FreedomTB

Competition Finalist

This entry has been selected as a finalist in the
Patients | Choices | Empowerment competition.

FreedomTB is a "Technology for Health" Initiative of ZMQ to combat Tuberculosis through mobile phones by creating "high-impact low-cost" general mass Awareness through mobile phone games; targeted m-Training interventions for healthcare providers using Smart phones; implementing Universal TB Management platform; and connecting patients for Adherence & Compliance through mobile phones.

About You

Organization: ZMQ Visit websitemore ↓↑ hide↑ hide

Section 1: You

First Name

Hilmi

Last Name

Quraishi

Organization

ZMQ Software Systems

Country

India, HR

Section 2: Your Organization

Organization Name

ZMQ

Organization Website

Organization Phone

+91-9871981960

Organization Address

Plot 113, Sector 7, IMT Manesar

Is your organization a

Non‐profit/NGO/citizen sector organization

Organization Country

India, HR

Your idea

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Name Your Project

FreedomTB

Country and state your work focuses on

India, HR

Describe Your Idea

FreedomTB is a "Technology for Health" Initiative of ZMQ to combat Tuberculosis through mobile phones by creating "high-impact low-cost" general mass Awareness through mobile phone games; targeted m-Training interventions for healthcare providers using Smart phones; implementing Universal TB Management platform; and connecting patients for Adherence & Compliance through mobile phones.

Innovation

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What makes your idea unique?

"FreedomTB" is a multi-dimensional mobile technology initiative to combat Tuberculosis. "FreedomTB" has identified 4 levels of technology interventions to combat TB -
1). Awareness for general public through mobile phone games, tools, ringtones and wallpaper on TB awareness;
2). Smartphones based Mobile Training Kits for for DOTS providers and community health workers;
3). Universal TB Management platform for DOTS centers for managing the treatment and patients; and
4). Mobile based disease (TB) Tracking, Treatment Adherence and Compliance for patients infected with TB and living in the remote regions and isolated locations.

The idea is unique in the following ways:
1). It is structured to use technology at all aspects of combating Tuberculosis and its management.
2). It uses the strenght of exisiting global strategy of WHO's DOTS program by creating a unified paltform of technology which is like "Plug-n-Play" to manage TB world under the National TB Programs of 179 countries who have adopted the DOTS strategy.
3). It employs a unique methodology of creating self-monitoring, observation and adherence system; thus significantly reducing the burden of human resource and associated management issues.
4). The solution helps in sigificant reduction of drop-out rates of patients, especially migrant population. It seamlessly transfers patients and treatment process throug a universal patient identification system.
5). It provides technollgy tools for health and DOTS workers, both for providing technology assisted community training and self-training.
6). It employs two-way connectivity between the DOT center and the patient, and vice-versa through the course of the treatment through mobile phones.
7). It uses iconic messaging and local context methodology for both for its patients and general mass awareness.
8). Games and edutainment for quick and effective learning; and longer retention of information, especially among semi-literate communities.

Do you have a patent for this idea?

Yes

Impact

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What impact have you had?

Impact of Mobile /Computer games for Mass TB awareness: Over 2.6 million TB games have been downloaded in last 16 months. School based games in local languages called “Stop TB Carnival” reached to over 1200 schools (22,000 CDs) with 650,000 students in India. Over 3 million beneficiaries with cost of reaching to per beneficiary is Re 0.42 (forty two paisa). Survey in 6 rural settings and 6 urban slums showed an increase in co-efficient on learning on TB from 0.27 – 0.56; and the virtual behavior change increased from 0.24 - 0.69. ZMQ mission of “High Impact – Low Cost” approach.
Impact of Training the trainers using Smartphones: 180 front-line health workers trained in 25 DOT Centers with two modules – a).Self training modules on DOTS to administer TB care, & b).Training the communities through the smart-phones. In two different quarters of year, there has been a rise in the number of patients coming for sputum to 265 – that is from 982 to 1247 patients with increase of 26.9% rate.
Impact of TB Management System (Connected DOTS) & Mobile Patient Tracking System (M-DOTS: Before using the system in a private DOT center: number of patients registered in two quarters of year were 84, patients completed treatment 73, drop-out patients 11 and drop-out rate being 13.1%. Whereas after implementing the system in that DOT Center; number of patients registered in next two quarters were 96, patients completed treatment 90, drop-out 6 and drop-out rate being 6.25%.; overall drop-out rate reduced by 6.85%.

