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Similaire à Med peds noon conference dec 2010
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Med peds noon conference dec 2010
- 1. Implementation Gaps and Quality Chasms: Building Health Systems in Rural Nepal Duncan Maru, MD, PHDCo-Founder| Nyaya Health Med-Peds Noon Conference, December 16, 2010
- 2. Learning Objective Think critically about healthcare delivery and quality in resource-poor areas 1
- 3. Where We Work: Nepal – Achham District, Far Western Region
- 4. Achham District, Far Western Region, Nepal
- 5. Achham District, Far Western Region, Nepal
- 6. Achham District, Far Western Region, Nepal
- 7. Achham District, Far Western Region, Nepal
- 8. Achham District, Far Western Region, Nepal
- 9. 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
- 11. To develop scalable models of healthcare delivery in resource-poor settings throughout the world
- 12. Founded in 2006; public-private partnership with Nepali Ministry of Health & Population in 2009
- 13. Managed by a volunteer Board of Directors and 27 full-time employed Nepali staff
- 14. Over 99% of all funds used directly in Nepal9
- 15. SanfeBagar Primary Health Center Sanfe Bagar Health Center: After Sanfe Bagar Health Center: Before 10
- 18. 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
- 20. Inpatient & Outpatient services
- 21. 24-hour emergency and obstetric services
- 23. Radiology: X-Ray & Ultrasound
- 24. HIV, TB treatment programs
- 27. Community Health Worker (CHWs) services
- 30. Solar energy
- 33. Case 1: Nosocomial Tuberculosis 27yo M lab tech from BH presenting with cough x3wks and hemoptysis Considered high-risk for TB exposure (3-4 sputa examinations per day)
- 34. Case 2: Infant Pneumonia An 8-month-old boy with severe respiratory distress and five-day history of pneumonia presented to the BayalpataHospital. Previously, the boy had been seen by untrained private “clinicians” in the community three times over four days. At presentation, the child was seen by one of Nyaya's mid-level practitioners who provided an initial course of antibiotics. Despite the child's ill appearance, supportive treatment including intravenous fluids and supplemental oxygen was not provided until discussion with the Medical Director three hours later. That evening, the hospital lost power – the public electricity grid shut off for its usual daily blackout, and the hospital generator had been improperly maintenanced and broken several days prior – so the electric nebulizer did not work. The oxygen canister was missing its regulator and therefore no oxygen could be provided during the power outage, nor could the patient be transferred via ambulance without oxygen. Additionally, due to the high costs of other regional health facilities the family refused transfer (our facility provides free services). That evening, after not being examined for some time by on-call staff, the child was found unresponsive with a thready pulse. CPR was not initiated for over ten minutes as the midwife managing the ward did not know the procedure and the AMBU bag was not at bedside. Following fifteen minutes of unsuccessful resuscitation, the child was declared dead.
- 35. Key Challenges Human resources Supply chain management Energy systems Telecommunications Community relationships, outreach Public sector relationships
- 36. Achieving Excellence in Healthcare Delivery… InstitutionalizeReflectiveDialogue: Mortality and MorbidityReviews InstitutionalizeTransparency in Reporting: Data Program
- 38. Lack of local and regional infection control; BH met standards!
- 39. Director of Medicine at foremost teaching hospital in Nepal: “never seen a safety hood in Kathmandu”
- 40. Solution 1a: Collaboration with international partners via GHDonline to design newly-constructed TB-specific lab space with negative pressure
- 41. Solution 1b: Collaboration with MOH & District to conduct infection control trainings
- 42. Issue 2: Personnel Safety
- 44. Oxygen protocol for ER
- 45. Dedicated ambu bag
- 46. CPR training for staff
- 50. Financial data
- 53. All pages viewable to the public
- 54. A forum to share lessons-learned from Achham with organizations in similar settings around the world
- 55. Opportunity for critical feedback and collaborationhttp://wiki.nyayahealth.org
- 56. Concluding Thoughts and Next Steps Summary Supporting public sector builds sustainable healthcare systems Quality healthcare relies on energy, telecommunications, logistical systems—management innovations are needed in both the clinical and non-clinical realms Commitment to place can drive global insights Nyaya’sNext Steps: Larger community health worker network Surgical capacity Solar energy systems Implementation Research
- 57. My Personal Vision for Bayalpata Hospital
- 59. The volunteers and individual donors of Nyaya Health
- 60. The Nepali Ministry of Health & Achham District Health officials: Dr. Deepak Gaylal, Mr. SailendraShrestha, Mr. JhanakDhungana
- 61. Institutional Supporters: Abbot Laboratories, AMD and the Open Architecture Network, America Nepal Medical Foundation (ANMF), BWH COE in Quality and Safety, Buddha Air, Cents of Relief, Child Health Foundation, CIWEC Clinic (Menlha Nursing Home), Ella Lyman Cabot Trust, EquityEditors Association, Ford Foundation, Frederick Lovejoy Foundation, Google Grants, Nepal Ministry of Health and Population (MOHP), New Aid Foundation, Partners in Health, QBC Diagnostics, Quidel Corporation, Singapore Internet Research Center, Ten Friends, The Hunger Site, The International Foundation, The Shelley and Donald Rubin Foundation, Until There's a Cure Foundation, UpToDate, William Prusoff Foundation, Yale University
Notes de l'éditeur
- Stress the “success” of being approached by the gov’t for collaboration – this slide should really just be “a few months after opening the clinic, we were approached by the government and local community, and offered to join in a public-private partnership to re-open the Bayalpata Hospital
- Stress the importance of our philosophy in how we approach our work
- 50,000 patients to date
- Make the point that even tho we have these problems, relative to other regional facilities, we are actually totally in line with the standards (Jason says he thinks we’re even in line with WHO guidelines, but likely better not to cite it cuz you might get into an argument re policy details), and that when (for example) you spoke w/mark zimmerman (NSI/PH) about this, he said that they were doing the exact same thing. It’s not that you were doing a bad job relative to what everyone said you were supposed to be doing, it’s that the standards are simply too low and thus, we needed to move outside the regional area for intl expertise on how to push the envelope forward, setting new precedents
- - This slide should be used to summarize Nyaya’s goals and highlight our next steps (which are key fundraising initiatives).