Geneva Health Forum Archive

Browse and download abstracts, posters, documents and videos from past editions of the GHF

Public Private Partnership in the Management of Primary Health Centers in India.

Author(s): Samal Sarangahdar1
Affiliation(s): 1National Youth Service Action and Social Development Research Institute, Bhubaneswar, India
1st country of focus: India
Relevant to the conference theme: Redesigning health services
Summary: In the PPP model, the skills, assets, risks, and rewards of delivering a service or facility are shared between public agencies and private sector entities through a contractual agreement. This innovative model of healthcare delivery has been successfully piloted over five years for two local community health centers in Orissa, India and is now being scaled up to other areas of the state and the country, with scope for it to be replicated in similar underserved rural settings around the globe.
What challenges does your project address and why is it of importance?: The public health sector in India is unable to provide basic services to the marginalized segments of the population due low investment (3% of GDP), poor infrastructure, inadequate management, physician shortages, lack of patient education or awareness, and shortage of resources in terms of manpower, medication, and supplies. In the state of Orissa, 90% of the 1166 government-run primary health centers (PHCs) are irregularly functioning or defunct. On the other hand, the private health sector has the capacity to provide high quality, efficient, accountable, and patient-centered care but cannot be accessed by poor, rural communities. There is thus a disconnect where the private sector has resources, knowledge, and skills that the public sector has never tapped into.
How have you addressed these challenges? Do you see a solution?: Based on the philosophy that synergy leads to better health outcomes, we introduced the PPP model in which public and private development organizations complement and supplement each other in a combined effort to reach joint goals. To rehabilitate two local defunct PHCs (Khankira GP, Dhenkanal district and Atta GP, Jajpur district), our NGO, NYSASDRI, partnered with the government at the local and state level. To ensure success, we ascertained that several key requirements of the partnership were met: commitment from the top by political leadership, the selection of the right private partner, active involvement of the public sector throughout the process, a well-thought out contract with clearly defined responsibilities and methods of dispute resolution, a dedicated income stream, the judicious use of resources, and collaboration with stakeholders in the local community.
How do you know whether you have made a difference?: Performance was measured through the routine monitoring and evaluation of outcomes by all parties involved. Categories assessed include quantity of services provided or advanced, percentage of the populationwho  receiving specified services, quality of service provided (e.g. waiting time), hospital care parameters (e.g. length of stay, cost per admission, patient turnout, facilities utilization), and the health status of the population (e.g. nutrition markers, health awareness). Qualitative analysis was done through patient feedback surveys and quantitative analysis was done via the comparison of predefined health indicators with both baseline and benchmark values.
Have you or the project mobilized others and if so, who, why and how?: To make management more participatory and ensure local ownership of the PHC, a hospital management committee (HMC) was formed with representatives of Panchayati Raj Institutions (a local system of governance), government health department officials, NGO representatives, women’s self help groups (SHGs), Kishori clubs (adolescent girls clubs), and other important villagers of the area. These participants were mobilized by holding multiple local and state level meetings for needs assessment, discussion, and negotiation. The HMC looks after the day-to-day operation of the PHC, customizing decisions to local priorities regarding which services will be rendered and the process of implementation.
When your donor funding runs out how will your idea continue to live?: In the two villages which conducted our pilot project, building renovations, the installation of basic facilities (electricity, telephone connectivity, medical equipment), and appointed staff members (doctors, attendants, pharmacists, sweepers) will remain permanent assets of the PHC under the oversight of the government and HMC even after the partnership ends. Meanwhile, the capacity building facilitated by our project has not only empowered the members of the local community organizations to act as advocates for their village’s healthcare, but inspired neighboring communities to do the same. Finally, on a larger scale, the success of our venture has paved the way for other private players to play a role in strengthening the rural healthcare systems in Orissa. Our political advocacy efforts brought about the necessary policy level changes to allow other NGOs and corporate institutions to partner with the government in the revival of other dysfunctional PHCs throughout the state. The PPP model has thus emerged as an important strategy for health care reform in the state of Orissa.

