Operation Asha is dedicated to bringing tuberculosis treatment and health services to the heart of India’s urban slums and rural villages. We are India’s largest NGO in tuberculosis treatment and prevention, making treatment available to more than 4 million individuals with little access to basic healthcare, let alone medicines to treat TB. With treatment centers established in more than 2,053 slums and villages in India, our team plans to expand beyond India’s borders to other regions of the developing world afflicted with TB, and help other organizations fighting TB adopt our methods and technology. “Tuberculosis is a scar on the face of the Earth,” says Dr. Shelly Batra, president of Operation ASHA.

TB is a scar we plan to erase, and together with our partners, supporters and you, we can achieve that goal by the UN Millennium Development Goal’s deadline: 2050.

Problem

Operation ASHA provides comprehensive education and treatment for Tuberculosis, to the poorest of the poor in India and Cambodia. “Tuberculosis has historically been one of the world’s biggest killers. Nearly one-third of over 11,000 (business leaders from across the world) expect TB to affect their business in the next five years”, states a report issued by the World Economic Forum. Obviously, TB is not only a health problem. It has severe socio-economic consequences. The underprivileged in India lose $300 million annually in wages because of weakness and death caused by the disease. In addition, the Indian economy loses $23 billion annually. Also, because of TB, 100,000 female patients are abandoned by families to die of disease and starvation and 300,000 children have to leave school (Govt of India). TB was declared a global emergency by WHO in 1993. TB eradication is also one of the millennium development goals of the United Nations.

Solution

TB treatment is long and tedious. According to the WHO sponsored regimen, the patient must approach a treatment center about 60 times over 6 months to swallow the drugs. Non-completion leads to drug-resistance, which is nearly impossible to cure and die. Worse than that, they infect 12 others and start a chain reaction. So every patient MUST complete the treatment. Therefore, OpASHA has come up with a community-based solution. It hires a local person with minimal education and trains her rigorously as a counsellor. She partners with a local entrepreneur who stock TB medicine and provide it to patients at a convenient time. The entrepreneur and counsellor are equipped with an eCompliance biometric device that tracks every dose taken by each patient through finger prints. If any patient misses a dose, the counsellor is alerted. This ensures 100% completion of therapy.

Example

The counsellor, a full time employee, has many responsibilities. He goes around the community for 3 hours a day, educate families on symptoms of TB and look for suspects, who are sent for testing. Those tested positive are examined by a physician and enrolled in treatment. The counsellor also provides counselling, prior to treatment and later. Counsellors are paid incentive based salaries. So our detection rate is substantially higher than others. The default is less than 3%, nearly the best in the world. Other organizations suffer from as much as 60% default. OpASHA counsellors open treatment (DOTS) centres deep in urban slums and remote villages in the premises of traditional healers, local businesses and homemakers, who stock the drugs. The counsellor visits there for 5 hours a day and provides drugs to most patients and meets them. Patients who come later are given the drugs by the center owner, who works for 12-20 hours. OpASHA pays the center owner a small stipend ($10-15 per month). Thus, services are available to the patient close to home and for long hours, at a low cost to OpASHA. Every center and counsellor has an eCompliance device, on which patients register with fingerprints and mark attendance every time. If a patient does not turn up, the system alerts the counsellor and the program manager. The counsellor has to track the patient within 48 hours, get the fingerprint, provide further counselling and convince the patient to re-join the therapy. This system also produces all reports, improves productivity and transparency and reduces staff cost.

Marketplace

There are thousands of NGOs working for TB across the world. The leading ones are Partners in Health (PIH) and BRAC. PIH works in many health areas through own hospitals, spends substantial funds and focuses on research. BRAC utilizes public health facilities and has lower costs. However, its Management Information System (MIS) is limited. OpASHA’s methodology is unique. It uses public health infrastructure, houses centers in existing businesses, uses a strong MIS and eCompliance technology. Also the centers are patient friendly: opne for long hours and close to patients’ homes. So OpASHA delivers unsurpassed results at a cost that is “19 times lower than any other NGO” (LGT Venture Philanthropy). All OpASHA centers in India are financially self-sustaining because of a government grant.