Problem

Tuberculosis is one of the leading causes of mortality in India and accounts 1/5th of global incidence. In India, every year, 1.9 million new cases of TB occur and 0.8 million are infectious new smear positive pulmonary TB cases. Worldwide 2 million people die of TB each year. TB is particularly prevalent in poor communities, along with HIV/AIDS and Malaria. TB has also been fuelled by HIV/TB co-infection. Another severe condition of TB called Multi Drug Resistant TB occurs when patient stops taking drugs during treatment or don’t take drugs correctly. In that case, prescribed medicine becomes ineffective and develops drug resistance, thus unable to kill the germs, and creates complexity. Strict adherence to prescribed medication regimen for a period of six months can lead to curing TB. For TB patients, accessibility of basic information makes a difference between life and death, especially where there is even no electricity grid, scanty healthcare infrastructures, and only handful of official doctors. Mobile Phones can provide patients information about their dosage, treatment schedules, reminder and alerts thus tracking progress and monitoring treatment compliance.

Actions

ZMQ's pioneering initiative Freedom TB is partnering with Delhi State TB Office - a nodal body of the NCR of Delhi for TB treatment. The program has been implemented in a private DOTS center in rural Delhi. We ahve also partnered with Microsoft for initial technology support. There are 573 DOTS centers in Delhi. We are trying to scale this for all the 573 DOTS centers by implmenting technololgy there.

Results

Impact of Mobile /Computer games for Mass TB awareness: Over 2.6 million TB games have been downloaded in last 16 months; there was an increase in the co-efficient on learning on HIV/AIDS from 0.27 – 0.56; and the virtual behavior change increased from 0.24 - 0.69.

Impact of Training the trainers using Smartphones: Till now 180 front-line health workers trained, there was increase in patients coming back to DOTS centers for Sputum testing by 26.9%.

Impact of the TB management system and mobile patient tracking & messaging: Using the TB management system (Connected DOTS) and mobile remote there was overall drop-out rate of patients reduced by 6.85%.

Thus the indirect effect and result was:
1. Increase in number of patients enrolled;
2. Increase in success rate of treatment;
3. Decrease in patient drop-out rate;
4. Increased in intake of medcicine;
5. Reduction in the cost of travel to hospitals for treatment

What will it take for your project to be successful over the next three years? Please address each year separately, if possible.

Our long-term goal is to take the Freedom TB initiative and its technology applications from state level to national level and then scale it to the global level. DOTS is a global strategy recommended by World Health Organization (WHO); and it is currently being implemented in over 180 countries. There is a great potential to replicate this solution based on Universal standards and protocols already in use with DOTS. We want it to be replicated and scaled in Africa. We already have serious calls from Ministry of Health from 2 countries in Africa – Kenya and Mali.

At the present moment (Year 2009-2010) "Freedom TB's" Games, Education & Training solutions are running all over India in 4 languages - English,Hindi, Kannada and Marathi. In the coming Year 2010 - 2011, we are scaling education and training part into 5 more languages of India - Kannada, Tamil, Bengali, Guijarati and Urdu; and in 2011-2012 plan to deploy it in Africa - countries of East Africa (Kenya, Tanzania and Uganda) and West Africa (Mali and Senegal) in their local languages - Kiswahili, Shen and French.

