This page details the ongoing expansion of Bayalpata Hospital, renovated and operated by Nyaya Health.

Current Draft Planning Documents

Work-Plan [PDF]: http://www.nyayahealth.org/Library/Expansion_Planning.pdf

Excel Costing Sheets: http://www.nyayahealth.org/Library/Expansion_Costing.xls

Excel Supplies Sheets: http://www.nyayahealth.org/Library/Expansion_Supplies.xls

Current Gantt Chart: http://spreadsheets.google.com/pub?key=p-TJjzE7A-O6gsHzwrsfSUA&gid=2

Agreement between Nyaya and Brigham Center for Surgery and Public Health: CSPH letter of intent.pdf

Executive Summary Text: 

Through our experiences caring for the community in Achham, and through our discussion with the local community and government, it has become clear that essential inpatient and surgical services must be provided to make a significant and comprehensive public health impact in the region.  The maternal health situation is particularly dire in this area, with best estimates indicating that a pregnant woman is 100 times more likely to die in childbirth in Achham (nearly one in 100 pregnancies) than in the United States.   The high maternal mortality rate, coupled with the lack of essential health delivery infrastructure, has been our primary motivation for working in the region.   We have begun to address the lack of infrastructure through Bayalpata Hospital, staffed by an all-Nepali team of healthcare professionals. The Hospital currently provides care to approximately 80 patients a day and includes 24-hour labor and delivery services, an in-house pharmacy, a diagnostic laboratory and emergency services.  We are rapidly expanding to meet the growing need for both healthcare delivery services, and the training of new Nepali healthcare workers.

Local citizens and government officials offered to us Bayalpata Hospital after it was abandoned for nearly 3 decades. We are currently in the expansion phase of the hospital which involved the following key actions, listed in the order of their planned implementation:

• continuing renovation of the abandoned government hospital in the village of Bayalpata. 
• expanding primary care, normal delivery services, and community health worker programs in the hospital;
• deploying diagnostic ultrasound (currently Nyaya has the only ultrasound for a region of approximately one million people);
• establishing X-Ray services;
• building a 14-bed inpatient ward to support our existing 24-hour maternal services;
• establishing blood transfusion capacity; 
• expanding our existing high-quality laboratory services, including culture microbiology;
• developing a surgical team capable of delivering essential surgical services including Cesarean sections, appendectomies, and basic orthopedic procedures.  This team would be led by a generalist Nepali physician trained through the national MD-GP (general practitioner) program. 

   

To achieve our objectives, we have created a step-wise plan of implementation and assigned project directors to oversee these steps. We have detailed the protocols and procedures that will be followed during the construction and expansion of services, produced contingency plans in the event of potential obstacles, and crafted an efficient but comprehensive budget for this initiative.

We will be raising $580,000 from our own fundraising campaign, which--together with resources from the government and in-kind donations of medical equipment--will provide the initial capital and 3 years of operating costs needed to fund these services. A plan involving gradual training and integration with the new parliamentary government's universal care initiative is also included, for long-term sustainability of the initiative as a community public health enterprise, after Nyaya Health establishes the protocols, system of delivery, and training programs. Throughout the implementation process, we will follow Nyaya Health’s responsible approach to health infrastructure development:

• Facilitating resource distribution to resource-denied areas.We will continue to utilize our expanding grassroots social network that is procuring finances and equipment to develop models for resource distribution to one of the most impoverished areas of Nepal. This work provides a necessary injection of critical resources for local communities to provide services, maintain and expand training programs, and begin to believe in their right to excellent health and their ability to achieve it.  Expatriate staff members provide technical expertise, training and assistance in clinic oversight, but do not receive any financial compensation. Nearly 100% of our grant funding goes towards the salaries of Nepali staff, supplies, pharmaceuticals, and other direct health service costs.
•  Fostering grassroots collective action to improve local ownership over healthcare.The local community members and district health officials have been advocating for the expansion of the very popular Nyaya Health services.  Local community members will take ownership over the health services through the expansion of our existing local management structures.  We will continue to employ a diverse all-Nepali staff from all socioeconomic and caste backgrounds.  We will expand local investment in healthcare through community-based health insurance and microfinance programs.
• Involving the central government in pro-poor health infrastructure.

  We believe that the government is ultimately responsible for providing healthcare to its citizens.  The Ministry of Health is providing essential medicines for maternal and child health, HIV, and tuberculosis.  The government has also agreed to provide us the abandoned hospital. We are currently finalizing the timetable for them to provide additional supplies and staffing, and ultimately take fiscal and operational control of the facility after we establish service protocols and provide operational oversight.

• Achieving transparency and collaboration in global health delivery

  As an open-source and transparent organization, we make all of our planning documents, costing tools, and clinical protocols available online for free download to the public (www.nyayahealth.org).

Data and monitoring

In cooperation with the Brigham and Women's Hospital Center for Surgery and Public Health (CSPH), we will conduct pre-program baseline data and concurrent program data to plan and continuously improve our services.

December 1-30, 2010:

We will conduct and deliver to the CSPH the following tools:

-WHO Needs Assessment and Evaluation Form for Resource Limited Health Care Facility (Essential Emergency and Anesthesia)

-Modified WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care

-Clinical Staff Skills Assessment

Since the opening of Bayalpata Hospita, we are using a local database system to transmit the following data over secure Internet:

(1) Mortality and morbidity monthly data

(2) Intraoperative events

(3) Postoperative events within 30 days

(4) Cases returned to OR within 24 hours

(5) Cases referred to another hospital for operation

(6) Cases referred to another hospital after surgical procedure

(7) Cases served

Links 

The structure of emergency obstetrical services in the hospital facility:

• Abreu E, Potter D. Recommendations for renovating an operating theater at an emergency obstetric care facility. International Journal of Gynecology and Obstetrics. 2001;75(3): 287-94.
• Dwivedi H, Mavalankar D, Abreu E, Srinivasan V. Planning and implementing a program of renovations of emergency obstetric care facilities: experiences in Rajasthan, India. International Journal of Gynecology and Obstetrics. 2002; 78: 283-291.
• Gill Z, Ahmed JU. Experience from Bangladesh: implementing emergency obstetric care as part of the reproductive health agenda. International Journal of Gynecology and Obstetrics. 2004; 85: 213-220.
• Gill Z, Bailey PE, Waxman R, Smith JB. A Tool for Assessing ‘Readiness’ in Emergency Obstetric Care: The Room-by-Room ‘Walk Through’. International Journal of Gynecology and Obstetrics. 2005; 89:191-199.

The approach we take towards emergency obstetrical services:

http://www.amddprogram.org/index.php?sub=4

Excellent article on the need for scaling up surgical capacity in resource-denied areas:  http://www.springerlink.com/content/e5k57877wvl23840/fulltext.html

Editorial on the need for surgical efforts to combat maternal mortality: http://www.washingtonpost.com/wp-dyn/content/article/2008/05/09/AR2008050902041.html

Another nice editorial on the need for surgical services:

http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050121&ct=1

http://www.who.int/surgery/globalinitiative/en/

http://globalsurgeryresearch.com/

Management approaches for health systems and hospitals:

http://www.who.int/management/en/ (see readings)