.w-background-video>video { max-width: -webkit-fill-available;

2020

ANNUAL IMPACT REPORT

August 1, 2019 - July 31, 2020

Reflections, Learning, and Moving Forward

This has been a difficult year for us all and as the impact of COVID continues to spread, we have been confronted with the compounding effect this pandemic has had on inequities created by systems of oppression. While these systems of oppression are not new, recent events and demands for justice have prompted an increased sense of urgency for us all to take deliberate action to reflect, learn and reimagine the ways we can combat these inequities.

We know that these systems of oppression and the harm they cause cannot be transformed overnight. We are inspired by our collaborators and the communities with whom we partner to probe deeper into the uncomfortable questions required for the ongoing work of healing, learning and growing. We acknowledge that for us to realize our vision of everyone everywhere having access to high-quality healthcare, we must ground our work in evidence, inclusion, and equity, and we are committed to this learning and understanding.

We dedicate this annual report to the memory of Siddhartha Auji, an employee of Bayalpata Hospital who died of burns following self-immolation. As we grieve, we have a responsibility to honor his memory by doing the deep reflection and learning to understand how we can reimagine the ways we work. After over a decade of work in Nepal, there is a need to reflect on our past so we can look forward. We do so with humility in the face of complexity.

Despite the challenges we faced this year, we continue to be in awe and utmost gratitude to our partners. Your wisdom, investments, and belief that everyone deserves high-quality healthcare, moves us forward. This report will highlight some updates and we will continue to share spotlights on our learnings and work as the year progresses.

Thank you, as ever, for being with us on this journey.
To doing the work,

Possible Team and Board of Directors

NYAYA HEALTH NEPAL CONTINUES ITS LIFE SAVING WORK ADMIST COVID-19

Possible provides technical and fundraising support to Nyaya Health Nepal (NHN). NHN is independently leading efforts to sustain the work we initiated together in Nepal over ten years ago. NHN continued providing essential healthcare services in the most remote areas of Nepal despite funding shortfalls and the horrible health and economic toll of the COVID pandemic. All NHN-managed facilities were able to continue regular services alongside COVID clinics. Below we provide a few snapshots of the year: 

NHN Achieved Historic Government Investments in its Programs

NHN has received historic investments for its work in Achham. For FY21, the provincial and municipal governments in Achham have committed over $750k for NHN programs and over $100k is projected from national insurance and vertical programs.

This year NHN reached the maturation of its post-earthquake work in Dolakha, where NHN developed a small primary health center into a provincial hospital with advanced surgical care and intensive inpatient capacity. This system was a replication of one created in Achham. Nearly all NHN staff have been absorbed by the municipal government, ensuring continuity and sustained public sector investment through the provincial and municipal government.

NHN Deepens its Pioneering CHW Program

NHN worked in partnership with another municipality in Achham to replicate the Community Health Program. The municipality hired 7 Community Health Workers (CHWs), and NHN provided training to these CHWs for household enrollment and home visits. This expansion of the Community Health Program continues to reinforce the feasibility of publicly financed, trained, professionalized CHWs for improved health outcomes. 

In Dolakha, from which NHN phased out after its four-year earthquake relief effort, NHN has transferred its CHW program to Kathmandu University's Dhulikhel Hospital. Dhulikhel Hospital is a leading academic center that Possible partners with. This ensures that NHN's first-of-its-kind CHW program can continue to be highly influential and develop a strong evidence base.

Photo: CHW supporting government immunization program in Kamalbazar community in Achham

NHN Continues to Grow its Leading Informatics Platform

NHN’s services are underpinned by digital tools that facilitate care coordination across the facility and community-based points of service. NHN completed the Insurance Integration Project supported by Digital Square. After this, NepalEHR is capable of submitting claim processing and claim submission to the Nepal Government Health Insurance Board. In partnership with GIZ, NHN is currently providing training and technical support to the Health Insurance Board, and Social Security Funds of the government of Nepal.

