Operation ASHA

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Operation ASHA: Operation ASHA – Serving the bottom of pyramid with effective last mile delivery

Delhi Delhi , India
Year Founded:
2005
Organization type: 
nonprofit/ngo/citizen sector
Project Stage:
Scaling
Budget: 
$500,000 - $1 million
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Operation ASHA serves 5.48 million disadvantaged people throughout India and Cambodia. Our methodology includes Training and employing locals to use innovative technology, hence increasing employment opportunities. We have successfully treated over 32,000 TB patients.

WHAT IF - Inspiration: Write one sentence that describes a way that your project dares to ask, "WHAT IF?"

What if health service delivery could be extended to the BoP with relentless focus and incredible efficiency?
About Project

Problem: What problem is this project trying to address?

TB stagnates socioeconomic growth as treatment is intense no less than 6 months; causing a loss in productivity. In India, the underserved lose $300 million in wages & the economy lose $23 billion each year. A lack of awareness saw 100,000 abandoned women & 300,000 children leave school. Globally, persisting stigmas resulted in 3 million undetected cases in 2012. The chance of figures decreasing lies in jeopardy as drug resistant TB rises.

Solution: What is the proposed solution? Please be specific!

OpASHA’s model utilizes local resources through partnering with community businesses to bring accessible DOTS centers. Locals receive rigorous training and employed to run the centers as providers. Their responsibilities include: active case finding, DOTS, individualized patient care, and imparting knowledge to raise awareness and prevent TB. Each DOTS center stores anti-TB drugs and equipped with a biometric technology, called eCompliance. eCompliance is used to scan a patient’s fingerprint, at the time of taking their medication; this is logged and recorded. In case of a patient’s absence the provider is alerted and follows up. eCompliance assists in assuring complete transparency and accountability within the program.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

For impoverished communities knowing where a local DOTS center is, literally provides a lifeline; Knowledge is as important as treatment. Through community engagement, providers increase awareness and do active case finding in an effort to destigmatize TB. Anyone presenting symptoms of TB are encouraged to be tested, if positive they are enrolled for treatment. It is essential the provider discusses the process and any worries the patient may have; this effectively and sensitively eliminates barriers and deterrents. Otherwise, a patient’s doubt and/or fear may easily trigger abrupt withdrawal from treatment. Before OpASHA default rate was as high as 36%, however, once OpASHA’s model is implemented default decreases to less than 3%.

Impact: What is the impact of the work to date? Also describe the projected future impact for the coming years.

With 245 centers serving 5.48 million people, OpASHA has successfully treated more than 32,000 TB and 14 MDR patients. 24 female TB patients received training to prevent them from being abandoned by families. OpASHA delivers last mile health services by supporting marginalized and vulnerable communities. OpASHA helps to reduce susceptibility to disease by distributing nearly 2 million drugs, 30,000 condoms, 12,000 ORS sachets, 3,500 protein supplement packets, 5 tons of food and 4,000 blankets OpASHA’s is scaling to a global level and implementing the high-impact and cost effective model OpASHA has. Upgradations to eCompliance, OpASHA can individualize and focus on monitoring diseases, treatment and vaccination programs. Increased employment opportunities. About 190 sustainable full time work opportunites were generated for people coming from disadvantaged backgrounds.
Sustainability

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

Although many NGO’s are working in the TB field, none have sufficient Management Information Systems (MIS). OpASHA ensures transparency in the way we use our MIS. Its transparency brings accountability to the workforce and ensures the patient’s health is not compromised nor jeopardized. It is a necessity to ensure adherence and minimize loss to follow up. No other system,has a robust cost-effective system such as eCompliance. OpASHA’s methodology is not only unique but its impact is phenomenal and at a cost “19 times lower than any other NGO”, it is a solution.
Team

Founding Story

A doctor & a former govt. official, Dr. Shelly Batra & Sandeep Ahuja, were unlikely partners, but in 1998 they teamed up to finance Dr. Batra’s free treatment & surgeries for patients who couldn’t afford life-saving procedures. As a surgeon, Dr. Batra performed countless operations and infant deliveries for free. The only obstacle was funding the incidentals needed for operations. She contacted her friends for donations, but her most regular contributor was Sandeep Ahuja. As India is the world’s worst TB-effected country. They decided to focus on a tuberculosis-free India and so, in 2005, Dr. Batra & Sandeep founded OpASHA. Together, they decided to answer one of India’s most urgent public health concerns.

