Possible commits to rebuilding Nepals healthcare system in Dolakha District, one of the districts hit hardest by the series of earthquakes that struck Nepal on April 25th. Possible will work closely with Nepal's Ministry of Health and Population to expand its durable healthcare model and ensure that damaged hospitals and clinics are rebuilt with earthquake-resistant design. Additionally, Possible will work with Direct Relief to bolster the supply-chain available to Dolakha District, and with Sharon Davis Design to plan and phase in permanent earthquake resilient infrastructure.
Phase 1 of this commitment will involve restoring access to 21 of 46 clinics that have been severally damaged and are unusable since the earthquakes by quickly constructing pre-fabricated healthcare facilities. The pre-fabricated structures will in time be replaced with permanent facilities. Possible will also install solar power at all 21 clinics in the first phase of the commitment. This will immediately restore access to healthcare for 74,464 people, the impact of which will be measured through continuous household survey in the final phases of the commitment.
In Phase 2, Possibles work will include construction of permanent facilities and management of the entire district's healthcare system. Possible will roll out an Electronic Medical Record (EMR) system, human resource and project management platforms, household data surveillance tools, medical education, and quality improvement initiatives. This is supported by full integration with the public sector supply chain for pharmaceuticals and consumables to deliver coordinated care across the health system. This will allow Possible to track impact across Nepals public healthcare model through the EMR system and continuous household surveys.
Investment in management systems and infrastructure will be undertaken in Phase 3, with targeted training for a 78-person clinical team at the hospital and clinic level and 183 female community health worker (CHW) network. Phase 3 will also include the launch of a full microbiology laboratory, pharmacy, digital x-ray, and dental services at the district hospital level. CHWs will be trained on and equipped with tools to survey, monitor, and refer patients with a specific focus on improving outcomes for pregnant women, children under two, and patients with chronic disease. Investing in building capacity for care providers, will also include clinical training at the district hospital to increase access to life-saving surgical care.
In support of this commitment, Cathay Pacific has offered donated flights for team members and excess baggage allowance. Funding support will be provided by Tata Trusts to support clinic expansion, and the Alwaleed Bin Talal Foundation to build earthquake-resistant healthcare infrastructure. Shesh Ghale, Nepals Special Envoy for Reconstruction, will support in securing additional resources and partnerships from Nepals government.
The action plan is split up into three primary phases:
Phase 1 - September December 2015: Immediate prefabricated construction for damaged facilities, solar electricity installations, and supplies systems improvements.
Q4 2015 - Initial assessment and pre-fabricated construction of 21 clinics; Managing supply chain distribution to the district, including donated supplies from outside the country
Phase 2 - January - December 2016: Continued rebuilding of any remaining targeted healthcare facilities, in parallel with support for provision of health services and healthcare management throughout the district.
Q1 2016 - District-wide, performance-based grant agreement between Nepal Ministry of Health and Population and Possible based on population-level six Key Performance Indicators (surgical access, equity, safe birth, chronic disease follow-up, outpatient use, and family planning);
Q3 2016 - Permanent rebuilding of the primary health center and clinics for earthquake resistance and disaster responsiveness, including solar electrification
Phase 3 - January 2017 - July 2017: Deepening of health systems strengthening including rollout of the same bundle of improvements Possible has developed elsewhere in Nepal utilizing an open-source electronic medical record system, human resource and project management platforms, household data surveillance tools, medical education, and quality improvement initiatives.
Q1 2017 - Delivering coordinated care via an integrated electronic medical record; Tracking patients and population outcomes via an electronic household survey
Q3 2017 - Staffing of all the facilities and training based on Nepal Ministry of Health and Population protocols;
Throughout this process, Possible will conduct the same NIH-supported implementation science work that translates service delivery into data and analysis for improving national and global policies.
The earthquake that stuck Nepal on April 25, 2015, and the subsequent aftershocks, affected over 5.6 million people, and have killed nearly 9,000 people and injured over 22,000. An estimated 93,000 pregnant women no longer have access to critical maternal healthcare services and hundreds of thousands of families have lost their homes (UNFPA, August 2015).
The earthquakes have left the country in an acute on chronic scenario, meaning an acute emergency has been layered on top of a chronic one. Nepal already had a weak healthcare system before the earthquakes. Now, there are over 1,100 healthcare facilities damaged or destroyed and an increased burden of disease and disability. Specifically, Dolakha District was one of the worst-hit districts where over 40% of the population now lacks access to healthcare since the earthquakes. Of the total 53 clinics in Dohlaka, 46 have been seriously damaged and are unusable, impacting 74,464 people.
Nepals current public healthcare system not only lacks the capacity to deliver high-quality, low-cost healthcare for both infectious and chronic disease, but also the physical infrastructure to withstand seismic events. Nepals population, most of which is rural, is experiencing a crisis of high maternal and child mortality, with chronic disease deaths predicted to increase to 66% in the next 15 years (IRIN, 2011). The public healthcare infrastructure lacks both the capacity and funding to provide high-quality healthcare to most of Nepals population who lack the resources to access private sector healthcare providers.
Now is the time to build back differently, and create the kind of healthcare system that can serve the poorest and be resilient in the face of future natural disasters. Possible, a nonprofit healthcare company that delivers high-quality, low-cost healthcare, has extensive experience from eight years of building, strengthening, and scaling healthcare delivery within rural Nepal's public sector infrastructure. Possible has delivered healthcare to over 279,000 patients as a partner of the Nepali government through a hospital, clinics, and a network of community health workers in one of Nepal's poorest regions: Achham District of Far-Western Nepal.