Strengthening Municipal Integrated Health Care System

As per Demographic and Health Survery (DHS) 2016, Nepal, neonatal mortality rate in Sudoor Pachim province is 41/1,000 live birth and only 29 per cent of the population has access to the government health facility within 30 minute distance. Health facilities and health care staffs with specialization are rarely available. Though it seems that the number of women getting Antenatal care by skilled health workers was highest in Far West Nepal, there is still room to improve in institutional delivery. Only 66% of deliveries in Far West were in health facilities. The rest of the deliveries were either occurred at home or on the road. The use of modern contraceptive method in the area is 48 % compared to National Health Sector strategy 2016-2021’s goal to reach the modern contraceptive prevalence rate of 52 % by 2020. Nepal has committed to doing its part to achieve the SDGs but severe inequities in maternal healthcare access and utilization and the poor quality of care are hurdles in the Country’s path to achieving the ambitious MMR and other health targets. Without significant investment in health system, particularly to improve quality of care at public sector facilities the goal of universal health coverage will not be achieved.

 Of the major service areas, NHN provides essential healthcare on reproductive, maternal, newborn and child health (RMNCH) through the facilities NHN manages and CHW networks. Women and girls are by far the most marginalized even among the underserved communities and NHN has a role to play in improving quality of care provided to women and girls through municipal integrated health care system. NHN prioritizes the further improvement of maternal, reproductive and child health care by strengthening the health system that has been implemented in the area.

Our solution is to provide equitabel health care for the underserved communities of Achham district (Far West Nepal). The aim of NHN is to build integrated care delivery systems, design and implement these interventions to scale a new model for healthcare in the country. The NHN approach is also to create an enabling environment to reach underserved communities in rural Nepal in line with WHO recommendations to build a robust health care system.  

Problem NHN are trying to solve through the solution are;

• • Lack of active disease surveillance in low/ middle income countries like ours.
  • Increasing burden of Chronic disease like Hypertension, Diabetes, and COPD ( Chronic obstructive pulmonary disease)
  • Decreasing trend in maternal and neonatal mortality but has plateaued; needs changes in current intervention modality to trigger further drop in MMR and NMR.
  • Unable to yet reach the target expected population for communicable disease like Tuberculosis, HIV.
  • Decrease the surgical burden,

Process and Technology that it uses:

A digital platform "CommCare" where all the person in the community have unique ID, which will be used for active surveillance and parameters noted in a mobile based device, which gets integrated to the hospital based digital system. This will serve as a unique digital health identifier for each individual and interventions can be directed to specific target population.

Inclusive Human centered design: All data collected will be of the active community population in the benefit of the community and people within it.

How better and or complementary to existing methods: Improve the active disease surveillance system and helps improve intervention from “home to hospital”.

In line with organization’s program, NHN is collecting real time data through Electronic Health Record System (EHR) in the hospital and Mobile based app (CommCare) by the community health program. Primarily, data is collected to monitor and evaluate the programs and use the data for improvement of the programs and secondarily is to report the program to different government entities and to the donors. NHN has been reporting to the Ministry of Health and Population in monthly basis and also providing the data to local municipalities. These data have been used for health program planning in local level and in national level for developing health strategy and policy and planning of nationwide health programs.

Nyaya Health Nepal (NHN) is providing free of cost, quality primary health care services to underserved communities of rural part of Nepal, mainly through integrated healthcare model. NHN operates a 50- bed hospital and primary healthcare center with 15 beds and runs community health programs in 6 different municipalities of Achham district of Nepal. In each of these 6 municipalities, NHN has network of community health workers who are integrating primary health care with facility based services through the counseling and care coordination services. Since this program has been implemented in the remote part of Nepal, it has been proved to be very impactful to serve the people residing in the region. NHN’s work has already shown to improve the institutional birth rate, a critical process indicator for maternal mortality, from 30% to 95% within the Achham district and has been able to save the lives of the people including the people who needed the emergency, surgical and mental health care services. 

NHN team are the right people to design and deliver the solution to the targeted  population due to below reason;

• NHN Bayalpata Hospital provides life-saving surgical services like cesarean sections and orthopedic surgery, care for complicated referrals from across our catchment area and beyond. NHN, PHC provides an opportunity for communities for easy access to healthcare facilities, which will ensure the inclusiveness and effectiveness of healthcare so that it empowers communities to achieve better health outcomes, which will in turn improve overall wellbeing of rural communities. Bayalpata Hospital is also a training site for mid-level practitioners who make up the vast majority of the workforce in a rural healthcare setting. Through continuing medical education (CME), mid-level practitioners (MLPs), NHN equips healthcare workers to deal with conditions like mental illness, chronic diseases, gender-based violence, trauma management, safe delivery and more. 
• Community Health Program team covers 60% of the total population of the targeted district of far west Nepal.
• Electronic Health Record Basic tools are already developed, the solution will add required tools as per need of the program to improve health of the underserved population.
• e-Health platform will be developed by the digital team and the report will be directly submitted to the Ministry of Health and Population (DHIS2)

Yes, the challenge will help us to successfull implement the program to improve health care services of the needy communities of rural Nepal. If we win the challenge we could advocate the solution as a success "Health Care Model" in rural health care services and collaborate with Government of Nepal to replicate the best practices in other Province of rural Nepal. In other words "Change is Possible" 

NHN modle is only one integrated health care model implemnting in rural Nepal. 

Yes, the best practices and learning can be replicated to other parts of Nepal as most of the rural communites do not have access to better health care services. 

NHN Goal is to provide "Quality health care services for All" 

NHN will achieve the goal by strengthening municipal integrated health care model in collaboration with three tiers of Goverrmen of Nepal ensuing sustainability of the model 

NHN Key Performace Indicators

• % of Institutional Birth Rate

• % of Neonatal mortality rate 

• % of Contraceptive demand satisfied 

• % of Surgical complication rate 

• % of Chronic disease control rate

NHN use digital platform where services provided from hospital through the hospital medical personnel or from community through the network of community health care workers are integrated together for an individual to actively track his health status. 

NHN is collecting real time data through Electronic Health Record System (EHR) in the hospital and Mobile based app (CommCare) by the community health worker in the targeted communities. 

NHN represents diversity in gender, caste, ethnicity, differently able and age of each tiers, functions and locations of the staffs.

OPS TEAM

25

CHT TEAM

72

Kathmandu Support Team 

10

Finance,

EHR,IT,PO,COMMS

7

MEDICAL TEAM

93

 58%   - Female                 42% - Male

NHN provides free health care support to the underserved communities as a value of population  both in terms of impact and revenue. 

NHN collaborates with Government of Nepal and philanthrophic organization for funding support to provide the services.

Fundng Modality of NHN

1. Collaboration to Governemnt of Nepal is our plan for financial sustainability.

2. Philanthropic Funding 

3. Local Municipaliites 

4. Health Insurance 

5. In kind Support 

Financial Plan of FY 2021-22, (August 2021- July 2022) of NHN 

Description

Percentage

Government of Nepal

39%

Local Government

5%

In-kind Support

3%

Health Insurance

2%

Intl Philanthropic Fund

49%

Others

1%

Total

100%