1. Building Health Systems in Rural Nepal: The story of Nyaya Health Duncan Maru, MD, PHDCo-Founder and President| Nyaya Health Harvard Kennedy School, February 17, 2011

3. Birth of Nyaya Health

4. Current services provided by Bayalpata Hospital

5. Challenges

6. Key features of the NGO

7. Next steps

8. Panel Discussion1

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

10. Achham District, Far Western Region, Nepal

11. Achham District, Far Western Region, Nepal

12. Achham District, Far Western Region, Nepal

13. Achham District, Far Western Region, Nepal

14. Achham District, Far Western Region, Nepal

15. Achham, Nepal 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 6% & 54% Female and male literacy rates, respectively 1 in 125 deliveries results in the mother’s death 64 number of stillborns for every 1,000 live births >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% 60% of children are chronically malnourished 8

17. To develop and disseminate effective strategies of healthcare delivery in resource-poor settings throughout the world9

18. Public-Private Partnership We operate services that aim to bolster the public sector at three levels: Referral-level: Government hospital Primary care level: Government health posts (clinics) Outreach level: Government community health workers

19. SanfeBagar Primary Health Center Sanfe Bagar Health Center: After Sanfe Bagar Health Center: Before 11

20. Bayalpata Hospital 12

21. Bayalpata Hospital

22. 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

24. Inpatient & Outpatient services

25. 24-hour emergency and obstetric services

26. Laboratory & Pharmacy

27. Radiology: X-Ray & Ultrasound

28. HIV, TB treatment programs

29. Malnutrition treatment (RUTF)

30. Ambulance services

31. Community Health Worker (CHWs) services

32. Telemedicine

33. 2011 Expansion Plans:

34. Comprehensive surgical suite

35. Solar energy

36. Expanded CHW network

39. Managed by a volunteer Board of Directors, 29 full-time employed Nepali staff and many volunteers around the world

40. Over 99% of all funds used directly in Nepal

41. Transparency

42. Prioritizing the most marginalized Staff: 70% achhami 60% female 35% dalit Patients: 65% female 17

43. Next Steps Continued Renovations 18

44. Next Steps Next Steps Surgical Services Quality Improvement Implementation Research 19

45. Next Steps Next Steps Solar Power 20

46. My Personal Vision for Bayalpata Hospital

48. The volunteers and individual donors of Nyaya Health

49. The Nepali Ministry of Health & Achham District Health officials: Dr. Deepak Gaylal, Mr. SailendraShrestha, Mr. JhanakDhungana

50. Harvard School of Public Health Global Health Forum and Nepal KoYuwa

52. Challenges: Facilities-Based Deliveries

53. Challenges: Transportation Infrastructure

54. Finances