Nyaya Health

Posted by Ryan Schwarz

The America Nepal Medical Foundation (ANMF) has generously awarded Nyaya a grant renewal, promising an initial $10,000 for 2009, and a commitment for further fundraising totaling $21,473, for the expansion of Nyaya’s obstetric services in Achham.

In an effort to combat crisis-level maternal mortality rates, Nyaya is currently renovating Bayalpata Hospital which, in addition to general inpatient and surgical services, will provide comprehensive emergency obstetric care to the Achham region. Together with funding from ANMF, and in cooperation with the Nepali Ministry of Health, Nyaya will train local obstetric healthcare workers and provide their salaries for the coming fiscal year. By specifically supporting local healthcare workers, ANMF and Nyaya will ensure a significant long-term impact on the obstetrics services and capacity of the region.

Through this program, Nyaya will also expand its community health worker (CHWs) and auxiliary nurse midwife (ANMs) networks to further address obstetric health in the region. CHWs are the front-line service providers in each of the communities in Nyaya’s catchment area. They function as community-level paramedics and public health practitioners, tackling issues of maternal mortality including ante- and post-natal monitoring and care, as well as associated problems such as childhood malnutrition and socio-economic barriers affecting access to care. Additionally, the reach of our CHW teams ensures Nyaya’s healthcare provision remains rooted in the needs of the communities where we work. Nyaya’s ANMs act as our core obstetrics providers, both in the clinic, and soon in Bayalapata Hospital, and assist in the care of obstetric inpatients and in the operating room during surgical procedures. The expansion of our obstetrics program will include the hiring and training of 15 CHWs and 7 ANMs throughout the first half of 2009, and will greatly enhance Nyaya’s ability to tackle the current diseases and mortality affecting women in Achham.

Gauri, an auxiliary nurse midwife and the Community Health Program Coordinator, leads a CHW training at the Nyaya Health clinic.

Currently Nyaya is able to provide the “Basic Obstetric Care Package,” as specified in the Averting Maternal Death and Disability (AMDD) program, including:

• intravenous and oral oxytocin for postpartum hemorrhage,
• intravenous and oral anticonvulsants for perinatal seizures,
• intravenous and oral antihypertensives for perinatal hypertension,
• removal of retained products of conception,
• manual removal of placenta, and
• vacuum- or forceps-assisted vaginal delivery for obstructed labor.

By partnering with ANMF, and increasing the breadth and scope of our CHW and ANM teams, Nyaya will be able to expand our services to fulfill the “Comprehensive Emergency Obstetric Services” as specified in the AMDD model. In addition to the services we are presently able to provide, the Comprehensive Package will include blood transfusion and the operating capacity and facilities for cesarean sections in the new Bayalpata Hospital.

Training for both CHWs and ANMs will increase and progress in a step-wise fashion such that by 2010 newly hired CHWs and ANMs will possess the skills necessary to fully implement the Comprehensive Package. Our ANMs and CHWs will be equipped to provide the necessary education, treatment, referrals, and follow-up to ensure that women in the Achham region have access to comprehensive obstetric care. Rather than simply treating emergency obstetric complications upon arrival to our clinic or hospital, this program aims to affect lasting change on the practices, knowledge, and health-seeking behaviors of individuals by working with women both in the clinic, and concurrently in their own communities.

As with all Nyaya programs, further information about this program and our epidemiological data tracking maternal mortality in our patient population is available publicly on our wiki.