This page outlines the operations of Nyaya Health as a fundraising and technical assistance international NGO to Nyaya Health Nepal, a Nepal-based NGO that implements health programs in partnership with the Nepali Ministry of Health and Population. 

Nyaya Leadership Structure

The Nyaya Health Leadership organizational chart can be found here. An organizational chart describing the combined work of the INGO and NGO can be found here.

Aims of organizational leadership teams

Tripp and Below's "Freeing the Social Entrepreneur" [1] outline 5 primary roles to be filled by all leadership teams. In considering our own leadership structure, we have designed roles in an effort to fill each of these conceptual positions:

1) Evangelist - a visionary of the organization responsible for continually refining vision, mission and culture of the organization and ensuring programs are developed and implemented accordingly. Also a person able to be the external face of the organization and spread the word and convincing both internal team members and potential supporters/ funders/ collaborators of the importance of the organization's work. (This role is filled by the founder, or if the founder is no longer present the current CEO or similar role.)
2) Scaling Partner - a person who thinks strategically and can help to practically implement the vision of the Evangelist and other team members. This person's role focuses on creating efficient systems for both organizational structure as well as individual team members to work together. Typically this is a person able to think big but also someone who is very detail-oriented. (This person is often referred to as a COO or similar role.)

3) Connector - a person able to fill in the gaps for background and ensure that the Evangelist is speaking to the right audiences/ target individuals, tying development efforts to program implementation and managing existing funding relationships. (This person is often referred to as a Director of Development or similar role.)

4) Program Strategist - this person is an expert in the field and ensures that programs achieve metrics/outcomes as laid out by mission organization. In addition to examining day-to-day operations this role also oversees scaling and further innovation in programming. 

5) Realist - a person able to keep organizational programming and team members aware of the financial situation and direct programming accordingly. (This person is often referred to as the CFO or similar role.)

[1] Below and Tripp. "Freeing the Social Entrepreneur." Stanford Social Innovation Review. 2010. Fall 2010, p36-41.

Leadership Team Structure

Nyaya's Leadership Team organizational chart can be found here. It is comprised of three bodies:
1) Executive Team
2) Board of Directors

3) Board of Advisors

All terms on each of the three leadership bodies are for periods of 1 year and will be reviewed/renewed/replaced during yearly Q4 Board of Director's meetings as per the decision of the Board of Directors.

Expectations of Nyaya Leadership Team members

All members of the Nyaya Leadership Team are expected to:

1) respond promptly to other Nyaya team members’ requests;

2) be honest about their time commitments and ability to meet tasks that they take on;

3) regularly contribute to the team with suggestions and constructive critiques;

4) communicate regularly with the ED and/or President/Chair of the Board of Directors to stay up to date on Nyaya work;

5) to work to fulfill and expand Nyaya's mission and vision.

Qualifications of Leadership Team Members 

The fundamental qualification of a member of the Leadership Team is that her/his placement advances the strategic direction and management of Nyaya Health. Roles will be selected per background and training, previous experience in the field, and an ability to offer specific advisory capacity in one of the key aforementioned areas. Notably, Leadership Team positions are not contingent upon prior work or involvement with Nyaya; in particular, Board of Directors and Board of Advisors members will frequently have little to no involvement in Nyaya before joining the Boards. Ultimately, Leadership Team membership should be considered on whether the individual will help advance the core goals of the Leadership Team (as above).

Nominations to Leadership Team positions

Nominations for membership on any part of the Leadership Team may be made by nomination from any Leadership Team member to the Board of Directors. Nominations should include biographical information of the candidate (i.e. CV and associated documents) as well as further explanation of why the candidate will be appropriate for the proposed position. The nominating member should list, in simple (non-prose) format the pros and cons of an individual's membership onto the leadership team; for the most part, leadership team members are expected to have a specific role and comparative advantage for the organization. Working with the President and Chair of the Board, the Board of Directors will review nominations and vote on the candidacy. A 3/4 majority will be required for candidacy approval and all terms will be for 1 year. Traditionally these nominations should take place ahead of one of the two yearly Board of Directors meetings, however, as required, nominations and review may take place over email as per the discretion of the President and Chair of the Board. 

