Nyaya Health December 6, 2010 Board of Directors Report

Nyaya Health December 6, 2010 Board of Directors Report 15.965 Global Health Delivery and Management Molly Bodell, Pompa Debroy, Sophie Cain Miller, & Evvie Nanni

Outline 1 Mission Statement 2 Background 3 Model 4 Recommendations

Nyaya Health has a two-pronged mission Overarching Mission: Quality Health Care Delivery 1 Deliver free community-based health care in rural Nepal 2 Establish & disseminate a scalable model of healthcare delivery worldwide Other Goals: - PIH model of delivery: No one is denied care Use CHWs (Community Health Workers) Permanent on-the-ground care Mission 3

Main challenges to delivering Healthcare in Achham, Nepal Geography: Mountainous terrain Poor road conditions History: Civil war Lack of existing medical care in district Poverty: Median household income <$1 / day Government: Unreliable provision of healthcare Source: 2009 Annual Report Image Source: Roof of Nyaya Health Clinic; Wikipedia Background 4

Key health status indicators in Achham prior to Nyaya Health INDICATOR Health Care Staff Nearest Operating Room Maternal Mortality Ratio Stillbirths STATISTIC 0 Doctors 10 hours by bus 740 deaths per 100,000 live births 64 per 1,000 live births Under-5 Child Mortality 83 deaths per 1,000 Migration Chronic Malnutrition rate 50% of men migrate to India for work 7% return with HIV 60% of children Source: 2009 Nyaya Health Annual Report Background 5

High maternal mortality ratio (MMR) in district United States: 17 Italy: 4 Nepal: 240 Achham: 740 Source: IHME 2010, Maternal Mortality (Global), Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5, Institute for Health Metrics and Evaluation, Online, viewed 13th April, 2010. Note: numbers are per 100,000 live births Background 6

Nyaya Health Employs Unique Model for Free, Quality Care Delivery VALUES Free care Nyaya Health Egalitarian US-based Staff Transparency Comprehensive health Historically care unpaid Accountability delivery volunteer 24/7 service Hired first 25 doctors and staff US-based ED 36,000 patients per year 67% women GOVERNMENT PARTNERSHIP 50% of patients travel 1-3 Owns facility hours by foot Provides 38% of funding Top 2 diagnoses: gastritis 5 year agreement with and upper respiratory Nyaya Health infections (URIs) Trains and hires CHWs Multiple sources of funding ORGANIZATION Nepal-based Staff 28 employees 82% Nepali TECHNOLOGY Open-source Information sharing Documentation and data collection Website, blog & Wiki Model 7

Nyaya Funding Comes From Multiple Sources Sources of Funding Spending Donors 59% Staff salaries c 57% Private Donations 29% Grants from US students research Pharmaceuticals Medical supplies c 32% 12% Nepali Government Maintenance Office expenses & telecom c 11% Model 8

Nyaya Health Employs Unique Model for Free, Quality Care Delivery VALUES Free care Egalitarian Transparency Accountability US-based Staff Historically unpaid volunteer Hired first US-based ED ORGANIZATION Nepal-based Staff 28 employees 82% Nepali GOVERNMENT PARTNERSHIP Owns facility Provides 38% of funding 5 year agreement with Nyaya Health Trains and hires CHWs Nyaya Health TECHNOLOGY Open-source Information sharing Documentation and data collection Website, blog & Wiki Model 9

At the End of the World: The Cutting Edge of Health IT Information Technology Advanced software to track medicine supply Connection to directors, located in five countries across the world Five areas of information made possible through IT Supply Chain Developed supply chain for medicines where none existed before Expect to double medicine procurement in the next year, with only 120% increase in cost Completely Open-source Operations All budgets and internal data available on open source Wiki Organizations can provide feedback on Nyaya s operations Model 13

Nyaya Wiki http://wiki.nyayahealth.org Model 14

Nyaya offers unique value proposition for four key audiences Achham Valley Nepali Health System Global Health Community Donors Free healthcare to 250,000 people Comprehensive healthcare Malpractice mechanisms Education Population served by traditional NGOs To serve as model for other facilities in Nepal Medicine supply chain to rural area Model for sourcing local doctors and medical workers Model for utilizing gov t trained CHWs Provide information, examples and templates for other facilities IT gold standard for rural healthcare Information and data completely accessible and open source Information completely accessible and open source, including budget, reach and evaluative data Frequent anecdotal reporting via Nyaya blog Stakeholders not traditionally served by global health community Model 15

