Nyaya Health

Posted by Duncan Maru

Operating a professional global health organization on all-volunteer power requires solid management structures. Our donors, our staff, and the communities we serve all demand professionalism. Our purpose in this post is to describe the distinct approach that Nyaya Health has taken to achieve efficiency, professionalism, and reliable results while maintaining the philosophical and economic benefits of a volunteer team. Through the strategies described below, Nyaya Health has been able to quickly build and operate a rural health center in Nepal which treats over 1000 patients per month, employs twenty Nepali healthcare professionals, and is opening the only physician-run hospital for a population spanning over 500,000 people.

We rely on a network of volunteer supporters to generate the financial, material, and technical resources to achieve this, while spending nearly 100% of our funds within Nepal. None of our non-Nepali directors, grant writers, clinical consultants, and fundraisers are paid. We have no office space outside of our health center in Achham. The few expenditures that we make outside Nepal — server fees for our websites, printing costs for grant applications, shipping costs for equipment– are typically paid for by our volunteers. In 2008, in which Nyaya spent $112,805 on operating our health center (click here to view our public access line-by-line-budget), our costs totaled only $266 on equipment shipping, $5000 on processing costs for a newly donated GE ultrasound machine, and $125 on outgoing wire fees.

Go open-source
Transparency is efficient. An all-volunteer organization does not have the time or resources to waste on documents that are hidden behind passwords. The centerpiece of our open-source strategy is the Nyaya Health wiki, on which our staff and volunteers post protocols, data, and program details. Our wiki manager periodically reviews the wiki to ensure quality and consistency. Since the wiki is open-access, we can quickly dialogue with new volunteers and collaborators without worrying about managing extensive user access controls. Furthermore, our volunteers can also be assured and inspired that their work will be available to global health collaborators and practitioners throughout the world.

Develop rapidly-editable web content
We have aimed to make the Nyaya Health website professional, dynamic, and compelling. Being a critical function of our United States-based operations, it is powered by an all-volunteer team. We use wordpress.org as our content managament system for our website. This allows a select group of non-technical Nyaya members to easily make text edits without requiring any software downloads or particular expertise. Editing is as easy as writing a blog post. This still requires a dedicated webmaster, but empowering a few additional volunteers to make minor text edits can significantly decrease the webmaster’s workload. Since the webmaster has an immensely valuable skill and pro-bono web developers are hard to find, having the webmaster focus on the technical back-end and then utilizing non-technical volunteers for front-end content makes the whole enterprise efficient and feasible.

Utilize user-driven materials to drive dynamic homepage content
In addition to our wiki and website, we also maintain an blog, to which any of our volunteers can write posts or put up pictures. The headlines of the blog posts are automatically linked to the website homepage using feedburner and the pictures are linked to a gallery on the homepage using wowzio. This strategy allows us to maintain an up-to-date, engaging homepage without requiring any editing of the page itself. To ensure quality and overall consistency, we have a volunteer blog manager who approves and edits all blog posts.

Construct specific, time-limited deliverables for volunteers
Since our volunteers are busy with multiple competing duties, we try to discretize tasks into manageable chunks to utilize their unique skills. We also electronically sign contracts with all our volunteers. These contracts are available publicly on our wiki. Ultimately, our aim is to maintain a system where we identify the comparative strengths and passions of our different volunteers and focus these into circumscribed, discrete roles.

Utilize a small core of long-term directors to provide sufficient oversight
Although crowd-sourcing of our wiki and utilizing a relatively non-hierarchical volunteer network is an important strategy philosophically and practically, we also need to ensure there is sufficient leadership, oversight, and structure within our organization. Our long-term leaders need to be effective at delegating tasks, at listening to our volunteers, and at fostering creativity. They also need to be able to quickly identify and solve problems when volunteers do not meet their tasks.

Create efficient file sharing strategies for volunteers
We rely on a few different collaborative technologies for file sharing, each one serving a unique purpose. We use Windows Live Sync, a free application, to share our 2000+ organizational files amongst our volunteers. All our agreements, grants, and protocols are available in this shared file cabinet. We additionally use Nyaya Health’s Google Apps account to share collaborative spreadsheets. This is particularly useful for publishing data onto our wiki. We use Evernote for our volunteers in Achham because it is a low-bandwidth program that helps us maintain an institutional memory on-site while allowing us to keep detailed practical information about our various programs, contacts, and plans organized.

Maintain a transparent internal operational structure
We believe it is important for our new volunteers to understand how key organizational priorities are set and critical decisions are made. Nyaya achieves this through several mechanisms. New volunteers join our internal team listserve, over which we discuss new initiatives, work through key problems, and report our failures and successes to each other. Our volunteers have access to all of our internal documents through our internal file sharing system, as well as all the content on our blog and our wiki. All of our organizational emails are kept in a single Google Apps mail archive that is accessible to all of our volunteers.

Deploy a streamlined volunteer application management system
We use Google Apps to efficiently manage volunteer applications we receive. Specifically, we use forms that are completely customizable, which have a professional appearance with an underlying simple and non-technical Google forms architecture. This also increase our management efficiency because we can quickly send templated rejection letters to reduce the inefficiencies of responding to the large number of applicants to whom we cannot provide a position.

Some have recently argued that non-profit organizations must be managed more like for-profit corporations for attention to efficiency and real results. There has, in fact, been a trend among non-profits to recruit executives from the for-profit sector in the hopes of transforming our industry and reducing waste. We certainly welcome such developments, and for many non-profits, professionalizing on the fundraising side indeed makes sense. However, we hope that this post demonstrates a model that can achieve efficiency and accountability while remaining true to the ideals of non-profit work.