Integration of the Commcare and NepalEHR has been successfully completed and the demographic information seamlessly integrated into the NepalEHR system and has been piloted in two wards.

IMPACT DASHBOARD

Photo: Auxiliary Nurse midwife using NepalEHR to see the treatment history of the patient

NHN Presented its Informatics Platform at the OpenMRS Conference

A virtual walk-through of Bayalpata Hospital and NepalEHR

WATCH FULL VIDEO 
A virtual walk-through of NepalEHR that was presented at the global OpenMRS conference.

WATCH FULL VIDEO 

NHN Achieved Historic Government Investments in its Programs

NHN has received historic investments for its work in Achham. For FY21, the provincial and municipal governments in Achham have committed over $750k for NHN programs and over $100k is projected from national insurance and vertical programs.

This year NHN reached the maturation of its post-earthquake work in Dolakha, where NHN developed a small primary health center into a provincial hospital with advanced surgical care and intensive inpatient capacity. This system was a replication of one created in Achham. Nearly all NHN staff have been absorbed by the municipal government, ensuring continuity and sustained public sector investment through the provincial and municipal government.

NHN Deepens its Pioneering CHW Program

NHN worked in partnership with another municipality in Achham to replicate the Community Health Program. The municipality hired 7 Community Health Workers (CHWs), and NHN provided training to these CHWs for household enrollment and home visits. This expansion of the Community Health Program continues to reinforce the feasibility of publicly financed, trained, professionalized CHWs for improved health outcomes.
 
In Dolakha, from which NHN phased out after its four-year earthquake relief effort, NHN has transferred its CHW program to Kathmandu University's Dhulikhel Hospital. Dhulikhel Hospital is a leading academic center that Possible partners with. This ensures that NHN's first-of-its-kind CHW program can continue to be highly influential and develop a strong evidence base.

Photo: CHW supporting government immunization program in Kamalbazar community in Achham

NHN Continues to Grow its Leading Informatics Platform

NHN’s services are underpinned by digital tools that facilitate care coordination across the facility and community-based points of service. NHN completed the Insurance Integration Project supported by Digital Square. After this, NepalEHR is capable of submitting claim processing and claim submission to the Nepal Government Health Insurance Board. In partnership with GIZ, NHN is currently providing training and technical support to the Health Insurance Board, and Social Security Funds of the government of Nepal.

Integration of the Commcare and NepalEHR has been successfully completed and the demographic information seamlessly integrated into the NepalEHR system and has been piloted in two wards.

IMPACT DASHBOARD

Photo: Auxiliary Nurse midwife, using NepalEHR to see the treatment history of the patient

A virtual walk-through of NepalEHR that was presented at the global OpenMRS conference.
WATCH FULL VIDEO 

NHN Achieved Historic Government Investments in its Programs

NHN has received historic investments for its work in Achham. For FY21, the provincial and municipal governments in Achham have committed over $750k for NHN programs and over $100k is projected from national insurance and vertical programs.

This year NHN reached the maturation of its post-earthquake work in Dolakha, where NHN developed a small primary health center into a provincial hospital with advanced surgical care and intensive inpatient capacity. This system was a replication of one created in Achham. Nearly all NHN staff have been absorbed by the municipal government, ensuring continuity and sustained public sector investment through the provincial and municipal government.

NHN Deepens its Pioneering CHW Program

NHN worked in partnership with another municipality in Achham to replicate the Community Health Program. The municipality hired 7 Community Health Workers (CHWs), and NHN provided training to these CHWs for household enrollment and home visits. This expansion of the Community Health Program continues to reinforce the feasibility of publicly financed, trained, professionalized CHWs for improved health outcomes.
 
In Dolakha, from which NHN phased out after its four-year earthquake relief effort, NHN has transferred its CHW program to Kathmandu University's Dhulikhel Hospital. Dhulikhel Hospital is a leading academic center that Possible partners with. This ensures that NHN's first-of-its-kind CHW program can continue to be highly influential and develop a strong evidence base.