Front Line Health Accountability – Citizen Voices and Action: Democratizing Health in Communities

Author(s): Stefan Germann1, Jeff Hall1, Thiago Luchesi1, Itunu Kuku2
Affiliation(s): 1World Vision International, Geneva, Switzerland, 2Graduate Institute of International and Development Studies, Geneva, Switzerland
Name your project or intiative: Front line health accountability - Citizen Voices and Action (CVA) - democratizing health in communities
1st country of focus: Uganda
Additional countries of focus: Albania: Armenia: Australia: BiH: Bolivia: Cambodia: Brazil: El Salvador: Georgia:  Haiti:  India: Indonesia: Kenya: Lebanon: Malawi: Mozambique: Pakistan: Peru: Philippines: PNG: Romania: Senegal: Sierra Leone: South Africa: South Sudan: Sri Lank: Tanzania: Zambia
Relevant to the conference theme: Equity and empowerment
Summary: Health related accountability mechanisms are critical to achieve better health outcomes for the money that is spent. There has been increased global attention to this. However, unless accountability efforts occur at the front line, we will not achieve increased health outcomes of well-intended interventions. Citizen Voice and Action is an approach that aims at increasing dialogue between ordinary citizens and organisations that provide services to the public. It also aims at improving accountability from the administrative and political sections of government (both national and local) in order to improve the delivery of public services.
What challenges does your project address and why is it of importance?: Over the past year there has been a significant increase in funding for global health issues such as communicable diseases, maternal, newborn and child health and some other areas. At the same time there has been the recognition that it is not just about ‘more money for health, but as well more health for the money’. Hence, in recent years there has been an increased focus on health related accountability issues and the recent concluded Commission on Information and Accountability is a demonstration of this. Inthe public clinic of many communities the absence of basic drugs and the frequent truancy of nurses and doctors have contributed to the chronic illness and death of dozens of community members. Others travel long, painful, and expensive distances for the most basic care. The cost of lack of front line accountability, with the provision of simple feedback loops for health services, is the loss of lives seen in large numbers of still birth, maternal, neonatal and child mortality over the 60 countries that are off track to achieve the health MDGs. Frontline accountability is critical to achieve health outcomes and ensure that limited resources are delivering good results.
How have you addressed these challenges? Do you see a solution?: CVA is a local level advocacy methodology that transforms the dialogue between communities and government in order to improve services like health and education that impact the daily lives of children and their families. It works by mobilizing citizens, equipping them with tools to monitor government services, and facilitating a process to improve those services. CVA includes one preparatory phase (Organizational and Staff Preparation) and three implementation phases (Enabling Citizen Engagement; Engagement via Community Gathering and Improving Services and Influencing Policy). Before beginning Citizen Voice and Action, the following preparations are needed: • Understanding the political and social context in relation to citizen and governance issues; • Training staff, partners and stakeholders to facilitate Citizen Voice and Action within communities, recognising the broader issues that relate to citizenship and governance within their country; • Contextualizing the CVA materials. We encourage staff to adapt CVA to respond to the civil society spaces that exist and use context analysis tools to better understand the power structures in society.  Phase 2 involves the following: Enabling Citizens Engagement: This Phase builds the capacity of citizens to engage with issues of governance and provides the foundation for subsequent phases. It involves a series of processes that raise awareness on the meaning of citizenship, accountability, good governance, and human rights. Importantly, citizens learn about how human rights translate into concrete commitments by their government under national law. Phase 3: Engagement via Community gathering: ―Community Gathering describes a series of participatory processes that focus on assessing the quality of health services and identifying ways to improve their delivery. Community members who use the service, health service providers and local government officials are all invited to participate. The process is collaborative — not confrontational. Generally, nobody wants an underperforming clinic in their community, and local authorities are often eager to work with citizens to improve these essential facilities. Phase 4: Improving Services and Influencing Policy: In this phase, communities begin to implement the action plan that they created as a result of the Community Gathering process. Citizens and other stakeholders act together to influence policy at both local and higher levels. In effect, communities organize what amounts to a local level campaign, with objectives, targets, tactics, and activities designed to influence the individuals who have the power to change the situations they face at the local level. Often, communities will work with other communities to identify patterns of government failure across large geographic areas.
How do you know whether you have made a difference?: The CVA methodology is a proven approach as was demonstrated by Bjorkman and Svensson (2009) published in the Oxford Quarterly Journal of Economics in an article entitled “Power to the People”. The researchers looked at a social accountability methodology nearly identical to CVA across 50 communities in 9 districts in a randomized field experiment.  In the communities using the CVA-like methodology, they found:• a 33% drop in under-five mortality • a 20% increase in the utilization of outpatient services; • a 58% increase in the number of deliveries at clinics, • a 19% increase in the number of patients seeking antenatal care; and • a 22% increase in the number of patients seeking family planning assistance. It is important to have a strong Monitoring and Evaluation component included in the CVA work. Monitoring and support of community members and groups is necessary in order to achieve the action plans to make sure that services are improved and policy influenced. Creating long term sustainable change is not easy. It is expected that power holders and duty bearers will be responsive to the voice of citizens. Often they respond, but this is not always the case. Monitoring and support serves a number of purposes:• to motivate those carrying out the actions• to see that planned actions are happening• to see that the strategies used are effective and helping to achieve the planned action• to enable problem solving if obstacles prevent the actions from being achieved• to report back progress to the community and users of the service. Monitoring will encourage the use of regular updates, report backs and feedback loops. All of these are useful to maintain citizen interest and commitment, which is often hard to sustain. Perseverance to achieve long term, sustainable change is often difficult to maintain. Starting with ‘quick wins’ – changes that happen easily to improve the services, is a good way to encourage initial citizen action and to build momentum for longer-term action. Documenting actions taken and progress made are very important to the monitoring and support process. Those responsible for carrying out the actions, should be encouraged to keep a record of what they are doing and the responses and results of their action. Regular reporting back of progress encourages other stakeholders, participants and the general community. World Vision conducted a number of CVA evaluations, the most recent one in Uganda (Waswaga, Winterford, Walker, Mugabi &  Otim 2011).
Have you or the project mobilized others and if so, who, why and how?: Citizen Voice and Action began with pilot programmes in Uganda and Brazil in 2005 and was jointly developed between World Vision and the World Bank. In 2008, CVA expanded to additional pilots in Peru, Kenya, Zambia, India, and Armenia. Today, driven by the demand of World Vision Offices, CVA operates in 29 countries in nearly 200 project sites and is recognized as World Vision’s premier local level advocacy approach. Below Map shows the countries and number of CVA project sites per country using colour coding:  Map uploaded Map 1: A number of World Vision partner organization have started to use the CVA or similar approaches, e.g. Professor Lynn Freedman at Columbia University, Mailman School of Public Health uses in several countries similar approaches for front line health accountability.
When your donor funding runs out how will your idea continue to live?: As the approach is a citizen’s empowerment approach, the sustainability is build into the process from the beginning as the only input costs are capacity related. However, it is critical that the process is followed and sufficient time of engagement is applied to ensure that citizen’s use voice and act for change. Whilst the communities that started using CVA over 6 years ago, are still actively engaged as citizen’s to improve their public services and to keep NGOs accountable as well, it is too early to have a definite answer on long term sustainability approaches, although other citizen empowerment approaches in the field of land rights or environmental community empowerment etc have shown to be long term sustainable and do not require donor funding after a solid empowerment process had been undertaken.


