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The Project in Nepal: Nepal is an Asian country with a population of around 30 million people and a per capita income of about $1,500 a year. Healthcare expenses fall almost entirely on the patients and their families, and healthcare facilities are largely inaccessible for those outside of Kathmandu, the nation’s capital. Specifically, regarding Hematology, the only advanced care center is the Civil Service Hospital, in Kathmandu, where approximately 400 patients, newly diagnosed with severe blood disorders, are seen every year. The cost of initial treatment for a patient with acute leukemia or other serious blood tumors, or the cost of stem cell transplant (bone marrow transplant, BMT), is on average $7500 (10 lakhs NPR).

As a result of this financial context, a very large portion of patients cannot sustain these expenses. For many other families, there are only 2 means for covering treatment costs. The first is selling the house or other assets (often a few animals) otherwise essential for the families’ livelihood at a fraction of their value. The second, often pursued in conjunction with the first, is taking out loans from usurers with interest rates of 30% or more. Thus, this “financial toxicity” that can preclude a patient from being treated leads to either the patient’s death at the hands of the disease or leads to the families’ bankruptcy.

To address the lack of sustainable means to access treatment for these patients, the YOU Foundation is funding two alternative plans for patients:

Low interest loan without collaterals partially guaranteed by the YOU Foundation (Option 1): Through an agreement with Laxmi Sunrise Bank in Kathmandu, the bank will provide a $3750 (5 lakhs NPR) 5-year loan at low interest without personal collaterals. The YOU Foundation deposits $2,000 per patient as a partial guarantee. Interests generated with this deposit will go to the patient’s account to lower the loan payments every year. Upon repayment of the loan and release of the guarantee, the YOU Foundation would refund the patient up to the amount initially served as a guarantee.

Matching funds (Option 2): A matching deposit system was established where a patient contributes approx. $750-1500 (1–2 lakh NPR), matched at a 1:2 ratio. i.e. $1,500- 3,000 (2-4 lakhs NPR) and this amount is matched by the YOU Foundation at 1:1:5 ration and by an additional 750$ (1 lakh NPR) from a donor directly identified by the YOU Foundation or the International Alliance YOU Foundation Nepal (IAYFN). Therefore, the final patient’s deposit is matched at 1:2 ratio. The money will be deposited into a new account that can only reimburse or pay directly invoices of medical bills.

In each of the two Options, we also consider that the Government supports cancer patients with 1 lakh ($750). (See Figure)

The Nepal Project is consistent with the mission of the YOU Foundation to engage players of local economy (government, banks, private sector) in creating a system favorable to each of them and helping patients and their families to receive cancer treatment. The long-term success of this initiative will be measured by assessing: number of patients who can receive treatment, patient and family financial outcome, sustainable business model for each entity, reduction of poverty caused by unaffordable healthcare costs.