)

5. Questions & Discussion, Facilities tour

Nyaya Health Nepal: Who We Are

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Social justice-oriented mission:

1. To provide free community-based healthcare in rural Nepal with a focus on the most marginalized populations

2. To work in a public private partnership with the Ministry to strengthen the public sector for long-term health systems development

Founded in 2063 in Nepal along with partner organization Nyaya Health International (NHI) in the USA

Opened Sanfe Bagar Medical Clinic in 2065 Public-private partnership with Nepali

Ministry of Health & Population in 2066 Opened the Bayalpata Hospital in Jestha

2066 Managed by a volunteer Board of Directors

and 27 full-time employed Nepali staff

Current Services: Bayalpata Hospital All health care services free of charge:

Inpatient & Outpatient services 24-hour emergency room Safe Motherhood program, CAC

services Laboratory & Pharmacy Radiology: X-Ray & Ultrasound HIV, TB treatment programs Malnutrition treatment (CMAM) Ambulance services Community Health Worker (CHWs)

services

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Next Steps for 2068: Continue Renovations

Next Steps

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Next Steps for 2068: Scale-up of Surgical Services

Next Steps

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Next Steps for 2068: Building Solar Power Capacity

Next Steps

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Next Steps: Expanding Community Health

Nyaya Health Nepal Financing – Income & Expenditures

All line-item financial statements available at http://wiki.nyayahealth.org for full organizational

transparency and accountability

Projected Budget FY 2066-67 vs. FY 2067-68

*Over 99% of all NHN funds used in Nepal

Outline of Presentation

1. Nyaya Health – Bayalpata Hospital, Overview (Dan Schwarz)

2. Maternal Health Programs Review (Ms. Megha Giri Bista)

3. HIV Services Review (Dr. Amir Bista)

4. Community Health Services Review (Ms. Ranju Sharma)

5. Questions & Discussion, Facilities tour

Maternal Health Programs

• Antenatal Clinic – – Six days/week with range of client flow being 5 to 15/day– One separate staff– Lab services and USG services– Needs: USG training

• PMTCT – – One trained staff – Testing all clients on first visit and during deliveries when indicated– Needs: PMTCT training to more staffs

• Delivery Service – – 24 hour service – Separate well equipped labour room ,vacuum and forcep delivery, – One SBA trained nurse and one New Born Care trained nurse– Ambulance with preference to deliveries – In-service training to the clinical staffs – Needs: SBA training to nurses and doctors, radiant warmer

Maternal Health Programs

Preventing Unwanted Pregnancies

Family Planning – Services (condom, depo, pills, IUCD) Counselling Locally developed patient information video

(shown in patient waiting area) Needs: training for implants and permanent

sterilization, better supply of IUCDs

Safe Abortion Services – CAC (MVA & MA) PAC Free of cost Needs: provision of free supply of

medabon for MA

Antenatal Visit and PMTCT Program

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ANC VisitsPMTCT TestingPMTCT Positive"+ve deliveries"

Bayalpata Hospital: Monthly Deliveries

Family Planning Service – Video education in OPD

Safe Abortion Service

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Outline of Presentation

1. Nyaya Health – Bayalpata Hospital, Overview (Dan Schwarz)

2. Maternal Health Programs Review (Ms. Megha Giri Bista)

3. HIV Services Review (Dr. Amir Bista)

4. Community Health Services Review (Ms. Ranju Sharma)

5. Questions & Discussion, Facilities tour

HIV in Nepal & in the Far West

• HIV in Nepal– National prevalence only 0.49%, but heavily focused in high-risk groups 1, 2

> CSWs> IDUs> Migrants / Wives of migrants – 3.3% in WoM’s in Doti/Achham 3

– Only ~16,000 out of an estimated 70,000 HIV+ have been diagnosed 2

– Only ~15% of those known to be eligible currently on treatment 4

> 24 ART sites in the country, 20 of which are MOH-run sites 5

• HIV in the Far Western Hills– Over 80% of the men are migrants; over 7% return from India HIV+ 6

– Resource-poor primary health infrastructure– Until 2008, no ART at all; now 4 MOH sites plus Bayalpata Hospital 4

MOH; 2009 UNGASS; 2010

Nyaya’s HIV Program—History to date

• Petition to NCASC beginning in 2008• Service pre-requisites: • Inpatient / outpatient• Radiology• Dedicated buildings for ART consultations• Dedicated pharmacy space

• Delays in program initiation while Bayalpata developed facilities

• Sub-center facility initiation: July 2010• Great progress for Achham• Improved access to care for many remote populations

who previously had to go to Mangalsen

• Currently: April 2011• Nine months of enrollment• 130 patients enrolled in treatment; 103 on ART

Bayalpata Hospital HIV/AIDS Treatment Program

Nyaya’s ART Program – Demographics

Nyaya’s HIV Program—Challenges

•Barriers to patient enrollment and follow-up:– Awareness– Inconsistent presence in the district

> Migrants> Agricultural demands

– Transportation to Bayalpata> Seasonal work demands> Seasonal access to roads

– Increased risk of LTFUs, drug-resistance

•Service constraints:– Cannot initiate HAART or change regimens– Lack of CD4 counter (must go to District Hospital)– Lack of PVL in all of the Far West– Lack of pediatric formulations

Outline of Presentation

1. Nyaya Health – Bayalpata Hospital, Overview (Dan Schwarz)

2. Maternal Health Programs Review (Ms. Megha Giri Bista)

3. HIV Services Review (Dr. Amir Bista)

4. Community Health Services Review (Ms. Ranju Sharma)

5. Questions & Discussion, Facilities tour

Bayalpata Hospital Community Health

• Innovative program to strengthen the MOHP FCHV program

• Partnership between Bayalpata Hospital and local FCHVs

> Surveillance of VDC> Clinical follow-up from Hospital visits> Enhanced FCHV training> Financial incentives weekly

• Currently in six VDCs, 70 FCHVs• Ridikot• Mastamandu• Sidheshwor

– Scale-up to six additional VDCs in 2068

• Bagheshwor• Chandika• Hatikot

Bayalpata Hospital Community Health

Constant Communication with the FCHVs to ensure that we, Never forget the

patients!Never forget the

FCHVs and their needs!

Questions, comments, discussion…

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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: 977-9845-236-035(KTM)