Termination of Leadership Team Tenure

Members of the Leadership Team will typically end their tenure voluntarily, by stating honestly that s/he no longer can make the time commitment necessary to remain in their post. If a Leadership Team member is underperforming, other Team members should air their concerns and discuss openly whether it is appropriate for that member to temporarily or permanently step down. It is the job of the President/Chair of the Board to facilitate the discussion and assess whether the individual has not been meeting his or her duties and request that s/he step down. Former Leadership Team members ideally will stay involved in a capacity as appropriate to their situation and can be considered to rejoin in their former, or a new, post in the future.

Leadership Decision-Making

The vast majority of day-to-day operating decisions for Nyaya will be made by the Executive Team in partnership with our colleagues in Nepal. The role of the Board of Directors and Board of Advisors is to support the Executive Team in this role, offering advisory capacity where and when required. While input from the BoD will typically only be solicited at scheduled quarterly meetings, members of the BoA may participate in discussions on a daily/weekly basis. For high-level decisions the Executive Team will utilize the leadership@ forum to solicit input to ensure that key team members outside of the Executive Team continue to have input in daily decision making when they are able to contribute. Finally, it is understood that due to the voluntary nature of the Board of Directors and Advisors rapid-decision making is difficult and a minimum of 1 week should be offered for feedback on specific requests. In some instances members of the Boards of Directors and Advisors may be called on for more rapid input, however such situations should be limited to the extent possible. 

Discussions requiring input from Leadership Team members will typically be facilitated over email discussions, however for certain conversations may also occur via conference calls and/or be subject for discussion at Board of Director's meetings. For those discussions facilitated through email, proposals should be concise, provide necessary background information, proposed next steps and responsible parties, as well as a timeline for both feedback and subsequent implementation. Members solicited for feedback, unless otherwise noted (as in previously mentioned cases), will be expected to provide comments within 5 days. Given the need for efficiency within a volunteer Leadership Team it is understood that lack of commentary within the 5 day period will be taken as tacit approval and the proposal can be carried forward. 

While some Leadership Team discussions are sensitive in nature, and therefore necessarily private, to the extent possible, discussions should be held in open-forum on Nyaya's team@ listserv. This ensures transparency amongst team members and offers non-Leadership Team members opportunities to learn more about the organization and offer input when appropriate. For sensitive and high-level issues discussions will take place over the leadership@ listserv. Further information about both listservs can be found here.

Accountability and Governance Structures

A fundamental role of the Leadership Team is to ensure accountability, responsiveness, and transparency to donors and to the communities in which Nyaya operates. These three primary objectives - accountability, responsiveness, and transparency - all re-enforce and depend upon each other. The primary strategies through which these aims are achieved are through: 

• month-by-month updates to the wiki of de-identified patient data: Data pages
• month-by-month updates to the wiki of line-by-line expenditures: Budget page
• weekly conference calls with Nepal-based staff and the US-based team to discuss progress and identify problems and solutions
• maintenance of collaborative, online organizational documents through wiki, Dropbox and Evernote software
• documentation and archiving of all meeting minutes for team members
• regular stories and updates that are posted to the blog

Our overall communications strategy is posted here: collaboration.

Leadership Team Structures

The following is a link to our leadership chart:

http://db.tt/hp4ftyOU 

Note: Executive Team Diversity

It is a current basic organizational failure that our executive team is non-diverse, composed of only men, only one of whom is Nepali, and none of whom are Achhami.  This is a common problem throughout industry, academics, non-profits, government.  That is, in any place where power dynamics are in play, individuals from demographics of historical exclusion are left out.  The power dynamics are complex, historical, social, and psychological, and frankly Nyaya has not been able to overcome these challenges at our young stage in development.  We have engaged in extensive discussions about this as a team and have yet to make effective steps in the direction of a more diverse executive team.  It is important for our soul and for those of our colleagues, that we continue to reflect on this and be opportunistic and innovative in reforming our own practices with the recognition that self-regulation, innovation, critical feedback, diverse networking and effective brainstorming are all significantly improved by the degree of diversity of the team.