Role of Future Family Physician in Rwandan Health Sector

First: Anaclet
Last: Mugali
1st country of focus: Rwanda
Relevant to the conference theme: New roles and responsibilities of health personnel
Summary: In 1963 the Rwandan government implemented its first University,  National University of Rwanda, which had many faculties including a Faculty of Medicine.  Since that time however, the Faculty of Medicine has produced only undergraduates (6 years for generalist Medical Doctors). In 1997 National University of Rwanda Staff decided to introduce a Master’s in Medicine: Postgraduate specialty training. In 2004 supported by the MInister of Health the first batch commenced with the 4 main disciplines: Surgery, Internal medicine, Ob/Gyn, and pediatrics. Anesthesiology was added in 2005. In 2008 the Family medicine and community (FAMCO) program started with 7 residents for 4 years of training.  The first Rwandan family physicians are expected to graduate in August 2012. According to this four year curriculum family physicians will be able to: coordinate and be involved in clinical activities within institutions, manage clinical programs such as palliative care; non-communicable diseases, communicable diseases, provide integrated clinical care within the scope of training experience and according to Family Medicine principles, coordinate community health care team activities and research, develop the community primary health care capacity at the health center level, collaborate with public health care authorities in the planning and implementation of preventive health care and health promotion activities, train all levels of health professionals i.e. medical students, post-graduate students (family medicine), nurses, Community Health Workers. Within our national health system structure we are looking at how family physicians can improve our communities primary health care.  Key words: Family physician, performance, Rwandan health system. Objectives: To improve our health sector structure by including family physician staff.  Setting: National University of Rwanda / Family Medicine Department / Minister of Health. Subjects: Family physicians in Rwandan health sector structure. .
What challenges does your project address and why is it of importance?: Within our national health sector structure, we are looking for strategies that encourage the family physician to constructively contribute to the the improvement of our health care services in general.
How have you addressed these challenges? Do you see a solution?: In terms of challenges we would like to do more advocacy by faciliating workshops with broad discussions with the Rwanda health program key leaders, districts hospital directors, medical doctors’ representatives, health providers at the district level and in the communities. These workshops, via a detailed explanation of the role of the family physician,  will illustrate how the accumulated knowledge  of the family physician can be delivered to the community.
How do you know whether you have made a difference?: Our future family physicians have not yet graduated and the emergence of this new form of professional staff will be in August 2012 after graduation.  After a certain period the evaluation of these new specialists contribution will be revealed by the evaluation criteria in our health sector policy report.
Have you or the project mobilized others and if so, who, why and how?: No.
When your donor funding runs out how will your idea continue to live?: There is no external funding.

