1. BAYALPATA HOSPITAL बयलपाटाअस्पतालNCASC, FHD, FHI, UNICEF PresentationAchham, 8 Chaitra 2068 Bayalpata Hospital RepresentativesDan Schwarz, Executive DirectorDr. Amir Bista, HIV Program DirectorMs. MeghaGiriBista, Nurse In Charge Ms. Ranju Sharma, Community Health Director

2. Outline of Presentation Nyaya Health – Bayalpata Hospital, Overview (Dan Schwarz) Maternal Health Programs Review (Ms. MeghaGiriBista) HIV Services Review (Dr. Amir Bista) Community Health Services Review (Ms. Ranju Sharma) Questions & Discussion, Facilities tour

4. Opened Sanfe Bagar Medical Clinic in 2065

5. Public-private partnership with Nepali Ministry of Health & Population in 2066

6. Opened the Bayalpata Hospital in Jestha 2066

7. Managed by a volunteer Board of Directors and 27 full-time employed Nepali staff2

8. Nyaya Health: Mission and operations Goal: infrastructure development, capacity building, not only care provision Goal: collaborate with the government in development of pro-poor, rural health care Government partnership contract for 5 years Jestha 2066 – Jestha 2071

10. Inpatient & Outpatient services

11. 24-hour emergency room

12. Safe Motherhood program, CAC services

13. Laboratory & Pharmacy

14. Radiology: X-Ray & Ultrasound

15. HIV, TB treatment programs

16. Malnutrition treatment (CMAM)

17. Ambulance services

19. Next Steps for 2068: Continue Renovations 6

20. Next Steps Next Steps for 2068: Scale-up of Surgical Services 7

21. Next Steps Next Steps for 2068: Building Solar Power Capacity 8

22. Next Steps Next Steps: Expanding Community Health 9

23. Nyaya Health Nepal Financing – Income & Expenditures All line-item financial statements available at http://wiki.nyayahealth.org for full organizational transparency and accountability

24. Projected Budget FY 2066-67 vs. FY 2067-68 *Over 99% of all NHN funds used in Nepal

25. Outline of Presentation Nyaya Health – Bayalpata Hospital, Overview (Dan Schwarz) Maternal Health Programs Review (Ms. MeghaGiriBista) HIV Services Review (Dr. Amir Bista) Community Health Services Review (Ms. Ranju Sharma) Questions & Discussion, Facilities tour

26. Maternal Health Programs Antenatal Clinic – Six days/week with range of client flow being 5 to 15/day One separate staff Lab services and USG services Needs: USG training PMTCT – One trained staff Testing all clients on first visit and during deliveries when indicated Needs: PMTCT training to more staffs Delivery Service – 24 hour service Separate well equipped labour room ,vacuum and forcep delivery, One SBA trained nurse and one New Born Care trained nurse Ambulance with preference to deliveries In-service training to the clinical staffs Needs: SBA training to nurses and doctors, radiant warmer

28. Counselling

29. Locally developed patient information video (shown in patient waiting area)

31. PAC

32. Free of cost

34. Bayalpata Hospital: Monthly Deliveries

35. Family Planning Service – Video education in OPD

36. Safe Abortion Service T-645

37. Outline of Presentation Nyaya Health – Bayalpata Hospital, Overview (Dan Schwarz) Maternal Health Programs Review (Ms. MeghaGiriBista) HIV Services Review (Dr. Amir Bista) Community Health Services Review (Ms. Ranju Sharma) Questions & Discussion, Facilities tour

38. HIV in Nepal & in the Far West HIV in Nepal National prevalence only 0.49%, but heavily focused in high-risk groups 1, 2 CSWs IDUs Migrants / Wives of migrants – 3.3% in WoM’s in Doti/Achham 3 Only ~16,000 out of an estimated 70,000 HIV+ have been diagnosed 2 Only ~15% of those known to be eligible currently on treatment 4 24 ART sites in the country, 20 of which are MOH-run sites 5 HIV in the Far Western Hills Over 80% of the men are migrants; over 7% return from India HIV+ 6 Resource-poor primary health infrastructure Until 2008, no ART at all; now 4 MOH sites plus Bayalpata Hospital 4 MOH; 2009 UNGASS; 2010

40. Inpatient / outpatient

41. Radiology

42. Dedicated buildings for ART consultations

43. Dedicated pharmacy space

44. Delays in program initiation while Bayalpata developed facilities

45. Sub-center facility initiation: July 2010

46. Great progress for Achham

47. Improved access to care for many remote populations who previously had to go to Mangalsen

48. Currently: April 2011

49. Nine months of enrollment

51. Nyaya’s ART Program – Demographics

52. Nyaya’s HIV Program—Challenges Barriers to patient enrollment and follow-up: Awareness Inconsistent presence in the district Migrants Agricultural demands Transportation to Bayalpata Seasonal work demands Seasonal access to roads Increased risk of LTFUs, drug-resistance Service constraints: Cannot initiate HAART or change regimens Lack of CD4 counter (must go to District Hospital) Lack of PVL in all of the Far West Lack of pediatric formulations

53. Outline of Presentation Nyaya Health – Bayalpata Hospital, Overview (Dan Schwarz) Maternal Health Programs Review (Ms. MeghaGiriBista) HIV Services Review (Dr. Amir Bista) Community Health Services Review (Ms. Ranju Sharma) Questions & Discussion, Facilities tour

55. Mastamandu

57. Chandika