Business model success dependent on feedback loop between two sides of mission Operations are transcribed directly to website Quality of Information available on wiki Demand increase through publicity and word-of-mouth Quality of care delivered in Achham Valley Key reinforcing feedback loop Awareness and use of Nyaya resource by other NGOs Operational & service delivery improvements Feedback on care delivery model More users will provide diversity of input & expertise Model 16

Despite successful model, Nyaya Health currently faces three key challenges GROWTH How can and should Nyaya scale to meet demand? Multiple locations or countries? What is the appropriate scope of services Nyaya should offer? REPLICABILITY How can Nyaya Health ensure model is easily replicable for other global health organizations? SUSTAINABILITY How can Nyaya Health ensure more consistent and sustainable funding? Is there opportunity to monetize services? Model 17

Recommendation 1: Growth in scale & scope GROWTH SCALE: Focus on flagship hospital as gold standard SCOPE: Increase scope of services, expand preventative and post-clinic care Recommendations 18

Recommendation 2: Strengthen available resources for model replicability REPLICABILITY Nyaya Health currently maintains website, blog & wiki Build awareness of resources Create more robust input loop (from local and global community) Reorganize and streamline online resources so that information is easier to navigate Recommendations 19

Recommendation 3: Create sustainable revenue streams; monetize services OPTION PROS CONS Brand and charge for materials/documents Small fees for service Create unrelated product and sell on site Conduct voluntourism Package and sell IT services Consulting/training for other global health orgs Materials already exist on website May help create demand for essential services Growing market Job creation Help with branding Has been successful in other areas of Nepal Expertise already in house Based on lessons learned Existing need in industry Thought leader Strengthen brand Not aligned with mission Not significant source of revenue Not aligned with mission May prevent patients from seeking and receiving care Not related to mission Would require added infrastructure Rural and remote area Not core competency Detracts from mission Would require additional staffing Possible mission creep Would require additional staffing Possible mission creep Recommendations 20

Q&A 21

Works Cited Phone interview with Dan Schwarz, Executive Director (Dan@NyayaHealth.org) Email correspondence with Ryan Schwarz, Director of Operations (Ryan@NyayaHealth.org) 2009 Nyaya Health Annual Report Nyaya Health Wiki: http://wiki.nyayahealth.org Nyaya Health Website: http://www.nyayahealth.org/ 22

Appendix 23

History of Nyaya 1996 2006: Nepalese Civil War, Only hospital in district shuts down 2008: Nyaya runs a newly opened primary health center to deliver care in Achham Valley 2009: Partnering with Nepali MOHP, renovated dilapitated Bayalpata hospital 2010: April: Starts a 5-year contract with MOHP to run Baylpata Hospital. May: Transitioned community health center to local health authorities. 2015: Government Funding set to expire 24

Nyaya budget is expected to increase by more than 250% in 2 years Source Financial Contribution Percent of Nyaya Budget Nepali Government $22,500 12% Individual Donors $59,838 32% Privation Donations $53,184 27% Grants from US Students ~$50,000 29% 2010 Total $185,522 100% 2011 (Projected) $350,000 $400,000 2012 (Projected) $500,000 25

Nyaya s Organizational Model US-Based Staff Hospital Nepali government Unpaid: volunteer to support Nepal Staff 28 Staff members (23 are Nepali) Owns Facilities Board of Directors: 12 members, Board of Advisors: 10 members Roles include doctors, medical director, pharmacists, nurses, administration Funding: provides 38% of Nyaya s operating budget Currently Recruiting Full-Time US Director Nurses oversee CHW s and FCHV s Trains CHW s and FCHV s 26

Nyaya Org Chart 27

Organizations with similar missions lack reinforcing feedback loop created by wiki Partners in Health Multiple countries Access to primary care, free health care and education, community partnerships, addressing basic and economic needs, serving poor through public sector Himalayan Health Multiple locations UNUSED Donates to SLIDES orphanages and provides care to patients in clinics through medical tourism, arranging for trips for medical volunteers Nick Simons Institute Based in Nepal Quality training for health care workers Support for rural health workers Scholarships for health leaders 28