Summary Funding Proposal to McKinsey Analysts

Description of the NGO and current project:
Nyaya Health is an international NGO partnering with the Government of Nepal to improve healthcare infrastructure in Achham. We are establishing a primary health centre focusing on Maternal and Child Health. The clinic is set to open on December 1, 2007. Within the next year, we will expand operations to a long-abandoned government hospital in Bayalpata to provide higher-level care with blood transfusion and operating capacity. The portal to better understanding how the clinic runs is found at: http://nyayahealth.pbwiki.com/Achham-Clinic-Operations.


Relevant statistics of the district:
• Number of citizens: 250,000

• Number of doctors (excluding Nyaya Health): 1 (located 5 hours from the clinic)

• Number of ultrasound machines: 0 (none in an area covering over 1 million people)

• 99.5% of babies are delivered outside a health center
• 1 in 125 deliveries result in death of the mother
• 60% of children are chronically malnourished
• Average person makes $150 a year
• Nearest functioning airport and hospital: 10 hour bus ride away, costs 1-2 months' average income

Funding Request

We are requesting the following items that appear to be of greatest interest to your group and are of highest priority for Nyaya Health. The list is a mixture of immediate, short-term, high-impact essential medicines, human resources, and long-term capital equipment. This should provide the donor group with sufficient diversity to deliver both immediate and long-term social returns on their donation.

The specific interventions include: supplies to treat infant pneumonia or sepsis; a portable ultrasound machine with 3.5 MHz convex transducer for basic obstetric imaging; oxytocin for use in preventing and treating postpartum hemorrhage (the number one cause of maternal mortality); and salaries and support for community health workers (CHWs).

With all our expenditures, we provide a complete, line-by-line accounting, found at:

http://nyayahealth.pbwiki.com/Budget.

Capacity to Absorb the Funds

Currently, human resources consist of approximately 50% of our budget. Our clinic staff knows how to administer antibiotics and oxytocin, utilize ultrasound for basic obstetrics, and work with CHWs. These funds will ensure that they have all the resources they need to deliver superior services to their clients. The CHWs in particular are some of the most cost-effective interventions in communicating information, triaging patients, promoting healthy interventions and delivering essential medicines in the most remote and deprived areas that lie 2-4 hours away by foot. Reaching in particular pregnant women, almost none of whom would deliver in a healthcare facility without CHW involvement, is a pressing issue.


Outcomes and Performance Evaluation
Two members of our Board of Directors, Sanjay Basu and Duncan Smith-Rohrberg Maru, are widely published epidemiologists in the final year of their MD/PhD training. Together with colleagues at Yale, they are developing modeling tools for performance evaluation. Bibhav Acharya, another member of the Board, worked at the New York State Department of Health to develop performance indicators for HIV services in New York. We have developed Clinical Record System (found at http://nyayahealth.pbwiki.com/Clinical_Records) that will be rigorously analyzed for adherence to protocol and for continued improvement of performance. We are improving our modeling tool for assessing our impact on the ultimate arbiter of epidemiological truth and our organization’s raison d’être: mortality. A draft of this model can be found on our budget page: http://nyayahealth.pbwiki.com/Budget.
Management Structure
Roles and responsibilities that afford ownership to the Nepal staff, the Achham community and the poorest of our patients are outlined in http://nyayahealth.pbwiki.com/Management.

The goal is to minimize overhead costs and maximize ownership of the project among staff members in the field, while at the same time ensuring that staff have access to the best knowledge and supplies. US-based staff are mainly involved in developing protocols, providing technical assistance and raising funds for the clinic. The US staff will not micro-manage the clinic but will regularly travel to Nepal and provide assistance and assist in strategic direction.

Note on Long-Term Relationship and Opportunities of Involvement

Ideally, our donors stay involved through ongoing updates, discussions, and, ideally, site visits. This does not necessarily mean ongoing funding. Rather, the primary aims for this is threefold. Firstly, for the donor, it is the best way to decrease the risk and maximize potential social returns on their investment. Secondly, for Nyaya Health, we greatly benefit from the ideas, connections, and feedback of our donors. The need is immense and there are several avenues for which analysts and consultants can advise us. Analyzing the healthcare delivery system, modeling community insurance programs, assisting with scale-up plans and developing microfinance initiatives are some potential opportunities. Finally, sustaining long-term relationships brings a degree of personal satisfaction and connection to all parties involved.