Note: Culture of Positivity

• Inspiration - each of us takes our inspiration from those around us, whether our leaders or our volunteers, our team is a critical part of what inspires us to action
• Encouragement - this isn't easy work, and some days it can be downright tedious and frustrating; we gain power from those around us to push on in spite of these frustrations because it is our teammates who remind us, in those moments, of our goals
• Validation - all of us, as human beings, like to get a pat on the back every now and again, and there is nothing wrong with this; it's fuel to keep going, to know that what you're doing is right and helpful and productive, and its an ego boost which helps you push through the challenging moments 

Note: Culture of Dialogue 

Nyaya volunteers and leaders engage in a social contract in which we agree to respect each other and give each other the benefit of the doubt.  Oftentimes, we have disagreements about issues we feel passionate about, and sometimes in the course of those disagreements we fall into a trap of moralizing.  It is a fine balance between firmly stating our own beliefs and telling other people how they should behave; it is one that I [Duncan, the author of this sentence] struggle with quite a bit.  The social contract goes both ways, where the speaker/writer attempts to state their beliefs openly, honestly, critically, but without pointing fingers or being moralistic.  The listener/reader similarly attempts to give the other party the benefit of the doubt that the speaker/writer is not being moralistic and attempt to focus on the content rather than the style or delivery of the matter.

It is critical that leadership@ members talk on the phone more, that we develop a culture whereby we are comfortable picking up the phone and calling each other randomly whenever we feel uncertain or angry or confused.  And of course scheduling more times to talk with each other.  Email leads to, for lack of a better word, essentializing of each other.  In real life, we have body language and a dialogue to create richness in how we perceive each other.  Our social minds really need those details in our relationships, and, when those details are not there, our minds fill in the details by making stuff up.  All of us have multiple experiences where someone emails us something and it just pisses us off and we ruminate and construct this elaborate story about that person and what they are trying to say.  This is how things spiral out of control; many such instances build up over the course of months in a virtual organization.  We can create elaborate characters of each other without having seen or talked on the phone for months and months. This is not because we as humans are evil; its because we're social.  This is in fact one of our best attributes.  We are so intensely social and email sometimes suppresses that instinct.

Finally, it is worth noting that, while open communication is a good thing, given the challenges of e-communication, forwarding along, direct quoting, or even adding on as a cc new people into a thread can sometimes lead to misinterpretations and should be done with care if at all; better to invite the person who wrote something to loop in other people or forward along their email.

Note: E-Etiquette 

Everyone on the Leadership Team must approach their work with a mutual respect for all other members. As Nyaya, moreso than other organizations, operates significantly over email, all Leadership Team members should be cognizant of "e-etiquette".  Email is a wonderful thing, but the challenge when it comes to emotionally-laden topics is that there is so much more to communication than words - there's body language, there's tone, and most of all, there's true real-time dialogue. Without those elements, we can often read too much into emails and bitterness can quickly develop. If you are upset by something someone says, wait and talk with them on the phone, or, better, in person. Avoid sarcastic, offensive, or accusatory language. Before sending a nasty email, take a deep breath and realize that it can be very unproductive and damaging to long-term e-communication if you say something accusatory over electronic media. In the real world, when we say something accusatory to someone, we can watch body language, we can resolve the issue through talking through, we can otherwise address concerns and criticisms productively. We can defuse our anger quickly, in person. That option is not typically available for e-communication, where there is a lag time in response, which can build stress and resentment on the other end that cannot be dealt with for a considerable amount of time. It is also important to avoid general criticisms that are likely to perceived as back-handed comments directed at individuals, particularly when they are sent out over listserves. For example, if you are frustrated with a individual's obstinancy against some policy, it is better to talk on the phone or communicate individually with that person rather than say "well I know some of us feel this is worthless..."

