Here’s how we measure the effectiveness of our integrated care delivery model.
Scale of Impact
We’ve treated over 600,000 patients since 2008. We currently have over 150,000 patient visits per year between our two sites.
patients treated to date.
We employ over 350 staff, of which over 90% are in Nepal.
team members employed.
Nepal’s government is our most significant partner.
of cash & in-kind support from Nepali government.
We track our costs, without compromising the quality of care.
per capita price point.
Optimizing for Quality and Affordability
Key Performance Indicators
We chose KPIs targeted at addressing the key drivers of morbidity and mortality in Nepal.
The KPIs represent the impact we are making for the entire population beyond any single tier (hospitals, clinics, community health workers or the referral network).
In addition to the overall KPIs, we publish progress of our work 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.
Post-partum Contraceptive Prevalence Rate
The % of married reproductive aged women (15-49) in our catchment area who delivered in the past two years who are using a modern contraceptive method.
Our KPI Progress
In order to improve integrated care delivery, we pursue aggressive data analysis, global and national recommendations and guidelines, and input from our government partners.
View our metrics creation protocol and approach to target setting here. The charts below show our performance of these four KPIs over time and provide brief context for each.
Surgical complications rate: Providing equitable and affordable access to safe essential surgical services 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. In the future, we aim to measure complication rates at the household after having being discharged to ensure longitudinal follow-up.
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 captures women’s perceptions of quality service delivery, and the healthcare system’s commitment to follow-up from antenatal care visits. The IBR is measured through data collection by Community Health Workers and is likely high compared to national averages because of our catchment area’s proximity to the hospital, and our Community Health Program’s strong focus on follow-up and birth planning.
Postpartum Contraceptive Prevalence 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
Our Community Healthcare team allows us to bring care closer to the home, especially for patients who are a five day’s walk from our hospital.
“Mother, child, pregnant, or sick, our job is to help them.”
Our hospital acts as an “innovation” hub, but our durable healthcare model strengthened by primary healthcare centers and community health workers. Our CHW’s live and work in the surrounding villages providing primary care and managing follow-up healthcare— acting as a critical liaison between communities, government-operated health posts, and hospitals.
See the path yourself. In the video, our patient Taruna has had a high fever for three days. After close care from our community health worker Debu Devi Suna, she takes Taruna and her family to our hospital—a three hour walk over mountainous terrain.
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 Possible’s 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 are pioneering a new approach to put safe births at the center of our 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.
Meet Our Medical Director, Dr. Binod Dangal
Dr. Binod joined our team in 2015 shortly after we expanded our work in Dolakha District when the earthquakes struck Nepal. Hear his inspiring story.
Dr. Binod’s journey is a unique one. At a young age, a British teacher volunteering in his rural village recognized his potential, and sent him to study in Kathmandu. He quickly immersed himself into city life, living with classmates who “didn’t like when someone studied more than they should.”
Having never spoken English until moving to Kathmandu, Binod barely passed his first exams. But he pushed forward with grit, and graduated high school with impressive scores, especially in science. He went to China to complete his Bachelors in Medicine, where he finished top of his class.
He conducted his higher-level MD studies in Nepal, and then moved to Dolakha, a three hour jeep ride on bumpy roads from the rural village where he grew up. He jokes that by now he’s probably treated every person here. When he visits his home, patients approach him with their back problems, headaches, and fevers, and he draws out the stethoscope from his coat pocket without hesitation.
When the earthquake struck Nepal, many rural villages in and surrounding Dolakha District were destroyed. His own home turned to rubble, and many of his family members and neighbors passed away. After spending countless, extended shifts to respond to the immediate needs of earthquake victims, he joined our team.
After his journey to Kathmandu and abroad, Dr. Binod now leads Possible’s medical strategy in one of the worst-hit districts in Nepal, while also coming back close to home to deliver dignified care.