NHN Continues to Grow its Leading Informatics Platform

NHN’s services are underpinned by digital tools that facilitate care coordination across the facility and community-based points of service. NHN completed the Insurance Integration Project supported by Digital Square. After this, NepalEHR is capable of submitting claim processing and claim submission to the Nepal Government Health Insurance Board. In partnership with GIZ, NHN is currently providing training and technical support to the Health Insurance Board, and Social Security Funds of the government of Nepal.

Integration of the Commcare and NepalEHR has been successfully completed and the demographic information seamlessly integrated into the NepalEHR system and has been piloted in two wards.

IMPACT DASHBOARD

PUTTING INNOVATION AND RESEARCH TO WORK FOR HEALTH JUSTICE

Over the last decade, Possible has worked to achieve the vision of everyone everywhere having access to high-quality healthcare. We have achieved this through a combination of fundraising and technical support to NHN. As we mark our 11th year, we recognize NHN’s important role in independently taking forward the integrated care model. Research and innovation are important for continuous improvement in health system processes and provide exploration of novel strategies to optimize access, cost, and quality of healthcare. Moving forward, Possible will build on our legacy of collaborative research to continue to build the evidence-base needed to address implementation and policy gaps in the equity, quality, and accessibility of healthcare. We will continue to root our work in places like Achham and Dolakha, where there is both great need and interest in engaging in research. Below we spotlight a few examples of how our research efforts complemented and enhanced care delivery efforts:

Expanding Access to Mental Health Service in Rural Nepal During COVID 

Possible has supported NHN to adapt its clinic-based mental healthcare to provide critically needed tele-counseling to combat distress and anxiety caused by the disruptions, restrictions and other stressors related to COVID. The team conducted a group discussion with the clinical team to identify steps in continuing mental healthcare followed by a preparedness check with counselors to assess their knowledge, skills, and availability to provide tele-counseling. We provided specific strategies to the counselors, as they made the challenging transition from meeting patients in-person to delivering therapy on the phone. With support from the National Institutes of Health, we adapted our ongoing research studies to move the intervention from in-person support to remote visits.

Photo: Psychosocial counselor in Achham counseling a patient

Our current studies are focused on improving adherence to care among vulnerable populations, such as those with HIV and those with depression. In a recent publication, NHN and Possible analyzed the data from the mental health program. This paper summarized the recommendations the psychiatrist made to ensure that a high-quality of care is delivered by the system and access to therapy is expanded. We aim to continue to build the evidence base for effective delivery of mental health services in rural areas during the pandemic and beyond.

Championing the Role of Community Health Workers through the COVID Pandemic

Possible supported NHN to adapt reproductive maternal neonatal and child health (RMNCH) care delivery protocols during the early phase of COVID. These adaptations are in line with Nepal Government, WHO and UNICEF community care guidance. CHWs provided COVID counseling alongside RMNCH services. Group RMNCH care activities were paused and adapted to remote based counseling to avoid physical contact.

With support from USAID, the National Institutes of Health, and others, and in partnership with the Community Health Impact Coalition, we are contributing to the global evidence base and policy dialogue about the essential role of CHWs for public health. Our recent publications on the cost analysis of the CHW program as well as its effectiveness in supporting postpartum contraceptive counseling further support the evidence base of the importance and the opportunities provided by utilizing locally trained paid CHWs.

Photo: Community Health Worker in Dolakha measuring the arm of baby to evaluate for malnutrition

Championing the Role of Community Health Workers through the COVID Pandemic

Possible supported NHN to adapt reproductive maternal neonatal and child health (RMNCH) care delivery protocols during the early phase of COVID. These adaptations are in line with Nepal Government, WHO and UNICEF community care guidance. CHWs provided COVID counseling alongside RMNCH services. Group RMNCH care activities were paused and adapted to remote based counseling to avoid physical contact.

