Operation ASHA establishes tuberculosis (TB) treatment centers within existing community locals (for example, strategically placed shops, homes, temples, or health clinics). Under the World Health Organization’s Directly Observed Therapy (DOTS), patients must take their medicines under the supervision of a health care worker. The model is designed to help patients procure their medicines conveniently without wasting time, spending money on transport, and losing wages. This also drastically reduces the effort, time and money that patients have to invest in taking their medication, which is key to ensuring that patients complete the entire course of treatment.
Operation ASHA trains community members (often former patients) to become tuberculosis health workers who are responsible for identifying new patients, ensuring adherence to the drug regimen, and carrying out regular educational campaigns. Operation ASHA works closely with the Government of India, who provides them with free medicines and diagnostic services. After a center has been established for two years, the government provides a grant for every patient cured, making OpASHA’s centers financially self-sustaining.
Ensuring patient compliance is important because of the threat of multi-drug resistant tuberculosis (MDR-TB), which has become one of the world’s largest public health issues. Resistant strains of the disease can take up to two years to treat (in comparison to the standard 6 month regimen). Second line medicines have more severe side effects and can also cost 50-200 times more. Such unrealistically high costs are essentially a death warrant to those below the poverty line.
To combat the rising MDR-TB epidemic, OpASHA launched eCompliance, a biometric initiative in collaboration with Microsoft Research, which uses fingerprint scanners to track patient visits. The system consists of three parts: a netbook computer, a USB fingerprint reader (from Digital Persona), and a GSM modem that uploads the visitation logs (via SMS) to a central location. Patients scan their finger every time they take medication, and these logs are visualized in the central office to monitor medication delivery. Missed doses trigger an SMS notification to managers, who ensure timely supervision or counseling to the patients and health workers involved. The health worker is then required to do a follow-up visit within 48 hours to deliver the medicines and supplementary health education. These home visits are also confirmed by biometrics. Currently the terminal is used daily in over 40 treatment centers, spanning Delhi, Mumbai, and Jaitpur; Operation ASHA is aggressively expanding the deployment to over 225 centers around the world. To date, the technology has enrolled about 2,700 patients and logged over 50,000 supervised doses. The biometric records are used to automatically generate reports to the government and other stakeholders.
With the help of eCompliance, Operation ASHA has reduced its default to 1.5%, which is much lower than other institutions. The cost of treating a patient for the entire therapy of is US $50.
In Dec 2010, Operation ASHA opened its first DOTS center in Phnom Penh, Cambodia. Unlike India, where Operation ASHA operates static centers, in Cambodia, the model employs counselors on motorbikes. The mobile model encompasses a counselor traveling from village to village on a motorbike, carrying anti-TB drugs and other supplies. The counselor dispenses the medicines to patients at their homes, as per DOTS guidelines and spends substantial time everyday looking for those potentially suffering from TB. Due to fewer resources for medical technology in Cambodia, smear microscopy tests for TB diagnosis can only be performed in the lab at referral hospital (one in each district). So for detection, the counselor collects sputum samples from each of the suspected carriers and carries it to a pre-assigned location, where another staff ‘Sputum Collector’, again on a motorbike, is waiting to take sputum samples to the government lab for diagnosis.
Under the Revised National Tuberculosis Control Programme by the Government of India TB medication for the complete treatment regimen, with an estimated value of $83per patient, are provided free by the government. Free diagnostics and physician consultation, estimated at $16 per patient, were also provided by the government at their DOTS-Microscopic Centers. Under the same program, the government also reimburses private partners up to $32 for each successfully treated patient. This amount partially pays for the recurring costs incurred by OpASHA annually.