Nyaya Health Workplan
The purpose of this document is to concisely and clearly delineate general operating principles, essential roles of our expanding member pool, and some goals for the upcoming six months. Parts of this document are found on the wiki in various forms; the aim is to have compiled in one place something for folks to refer to when they are trying to make a decision or decide on the next steps. The workplan will evolve rapidly; everyone should be actively thinking about we are going about things. As with all documents we produce, all members are asked to please contribute by providing edits and additional content.
Major Goals byApril 1, 2008
Major Goals by September 1, 2008
Timeline
Overview of Roles and Responsibilities
CommunityManagement Structures
Nyaya Health INGO
Nyaya Health-Nepal
Board of Advisors
Clinic Personnel
PatientFlow
Clinic Scheduling
Insurance Policies
Staff Scheduling
Staff Professionalism
Fees for Services
Laboratory, Waste Management, and Logistics
Supplies Chain/Procurement
Patient Forms and Databases
Accounting
Budget Forecasting
Expansion of Services
GovernmentRelations—Kathmandu
Government Relations—Achham
Community health workers
HIV Program
TB Program
Telemedicine
Telecommunications
Travel and Living Expenses
Research
FinalNote
Major Goals by April 1, 2008
This excludes the fundraising and grants goals of the US-based team.
-hire the doctor, hopefully get him HIV training prior to this
-start the clinic
-establish 24-hour delivery services
-train and hire ten CHWs
-get PMTCT program going
-start VCT program
-get VSAT internet and phone system working reliably
-submit Nyaya Health Nepal paperwork
-submit TB proposal to SAARC
-expand board of technical advisors
-solidify supply chain management with mSupply
-improve medical record keeping
-make all the necessary preliminary preparations for telemedicine center
Major Goals by September 1, 2008
This excludes the fundraising and grants goals of the US-based team.
-establish a network of at least 20 CHWs
-have in place a reliable system of data collection for performance and evaluation
-initiate basic telemedicine applications linking CHWs and the clinic
-establish ultrasound and X-Ray diagnostics
-initiate the community management and users advisory boards
-start some form of community-based financing
-routinize the PMTCT and VCT programs
-establish the clinic as a DOTS microscopy center
-solidify round-the-clock delivery services and expand reach to achieve 30% coverage of all deliveries within a two-hour radius
-start construction of the telemedicine center
Timeline
-Sometime in March will be the opening date
-On-site leadership at that time (hopefully): Ana, Tenzing, Dr. Bijay, new doctor
-ana will be at the clinic through may +/-.
-shaan will hopefully start for a year sometime this summer.
-tenzing will be at the clinic through august +/-.
-gaurav likely to start around june, will do a trial period then consider a 1-2 year posting
-AMD/OA design team starting in june
-bibhav starting june 15 for ten weeks
-Ali June 15 for ten weeks (focus on healthcare financing and microfinance)
-jason likely to be at the clinic in early june for 3-6 weeks
-Ben, Juliana to be at the clinic for several weeks this summer
-astha likely to start in september, hoping to be there for a year
Overview of Roles and Responsibilities
This provides a concise summary of the Nepal-based leadership team. See the more detailed descriptions on the wiki (including downloads of the job descriptions). Firstly, there is a small team in Kathmandu that provides administrative support. This is led by the administrative director:
Administrative Director (Manindra Malla). He will manage specific tasks pertaining to Kathmandu needs, which includes: 1) writing checks from SCB account as needed to BSC, MSMT, and Doti RABA; 2) purchasing plane tickets from Kathmandu to Dhangadi as needed by staff; 3) providing strategic advice on telecommunications plans; 4) other government-and business-collaborations that he desires.
In Achham, the clinic management board consists of the Program Director, Medical Director, Clinic Superintendent, and Director of Logistics. Currently, aside from the Medical Director, these are unpaid, volunteer positions. The Clinic Management Board is responsible for hiring of staff and making key management and strategic decisions. In the future, these leadership positions may be fully or partially filled by paid staff. Certain roles and responsibilities of these leaders may be delegated to part-time volunteers, particularly during the summer months. The management philosophy in general should support inclusiveness, respect for alternative viewpoints, flexibility, and efficient decision-making. This will evolve rapidly over the course of the next months, particularly as we clarify who exactly will be at the clinic over the next year.
Program Director (Tenzing Tekan). He will provide general strategic direction to: 1) ensure the efficient management of the clinic; 2) improve the flow of patients through the clinic; 3) develop community-based management strategies; 4) identify local citizens who might be effective leaders at the clinic; 5) have ultimate responsibility, with the logistics director and medical director, over hiring, firing, and day-to-day budgeting.
