Operation ASHA replicates in Afghanistan with help from CHMI

12,000 people die from tuberculosis in Afghanistan each year[1]. Despite a challenging environment for TB treatment and control, Afghanistan has celebrated recent gains in the fight against tuberculosis (TB). According to Sandeep Ahuja, founder and CEO of Operation ASHA, “Tuberculosis is a disease of poverty. The poorest 20 percent of a population is 5.5 times more likely to be diagnosed with TB.” Thanks to funding from CHMI’s Learning Exchange grant, Operation ASHA has guided Afghanistan’s TB Program to launch activities that are poised to combat the lack of adequate TB care in the country.

Since its founding in India in 2006, OperationASHA has provided technology, training, and services to ensure TB treatment and health care for the last mile. OperationAsha uses community-supported and technology-enhanced DOTS (direct observed treatment, short-course) to help treat TB patients in India and Cambodia.

After ten years of successful leadership in TB treatment, OperationASHA has consistently stood out as a program worthy of adaptation and replication. OpASHA combines community health worker empowerment with biometric technology to track TB treatment. Their approach uses widely available hardware and a user friendly, interface with limited text to ensure that the technology remains low-cost and easy to scale. Community health workers register patients with a fingerprint on a mobile tablet or phone. Simultaneous fingerprints by CHWs and patients then provide documented evidence of each visit to a TB patient in OpASHA’s treatment course. Today, Operation ASHA reaches 14.6 million people. “in the next 10 years, we expect our tech and model to impact everyone in the three billion people at the BOP [bottom of the pyramid] everywhere in the world, including the US,” says Sandeep Ahuja.

The Afghan Community Research & Empowerment Organization for Development (ACREOD) has worked in Kabul since 2010 to identify TB cases, implement treatment activities, and provide prevention education. Alongside outside donor support, ACREOD has partnered with Afghanistan’s National TB Control Program to find innovative ways to eradicate the disease. After meeting through a USAID-sponsored NGO exchange program, ACREOD, with support from the Afghan National TB Control (NTP) Director and OperationASHA agreed to apply for funding to partner through the CHMI Learning Exchange. This grant allowed ACREOD to establish an OpASHA-styled center in Kabul in 2015, where results were so good that expansion plans are already being implemented.

Through the CHMI-funded exchange, ACREOD, NTP Director and OpASHA discussed the adaptation of OpASHA’s technology, staffing structure, and monitoring and evaluation practices to the Afghan context. The hardware of fingerprint scanners and tablets was rapidly adapted to fit the Afghan context, as much of the software uses imagery and short text-based algorithms to direct CHW’s interaction with patients. As with OpASHA’s work in India and Cambodia, semi-literate youths are being trained as CHWs in Afghanistan to provide home visits and staff centers for DOTS treatment. These youths are motivated by a strategic incentive system to identify and treat patients, and the organization can provide treatment at a rate of only $25 per patient.

Now, thanks to an expansion grant from DFID, ACREOD is working with OperationASHA to rapidly expand across Afghanistan. By the end of March 2017, the organization will open 20 centers with the potential to reach 4 million people, 8 percent of the entire country.. “Afghanistan is a perfect experimentation ground,” says Ahuja, noting that the small geographic range and the population’s lack of mobility can help track patients through the entire TB treatment course. As ACREOD launches OpASHA-inspired TB treatment through the country, OperationASHA staff will provide expertise in software, management, M&E, and decision making; however, their preferred method of replication ensures that country-based NGOs are the owners and leaders of each project.

Reflecting on the CHMI Learning Exchange for knowledge transfer, Sandeep notes “there should be more of these. It’s time we stopped doing pilots, and instead scale  local solutions that have the potential” to deliver improvements in health care to the base of the pyramid. “We need to improve the work rather than reinventing the wheel every time.” The strength of their system has allowed OperationASHA to expand beyond TB treatment and prevention to include , HIV treatment, hemophilia and other essential medications. With the use of their biometric technology and eCompliance system, OpASHA seeks to open a pipeline of health care services delivered to the poor. Thanks to their commitment to improvement, innovation, and replication, OperationASHA leads the way in proving that high quality and affordable care can be delivered to the last mile, and adapted around the world.