Operation ASHA

Founders' Bio

Dr. Shelly Batra is the President of Operation ASHA since 2005. She is Schwab Foundation's Social Entrepreneur of the Year 2014, renowned Senior Obstetrician and Gynecologist, Advanced Laparoscopy Surgeon, and a best-selling Penguin author. She is a powerful advocate for better policies in TB across the world.

As CEO, Sandeep has led the organization since 2006. He was member of the Board of the Stop TB Partnership from 2009-12 where he represented NGOs of developing countries. Before founding Operation ASHA, Sandeep served for many years as additional commissioner for the Government of India.

Social model

Operation ASHA has established DOTS clinics in existing and accessible locations such as businesses, temples, and pharmacies where field staff supervise treatment. Going to these common places, rather than a separately established clinic, allows patients to avoid the negative stigma associated with TB. In rural areas, Operation ASHA uses mobile delivery, where a community health worker travels from village-to-village on a motorcycle/scooter carrying with him anti-TB drugs, supplies and equipment.

Operation ASHA stresses upon employing and training disadvantaged youths from the local community who understand the local culture and customs as TB-specific health workers. Two-thirds of Operation ASHA's staff is semi-literate/illiterate. Currently 193 community field staff are employed in India and 54 in Cambodia.

In addition, people are employed in India in the field of Haemophilia detection and care.

eCompliance

Developed in 2010 in collaboration with Microsoft Research, eCompliance is a biometric terminal that can be downloaded on a simple seven-inch tablet with a SIM card. The tablet is connected to a central server through internet or SMS messages and updates that server every 20 minutes, allowing data to be easily accessed from a central server. eCompliance technology also advises community health workers to carry out pre-treatment counselling.

All TB patients must register with eCompliance using a fingerprint scanner. From then on both the patient and their counselor (community health worker/DOTS provider) will have to use the scanner before the patient receives treatment to create accountability. Using an alert system, eCompliance ensures that the patient took his/her medication and keeps track of missed doses. The health worker is then required to track down the patient within 48 hours to give the medicine and further counsel the patient, encouraging them to stick with their treatment.

Replication of eCompliance in Uganda was done by Columbia University, Earth Institute, and the Millennium Villages. Professor Yanis Ben Amor describes the system as "a staggering improvement". Replication was also accomplished in Kenya, Peru, Dominican Republic, Afghanistan and Tanzania between 2012-15.

eDetection

eDetection is an algorithmic questionnaire designed to track down and diagnose tuberculosis. Using a decision-based algorithm, eDetection analyses a patient's responses to identify TB suspects, who are then tested for the disease. The guided diagnostic process is simple and easy-to-follow, which is necessary for disadvantaged communities where many persons are illiterate. The technology is easily downloaded and accessed using 3G connection and responses are systematically archived and integrated into the eCompliance system. With a highly infectious disease like tuberculosis, it is important to locate new cases. By putting positive patients on the geo map using GPS, eDetection locates communities with greater numbers of infected patients.

eDetection has also been adapted for Haemophilia diagnosis.

eAlert

End users, mainly lab technicians, enter patient contact details and lab results onto the system which then sends the information over the internet to a central reporting system. An SMS message is sent to concerned health workers who inform patients of their status. Lab Alert System delivers lab results more quickly and efficiently and can be installed on any tablet. This decreases the delay in enrolling patients in DOTS, minimizing the chance of spread of the disease.

eCompliance+

Tracks MDR-TB patients continuously throughout the treatment course for a span of 2 years.

Impact

Operation ASHA increases TB-detection rate by 50-400% within 6-18 month of starting work in any area. Also, DST-TB treatment default rate has been maintained at 3%, compared to 32% in a triangulation study in India.

As of 2016, Operation ASHA has treated a total of 60,559 patients of DST-TB in India (including 9,003 patients in Cambodia), 333 patients of MDR-TB, and one patient of XDR-TB. Another XDR-TB is also undergoing treatment in India. 245 Haemophilia patients have been detected and started on treatment. Operation ASHA has also detected thousands of patients of diabetes, heart disease and mental depression, and is helping with the management of their health issues.

Following treatment, patients earn an additional $13,935 (Rs. 8.36 Lakh) on average through reinstated productivity in their lifetime (Annual TB Report 2013, Government of India). Thus, treated patients have benefited by a whopping $843 million (Rs. 5,485.3 Crore). Also, with treatment of each patient, the economy saves $12,235 (Rs 7.34 Lakh) in indirect losses (Annual TB Report 2013, Government of India). Thus, the Indian and Cambodian economies have saved a total of $740.9 million (Rs 4,816.1 Crore) for patients who have successfully completed the treatment.

Operation ASHA has also distributed millions of analgesic, antacid, antiemetic, iron and calcium tablets, condoms, Oral Rehydration Salts, protein supplements, in addition to 8 tons of food and 9000 blankets.

Operation ASHA in India

In India, Operation ASHA operates in the following states for Tuberculosis -

Chhattisgarh (Raipur, Durg-Bhilai, Korba), Delhi NCR (East Delhi, West Delhi, South Delhi), Jharkhand (Koderma), Karnataka (Hubli), Madhya Pradesh (Bhopal, Gwalior, Gwalior Ghati Block, Indore, Sagar, Mandla), Maharashtra (Bhiwandi, Dharavi (Mumbai)), Orissa (Bhubhaneswar), and Rajasthan (Jaipur).

Operation ASHA's Haemophilia centers are located in Haryana (Bhiwani, Hisar, Fatehabad, Sirsa) and Uttar Pradesh (Aligarh, Meerut and Lucknow).

Operation ASHA in Cambodia

In Cambodia, Operation ASHA works closely with the National Tuberculosis Program in 15 Operational Districts across 6 provinces (Phnom Penh, Takeo, Kampong Speu, Kampot, Kep and Sihanoukville) serving 15% (2.27m) of Cambodia's population.

Since starting operations in Dec 2010, it has enrolled more than 11,000 patients for Tuberculosis treatment.

Operation ASHA Cambodia Website: http://opashacambodia.org

Current Research

In collaboration with Johns Hopkins-Economic Department and MIT-J-PAL, Operation ASHA studied incentivizing community health workers to determine if monetary rewards for finding new TB suspects will result in health workers identifying more TB patients that can then be treated, as well as preventing patients from default.

Operation ASHA worked with University College London (UCL) to study the detection of depression in TB patients and family members. If a correlation between adherence to treatment and depression is found as suspected, an intervention program similar to one used in the UK can be developed for India and implemented at a later stage of the study.

Currently, Operation ASHA is involved in a research project with University College London wherein TB specialist Dr. Marc Lipman and his team have analyzed the eCompliance data for the past two years. The same has been accepted for a poster presentation for the International Union Against Tuberculosis and Lung Disease Conference 2016. The paper is also being submitted for publication.

Awards and Honors