With support from USAID, the National Institutes of Health, and others, and in partnership with the Community Health Impact Coalition, we are contributing to the global evidence base and policy dialogue about the essential role of CHWs for public health. Our recent publications on the cost analysis of the CHW program as well as its effectiveness in supporting postpartum contraceptive counseling further support the evidence base of the importance and the opportunities provided by utilizing locally trained paid CHWs.

Photo: Community Health Worker in Dolakha measuring the arm of baby to evaluate for malnutrition

Expanding Access to Mental Health Service in Rural Nepal During COVID 

Possible has supported NHN to adapt its clinic-based mental healthcare to provide critically needed tele-counseling to combat distress and anxiety caused by the disruptions, restrictions and other stressors related to COVID. The team conducted a group discussion with the clinical team to identify steps in continuing mental healthcare followed by a preparedness check with counselors to assess their knowledge, skills, and availability to provide tele-counseling. We provided specific strategies to the counselors, as they made the challenging transition from meeting patients in-person to delivering therapy on the phone. With support from the National Institutes of Health, we adapted our ongoing research studies to move the intervention from in-person support to remote visits.

Our current studies are focused on improving adherence to care among vulnerable populations, such as those with HIV and those with depression. In a recent publication, NHN and Possible, analyzed the data from the mental health program. This paper summarized the recommendations the psychiatrist made to ensure that a high-quality of care is delivered by the system and access to therapy is expanded. We aim to continue to build the evidence base for effective delivery of mental health services in rural areas during the pandemic and beyond.

Photo: Psychosocial counselor in Achham counseling a patient

Championing the Role of Community Health Workers through the COVID Pandemic

Possible supported NHN to adapt reproductive maternal neonatal and child health (RMNCH) care delivery protocols during the early phase of COVID. These adaptations are in line with Nepal Government, WHO and UNICEF community care guidance. CHWs provided COVID counseling alongside RMNCH services. Group RMNCH care activities were paused and adapted to remote based counseling to avoid physical contact.

With support from USAID, the National Institutes of Health, and others, and in partnership with the Community Health Impact Coalition, we are contributing to the global evidence base and policy dialogue about the essential role of CHWs for public health. Our recent publications on the cost analysis of the CHW program as well as its effectiveness in supporting postpartum contraceptive counseling further support the evidence base of the importance and the opportunities provided by utilizing locally trained paid CHWs.

Expanding Access to Mental Health Service in Rural Nepal During COVID 

Possible has supported NHN to adapt its clinic-based mental healthcare to provide critically needed tele-counseling to combat distress and anxiety caused by the disruptions, restrictions and other stressors related to COVID. The team conducted a group discussion with the clinical team to identify steps in continuing mental healthcare followed by a preparedness check with counselors to assess their knowledge, skills, and availability to provide tele-counseling. We provided specific strategies to the counselors, as they made the challenging transition from meeting patients in-person to delivering therapy on the phone. With support from the National Institutes of Health, we adapted our ongoing research studies to move the intervention from in-person support to remote visits.

Our current studies are focused on improving adherence to care among vulnerable populations, such as those with HIV and those with depression. In a recent publication, NHN and Possible, analyzed the data from the mental health program. This paper summarized the recommendations the psychiatrist made to ensure that a high-quality of care is delivered by the system and access to therapy is expanded. We aim to continue to build the evidence base for effective delivery of mental health services in rural areas during the pandemic and beyond.

OUR NEXT STEPS IN 2021 AND BEYOND

Moving forward Possible will build on its legacy of collaborative innovation and healthcare research. This will include ongoing work with NHN and working with other organizations on testing and adopting alternate models of care to address implementation and policy gaps in the equity, quality, and accessibility of healthcare. Leveraging the inherently collaborative nature of research, Possible, as a global enterprise, can continuously inform and source ideas on a global scale while having a strong rooting in local contexts.