Logistics Director (Ana Serralheiro). She will provide general strategic direction to: 1) ensure the safe and efficient management of waste and laboratory services; 2) maintain the accounting and supply management software in good working order; 3) have ultimate responsibility, with the program director and medical director, over hiring, firing, and day-to-day budgeting.
Medical Director (TBD). His duties will include 1) provision of clinical care; 2) oversight of public health programs; 3) ultimate responsibility, with the logistics director and medical director, over hiring, firing, and day-to-day budgeting collaborating with government agencies for supplies, and managing clinic staff and operations.
Clinic Supervisor (Rajan Kunwar). He is responsible for 1) maintenance and outfitting of the clinic; 2) assisting the program director in public relations and local approval processes.
In general, labor is readily available and it is best to train and hire someone locally to perform any repetitive or non-leadership tasks. This will free CMB and other members’ time for performing essential leadership tasks. Identifying and training local leaders is a major challenge but is eventually critical to achieving a strong and sustainable community base.
Most minor purchases can be decided upon by the clinic management team without emailing the Nyaya Health core team. Our team (of between 10-20 members) is available for consultation by email or by chat whenever any needs arise. In contemplating major purchases or purchases that may seem somewhat outside of the Nyaya Health mission, the clinic management team should email the board email list. The board is expected to respond within 3 days of receipt of the email. Decisions are not made by consensus but are rather made through reasonable and thoughtful deliberation by whichever board members are available at the time of decision-making. Consensus would be difficult given the unpredictability and highly saturated nature of board members’ schedules. Additionally, the Nyaya Board is primarily for advisory rather than micromanagement purposes.
The core team will try to have at least one member available via chat at all times. Please log in to nyayahealth@gmail chat if you need to discuss any issues. CDMA typically works okay for chat even during high-volume periods, but best is between 9PM-7AM.
Please email henever you have crucial questions or ideas for the entire group. You should check your email at least three times per week to ensure that you receive critical emails in a timely fashion.
Community Management Structures
Over the next several months, we will be working to develop structures that improve the accountability, responsiveness, and responsiveness with which we operate vis-à-vis the community. There is some discussion of this at:
Presently, Bibhav is coordinating with a team of MIT students to further develop these models. Below is an outline that we have provided to these students and in our annual report. Over the next few months, as the community begins to engage in the clinic, it will become clearer as to what is feasible and what is not.
We are interested in community management structures because we recognize communities as heterogeneous and dynamic assemblies of people with varying beliefs and needs. Within poor communities, there are disparities based on gender, class and other categories that hinder our ability to reach those with the greatest need. We aim to create management structures that will engage the members of the community we serve allowing us to:
-Clearly identify the needs of our target population.
-Gain a deep understanding of socio-cultural complexities in the region.
-Create management advisory boards with proper representation from the community to influence Nyaya's management and policy.
-Hear and understand the needs of the most marginalized people and meet those needs.
-Be accountable to the community we serve.
-Utilize local resources to provide services.
-Respond to the changing needs of the community.
-Facilitate maximum transparency and gain trust of the community.
-Increase the ownership of our work among community members.
Community Advisory Board
CAB will have representation from social workers, teachers, leaders in several political parties, government institutions and key NGOs in public health in the area.
-CAB meets at least 4 times a year (more frequently in the beginning). A member of the UAB (see below) and Program Manager of the clinic will attend at least the quarterly meetings of CAB.
-Members of the board act as liaisons between the clinic and their respective organizations and the community.
-Provides feedback and advises the clinic management on the latter's quarterly reports, current services and long-term plans. A member of the CAB will directly communicate with a contact person on the Board of Directors of Nyaya Health.
-Engages the community to help improve services and infrastructure of the clinic.
-Advises the clinic on ways to engage the community and meet its needs.
Users Advisory Board
UAB will have representation from ethnic minorities, women, patients from low-income families and remote parts of our target area.
-Given that the focus of the clinic is MCH and given the marginalization women face, at least 80% of the UAB is female.
-UAB meets at least 4 times a year. A member of the CAB and Program Manager of the clinic will attend at least the quarterly meetings of UABa.
-Members provide direct feedback to the clinic on clinical and public health services and the long-term plans of the clinic.
-Members are responsible for promoting the clinic's services in their area of residence. They form a network of contact persons across the clinic's target area and support any outreach and public health work in their communities.
-One member of the UAB will be in direct communication with a contact person on the BOD of Nyaya Health.