"Freedom TB's" Health Management System and Remote Mobile based Patient Tracking System is running in a private DOTS center in rurl area of Delhi. In the coming year (Year 2010-2011) we plan to extend it in the whole state of Delhi and then Haryana. Then in the subsequent year (Year 2011 -2012), we plan to launch it at a national level and make it a part of the RNTCP (Revised National TB Control Plan) of Government of India. This will also allow us to globalize the system from India to Africa and implement the TB Managament and Mobile based system for remote patient tracking in African nations of Kenya and Mali, as we have interest shown up by the Ministry of Health in these countries.

The success of the program is/will be determined by:

• The increase in the number patients enrolled for the treatment;
• The increase in the success rate of the treatment;
• The decrease in the patient drop out rate;
• The decrease in the cost of management of the whole system; and
• The increase in the intake of medicine/dose for greater accuracy of treatment.

What would prevent your project from being a success?

The success of the project will be hampered in two cases:
1. If we try to stick to only a particular langauge. It is very important to have the solution in the local language based on country, region, community and culture. It is extremely important to localize the solution for community needs. The use of iconoic language is also important (which we are already using in our games and trianing). This is important because the majority of users being addressed are semi-literate.

2. The second most important issue is the use of mobile platform. It is important to be flexible in using the mobile platforms. Today various different paltforms are being used like Java, BREW, Android, Microsoft and iPhone. If we really want to globalize the project world-wide, create an Universally applicable solution and make it a huge success; we need to move to a multi-platform approach, depending upon the region and country where we need to implement this solution.

How many people will your project serve annually?

More than 10,000

What is the average monthly household income in your target community, in US Dollars?

$50 - 100

Does your project seek to have an impact on public policy?

Yes

Sustainability

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What stage is your project in?

Operating for less than a year

In what country?

India, DL

Is your initiative connected to an established organization?

Yes

If yes, provide organization name.

Delhi State TB Office, New Delhi (Nodal Agency of the Government of NCT of Delhi on TB Control under RNTCP)

How long has this organization been operating?

1‐5 years

Does your organization have a Board of Directors or an Advisory Board?

Yes

Does your organization have any non-monetary partnerships with NGOs?

Yes

Does your organization have any non-monetary partnerships with businesses?

Yes

Does your organization have any non-monetary partnerships with government?

Yes

Please tell us more about how these partnerships are critical to the success of your innovation.

Partnerhsip is a success to any social program. We partner with:

1. Government - Delhi State TB Office acts as a knowledge partner where they authnticate the knowledge we provide. At the same time, they give us access to number of health centrs (DOTS Centers) where we implement the program.

2. Dispensaries, DOTS Centers and Hospitals

3. Education Department: Gives access to numerous schools where our games based solution is implemented.

4. NGOs: We work with over 40 different NGOs - both big and small. NGOs are provided technology based tools, which they disseminate in their communities and beneficaries. At the same time, we use the front-line health workers of NGOs, which go from door to door in the communuity and train people how to use the mobile based solution. (CASP PLAN, ORDS etc)

5. Mobile Operators: Leading mobile Operators like Reliance Mobile gives us a channel to distribute our games and content to communities either free or at a very low price.

6. IT and Mobile Tech Companies: Tech giants like Microsoft and Qualcomm(BREW) provide us technology support tools.

7. Pharma Company: Eli Lilly & MDRTB Partnership as support partners for the initiative

What are the three most important actions needed to grow your initiative or organization?

1. Right Partnerhsip - Government, NGOs, Hospitals, Dispensaries, DOTS CentersPrivate Sector etc. Inclusion of the this system to become part of the government channel.
2. Multi-Platform Approach
3. Multi-lingual and Multi-cultual (context based) Approach
4. Working closlely with the local communities through locl partners like NGOs; and CBOs.

The Story

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What was the defining moment that led you to this innovation?

