Integrated healthcare has yielded improvements in maternal and child health.
Scale of Impact
Possible has supported over 824,000 facility-based visits to date, and over 241,000 home visits.
The team of over 400+ staff, including 100+ CHWs, provide integrated care delivery to a catchment population of over 218,000.
team members employed.
We track our costs, without compromising the quality of care.
per capita price point.
Optimizing for Quality and Affordability
Key Performance Indicators
We selected key performance indicators, based on the health priorities of the Nepal government, and Sustainable Development Goals more broadly.
We document our progress in Quarterly Impact Reports.
Key Performance Indicators
The % of surgical patients with complication after surgery.
Chronic Disease Control
The % of total chronic disease patients under our care who have their disease under control.
Institutional Birth Rate
The % of births in a healthcare facility with a healthcare professional present.
PostPartum Contraceptive Demand Satisfied
The % of married reproductive age women (age 15-49) who have their need for family planning satisfied with modern contraceptive methods.
Our KPI Progress
In a series of prospective, longitudinal studies between 2012 and 2017, we demonstrated an increase in institutional birth rate, a critical process indicator for maternal mortality, from 30% to 95% within a 14-village region in Achham district, where we have been implementing our integrated delivery model and each village served as its own historical control.
Furthermore, we have observed steady reductions in the infant mortality rate from 19 to 14.5 to 11.9 per 1,000 live births over a three-year period within the same region.
View our metrics creation protocol and approach to target setting here.
Surgical Access: Providing equitable and affordable access to safe essential surgery is central to addressing the burden of treatable conditions in low- and middle-income countries like Nepal. We measure surgical complication rates amongst patients before they are discharged from our hospitals.
Chronic disease control rate: As the burden of non-communicable and chronic diseases increase in low- and middle-income countries like Nepal, healthcare systems need to track and follow-up with patients in a longitudinal manner. Each chronic disease we track has an established primary control metric, which we aggregate to get a single control metric representing the percentage of NCD patients achieving their disease-specific target over time.
Institutional Birth Rate (IBR) is measured through data collection by Community Health Workers. is likely high compared to national averages because of our our Community Health Program’s strong focus on follow-up and birth planning, in addition to proximity of catchment area to a facility.
Contraceptive Demand Satisfied has been linked to lower rates of poverty and reduced maternal and child mortality. This KPI encompasses uptake methods of contraception including intrauterine devices and implants, condoms, and contraceptive pills. In Nepal, an estimated 41% of married women of reproductive age use some method of contraception. There are challenges to setting targets for contraceptive use; however, based on our original measurement and available regional data, we are in the process of refactoring the target.
The Path to Healthcare for All
The Community Healthcare team brings care closer to the home, especially for patients who are a five day’s walk from our hospital.
“Building systems that save lives.”
Over the past decade, we have invested significant resources in Bayalpata Hospital in Achham and Charikot Hospital in Dolakha. Through this high-touch operation and management, we have had the experience to design the type of facility-to-home integrated care that is necessary to improve health in underserved communities.
See the path yourself. In the video, the patient experiences a complicated delivery. After close care from our community health worker Bhajan Kunwar, she connects the patient to our facility, to access surgical care that is required to save her life.
Investing in public facilities that were poorly functioning, has helped to transform health outcomes — only when facility care happens in coordination with Community Health Workers, who live and work in the surrounding villages—- and act as liaisons between communities, government-operated health posts, and hospitals, and can be champions and advocates when timing is critical.
When a Hospital Isn’t Enough
Why mothers need more than a hospital to bring their babies safely into the world.
“It wasn’t like this when I was born – I was born at home. But there are many difficulties with home births.”
+ Rupa, a new mother
In rural Nepal, pregnancy is referred to as a “gamble with death.”
There was a pregnant woman named Rupa who nearly lost that gamble. She, like so many other women, wanted to give birth in a safe healthcare facility near her home. She herself was born in her home, and her mother warned her of the dangers of home births.
Because of that, when she went into labor, she immediately journeyed to the nearest clinic. Yet, there was only one midwife there, and part way through her delivery, the nurse realized she didn’t feel comfortable proceeding alone because she suspected a complication with the delivery.
Because of that, Rupa called for an ambulance, and the ambulance driver came to pick up Rupa and bring her to the hospital. This 3-minute video shows what happened next.
Rupa’s story has a happy ending. And for many mothers who are fortunate enough be close to a hospital, that is the case. At Possible’s hospital hub in rural Nepal, the number of births taking place within the facility has grown 197% from 2010 to 2013.
But a hospital isn’t enough. What pregnant women really need, in a region with one of the highest maternal mortality rates in the world, is access to safe birthing centers closer to their homes and support throughout their pregnancies.
That’s why we approach our work from an integrated healthcare model.
It’s also why the percentage of women delivering in health facilities is one of our six Key Performance Indicators.
We solve for the problems of pregnant mothers like Rupa by having female community health workers provide training and referral support in villages, working with local community governments to transform clinics into safe birthing centers, and linking clinics to a central hospital with ambulances for emergency deliveries.
This model is supported financially through a partnership with the Nepali government’s Safe Motherhood Program, where both pregnant mothers and Possible receive payments for attending prenatal care visits and delivering in a health facility.
It’s a model of safe births that works fully for pregnant women, not partially.