Nyaya Health-INGO
The role of the INGO is to fundraise, write grants, provide technical assistance, procure equipment outside of Nepal, provide general strategic advice, and recruit volunteer physicians and technicians. The NGO is governed by the Board of Directors and other key members in a decentralized fashion. Most of the key decisions are made over email. The board as a rule defers to the judgment of the Nepal-based team members, and seeks to support those staff and volunteers in whatever they are doing rather than directthem. Appointments to the board of directors are made on the basis of consensus and internal discussions among directors and members. Biographies of our team are described on the wiki:
All members are encouraged to add and update their biographical details to this page.
Nyaya Health-Nepal
We will be setting up Nepali NGO that from now on will be the major implementer of projects. It will be run by Nyaya Health INGO leaders who are citizens of Nepal. This is done to ease the bureaucratic process. All new projects, including the building of Bayalpata hospital, should be undertaken through the legal mechanism of the Nepali NGO. The following elements have to be in place for the transition; we should try to get this in place relatively quickly:
Registration with the Social Welfare Council as a Nepali NGO
Setting up a bank account [need to look into how to use the existing bank accounts for Nyaya Health INGO; if there is some mechanism of “country program” that is technically a Nepali NGO but can still use the same bank account. We need to keep the accounting minimal. For Etrade, the name on the account needs to be the same to allow for international wire transfers].
Board of Advisors
The role of the Board of Advisors is to provide technical assistance and directly advise Nyaya members on ideas, strategies, and programs. Most Board of Advisors offer advice predominantly over email and telephone and may never visit our clinic site. Others, however, may take a more active role and may even take the three days’ journey to Achham. The only formal obligation is to allow their name to be posted with a brief biography on the website of nyayahealth.org. If you have someone in mind that you feel should be included on the advisory board, please email the , preferably with the link describing who they are that we would put up under their name on our webpage. Typically we will agree, it is just a matter of letting us all know who we have. The board of advisors invitation is in Foldershare SharedNyaya\Clinic Documents\Personnel.
Clinic Personnel
All of the contracts and job descriptions for clinic staff are found at:
Foldershare SharedNyaya\Clinic Documents\Personnel.
We try to keep this page updated also:
The following are the key staff members for the start of the clinic:
-Administrative Clerk (1)
-Cleaning Staff (1)
-CHW(4; can work to establish some rotating system among local CHWs)
-Health Assistant (1-2)
-Lab Technician (1)
-Medical Director(1)
-Night Watchman/Security (1-2)
-Nurse Midwife(4)
PatientFlow
We are still trying to more effectively process patient flow. For the beginning, we made the strategic decision not to go with EMR, but we have designed our record system with simple-to-use check boxes that are efficiently utilized by clinical staff and easily transferred to a database for monitoring and analysis: nyayahealth.pbwiki.com/Clinical+Protocols
We have printed 500 copies of these protocols in Mangalsen to pilot. This is a constant work-in-progress, and it is expected that clinic staff will adapt this and request for advice and new forms from the technical advice team. Eventually, we will need to translate them into Nepali because most staff members will prefer to fill them out in Nepali.
For the most part, female patients will be seen by the ANMs in the delivery suite. The other examination room will be primarily for male patients and will be typically staffed by the HA. The physician will provide overall oversight and advice on complex patients. This is diagrammed schematically here:
This is only provided as an initial template and is admittedly largely based on the US academic model. This will be adapted as is suitable to the clinical team.
For night duty, there will be one CHW, one ANM midwife, and one night watchman. Their primary role will be in the management of labor and delivery. They will call the physician as necessary for emergencies. The ANM should carry a watch or some timer for night duty staff to regularly check patients.
Clinic Scheduling
Here is a tentative schedule. The timings can be changed as needed. 10-5 is arbitrary and may not meet community or staff needs well. For example, perhaps a few days or more a week can make the clinic open and close earlier, say 8-3. Also, if staff prefer to have a few days of 8-6 OPD and then have Friday completely closed, that is fine as well. The optimal schedule is one that balances staff schedules and community needs.
24 hours, 7 days a week: clinic is open for monitoring of peri-partum patients
Saturday: clinic is closed for non-peri-partum patients
Sunday: General OPD 10-5 [doctor and HA]; antenatal, and reproductive health clinics [ANM]
Monday: pediatrics OPD 10-5 [doctor and HA], antenatal, and reproductive health clinics [ANM]
Tuesday: General OPD 10-5 [doctor and HA]; antenatal, and reproductive health clinics [ANM]
Wednesday: pediatrics OPD 10-5 [doctor and HA], antenatal, and reproductive health clinics [ANM]