Our pilot project in GhumarChowk and Lamatar is a partnership between three key partners. We believe that it is vital that the community that is being served has a key stake in the decisions made around healthcare delivery, and our model, described below, allows us to advance that notion. We propose two different models, also described below, for our pilot project in these villages.
Partner 1: First partners are the Health Advancement Committees (HACs). The HAC will consist of a group of representative from the specific village that will serve as the community arm of the model. The HAC includes women leaders, village teachers, local police, youth leaders, VDC secretary and other village activists interested in health advancement. The HAC will be the voice of the community and help everyone involved understand the community’s specific health problems. In effect, they are the representatives of the demand side of the model.
Partner 2: The second partner is the government health service entity in each village. These include the health post employees and the officers from the District Public Health Office (DPHO). These villages lie in 2 different districts, so we engaged with the DPHOs from both Kathmandu and Lalitpur district. This is the supply aspect of our model.
Partner 3: Finally, the third partner is our team, HAPSA-Nepal (Health Advancement Programs in South Asia – Nepal). Founded in 2011, HAPSA started out as a student organization from UT Austin doing health awareness programs and fostering educational initiatives for a few children in the slums of Lucknow. While HAPSA is undergoing the process of being registered as a 501(c) non-profit entity in the US, HAPSA-Nepal has completed registration (Reg. No. 646) as a NGO in Nepal. This team is primarily youth that belong to the medical, public health and managment fields. HAPSA works with both the supply side and demand side to bring their interests together.
Proposed plan for Lakuri Bhanjyang: Private-Public Partnership
After the earthquake, we used some of the funds to build a temporary health post in Lakuri Bhanjyang. Following our meeting with the District Public Health Officer (DPHO) of Lalitpur, the health post workers, and the HAC, we decided to create partnership there that would be unique. A verbal agreement was made to sign a memorandum of understanding (MOU) with the DPHO that will allow HAPSA to help the government strengthen its already existing services and add additional ones as well. For example, DPHO is unable to provide a birthing center in this village although this is mandated under Nepal’s constitution. HAPSA will provide some funds and help the government to establish this. In return, the DPHO will allow the HAC and the HAPSA team to oversee the management of the health post. Furthermore, we will also incentivize the health post workers to work more hours by increasing their salary by 20%. In partnership with Institute of Medicine – Teaching Hospital, we will also bring physicians to these villages for special care at least once a month. A formal MOU between the DPHO and HAPSA-Nepal has not been signed yet, and is currently a work in progress.
Proposed plan for GhumarChowk: Private Clinic Model
In GhumarChowk, the existing health post is too far for the villagers and utilization has been low because of this. Focus groups in this village strongly reflected the need of a closer health facility. The Rotary club of Thamel had sponsored a clinic for a long time in this village, but stopped doing so because they ran out of funds. Furthermore, this facility was destroyed in the earthquake. The villagers and the HAC of this village proposed a plan of turning an existing community building into a HAPSA-run clinic. The municipality has also agreed to donate some of their funds for transforming this building into a clinic. We will be coordinating with the health post and will conduct a needs assessment with the villager to prioritize services. Our plans include hiring a Health Assistant and a nurse for the clinic. We will partner with the health post to provide basic lab services. Management of chronic illnesses and awareness surrounding alcohol use will be main focus of this center. We will be working closely with the HAC to conduct regular needs assessments and understand demand. We will also work closely with the health post to keep track of supply. The clinic will function independently. Our partners from Institute of Medicine – Teaching Hospital will help with healthcare delivery. The clinic construction process has begun and an agreement with the HAC has been reached.
Concluding thoughts on the three-way partnership
Ultimately, we hope that these pilot projects lead to relevant, useful policy revisions at the level of Department of Health Services of the Ministry of Health in order to make healthcare delivery more community-centric and more effective. Through our models, we are engaging with and hopefully empowering community members to fight both for the right to their health care as well as the decisions around it.