Family Medicine Initiative: Rwanda

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Author(s): Rene Kabera1
Affiliation(s): 1Faculty of medicine, National University of Rwanda, Butare, Rwanda
1st country of focus: Rwanda
Relevant to the conference theme: Redesigning health services
Rwanda is an African under developed country with 10.412.820 population. Maternal and infant mortality rates are still high. Infant mortality: 50/1000 -2010, Maternal mortality: 383/100,000 -2009. Rwanda has a ratio of 1 medical doctor per 18.000 people, only 20% work in the rural areas where the majority of the Rwandan population lives. In spite of increasing specialization in the various fields of medicine, authorities have recognized that the health and well-being of a population is still dependent on high quality primary health care. Family Medicine was established in Rwanda in 2008.
What challenges does your project address and why is it of importance?:
  • Redesign the curriculum of the program according to local needs.
  • Lack of Trainers and Faculty staff in different districts hospitals.
  • Education priorities and resources at the district training hospitals.
  • Assurance of budget and continuous funding allocated to the program.
  • Mobilization of Family Medicine postgraduates to join the program.
  • Importance of Family Medicine is seen at several levels:
  • Humanistic and comprehensive care of the whole family.
  • Broad-based care of the person rather than focusing on the disease.
  • Biomedical, behavioral and social sciences integration.
  • Community based healthcare.
  • Mindful of the cost effectiveness related Primary health care services.
How have you addressed these challenges? Do you see a solution?: To overcome such challenges we advocate for Family and community medicine and highlight its role and importance in Rwanda health system :

  • Advocacy for the role of family medicine with government ministries, universities, health districts and the public The commitment of the trainees, to be engaged in the daily work, in order to highlight the importance of family medicine
  • Full support from the Government by delivering the budget and funding the trainees
  • The financial and academic support from Tulane University (USA), Colorado University (USA) and  Primafamed Edulink ACP EU project (Ghent university-Belgium)
How do you know whether you have made a difference?: 2008:  The program started with 7 trainees   1 faculty member and 2 sites of training(Kabgayi and Ruhengeri Hospitals)    Family and Community Medicine was not recognized  as a specialty in Rwanda

2011:   The program has 6 permanents faculty members and  Visiting expatriate professors joined the program,  17 trainees in 3 training sites(Kabgayi Hospital,Ruhengeri Hospital,and Rwinkwavu Hospital) Family and Community Medicine is fully recognized as a specialty in Rwanda
Have you or the project mobilized others and if so, who, why and how?: With advocacy and determination the Family and Community Medicine concept is growing and being understood in Rwanda and we are planning to join International Organizations of Family medicine

Partnership was raised with the Limpopo University in South Africa
When your donor funding runs out how will your idea continue to live?:
The Program is fully supported from the government who has allocated a budget for the training of traunees.
  • The funds are helping in different ways:
  • To build capacity to establish Family Medicine as a specialty in Rwanda
  • To support country to build its capacity in the trainig of trainers in Family Medicine
  • To support strengthening of the health care services in Rwanda including primary health care, by incorporating family medicine in the national health system.
  • With above interventions local graduates will continue to support and work on sustainable program.

