Operation ASHA: Going the “Last Mile”
Treating TB in India’s Slums
The World Health Organization (WHO) announced on Thursday that health authorities around the world must do more to fight tuberculosis, a disease that killed an estimated 1.7 million people last year. As the search begins for new and innovative ways to fight this disease, Operation ASHA (OpASHA), which operates TB centers in the slums of India, will undoubtedly stand out as a program worthy of replication.
According to OpASHA’s president, Shelly Batra, although the developed world considers TB to have “gone out with the Plague,” the disease is still ravaging many developing countries. Every year in India, 300,000 children drop out of school because they or a parent have TB, 100,000 infected women are thrown out by their families to die of disease and starvation, and the Indian economy loses 3 billion dollars due to lost productivity. Combined with the fact that the average untreated TB patient infects ten to fifteen others, it is clear that the disease will have even more disastrous effects if left unchecked.
What makes OpASHA different from other TB programs is its ability to go the “last mile”: to bring TB treatment to the doorsteps of the poor. To visit government centers, slum-dwellers often have to travel long distances, skipping work and giving up valuable wages (Under the Directly Observed Therapy, Short-course [DOTS] system used around the world, patients can only take their medicine in the presence of a health worker). As a result, many will simply forego treatment. To solve this problem, OpASHA has opened treatment centers in the most disadvantaged areas of thirteen cities. Operating out of local shops, huts and other community locales, the center’s convenient locations and extended operating hours allow slum-dwellers to access TB treatment without significant loss in wages or disruption to their daily lives.
But OpASHA doesn’t stop there in its efforts to increase adherence to treatment. In one case, workers used government-provided tea and samosas to encourage slum residents to discuss TB and identify any members of their families who exhibiting symptoms. OpASHA also leverages trusted community leaders to help diminish the stigma associated with TB. For example, various imams have been encouraged to announce the benefits to the community of seeking treatment during Friday prayer. Finally, OpASHA uses an innovative biometric system to register patients and ensure that they do not miss doses. Using only a cell phone, laptop and small fingerprint scanner, patients register and then “check-in” every time they take their medicine. This system will also automatically send OpASHA counselors a text message if a patient doesn’t come in, allowing the counselor to go to the patient’s home and administer the drug.
What have been the results? OpASHA currently serves a population of nearly 4 million and enrolls 7,000 patients a year, with plans to expand to a population of 24 million and 25,000 enrollees by 2013. In addition, detection rates are 80% higher and the default rate is 5 to 30 times lower than other TB-focused nonprofits. Finally, OpASHA spends only $25 to treat a single TB patient, compared to the average $300; and because the Indian government will pay $25 for every successfully treated patient, OpASHA’s treatment centers become self-sustaining within two years!
OpASHA is making a huge difference in the lives of TB infected-persons in India and its replicable model offers the possibility of bringing true change to those suffering from TB all over the world.