1. Nyaya Health:
Providing healthcare
in rural Nepal
Shefali Oza
shefali@nyayahealth.org

2. The Sanfe Bagar
Medical Clinic
(April 2008 –
June 2009)
Outpatient department (OPD), maternity suite, 24-hour
emergency care, laboratory, and pharmacy
Community health worker network
No user fees
20 all-Nepali staff, including one doctor
Treated over 17,000 patients in 14 months

3. Bayalpata Hospital
Abandoned hospital in Achham built 20+ years ago
5-year contract signed with MOHP to renovate and operate
the hospital
Services will begin mid-June 2009
Current goal (2009-
2010): OPD, 24-hour
emergency, inpatient
maternity care, VCT,
PMTCT, DOTS, X-Ray,
expanded CHW network
2-5-year goals: ARVs,
surgical services with
blood transfusion,
inpatient ward

4. Our model: 5 key pillars
Free healthcare for all patients
Full Transparency
– All data, line b line expenditures, and protocols are
- -y
available at http://wiki.nyayahealth.org
Working together with community and government
Clinical services and community care/outreach must
be integrated
Evidence-based medicine through rigorous data
collection and evaluation

5. Monthly expenditure
Operational
budget
Breakdown by category
From our wiki:
http://wiki.nyayahealth.org

6. Current key priorities
Maternal and child health
Community-based initiatives
HIV/AIDS and tuberculosis
Technology

7. Maternal and child health
Maternal Mortality Ratio (deaths
per 100,000 live births) in
Achham: 800
– 200x that of areas in USA
Nearest C-section facility is 5
hours by bus
99.5% of deliveries occur outside
a health center
60% of children are chronically
malnourished in Achham
Nyaya Health patient data:
– 68% chronically malnourished
– 35% severely malnourished

8. Our maternal and child health program
Safe delivery and abortion services
Maternal inpatient and pre-delivery beds
Antenatal and post-natal services
Community and clinic-based monitoring
Outcome tracking and evaluation
Targeting malnutrition
at the clinic and
community level
– Pregnant women and
young children
Community health
workers provide
education, treatment,
referrals and follow-up

9. Some of our community-
based initiatives
Paid Community Health Worker
network for multiple programs
Reducing indoor air pollution
through clean stove technology
(planned)
Providing clean water by
distributing hospital-generated
chlorine solution (planned)
Community accountability
structures for improved health
care

10. Our Community Health Workers (CHWs)
Main reasons for CHW network
– limited transportation but long
distances
– high prevalence of chronic
diseases requiring long-term
medication adherence
– social challenges in accessing
existing healthcare services,
especially among the vulnerable
– lack of highly trained healthcare
personnel
Nyaya’s CHW program
– monitoring community for illnesses, pregnancy, and malnutrition
– general patient follow-up and antenatal/postnatal follow-up
– directly observed treatment (DOTS) for TB patients
– community-based malnutrition program
– health education and awareness outreach

11. HIV/AIDS and Tuberculosis
Migrant labor to India
leading to rapid rise in
Achham’s HIV incidence
Risk of multi-drug resistant
TB increasing due to
prescribing practices and
incomplete TB treatment
Roll-out of VCT, PMTCT, and ARVs at Bayalpata Hospital
Community-based education and nutritional support programs through
CHWs
CHW-based Directly Observed Treatment (DOTS) for TB
Strengthening TB diagnostic capacity, including drug sensitivity
Piloting active TB case finding in the community

12. Our use of technology
Diagnostics
– Ultrasound
– X-ray (by 2010)
– Laboratory equipment (I-Stat machine, QBC machine)
Data collection
Connectivity
– Telemedicine
– CHW networking

13. Some key challenges
Transportation
– Hilly region with
one road that ends
in Sanfe Bagar
– Restricts access to
health facilities and
patient follow-up
Communication
– No area-wide cell phone tower, internet, or landlines
Unreliable electricity grid
Deficits in water quantity and quality

14. Our funding sources
Private donors
Foundation grants
Nepali government
In-kind donations of equipment and
supplies
Collaborations with NGOs

15. Our online presence
Website (http://www.nyayahealth.org)
– Provides general information about our organization
and directs visitors to contacts and/or further
information
Wiki (http://wiki.nyayahealth.org)
– All of our data, line-by-line budget expenditures,
protocols, and expansion plans
Blog (http://blog.nyayahealth.org)
– Up-to-date posts about our work, including news
events, patient stories, and logistical/management
issues

16. Thank you from Nyaya Health