Youth Friendly Health Services: A Chibombo District Experience

First: Victor
Last: Silumbwe
1st country of focus: Zambia
Relevant to the conference theme: Vulnerable groups
Summary: Chilbombo Child Development Agency is implementing the integrated HIV/AIDS project with a focus on Youth Friendly Health Services. youth friendly services meets young peoples sexual and reproductive health needs, regardless of their sex, religion, ethnicity,religion as well as cultural diversity. This was achieved through capacity building and sensitization meeting on the importance of making health services more youth user friendly
What challenges does your project address and why is it of importance?: low utilisation of health services among youths in three rural health posts of  Chibombo District , central province Zambia, due to judgemental tendancies by health staff, long waiting queues as well as lack of privacy
How have you addressed these challenges? Do you see a solution?: 1. Capacity building training to health staff, community health care providers and youths  in Youth Friendly health services Management 2. Construction of 3 youth friendly corners 3. Community sensitization meetings through participatory mass media 4. monitoring and evaluation
How do you know whether you have made a difference?: There has been a drastic increase in the number of youth accessing health services in rural health centres from 10% to 60% as of June, 2011. Chibombo District Health Office Report
Have you or the project mobilized others and if so, who, why and how?: yes the project has mobilised other relevant stakeholders in Chibombo District, to support youth friendly health services advocacy efforts through district stakeholders meetings
When your donor funding runs out how will your idea continue to live?: youth friendly health services will be integrated into the activities that Chibombo Child development agency is implemeting. Peer counsellors will continue providing the service at the local rural health centres.i

Improving Type 1 Diabetes Management Through Youth Empowerment: Dominican Republic

