User:Roger Wellington-Oguri/Nyaya Health

Nyaya Health is a non-governmental organization (NGO) providing free health care in Achham, a district in the Far Western region of Nepal. Nyaya (Nepali for Justice) operates Bayalpata Hospital, one of only two hospitals in Achham (population 250,000), in cooperation with the Nepali government's Ministry of Health and Population. It also manages the Nepali government's community health worker program in a number of communities around the hospital.

Nyaya is a partner project of Partners in Health.

History

 * Nyaya Health was founded in 2005 by three Yale School of Medicine students - Jason Andrews, Sanjay Basu and Duncan Maru. Their first project was a community-based antiretroviral therapy program in Kathmandu, the capital of Nepal.


 * In 2006, Andrews and his film-maker wife Roshani traveled to Far Western Nepal to make a documentary film of the HIV epidemic in that region. One meeting he had was with 20 HIV-infected widows who described the health care that was available to them. When Jason returned to the US, he sent an impassioned email to Duncan and Sanjay asking what they could do for the these people.  The three of them started working out plans for raising money for treating HIV in Achham.  In September, they were awarded a $10,000 grant from the Ford Foundation.


 * Nyaya Health spent the next year doing epidemiological studies, negotiating with the Nepali local and central governments, establishing supply chains and raising funds. A former grain shed in Sanfe Bagar, Achham District, was selected as the site for a clinic.


 * The Sanfe Bagar clinic was opened on April 7, 2008. Initial programs focused on maternal health, child malnutrition, and HIV and tuberculosis treatment.


 * In 2007, Nyaya was selected as one of three organizations around the world to be beneficiaries of an international design contest sponsored by Open Architecture Network and AMD. The design challenge was for a telemedicine center, and was won by Max Fordham LLP of London, UK. However, the telemedicine center was never built due to lack of funding.


 * Soon after the opening of the Sanfe Bagar clinic, the community requested that Nyaya Health take over the administration of nearby Bayalpata Hospital. The hospital had been build in 1976, but had never been staffed and had fallen into disrepair.  Nyaya negotiated with the Nepal Ministry of Health and Population to be allowed to rebuild and administer the hospital for five years.  The hospital opened for the first time in 2009.


 * In August of 2009, the first ultrasound machine in rural western Nepal was installed at Bayalpata Hospital.


 * In September 2009, Nyaya instituted a new Mortality Review Program. Each death occurring at the Bayalpata hospital is reviewed by both the Nepali and international teams for systems-level changes to prevent future deaths. The de-identified reports are then published for review by the Web community.


 * In 2011, the hospital revamped and expanded its Community Health Worker program by integrating it with the Nepali government's Female Health Care Volunteer program. To do this, an agreement was negotiated whereby Nyaya Health would pay the women volunteers for performing certain tasks, thus raising the status of the women and establishing accountability for the first time.

Organizational Structure
Nyaya Health is organized as two closely connected NGOs, the Nepal-based NGO that implements health programs in partnership with the Nepali Ministry of Health and Population, and the International NGO that provides technical assistance and fundraising for the Nepal NGO. Many of the INGO volunteers are young Nepalis who have gone abroad for higher education and are now using their skills to improve conditions in their homeland.

Open Access and Transparency
Since its inception, Nyaya Health has focused on using Web technologies to create as open and transparent an operation as possible. The primary mechanism for this has been to maintain a public wiki, where clinical protocols, management strategies, programmatic work plans, deidentified aggregate patient data and detailed budget reports are routinely posted. In addition, all of the internally generated documents that are available to team members are also available for public examination.

Advocacy
In addition to providing free health care in Achham, Nyaya Health's international volunteers, both individually and collective, act as advocates for various topics affecting the well-being of the the poor in rural Nepal. These topics include the cultural and economic forces that result in resource denial,  the status of women, active screening for visceral leishmaniasis, and the need for political decentralization in order to bring about socio-economic transformation in underprivileged areas.