Team

A highly experienced technology team, dynamic Operations Team and a Development & Communications Team with inspiring foresight, assures OpASHA’s sustainable growth. OpASHA’s evolving nature naturally leads to expanding teams, but does not compromise the quality in care services nor delivery.
About You
Organization:
Operation ASHA
About You
First Name

Shelly

Last Name

Batra

LinkedIn URL
About Your Organization
Organization Name

Operation ASHA

Organization Country

, Delhi

Country where this project is creating social impact

, Delhi

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Impact
Full Impact Potential: What are the main spread strategies moving forward? (Please consider geographic spread, policy reform, and independent replication/adoption of the idea or other mechanisms.)
Barriers: What barriers might hinder the success of your project and how do you plan to overcome them?
Sustainability
Partnerships: Tell us about your partnerships.

Approximately 75 words left (450 characters).

Closing the Loop
How does your project primarily ensure that feedback delivers results?

Demonstrate how closed feedback loops can make a difference in people’s lives.

Please elaborate on your answer to the above question.

Robust quality audit reports are generated through our eCompliance system, and contains the following: outcome metrics, cost & sustainability metrics, access & utilization metrics, patient satisfaction, and achievement of positive health outcomes. By leveraging technology to produce tamperproof data, and by performing regular & randomized check-ups at our centers, we are able to immediately verify whether patients are properly receiving treatment and to identify the source of any discrepancies that may arise. OpASHA's auditing process has been finetuned to eliminate any space for assumptions.

Languages: In what languages are you able to read and write fluently?

English.

2nd Round Questions
Thinking about your feedback loop; what information are you trying to get from whom, to whom, and to bring about what change?

OpASHA has brought eCompliance (a biometric technology designed and developed by OpASHA) and providers (locals educated and employed by OpASHA) together, to ensure a reliable feedback loop system to sustain an existing robust methodology in the delivery of TB diagnosis, treatment and prevention.
eCompliance collates real-time data and produces analysis reports, this is complemented by our Providers who implements eCompliance within the communities, enrols each and every patient to facilitate in eCompliance logging each visit. In the ‘back office’ such data is disseminated and analysed to deliver measurable results on a day to day, weekly, monthly and annual basis.
From such reports we extract and prioritise information according to the pressing needs and demands within communities and of individuals. We investigate reoccurring anomalies, trends and/or inconsistencies to develop further understanding of how to strategically resolve any barriers.
As OpASHA is committed to providing last-mile delivery to the BoP, we wholeheartedly care for what patients, the workforce and communities have to say. For maximum affect within the community we have proven that educating and employing locals as providers is the most effective way to ensure patients are comfortable to express themselves and trust their Provider. eCompliance can offer the data but Providers offer the heart of humanity; both are integral parts of our effective monitoring and evaluation system.

What is the purpose of your feedback loop?

Improve quality of programs

If other, please specify
What mediums or mechanisms do you use to collect feedback? (check all that apply)

Physical gathering, Other.

If other, please specify

eCompliance, a biometric technology

Could you briefly describe the way you collect the feedback?

eCompliance collates data based on patient’s regimens, however, it also consists of applications to further decipher the trends of TB and the emergence of MDR-TB among communities. Local Providers works with eCompliance in the field which automatically uploads such metrics at the end of a Provider’s working day.
OpASHA’s ‘Contact Tracing App’ verifies patient relationships and contacts, to ensure focus areas where people could be at higher risk of contracting TB. Additionally, the ‘Lab Alert System’ (LAS) measures the time it takes from a sputum sample being taken, delivered to the Government Lab Facility to the point a result is issued and diagnosed.
Such metrics exemplify what is prohibiting full impact of the OpASHA model, thus allowing Providers to use such information to address and resolves issues as well as reduce and, where possible, prevent reoccurring barriers. Resulting to being able to deliver timely diagnosis, initiate treatment and ultimately prevent the spread of TB and ‘turn the tap off’ MDR-TB.
Harmonising the two components of Technology and Providers authenticates a feedback loop which is imperative to tailoring a patient's regimen. It brings positive impact to communities as such metrics facilitate OpASHA in implementing a non-invasive program which can be adhered to, as it is both suiting and relative to the personal day-to-day demands and needs of an individual.