Author(s): Merith Basey1, Molly Lepeska1
Affiliation(s): 1Ayuda, Arlington, United States,
Name your project or intiative: Improving type 1 diabetes management through youth empowerment
1st country of focus: Dominican Republic
Additional countries of focus: Ecuador
Relevant to the conference theme: Non-communicable chronic diseases
Summary: An organization run for youth by youth, AYUDA’s work is based on the idea that youth can be agents of change in diabetes communities, where a lack of education is as dangerous as a lack of insulin.  With its focus emerging from Latin America, AYUDA works with local diabetes communities in countries like the Dominican Republic and Ecuador, to develop and implement local, sustainable diabetes projects.  AYUDA’s peer learning model uses international volunteers as catalysts to empower local youth living with diabetes to form healthy habits that allow them to improve the management of their diabetes and live happier lives.
What challenges does your project address and why is it of importance?: Today 366 million people are living with diabetes; 70% of whom live in low- and middle-income countries where 80% of deaths occur as a result of non-communicable diseases (NCDs).  In Latin America and the Caribbean, NCDs and diabetes are estimated to cause as much as 60% of the mortality in the region. Approximately 20% of the total population in Latin American and the Caribbean is aged 15 and 24 with an average of 39% living in poverty. Youth is when people engage in high risk behavior and lifestyle habits are established. In the region, 25% -32% of the 12 to 24year old population is suffering the consequences of at least one kind of risky behavior. Although NCDs like diabetes affect many young people, most prevention measures are not targeted towards youth. It is young people who will bear the brunt of the economic, social and emotional burden of NCDs throughout their lives.  Adopting a healthy lifestyle is even more important for youth with diabetes because complications set in slowly and are irreversible. Extensive research demonstrates that diabetes control and health outcomes of people living with diabetes depend largely on their active involvement in managing their condition.
How have you addressed these challenges? Do you see a solution?: AYUDA has established an international volunteer program that mobilizes individuals (many of whom have diabetes themselves) - ranging from high school students to world-class medical professionals - to support diabetes leadership and empowerment programs primarily throughout Latin America and the Caribbean.  AYUDA  has been implementing sustainable low cost programs for children with type 1 diabetes in developing countries in conjunction with local partner organizations in 9 countries for over a decade. By empowering young people living with diabetes to work with and educate other youth with the same disease, AYUDA has found improved health outcomes for children when compared to alternative interventions in resource poor settings, in particular with regard to psychosocial outcomes. Since current research estimate 50% of people living with diabetes suffer from depression the psychosocial benefits from such interventions should not be overlooked from a mental health perspective. AYUDA programs are built on the fundamental idea that youth can serve as agents of change and that a lack of education is as dangerous as a lack of insulin.  As an organization, AYUDA has been recognized for its social entrepreneurship and innovation by Ashoka: Innovators for the Public, the World Bank as a 2007 Development Marketplace Finalist, and the United Nations as an NGO in Special Consultative Status with the Economic and Social Council of the UN. The socioeconomic backgrounds of the local diabetes communities AYUDA serves are diverse, although in general the children and families are from low to middle socioeconomic backgrounds.   Although today there is no cure for diabetes- the condition can be effectively managed with the appropriate tools and education,  including  peer-to –peer learning and empowerment,  which will enable young people with diabetes to live healthier, happier and more productive lives.
How do you know whether you have made a difference?: In the past decade AYUDA has expanded its support to diabetes communities by creating the AYUDA Volunteer Program that has sent more than 300 volunteers abroad to work with local partner organizations in 9 different countries.  AYUDA employs a results-based approach to implementing its strategy and programs and is committed to monitoring outputs, outcomes and impact . On the local program level, AYUDA works with its local partners to help develop logic models and measure effectiveness in order to demonstrate tangible results.  While AYUDA’s local partners are responsible for monitoring their own outcomes, AYUDA provides technical assistance in the form of volunteers and staff to help ensure effectiveness and impact are measured. In Ecuador, the country where AYUDA first began its work, the Campo Amigo program has reached approximately 80% of children and youth living with diabetes in the country.  Since 1999, over 760 Ecuadorian campers, 200 AYUDA volunteers, and 50 Ecuadorian health professionals have participated in the program. Cohort data demonstrates improvements in short-term and long-term glycemic control (HbA1c values). Campo Amigo Ecuador led to the establishment of the Fundación Juvenil de Ecuador (FDJE), which now serves as the collective voice for children and families with diabetes throughout the year. The FDJE has negotiated the lowering of prices of diabetes supplies from pharmaceutical companies, and initiated talks with the government to extend health coverage benefits to children and families with diabetes.  The FDJE now serves hundreds of families and children living with diabetes throughout the year and currently sponsors the supplies of 50 low income children with type 1 diabetes. The more recently established Dominican program supports over 150 children with type 1 diabetes in the Dominican Republic in conjunction with local partner Aprendiendo a Vivir (AAV). The program has recently integrated AYUDA’s youth leadership model and is currently sponsoring low income children with insulin and strips. It is estimated that close to 90% of low income families who have a child with type 1 diabetes reach AAV’s services via the local public children’s hospital ‘Roberto Reid Cabral’ in Santo Domingo.
Have you or the project mobilized others and if so, who, why and how?: AYUDA’s youth-to-youth empowerment model for transforming local diabetes communities has directly helped to mobilize: (a) local youth with diabetes and their families, (b) local health professionals, (c) local governments and ministries of health, and (d) AYUDA’s volunteers both with and without diabetes who will be able to apply their acquired leadership skills in different environments in the future. Having been trained to become young leaders of social change, AYUDA’s volunteers gain valuable skills and experiences that transform their lives personally, emotionally and professionally. Local youth with diabetes receive fundamental,  diabetes management education in a way that motivates them to take control of their health live happier lives.  AYUDA has worked to establish successful partnerships and relationships with a variety of institutions, including international organizations, pharmaceutical companies, diabetes camps and hospitals, and local partners. These relationships play an essential role in promoting AYUDA’s programs, fundraising, recruiting and identifying volunteers and acquiring in-kind diabetes medical supplies.  More recently, AYUDA has taken its model of youth empowerment into the greater arena of non-communicable diseases, for which diabetes is a considerable part – by becoming increasingly involved in the global policy around the High Level Meeting on  NCDs.   After co-hosting a side meeting at the summit, AYUDA is moderating a  Global Youth and NCDs working group of over 60 members from around the word, including the youth leaders from the countries in which we work, with the goal of creating a youth movement that ensures that young people,  especially those living with and working within NCDs are a meaningful part of the global NCD decision-making process. One particular partnership that AYUDA would like to highlight is with Ashoka: Innovators for the Public and Youth Venture, a world renowned leader in promoting social entrepreneurship, whom provided AYUDA with its initial seed funding. Today, AYUDA is housed within Ashoka’s global headquarters as an example of a sustainable model of youth-led social entrepreneurship.
When your donor funding runs out how will your idea continue to live?: Key elements of AYUDA program sustainability include: 1. Innovative Funding Model- AYUDA’s programs are substantially funded through an earned income stream resulting from volunteer fundraising that covers both the volunteer costs of participation and subsidizes overall program costs.  The fundraising requirement also trains volunteers in advocacy and social entrepreneurship.   AYUDA’s operation goal is to have volunteer fundraising approach 100 percent of operation costs, allowing additional revenue (ie, grants and events) to contribute to organizational development. 2.  In-Kind Donations of Medical Supplies & Equipment - Medical supplies and equipment represent a large portion of local program budgets and AYUDA works to ensure Local Partners do not have to pay for such prohibitory costs (which are usually free to diabetes camps in the US). 3.  Partnerships with Other Organizations- AYUDA has worked to establish successful partnerships with a variety of institutions, including international organizations, pharmaceutical companies, diabetes camps and hospitals.  These partnerships play an essential role in promoting AYUDA’s programs, recruiting and identifying volunteers and acquiring in-kind diabetes medical supplies.

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