FINANCIALS

Fiscal Year 2020: August 1, 2019 to July 31, 2020

In the midst of the uncertainties levied by COVID-19, we have taken strides to improve our financial standing and fiscal oversight.

Statement of  Activities

*As we continue to support the independence of Nyaya Health Nepal (NHN) there has been a shift in donors providing funds directly to NHN which results in an equal amount of decreases in contributions and expenses.

Revenue by Type

Expenses by Type

THANK YOU

$250,000 to $499,999
Deerfield Foundation
Younger Family Fund
UBS Optimus Foundation
Nick Simons Foundation
$100,000 to $249,999
Schooner Foundation
Sheela & Duncan Maru
National Institutes of Health
Arnhold Institute of Global Health
Google Adworks
Alwaleed Philanthropies
Justin Durand
Open Road Alliance
Pfizer Foundation
Silicon Valley Community Foundation
$50,000 to $99,999
Preston-Werner Ventures
Horace W. Goldsmith Foundation
Albert Kaneb
Bob Heine
Paul Bechtner Foundation
Sall Family Foundation
$10,000 to $49,999
The Life You Can Save
Capital Group Companies Charitable Foundation
Christine Curry
Angelo Tomedi
Digital Square
Pavan Makhija
Eswar Priyadarshan
Anand Subramanian
John Bauman  
Knut Skyberg & Borgny Ween
Dimagi, Inc.
Latika & Rajiv Jain Foundation
$1,000 to $9,999
Asana
Dropbox
Small Improvements
A to Z Impact Foundation
First Dollar Foundation
Herrnstein Family Foundation
Jeffrey Schwarz
Joel Wittenberg & Mary Ann Ek
Lenzmeier Foundation
Merck Foundation
Muna Bhanji
Ryan Schwarz
VivCourt Trading
Community Health Impact Coalition
Anshuman Patwardhan
Jackie Bullis & Ryan Duffy
Maurice and Jeanne Ferrante
Dan Schwarz
Patrick McKee
Plato Malozemoff Foundation
Susan Fletcher
MasterCard
LiberatED Scholar
Sarah Hanck
Angela and Nicholas Kalayjian Fund
Planned Parenthood League of Massachusetts
Vivek Maru
Bibhav Acharya
Andrew Morgan
Ashish Maru
Bridgit Burns
Elisabeth Baron
Exelon Foundation
Isha Nirola
Jan Hartman
Ross Family Foundation
Sharon Davis Design Foundation
Sneha Maru
Will Clark Shim
Usha Barbaria
$500 to $999
Mike Filbey
Ondrej Sliva
Jaya Nagda
Jhapat Thapa
Cliff B
Jogi and Indra Makhija
Rachel Maley
Peter Kautsky
Analysys Mason Limited
Andrew Wyckoff
Barbara Kamholz
Constance Liu
Jessica  & Ari Beckerman Johnson
John and Roxanne Castleman
Martha Straw
Mary DeChant
Ranjan Sitaula
Richard Katzman
Roberta Carlise
Sharad Jain
The Brennan and Cianciolo Family Fund
Thomas Reynolds
William Garmany

Bibhav Acharya, MD

Duncan Maru, MD,PhD

Isha Nirola

Thank you to our outgoing Board Chair Terhilda Garrido and outgoing board members Eswar Priyadarshan, Justin Durand, Muna Bhanji,
Marta Bralic, Mila Skulkina, Sandro Lazzarini, and Jeff Kaplan for your heart, passion, generosity, and service. Your impact will be long-lasting.

Arnhold Institute for Global Health at Icahn School of Medicine at Mount Sinai

Ariadne Labs

Dhulikhel Hospital - Kathmandu University Hospital

Division of Global Health Equity at the Brigham and
Women's Hospital

Department of Psychiatry and HEAL Fellowship Program
at the University of California San Francisco

Department of Global Health and Nepal Studies Initiative
at the University of Washington

Department of OBGYN at the Boston University School of Medicine