Possible
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Possible

Possible improves healthcare for underserved communities in Nepal, a country devastated by civil war and natural disasters. In partnership with the government, they are designing and implementing integrated public healthcare systems to deliver affordable care to 10 million people.

Donate to Possible

800K
patient visits
200K
community visits
US$21.27
annual cost per patient

The problem: lack of affordable healthcare

In Nepal, 10 million people don’t have access to quality healthcare.

Imagine an expecting mother who arrives at a facility in time to give birth — and it’s the first time she’s ever been seen by the physician. For many people in last-mile communities in Nepal, this is the reality. The nearest medical facility might be a five hour walk away, or an exorbitantly expensive jeep ride.

The solution: integrated healthcare

Possible is developing a model for integrated healthcare that is customized for low-resource settings and delivered at the local level. The goal: a patient wouldn’t have to travel outside of their community for essential health services, regardless of condition (such as mental or maternal health) or type (i.e. preventive versus curative).

In Nepal, over 10 million people don’t have access to quality healthcare.
Possible healthcare workers in Nepal helping person on stretcher

How Possible works

Possible starts with the belief that system-wide improvements — as opposed to silver bullet solutions — are required for changing the health outcomes of entire populations. More and more, there is a global consensus reinforcing the need for integrated, people-centered primary healthcare systems that reach last-mile communities without financially burdening families.

Possible has been developing these systems improvements for over a decade. Key components of their healthcare model include:

  • High-quality, interconnected facilities that deliver essential services, support training of healthcare workers, and are places of learning and healing.
  • Community health workers who proactively identify conditions, longitudinally deliver care, and link communities, households, and individuals to facilities. (This includes care delivered in an individual’s home.)
  • Linked digital systems for frontline workers, including supply chain, billing, operations, patient tracking, population management, and quality improvement tools.
  • Affordability, with minimal point-of-care fees to encourage timely access to care and offer financial protection to families.

Let’s continue with our expecting mother example. As opposed to having to travel to a medical facility hours away, pregnant women in Possible’s catchment areas are visited by Community Health Workers (CHWs), who conduct antenatal screenings and anticipate complications long before a patient’s due date. In the field, a CHW enters patient data using a smart phone, which is integrated with patient records at the facility level, so that health workers across sites can access information for accurate diagnosis and treatment.

Possible patient in Nepal holding her baby

Possible operates in some of the most underserved communities in Nepal, including Achham, once an epicenter of both the HIV epidemic and civil war; and Dolakha, a remote district whose infrastructure was ravaged by the 2015 earthquakes. They work at the direct delivery and policy level, with a vision of scaling to serve all 30 million people in Nepal through government adoption. They hope their model can be adapted to other low-resource settings experiencing similar constraints.

What makes Possible so effective


Cost-effectiveness

Possible estimates their annual cost per patient to be US$21.27, including home visits and surgery. There is no fee-for-service at the point of care. [1]

Wide reach

In just over a decade, Possible has provided over 800,000 patient visits and 200,000 community visits to underserved communities in Nepal. 

Digital integration

Possible’s technology platform, NepalEHR, enables information sharing between medical facilities and community health workers, allowing for efficient and coordinated care.  

Real impact

In the 14 village clusters where they work, Possible has seen institutional birth rate — an indicator of maternal mortality — increase from 30% in 2012 to 95% in 2017.

Possible’s accountability and sustainability

Possible produces quarterly and annual impact reports. [2] [3] They use a quadruple aim framework to measure success:

  • Population health outcomes
  • Patient satisfaction and care
  • Affordability (costs to patient and financing within public health system)
  • Staff diversity and retention

Possible’s operations are financed by philanthropic institutions, Nepal’s government, and individual donations. They overwhelmingly employs and trains local health care providers and staff. Possible’s direct delivery team of over 400 is 98% Nepali.

Frequently Asked Questions

What types of programs does Possible run?

Possible’s long-term vision is achieving Universal Health Care and financial protection for the underserved population in Nepal. Their key performance indicators include measuring and setting targets around: 

  • newborn survival
  • institutional birth rate 
  • contraception demand satisfied
  • chronic disease control
  • surgical complications
  • percentage of healthcare expenditure that is out of pocket.
Why does The Life You Can Save recommend Possible?

We recommend Possible because their work earned a Standout charity rating from GiveWell in 2011, one of our charity evaluators (at the time, Possible was called Nyaya Health). They have also undergone an impact audit by ImpactMatters, which concluded that “Possible improves health outcomes among people who otherwise lack high quality care, and improves health care access and health outcomes for the marginalized.” [4]

Would my donation be tax-deductible?

Sources

All photos and videos courtesy of Possible

[1] Possible, 2018 Annual Report

[2] Possible, Quarterly Impact Report

[3] Possible, 2018 Annual Report

[4] Impact Matters, Possible impact audit