27 December - 2 Janauary 2014 #687

Crowding it out

An innovation that may revolutionise surgical care is taking hold in rural Nepal

GLOBAL AND LOCAL: A staff at Bayalpata Hospital in Achham takes down details of an expecting mother for possible crowdfunding through the internet.
Most Nepalis don’t have access to surgery, for things as common as cesarean sections, burns, cancer, or vehicular accidents. One in 10 of the diseases can be treated with surgery, yet the rural poor have no access.

Tired of hearing excuses on why surgery wasn’t possible for the rural poor, Nyaya Health which works with a hospital in Achham in western Nepal, has built an innovative new crowdfunding model. Patients who require complex care grant permission for their story to be told online and then anyone around the world can directly fund a portion of their cost of care for as little as $10. Funders are given updates on the patient’s status.

The stories of patients on the site, captured by photographer Robert Fogarty of Dear World, reveal the transformation crowdfunding has brought patients who otherwise would have gone untreated. A 60-year-old farmer wrote she would “age without fear” after her fracture was repaired with surgery. A new mother held her baby and shared the message that they “could have died at home” were it not for a funded safe birth and a young boy who fell from a guava tree and fractured his leg said, “Now I can be a doctor.”

In 2013, the website raised money for 86 urgent operations in its hospital in Bayalpata of Achham. Nyaya Health’s strict rules on transparency help recruit donors and improve efficiency. Patients can be identified and their stories put up online for funding within one day.

“The idea that surgical care is too expensive and that it cannot be scaled, simply isn’t true. And this crowdfunding model is further disproving that idea,” says Nyaya Health CEO Mark Arnoldy.

Nyaya Health is becoming known for its remarkable ability to refute ideas many hold about delivering healthcare to Nepal’s poorest, Arnoldy says, and the crowdfunding idea is the most effective yet. Practitioners say crowdfunding has the potential to become a model for rural healthcare in developing countries, transform popular understanding of poverty and health issues, and hold healthcare providers accountable.

Nyaya’s Arnoldy sees crowdfunding as a step in the right direction of being able to provide this type of comprehensive care for the poor. “Most important for us as healthcare providers is that crowdfunding is much more than a new source of financing,” he says.

“The very standards it inherently demands as a model - that patients are identifiable and costs will be made transparent - have led us to create a new national referral network in Nepal,” he explains, adding that case costs advertised by the Nyaya Health campaign include everything from diagnosis to follow-up care.

The World Health Organisation (WHO) has stated that referral care for patients once they leave the clinic after an initial diagnosis is a common weakness of health systems in developing countries. Says Arnoldy: “This model of investing directly in the healthcare of another human being makes global health more accessible for a larger population.”

The Nepal government is so impressed with Nyaya’s contribution to medical care in Achham and surrounding districts that last month it signed a new partnership agreement, doubling its cash funding and providing pharmaceutical goods from its supply chain.



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