If we do slip and send out a poorly worded email, we all should remember we share a basic respect for each other and for the work we are collectively doing. As such, we should always assume that a member is meaning well and not trying to disrespect rather than the other way around. If we remember that, then we can continue to have productive, critical dialogues without worrying too much that we are potentially frustrating each other. Apologies and notes of appreciation go a long way towards maintaining the team coherence we need to fight poverty, disease, and injustice. These awful realities are far bigger than any of our individual egos.

Note: Transparency

The Leadership Team conducts its business largely over email or conference calls. While many issues discussed among Leadership Team members is of a sensitive nature, for all issues that are otherwise non-private, the team(AT)nyaya listserv should be used. The reasons for using the team@ list are as follows: 

1) many general team members are very active and should be informed of ongoing issues;

2) team members are often inspired by the dialogues and discussion;

3) many team members have contacts and insights to contribute, ESPECIALLY on the tough decisions.

The downsides of this approach, with the rebuttal as to how Nyaya overcomes them, are: 

1) Some less-active board members may receive an excess volume of email.  Such members easily figure out ways of selecting out emails to read or archiving.  

2) There are dangers to discussing/debating sensitive matters in an open-format.  

3) Some board members may not feel comfortable debating certain items-- be they because a) they are perceived as minutiae or b) because they are thought to be controversial-- in an open format.  Nyaya as institution must work to encourage them that a) health as human rights can only happen through the minutiae of logistics, supply chains, and staff management; b) the more controversial topics, the all the more reason for all members to be aware of the debates, the thinking, and the dialogue.  Addressing controversies, when debated in a productive and respectful manner,  helps to drive our work forward and to make tough decisions.

4) Non-board-members may contribute less helpful comments or otherwise had inefficiency to the email threads.  Nyaya organizationally and board members individually must work with such members to become more productive and efficient members of the e-dialogue, as we discuss here: collaboration

It should be emphasized that, while the business is conducted openly, on key decisions, Board members are ultimately responsible for helping to make those decisions, whereas non-Board members are not.  

Board members are expected to have the foresight, leadership, and belief in Nyaya's long-term goal of a culture of openness to use the team@ list extensively, courteously, and productively.  

Note: Confidentiality of Staff Medical Problems

One major issue that the Nyaya leadership will occassionally have to deal with are complex medical issues confronting our own staff.  In these instances, there may be complex interpersonal and medical issues that the Achham-side leadership will be looking for guidance on.  The Achham-side leadership should be cognizant of our staff's rights as patients and should make sure that aspects of medical care are only discussed with clinicians and with the knowledge of the staff member.  The complex interpersonal issues that may accompany the medical issues and which often do need to be discussed for the Achham-side leadership to make effective decisions should be discussed in a way that tries to protect the confidentiality of staff member and their medical problems.

Note: Crises as Opportunities

Throughout the history of any organization, crises arise that threaten in some cases the very viability of the enterprise, and Nyaya Health is no exception. The key challenge is to take these crises and transform them into opportunities to do better.  As when we conduct reviews of mistakes or "near misses" in medical care and review them in a thoughtful, transparent fashion to improve our future care, by critically addressing organizational crises, we can diffuse the crisis and improve our operations.  Crises will continue to happen, but we can institute strategies that, given the realities of human nature, promote structures for optimizing safe and effective operations.  We maintain a private document where we place links to descriptions of crises and our management of them.  

Functions of the INGO

The following is a general list of some of the tasks included in daily and weekly INGO operations. While the Executive Team may perform many of the functions temporarily, the ultimate goal is to recruit other team members to perform each of the following roles. 

Contracts

This Director of Contracts is responsible for overseeing the writing of contracts and agreements for the Nepal-based team, including those for personnel, NGO collaborations, government agreements, and corporate partnerships. This individual should have a solid understanding of the legal and government culture in Nepal and should be an excellent writer. Fluency in written Nepali would be helpful but not required.

Grants and Reports

The Director of Grants is responsible for the applying for grants and maintaining relationships with existing foundations. Responsibilities include:

1) search regularly for new grants and maintain an updated list;

2) oversee the writing of all grants and be responsible for ensuring that all grants meet tax compliance and Nyaya standards;

3) provide regular updates on the status of the grants program to the Nyaya Executive Team.

