eDOTS: Exigiendo resultados confiables en los tratamientos de tuberculosis

Akila, thank you for your comment, we are glad to see a positive yet critical response from someone who has been involved with tuberculosis treatment.

Under standard DOTS treatment, a patient has to make the trek to a care center every time they take a dose (they already do this three times a week). This is done during the first two months of the intensive phase treatment. After this, they are only required to visit the center one a week for the remaining four months. While this is an inconvenience, Operation ASHA establishes treatment centers in existing locations such as homes, businesses, and pharmacies, which allows us to remain open during unconventional hours (before and after work). As a general rule, we try to ensure that our patients do not have to walk more than 2 kilometers.

We have implemented our eDOTS biometric devices in 17 of our centers in Delhi. This initial implementation has been used to find the problems in the system. In the last three months we have had less than 1% default. The cost of a single biometric device is about US $240 (Rs. 1900) and costs approximately US $1.50 (Rs. 70) per patient. Because OpASHA has essentially eliminated default through eDOTS, the system has the potential to halt the incidence of MDR-TB if widely accepted.

Biometric devices can only assure the attendance of the patient, which is why they are operated by a health worker. It is unlikely that a patient will walk all the way to an eDOTS center to register his or her fingerprint, only to refuse the medications. If this was the case, our health workers can refuse to scan the finger until after the patient has taken the medicine. Biometric tracking does not take the place of direct observation, but it verifies the presence of a patient at a eDOTS clinic.

It is also unlikely that patients will abuse the home visits because it comes with targeted counseling. Further, because the home visits take up the time of our health workers, the visits are likely to be less cordial if they are a repeated occurrence.

As far as the expansion of the eDOTS system, Operation ASHA has been working with some academic institutions to start a trial study using biometric tracking for immunizations. We believe that the system could be used for diabetic, HIV, and ante natal patients. Importing the eDOTS software onto a smartphone is also an innovation to expect in the near future. This would make eDOTS easily adoptable by other TB organizations. While our expansion will focus on India first, we encourage TB institutions across the world to adopt our system.

The Government of India plays a large role in the sustainability of Operation ASHA’s eDOTS program. We receive free medicines and access to diagnostic labs and physicians’ services free of cost. In addition, we awarded a grant. This grant allows eDOTS sustainable. However, there is a two year lag time before we receive the grant. This gap is bridged with funding from donors.
The system also provides for tracking of staff, which eliminates absenteeism and improves productivity. eDOTS increases productivity of field staff by 30%. The savings in the very first year cover the entire cost of hardware and the set up. Savings in subsequent years will reduced the cost of our core program. Given a three-year hardware lifespan, the social return on investment for eDOTS is over 30 times the initial investment. It also provides for inventory management.

Looking Ahead at Future Opportunities:

With enormous success of the eDOTS initiative, it has now developed a life of its own. We are already working on including the addition of audio tracks for illiterate users and a migration to smart phones. It is now evident, however, that the system is capable of much more. It can be used in any situation in which long-term tracking of beneficiaries is needed, as well as where accuracy and transparency is critical. That is, with the appropriate additions and developments, this system could revolutionize the way that services are provided, wherever payments are linked to presence.

The founders of Operation ASHA, along with key personnel who have been involved in the development of the biometrics system, propose to expand and dramatically improve the biometrics system with the goal of making it the world’s most effective technological solution to track patients/ staff and other beneficiaries. The project will be established as a private, for-profit company, and will be open to venture capital investors. Customers will be governments, public health systems and NGOs seeking solutions to the challenges inherent in providing health care in a low-resource setting, using community health workers, mobile phones and intuitive technology to ensure transparent, quality results. Profits from this company will partly meet the funding requirement of Operation ASHA, not just the eDOTS system.