1. The challenges of transparency, accountability, and collaboration in global health Dan SchwarzExecutive Director | Nyaya Health dan@nyayahealth.org

2. Outline of Presentation Nyaya Health Overview Developing a scalable model for health care delivery 1

4. Public-private partnership with Nepali Ministry of Health & Population (2009)

5. Managed by a volunteer Board of Directors and 26 full-time employed Nepali staff

6. Over 99% of all funds used directly in Nepal2

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

8. Where We Work 250,000 population of Achham 0 number of allopathic doctors in Achham before Nyaya 10+ hours in bus to reach the nearest airport and 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 50% 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 4

9. Achham District, Far Western Region, Nepal

10. History: Sanfe Bagar Primary Health Center 6

11. History: Sanfe Bagar Primary Health Center Opened for service April 6, 2008 Served over 17,000 patients between April ’08 and May ‘09 Services included: Outpatient department 24 hour emergency services Maternity suite with 24 hour-obstetric services Diagnostic laboratory Pharmacy 23 all-Nepali staff All services completely free

12. History: Transition to Bayalpata Hospital 8

13. History: Transition to Bayalpata Hospital Goal: infrastructure development, capacity building, not care provision Goal: to collaborate with the government in the development of pro-poor, rural health care development Government contract for 5 years signed June 2009 – June 2014 Ministry of Health & Population to take over Bayalpata Hospital in 2014

15. Inpatient & Outpatient services

16. 24-hour emergency and obstetric services

17. Laboratory & Pharmacy

18. Community Health Workers (CHWs)

19. Clean water supply for surrounding communities

20. 2010-2011 Expansion:

21. Surgical suite

22. X-Ray Services

23. Expanded CHW network

25. Background: Importance of transparency, accountability, collaboration Questions: What are best practices for health care delivery in resource-poor settings? How can NGO’s ensure accountability to stakeholders in global health delivery? Background: Historic lack of transparency and collaboration between NGO’s, especially in health 2008 Global Accountability Report (One World Trust) revealed that many non-profits scored even worse than for-profit multinational corporations Implications: Lack of transparency decreases accountability and misses opportunities for collaboration Particularly in health sector, collaboration is needed to develop best practices Transparency, accountability and collaboration can aid the development of a scalable model for health delivery

26. Attributes of a scalable model of healthcare delivery Transparency Collaboration Accountability

27. Take-home message A lack of transparency not only reduces the accountability of individual programs, it also misses an opportunity to advance global health delivery by establishing best practices in the field and collaboration between partners in these efforts to create best practices.

29. Clinical, financial and managerial

30. Open-access data fostering:

31. inter-team communication, and

32. collaboration with global health delivery community

33. Fully transparency aimed at accountability to stakeholders

35. Management policies

36. Financial data

37. Clinical protocols

38. De-identified clinical data

39. All pages viewable to the public

40. A forum to share lessons-learned from Achham with organizations in similar settings around the world

41. Opportunity for critical feedback and collaborationhttp://wiki.nyayahealth.org

43. Fluid communication is critical to a collaborative model

44. Nyaya uses low-bandwidth, user-friendly, open-access, free technologies to communicate and facilitate work among team membersGmail Archive Google Docs EverNote

45. Challenges and barriers to effective communication Two locales & two teams Discontinuous communication Details of day-to-day life lacking Context for decision-making lacking Uncomfortable tensions: Micro-management vs. “hands-off” approach Empowerment vs. “letting go” of control Deferral to local authority …An imperfect system

46. Communication challenges Nyaya is a collaboration between Nyaya Health INGO (USA) and Nyaya Health Nepal (Nepal) Fluid communication to facilitate inter-team collaboration is critical to model Nyaya uses low-bandwidth, user-friendly, open-access technologies to communicate among team members

50. TH and NH face similar challenges in effective health delivery practices

51. Via transparent operations and inter-team collaboration, TH and NH have been able to enhance work in both Liberia and Nepal

52. Successful collaborations including:

53. Financial accounting protocols

54. Pharmacy and inventory management

56. Thank You… Questions? 24