Duncan Maru


Possible is a nonprofit healthcare company that delivers high-quality, low-cost healthcare to the world’s poor in rural Nepal.

Focus: Health
Geographic Area of Impact: Nepal
Model: Leveraged Non-Profit
Number of Direct Beneficiaries: 56,106 (2014)
Annual Budget: USD 1.7 million (2014)
Percentage Earned Revenue: 4% (2014)

The Social Problem
According to the WHO, Nepal ranks 139th in terms of life expectancy. Disease prevalence is higher in Nepal than in other South Asian countries, especially in rural areas. While Nepal’s constitution guarantees the right to universal healthcare for the poor, the country still lags behind in terms of access and quality of care. Government facilities are unable to deliver quality and the private sector is too expensive for many citizens. There are pockets of excellence but they are often unable to deliver at scale. The country’s mountainous terrain further limits healthcare access for many of its citizens.

Innovation and Activities
Possible has built an innovative healthcare delivery model called durable healthcare, where the Nepali government pays them on a performance basis to deliver high quality, low cost healthcare within their infrastructure. This design brings together the best of each sector: access from the public sector, quality from the private sector, and innovation enabled by philanthropy. Because the Nepal government grants universal healthcare to its citizens, the care is free for their patients (who make less than $1 a day), and Possible’s performance-based financing system means they get paid only if they deliver population-level health outcomes.

A significant emphasis of durable healthcare is decentralising service delivery: Possible operates through a hub and spoke structure with a main hospital, 13 clinics, and over 160 health workers. The hub is Bayalpata Hospital, which is situated atop a hill in one of the remote regions of Nepal—36 hours away by bus from Kathmandu. The hospital stood empty for 30 years before Possible partnered with the government to reopen and scale up its services. To date, Possible has treated over 235,000 patients at a cost per patient of USD 26 and cost per capita of USD 4.8, as opposed to the government’s current spending of USD 6-7 per capita. Possible clinical team partners with Harvard’s Division of Global Health Equity and the Brigham and Women’s Hospital to provide clinical guidance and resources to its team who is 98% Nepali.

Possible treats the performance-based funding it receives from the government as revenue, and seeks to be funded over 50% by the Nepali government by the end of 2018. It aims to continue to significantly raise quality without exceeding the current price per capita, and serve 500K patients annually by 2019.

The Entrepreneur
Prior to Possible, Mark Arnoldy worked closely with a Nepali social entrepreneur for three years to create an innovative way to treat malnourished children, and he helped create two U.S. businesses that fund nutrition programs in Nepal. He graduated Summa Cum Laude from the University of Colorado at Boulder, completed Harvard's Global Health Effectiveness Program, and was a Fulbright Scholar to Nepal. In 2014, Mark was named one of Forbes Magazine's top 30 Under 30 Social Entrepreneurs.

Duncan Maru, MD, PhD, is Co-Founder, Chief Programs Officer, and a non-voting Board Member of Possible. Duncan is a faculty member at Harvard Medical School through the Brigham and Women's Division of Global Health Equity. He also practices part-time on the Complex Care Service at Boston Children's Hospital.