Summary

Program goals

India holds a quarter of the world's TB burden with 2 million cases and 330,000 TB-caused deaths every year. Patients who do not complete treatment often develop Drug Resistant TB (MDR/ XDR/ XXDR), turning a curable disease into a death warrant for those below the poverty line. Operation ASHA's mission is to eliminate tuberculosis among disadvantaged communities across the world.

Key program components

Operation ASHA establishes TB treatment centers within existing community locals (e.g. strategically placed shops, homes, temples, or health clinics). Each center serves 5,000-25,000 people within 1.5 kms under OpASHA’s Urban Model. The model is designed to help patients procure their medicines conveniently without wasting time, spending money on transport, & losing wages. This also drastically reduces the effort, time & 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 TB health workers who are responsible for identifying new patients, ensuring adherence to the drug regimen, and carrying out regular educational campaigns.

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. 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 78 treatment centers, spanning Delhi, Mumbai, Bhiwandi, Bhopal, Indore, Sagar, Jaipur, Raipur, Durg-Bhilai & Korba; Operation ASHA is aggressively expanding the deployment to over 225 centers around the world. To date, the technology has enrolled about 4,931 patients and logged over 105,557 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 $80.

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 providers on motorbikes. The mobile model encompasses a provider traveling from village to village on a motorbike, carrying anti-TB drugs and other supplies. The provider dispenses the medicines to patients at their homes, as per DOTS guidelines and spends substantial time everyday looking for those potentially suffering from TB.