Management notes document: Grants, ReportsManagement

Finance

The Director of Finance is responsible for all aspects relating to the finances of the organization. Specifically, s/he is expected to:

1) file all necessary tax forms;

2) manage donations and grant funds;

3) work with the Achham team to receive accounting exports and provide to the data team for uploading to the wiki;

4) provide the Executive Team with regular reports detailing Nyaya's expenditures, income, and the state of our financial solvency;

Management notes document: FinancialManagement, DonorManagement

Fundraising

The role of this position is to assist team members with personal fundraising. This is a critical position to meet our overall objective in engaging a broad base of people involved in resource redistribution. Tasks involve:

1) oversee and coordinate team member fundraising campaigns and events;

2) organize at least one fundraising event per year.

Management notes document: PersonalFundraising

Transparency and Monitoring

This position involves oversight of Nyaya's data program.  S/he will work closely with the Director of Data Management. Tasks include: 

1) performing regular audits of our data practices and researching new avenues;

2) identifying further analytical techniques and strategies to improve our ability to effectively monitor our programs;

3) applying to grants specific to global health outcomes monitoring and epidemiology.

Management notes document: DataManagement

Data Management

This position entails managing Nyaya's budgetary, pharmacy, spatial, and utilization data monitoring program that Nyaya uses to improve services and provide leadership in the science of global health delivery.  S/he will work closely with the Director of Transparency and Monitoring. Specific tasks include:

1) working with Achham-based staff to develop needs assessments, surveys, and clinical databases;

2) defining clinical outcomes, indicators, and community goals;

3) coordinating databases and updating budgetary, pharmacy, and utilization charts, graphs, and spreadsheets on the wiki monthly;

4) reporting to core members utilization statistics and clinical outcome assessment results every quarter; and

5) interfacing with the grant-writing team to supply necessary statistics for proposals and follow-up reports.

Management notes document: DataManagement

Technology

The Director of Technology is responsible for the implementation of our internet presence. Responsibilities include:

1) perform the functions of, or otherwise oversee, the webmaster;

2) oversee the technical aspects of Nyaya's presence on social networking sites;

3) maintain the Google Apps accounts and member emails;

4) propose and implement additional technical innovations;

5) provide regular reports to the Executive Team as to the effectiveness of our different sites, with specific statistics.

Management notes document: WebManagement

Collaborative Technology

The role of this position is to ensure that we continue to innovatively utilize collaborative technologies for the purposes of marketing and collaboration. Responsibilities include:

1) manage the organizational Dropbox file cabinet, keep it organized and clean, and invite new board members to foldershare; update the collaboration page as needed;

2) manage the Nyaya Wiki; update the WikiTips page as needed;

3) manage the Nyaya Blog, request content from members, edit blog entries;

4) recruit subscribers, spread the word among other blogs;

5) encourage members to contact their local newspapers about their work with Nyaya;

Management notes document: CollabTechManagement; Marketing and Communications

Volunteers Management

The role of this position is to manage Nyaya's volunteer team. Responsibilities include:

1) manage the outside-Nepal volunteers by working with them on their tasks lists, goals, deadlines;

2) manage the within-Nepal volunteers by working with them on their itineraries and trip planning;

3) identify volunteers needs and recruit new volunteers.

Management note document: VolunteersManagement

E-Commerce

This person will oversee any e-commerce activities used in fundraising.

Management notes document:  E-commerce 

Laboratory Services

The Director of Lab Services provides oversight regarding the overall quality of medical services provided by Nyaya Health. Tasks include:

1) dialoguing with Achham team about the quality of the laboratory services and additional needs;

2) researching appropriate laboratory technologies for our setting;

3) pursuing companies, together with the director of procurement, involved in laboratory supplies;

4) helping to develop the costing and projections sheets for laboratory services 

Research

Ensure that any research being proposed or conducted with Nyaya meets ethical, scientific, and social justice standards. Responsibilities include:

1) review all IRB submissions;

2) review all research protocols and work plans prior to their being implemented;

3) review all manuscripts for publication prior to submission.