Posted by Ryan Schwarz
As Nyaya’s Director of Operations I’m asked regularly how I, or any of Nyaya’s other volunteers not in Nepal, can help to expand access to health care services without actually being in Nepal. And as a medical student my colleagues often presume that my work with Nyaya is caring for patients. But in actuality the vast majority of the Nyaya team does not see patients (including myself) – and we have quite a large team. The importance of the rest of our team who do not provide clinical services is often not discussed but is equally critical to our ability to provide health services in Achham. Sadly, this work is also often described as “the grunt work” and viewed as less important than the clinical roles directly providing care to patients. But nothing could be further from the truth – without this “grunt work” none of Nyaya’s clinical services would exist or continue daily. A colleague who works for a similar organization recently joked with me that “seeing patients is the easy part of this work – it’s making sure they get seen that is the challenge.”
At Nyaya, our team is composed of our full-time staff in Nepal and our volunteer team internationally; without players in either sphere our direct health services in Achham would simply not be possible.
Outside of Nepal we have a great team of volunteers who handle many of the “back-office” functions of the organization:
· Volunteer management – our volunteers range from once a month to round-the-clock involvement and require oversight, engagement and coordination. These volunteers support an immense amount of work and are absolutely critical to Nyaya´s continued operations.
· Fundraising – one of the most important roles of our volunteer team is raising the funds to ensure our ongoing work can continue. Approximately 60% of Nyaya´s operating costs are rasied by our volunteer team through grants, individual giving campaigns and personal gifts
· Financial management – several of our volunteers are in charge of overseeing our financial management including 4 bank accounts between the USA and Nepal, accounting for all of them, regular transfers between them, yearly taxes in both the USA and Nepal and the budgetary planning that is needed to run our operations
· IT support – this blog, our website, our wiki, multiple team and public listservs, Facebook, online hard drives and file transfer programs are all run by volunteers and require a great deal of maintenance and upkeep
· Communications and publicity – to pursue further fundraising support, collaborations with partner organizations, or advocate for global health work requires the development of endless materials, revising, editing and revising again. These ultimately result in our blog posts, annual reports, news articles, lectures and presentations, and informational documents for our funders.
· Data management for auditing and reporting purposes – in order to fulfill the requirements of our funders, to be accountable to our patients and our partner organizations, and to communicate the work we do with the health delivery community, we spend a great deal of time processing and transferring data between our Achham and international teams. These data are all publicly available through our reports and on our wiki.
· Vision and program direction – in addition to supporting the daily operations of Nyaya´s work, our volunteer Board of Directors as well as many of our team members are involved in regular discussions with our Nepali team to ensure our programs are developed and maintained in a manner consistent with our mission .
In Nepal a part of our staff sees patients every day – we have a clinical team of two doctors, four Health Assistants, and six nurse midwives. While our blog frequently talks about these clinical matters, over half of our Nepali team is actually responsible for overseeing the “back office” – critical to enabling our clinical team to offer patients the care they need. A quick glance at just a small portion of this work includes:
· General management – between Kathmandu and Achham our Nepal team is 29 staff members, requiring effective recruitment and hiring strategies, training of new staff, continued training for veteran staff, as well as general oversight
· Supply chain management – our administrative team in Achham spends a great deal of time managing inventory of both clinical and non-clinical equipment, consumables and capital investments, and the multiple suppliers domestically (Nepal) and internationally required
· Financial accounting, documentation, and data management – to adhere to government as well as funder guidelines there is an enormous amount of proper documentation and data required including everything from line by line financial accounting to collection and reporting of the results of pregnancy tests and the number of doors we’ve recently installed. Without such documentation neither our collaboration with the Nepali Ministry of Health and Population (which provides 40% of our budget) nor any of the grants Nyaya has been awarded (another 30% of our budget) would be possible. Such documentation is also critical to local health authorities who regularly offer our staff free trainings to enhance our clinical services.
· Program management and development – whether it’s oversight of our new community health worker initiative or the development of protocols for our pediatric malnutrition program, such coordination is the foundation to delivering effective health services and critical to our continued efforts to enhance health broadly in the Achham region.
· Infrastructure expansion – our Nepal team is working with the Ministry of Health to redevelop a hospital complex over 30 years old. Renovations are ongoing and continuous and require regular contract negotiations, discussions and oversight with local contractors, utility providers and engineers. Without this work our patients would not have a laboratory, our staff would not have quarters to sleep in, and the surgical theater we hope to open in 2011 would not have a roof.
· Coordination, logistics and outreach – several of our staff spend many hours each day working with our patients to get them properly registered, coordinate their clinical visits and ensure they get the services they require. Other staff spend their time ensuring the hospital complex is clean and a sanitary place for patients to come. Others work to ensure security of our patients staff and facilities, and one works full-time to ensure our on-call staff have food round the clock. And outside of the hospital we have several dozen community health workers in the communities who help us enhance health literacy and provide follow-up to patients after their visits to the hospital.
Nyaya’s mission is to provide the best health services possible to the people of Achham, while doing it in a way that also helps to inform the larger global health delivery community. To achieve this mission Nyaya relies on a team who come from multiple backgrounds and bring many different skills – ultimately to deliver free health services requires much more than just our clinical team.
We are humbled and honored by the opportunity to work with so many dedicated and inspirational people and hope this brief glimpse into the “back office” offers our readers and supporters an appreciation of the critical work they do, and more generally, the importance of supporting such roles in the field of global health delivery generally. We must continue to strive to enhance our clinical abilities, yet at the same time we as a community must work to support the continued expansion of human resource capacity in the many critical roles of health delivery.