TACOMA, Washington — It is estimated that over the next 10 years, the world will lose more than four trillion dollars and millions of lives due to tuberculosis (TB). India has the highest global tuberculosis rate, with 2.2 million new cases and 250,000 deaths annually. Patients who do not complete their treatment can develop drug-resistant TB, which can turn a curable disease into one that is deadly. India now has a growing number of multi-drug resistant (MDR) and extensively drug-resistant (XDR) TB cases. Although the government offers free TB services, there are many challenges in terms of adherence to follow-up medical visits and treatment. Especially for low-income communities, extensive commutes to health care facilities, long waiting times and financial hardship due to missing work cause patients to skip treatment. Operation ASHA is combating TB in India and Cambodia as well.
Effective New Methods for Treating TB
A nonprofit in India is working to combat these difficulties by bringing tuberculosis treatment at reduced rates to disadvantaged communities. Co-founded by Dr. Shelly Batra and Sandeep Ahuja in 2006, Operation ASHA is an organization with a mission is to detect, treat and prevent tuberculosis in India and Cambodia. Operation ASHA started out in one economically depressed urban area in India and has now expanded to 5,000 slums and villages in six Cambodian provinces and six Indian states.
The Operation ASHA team travels long distances to reach rural villages. Its community health workers visit three times per week to identify and treat individuals with TB in India. Along with rough terrain and long distances, the unique cultures of rural areas must be taken into account. Hence Operation ASHA trains and hires villagers to work as community health workers, instead of sending outsiders. Health workers from within the community know the local languages, customs and religions, which gains patients’ trust. This model also provides much-needed jobs for community members.
In urban slums in India and Cambodia, Operation ASHA serves 3.5 million people who previously had minimal to no access to TB treatment. The organization places treatment centers in shops, homes, health clinics and temples. Each center serves between 5,000 and 25,000 people within a 1.5-kilometer distance. This allows patients to receive medicine in a convenient manner, without having to spend time and money on transportation — a key aspect of ensuring that the entire course of treatment is completed. Prior to Operation ASHA, patients traveled around eight kilometers, requiring up to six hours daily in order to obtain medicines. Now, patients walk less than 10 minutes from their homes to obtain treatment.
High-Tech Treatment for TB
One key problem is determining if the patient is actually taking the prescribed medication. With Microsoft’s help, Operation ASHA developed eCompliance, a device that records an electronic fingerprint from the patient and the community health worker, to verify that treatment has been given. Every evening the data is uploaded to a server, which identifies missed treatments and allows follow-up with the patient, health worker and an Operation ASHA supervisor.
TB can be difficult to recover from and often the medications make the symptoms worse before they improve. Operation ASHA uses both education and medicine to address this issue. The tripartite system consists of a netbook computer, a USB fingerprint reader and a GSM modem that uploads visitation logs to a central Operation ASHA office. When a health worker enters a patient into the computer system, a profile is created, after which the system is locked for 45 minutes. During that time, the health worker counsels the patient and family members about what to expect during the treatment, how to avoid spreading the disease to others and why the patient must finish the treatment regimen. The workers also bring over-the-counter medications that lessen side effects including fever and nausea. Secondary treatments can encourage patients to finish the full course of their TB medication.
The eCompliance system is an invaluable tool to ensure proper administration of the medicines for patients with TB in India. The system is used 78 treatment centers spanning Delhi, Korba, Indore, Mumbai, Bhopal and Raipur, among other areas.
TB Outreach in Cambodia
Operation ASHA is combating TB in Cambodia too. In December 2010, Operation ASHA opened its first short-course (DOTS) center in Phnom Penh, Cambodia. Providers travel to villages on motorbikes, carrying drugs and supplies. The provider seeks out community members who exhibit TB symptoms and medicine is given to patients in their homes.
Social Entrepreneur of the Year
A total of around 4,930 patients have been enrolled and more than 105,550 supervised doses have been logged through eCompliance. Operation ASHA’s default rate has been reduced to 1.5%; much less than that of other institutions. The entire cost of treating a patient is $80 compared to around $300 per patient among other NGOs. In recognition of this innovative, effective methodology, in 2013, Operation ASHA’s president, Dr. Shelly Batra, was chosen as Social Entrepreneur of the Year. Operation ASHA is combating TB and simultaneously addressing the effects of global poverty.
– Sarah Betuel