Residents make healthcare possible in one of the world's most impossible places
Duncan Maru, MD, PhD
Ryan Schwarz, MD, MBA
Dan Schwarz, MD, MPH
Nepal is one of the world’s poorest countries, but it also has some of the most progressive healthcare policies. The country’s constitution guarantees the right to health and universal healthcare for the poor. However, in rural areas, millions don’t get the care they need from the traditional private, public and philanthropic approaches to healthcare. That’s where Possible and its durable approach to healthcare come into play. Durable healthcare is a public–private partnership that enables a nonprofit healthcare company to be paid by the government to deliver healthcare within the government’s infrastructure. It brings together the quality of the private sector, access of the public sector and innovation enabled by philanthropy. Core financing is tied to performance.
“We never were interested in just running a clinic. We were very interested in making a large population-level impact for health service delivery,” says Dr. Dan Schwarz. “We run a company whose explicit vision is to work in what we call public–private partnership with the government. In other words, we are a private non-governmental organization working in direct contract for the government/public sector. Our work is explicitly to develop healthcare services within the public sector.”
On April 25, 2015, an earthquake hit Nepal, killing more than 8,500 people. In response, Possible is now focusing its work on the Dolakha district. “It was one of the hardest-hit districts in the recent earthquakes,” says Dr. Ryan Schwarz who serves as Chief Operating Officer at Possible. “We’re working with the Ministry of Health to rebuild much of the healthcare infrastructure that was destroyed there. We are now starting construction on new health posts.”
Possible has committed to building 21 health clinics by the end of 2015. But the work does not stop there. The long-term goal is to work with the Nepali government to ensure damaged hospitals and clinics get rebuilt with earthquake-resistant design, and then manage the healthcare system in Dolakha across hospitals, clinics and community health workers. Possible will do this by both building the infrastructure and training and managing the Nepali clinicians.
Duncan Maru is Co-Founder, Chief Strategy Officer and a non-voting Board Member at Possible. He is also a faculty member at Harvard Medical School, where he is the Principal Investigator of the Healthcare Systems Design Group within the Division of Global Health Equity at Brigham and Women’s Hospital. He says of his organization’s work in Nepal, “Nepal is at a critical moment, not unlike the US healthcare system seventy years ago, where a powerful point-of-care fee-for-service for-profit system is outcompeting the public sector. This is particularly true in the aftermath of the earthquake, which has devastated the public sector but left largely unscathed most private facilities. At Possible and the Healthcare Systems Design Group, we’ve developed a unique public sector business model while conducting implementation research that aims to advance public policy.”
Possible’s mission is to go beyond a simple response to the acute crisis of the 2015 earthquake. Their goal is to address the chronic issues the people of Nepal face in terms of healthcare in hopes of building the system back to be stronger and more efficient than it was before the earthquake. “We stand hopeful that Nepal will emerge from this crisis with a stronger government and stronger communities resistant to the ravages of both earthquakes and poverty,” says Maru.
Cracked walls of the Bhirkot Health Post that was damaged during the earthquake and