The treatment of TB is sure if taken accurately, but is very long - from six to eight months. Patients need to take medicine (fixed dosage regimen) three times in a week for all these months. Majority of patients being poor and semi-literate, they miss out on the dates of dosage due to various reasons and circumstances. It is also very important that the patients take medicine without any interruption. Interruption in treatment of TB leads to a severe form of TB called drug resistance TB, which is much harder, longer and expensive to treat. Hence, regular reminders sent to the patients seem to have been very successful and effective.

There is another severe condition of TB called Multi Drug Resistant TB (MDR TB), which develops during the treatment of TB and is now becoming a growing problem. This occurs if a patient stops taking treatment drugs during their recovery or if they do not take the drugs correctly. In this case, the prescribed medicine becomes ineffective, as it is unable to kill the TB germs any longer. In such cases, a resistance to the medicine is developed. This makes the disease harder, longer and more expensive to treat.

I was moved by the story of a very poor migrant worker (labourer) - Ram Dhan, who has come from the state of Bihar - one of the poorest states in India. The poor patient worked for 2 years in Punjab (a prosperous state). He was detected with Tuberculosis. He got enrolled at a DOTS center treatment, and got the treatment for 6 weeks. Unfortunately, his old mother developed some serious problem and he left to his home town. Due to poverty and his won serious problems at home, he could not continue a regular treatment in Bihar. Infact there is no provision for any patient to shift the center of treatment. So he took new medicine course for a few weeks again in Bihar on his return. After a while, he lost hsi mother. But by then he has also lost his job, whihc is never secure for a migrant worker. So he came down to Delhi in search of livelihood. I met this guy in Delhi while working in a slum contruction area. Ram Dhan looked very weak and was severly coughing. I asked him about his illness and he narrated his story to me. My God, I was shocked, as he had alreadt taken TB doses 2 times, thgat too in parts not a complete course. I immediately got him enrolled in a nearby DOTS center. After diagnozing, he was detected with drug resistant TB (MDR-TB) which I had already suspected - drug resistance to general TB antibiotics. MDR TB is also 10 times more complex in treatment, time and money. But the most positive thing was that Ram Dhan was carrying a mobile phone to be in touch with his wife and childrne in the village. This really gave me a boast to develop a Universall TB Management System whihc can be implemented at national level, which can store all patient data who are enrolled throughout the country (and later can also be globalized in other countries). His mobile phone can also be registred and he can be given regualr information about the dosage and medicine he has to take regularly. This was the most enlighting moment in my life. Thanks Ram Dhan for opening new approach in TB treatment.

Tell us about the social innovator behind this idea.

My self - Hilmi Quraishi. I am always on look for implementing technology based solutions using mobile phones in the rural communities, which can really help the last person on the planet. I have been a Serial Entrepreneur and Technovator using technology to empower marginalzied, rural and isolated communities. I am also an Ashoka Fellow. I believe that just like every person's right to get clean water or clean air, food or shelter, health or education; similarly mobile should be every person's " right to own and use" with some dedicated bandwidth for services on a non-commercial basis. Only this can enable connecting the poorest of the poor, and thus delivering them basic services around fundamental rights. So the s;logan is "Mobile for Everyone". This give access to all people to get critical social information on various doamins from healthcare, agri, sustainable development, education, trainign and livelihood generation.

How did you first hear about Changemakers?

Personal contact at Changemakers

If through another, please provide the name of the organization or company

No, it is my Organization only: ZMQ Software Systems (a Technology for Development Social Enterprise)

207 weeks ago sunita singh said: Dear Hilmi, many, Many Congratulations for being a finalist!! and Many Many Congratulations for being so thoughtful to innovate this ... about this Competition Entry. - read more >
210 weeks ago Jacquelyn Caglia said: Congratulations on being selected as a finalist! about this Competition Entry. - read more >
210 weeks ago FreedomTB has been chosen as a finalist in Patients | Choices | Empowerment.
217 weeks ago Hilmi Quraishi updated this Competition Entry.
217 weeks ago Hilmi Quraishi updated this Competition Entry.
223 weeks ago Hilmi Quraishi submitted this idea.