Nyaya Health 2010

Building Health Systems in Rural Nepal:

The story of Nyaya HealthDuncan Maru, MD, PHD

Co-Founder and President| Nyaya Health

Harvard Kennedy School, February 17, 2011

Nyaya Health 2010

Outline

2

Introduction to Achham

Birth of Nyaya Health

Current services provided by Bayalpata Hospital

Challenges

Key features of the NGO

Next steps

Panel Discussion

Nyaya Health 2010

Where We Work: Nepal – Achham District, Far Western Region

Nyaya Health 2010

Achham District, Far Western Region, Nepal

Nyaya Health 2010

Achham District, Far Western Region, Nepal

Nyaya Health 2010

Achham, Nepal

9

250,000 population of Achham

0 number of allopathic doctors in Achham before Nyaya

6+ hours in bus to reach the nearest 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

>80% 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

Nyaya Health Snapshot

10

Founded in 2006; public-private partnership with Nepali Ministry of Health & Population in 2009

Social justice-oriented mission: To provide free community-based healthcare in rural

Nepal that strengthens the Nepali Ministry of Health’s public sector

To develop and disseminate effective strategies of healthcare delivery in resource-poor settings throughout the world

Nyaya Health 2010

Public-Private Partnership

We operate services that aim to bolster the public sector at three levels:Referral-level: Government hospitalPrimary care level: Government health posts (clinics)Outreach level: Government community health workers

Nyaya Health 2010

Sanfe Bagar Primary Health Center

12

Sanfe Bagar Health Center: Before

Sanfe Bagar Health Center: After

Nyaya Health 2010

Bayalpata Hospital

Infrastructure development and capacity building, not care provision alone Government collaboration: Government partnership contract for 5 years signed June 2009

– June 2014 Currently one of the highest levels of clinical care in the Far West (2 million people) 50,000 patients seen to date

Nyaya Health 2010

Bayalpata Hospital All health care services free of charge:

Inpatient & Outpatient services 24-hour emergency and obstetric services Laboratory & Pharmacy Radiology: X-Ray & Ultrasound HIV, TB treatment programs Malnutrition treatment (RUTF) Ambulance services Community Health Worker (CHWs) services Telemedicine

2011 Expansion Plans: Comprehensive surgical suite Solar energy Expanded CHW network Teaching hospital status

Nyaya Health 2010

Key Challenges

Human resourcesSupply chain managementEnergy systemsTelecommunicationsCommunity relationships,

outreachPublic sector relationships

Nyaya Health 2010

Nyaya Health: Unique Features

Collaboration with the Government Managed by a volunteer Board of Directors, 29 full-time employed Nepali

staff and many volunteers around the world Over 99% of all funds used directly in Nepal Transparency Prioritizing the most marginalized

Staff:70% achhami60% female35% dalit

Patients:65% female

18

Nyaya Health 2010 19

Continued Renovations

Next Steps

Nyaya Health 2010

Next Steps

20

Surgical Services

Quality Improvement

Implementation Research

Next Steps

Nyaya Health 2010

Next Steps

21

Solar Power

Next Steps

Nyaya Health 2010

My Personal Vision for Bayalpata Hospital

Nyaya Health 2010

Acknowledgements

The staff of Bayalpata Hospital & the people of Achham, Nepal

The volunteers and individual donors of Nyaya Health

The Nepali Ministry of Health & Achham District Health officials: Dr. Deepak Gaylal, Mr. Sailendra Shrestha, Mr. Jhanak Dhungana

Harvard School of Public Health Global Health Forum and Nepal Ko Yuwa

Institutional Supporters: Abbot Laboratories, AMD and the Open Architecture Network, America Nepal Medical Foundation (ANMF), BWH COE in Quality and Safety, Buddha Air, Cents of Relief, Child Health Foundation, CIWEC Clinic (Menlha Nursing Home), Ella Lyman Cabot Trust, EquityEditors Association, Ford Foundation, Frederick Lovejoy Foundation, Google Grants, Nepal Ministry of Health and Population (MOHP), New Aid Foundation, Partners in Health, QBC Diagnostics, Quidel Corporation, Singapore Internet Research Center, Ten Friends, The Hunger Site, The International Foundation, The Shelley and Donald Rubin Foundation, Until There's a Cure Foundation, UpToDate, William Prusoff Foundation, Yale University

Nyaya Health 2010

Bayalpata Hospital 2010

Nyaya Health 2010

Challenges: Facilities-Based Deliveries

Nyaya Health 2010

Challenges: Transportation Infrastructure

Nyaya Health 2010

Finances