What mechanisms are in place to protect people from retribution?

Secured protection on information

If other, please specify
What are the immediate benefits or incentives for people to provide feedback?

Other

If other, please specify

Improved services to suit their needs

How do you ensure new and marginalized voices are heard?

Specific targeted outreach efforts

If other, please specify
What are the incentives for the intended recipient to act on the feedback?

Other

If other, please specify

The understand that feedback is necessary to bring further positive services

How does the feedback mechanism close the loop with those who provided feedback in the first place?

Meetings discussing results with providers

If other, please specify
How is feedback published/transparent?

Other

If other, please specify

Online reports generated through our server

Give two concrete examples of how feedback loops have brought a program or policy more in line with citizens’ desires.

eCompliance brings measurable feedback whereby OpASHA can identify a patient’s failure to attend the DOTS center, missed doses, default, death, and returning patients for retreatment of TB, or worse still, MDR-TB.
Together, eCompliance alongside Providers, create authenticity in the feedback loop and demonstrates efficacy in the model. The results, since it implementation in 2010, have dramatically improved adherence, decreased default to less than 3% and done so in the most cost-effective way.
Such feedback loops have facilitated in further developing and creating additional measurable metrics to eCompliance to enhance our impact even further. We are now able to:
1. Receive notifications when a patient did not attend for their TB treatment, resulting in timely follow-ups and less missed doses.
2. Replicate the model in rural and tribal areas.
3. Implement a non-text based app for totally illiterate Providers in areas where literacy is poor.
4. Replicate the models in other areas of the world such as Cambodia, Uganda and Dominican Republic.

Another example is realising the value in having DOTS centres open early and close late brought massive benefits to patients and communities. However, this would not have been understood without our robust feedback loop. OpASHA seeks to extend its reach and eliminate barriers which generally deters patients from continuing their treatment as well as attract the attention of potential patients. By addressing the gaps in the existing system we ensure accessibility and last mile delivery.

If there was one thing you could change to increase the impact of your feedback loop, what would it be?

We wish to integrate the 3 technologies and synchronise data between eCompliance, Lab Alert System (LAS) and Contact Tracing. This would automate all the processes and transfer data real-time. Thus, reducing any delay and maximizing the impact of the feedback loop.

What are your biggest challenges or barriers in “closing the feedback loop”?

Lack of funding for feedback data collection

If other, please specify
Are you aware of The Feedback Store?

No, but I would like to be on it

What are the main uses you can envision for the Feedback Store?

A platform to bring together all the application developers involved in resolving the social etc. Issues.

What is the one thing you would most like to see changed to improve the competition process?

The platform could be simple, as someone using Changemakers for the first time, I found it a little hard to navigate myself through the projects and access the 2nd stage questions.

What are you doing to make sure that feedback providers know that they are empowered by the information they can give and that they know exactly what the information they are providing?

Despite eCompliance being spoken about as an effective tool, working with communities is just as integral. OpASHA is a community-based model which is patient-centric. Through community engagement, DOTS and the presence of Providers, it is demonstrable to community members how impact, change and results stem from their own effective feedback, expression and involvement, respectively. Rather, they understand that eCompliance is a simple measuring tool which authenticates our data, but what is most important to OpASHA’s growth and quality of services relies on their voices.
A Provider effectively seeks to address barriers and risk factors for each and every patient. Providers also impart their knowledge of TB to the patient, their family, and whole communities to eliminate misconceptions and deplete stigma.