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TB elimination: Op-ASHA’s mission

Over 10 million people contract and die of tuberculosis across the world every year; Operation ASHA is combating one of the world’s biggest health concerns.

Published on December 20, 2020 at 3:49 am

Updated on March 20, 2021 at 06:48 am


A community health worker of OpASHA traveling on boat to detect TB and deliver medication in Cambodia.
Dr Shelly Batra
Over 10 million people contract and die of tuberculosis across the world every year; Operation ASHA is combating one of the world’s biggest health concerns.
The detection rate of Operation ASHA is 2.4 times higher than average detection in the country and 1.6 times higher than the WHO benchmark. The key reason for better achievement by Operation ASHA is Active Case Finding with the support of eDetection software.
Tuberculosis (TB) is the biggest infectious disease and one of the world’s biggest health crises today. 10.4 million people contract TB annually, of which 1.8 million die. TB-related stigma leads to great suffering. In India, one lakh women are abandoned and three lakh children forced to leave school annually. People lose jobs, and loss of wages is $300 million annually in India alone. It is estimated that the world will lose over US$3.4 trillion because of TB in the next decade. Incomplete treatment has led to the emerging man-made epidemic of Drug-Resistant TB, which has the potential to wipe out millions.
Operation ASHA, a New Delhi-based non-profit organisation, provides last-mile delivery solutions for health, serving the poorest of the poor. Its focus is on combating TB, a fully curable infectious disease that has become a global pandemic. Operation ASHA is the largest NGO for TB detection and treatment in India, and the third-largest in the world.
The model formulated by Operation ASHA is simple. It collaborates with the National TB programmes, providing last-mile delivery of end-to-end TB services. Even as the governments provide free medicines, diagnostics and physicians services, accessibility remains a challenge. Operation ASHA’s doorstep delivery model has treatment centres within community premises, open at convenient hours.

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A TB treatment centre at Gurgaon, Haryana.
In its fight against TB, the organization hires and trains local people. All health workers of Operation ASHA belong to the community they serve, and most of them are women. In rural areas, Operation Asha’s workers can be seen on bikes or boats. They use eDetection technology to screen people for TB and eCompliance (biometric fingerprinting) for adherence. This gives real-time information of missing patients to workers for follow-up. The services reach the doorsteps of the disadvantaged for free. Health workers associated with the organization carry out awareness, counselling and take care of stigma and myths. They carry sputum samples from those with symptoms of TB to government laboratories for testing and subsequently ensure assessment by specialists. They supervise daily doses for 6 months and use eCompliance, (fingerprint/iris scans) on each visit. This prevents Drug-Resistant TB. The technology ensures accuracy; a fingerprint cannot be fudged.

eCompliance biometric system used by OpASHA.
Operation ASHA’s results far exceed the country averages, as proved by third-party evaluations. The following reports reflect the impact of Operation ASHA’s model:
1. Evaluation Report submitted by a High-Level Committee appointed by the Government of India stated:
• ‘The detection rate of Operation ASHA is 240 patients/year/1,00,000 population. This is 2.4 times higher than average detection in the country and 1.6 times higher than the WHO benchmark. The key reason for better achievement by Operation ASHA is Active Case Finding with the support of eDetection software.’
• All the patients who were detected by Operation ASHA were enrolled on treatment with zero initial default. This means all patients were put on treatment. In contrast, the initial default across India is 18%, which means that 18% of patients go untreated after detection. They go on infecting others and their own condition worsens, leading to complications and deaths.
• Treatment Success Rate (TSR) of patients treated by Operation ASHA is 88%. In contrast, TSR across India is 74%.
2. According to CSIS (Centre for Strategic and International Studies), Operation ASHA’s dropout rate is less than 3%, as compared to 36%. Our cost of detection and treatment is only $80 per patient, which is at least 32 times less than others. (https://www.csis.org/blogs/smart-global-health/achieving-tb-milestones-through-last-mile-delivery-india).
3. Harvard Business School and the World Bank completed a randomized control trial which showed that the dropout rate is lower by 20% among patients treated with eCompliance.
4. The Country Director of the World Bank in India wrote that “If Operation ASHA could be rolled out everywhere where there is TB, we could stop multi-drug-resistant TB and save many lives. What Operation ASHA does is literally to deliver the elusive last mile in service delivery, the mile that lies in between well-intended government programmes and results on the ground. And they do it with relentless focus and incredible efficiency. What if we could develop Operations ASHA for other problems as well. It would be incredible.”
(http://blogs.worldbank.org/endpovertyinsouthasia/last-mile-last)
5. Publications in leading journals such as Public Health Action, UK, and the American Journal of Tropical Medicine give further proof of our low cost, high impact model.

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An Op ASHA centre.
Achievements:
• It serves 10 million people in India and Cambodia, in urban slums, in rural areas, mountainous areas and on islands.
• Third-party replication has been done in Uganda, Kenya, Peru, Dominican Republic, Afghanistan, and Tanzania.
• In Cambodia, it serves 16% of the population and treats 16% of all TB patients, and has trained 4,000 village health workers in its model.
• Over 95,719 patients of TB and 466 patients of Multi-Drug Resistant TB have been treated.
• Over 7 million people have been screened to detect TB.
• 252 disadvantaged people given dignified jobs.
• In Afghanistan, Operation ASHA was funded by DFID to collaborate with a local NGO and the National TB programmes to treat 8% of all TB patients.
• In Tanzania, 3,000 TB patients are on eCompliance in collaboration with the government and a local NGO.
• TB treatment is a poverty alleviation programme. After treatment, patients earn an additional $13,935 through reinstated health, and the economy saves $12,235 per patient (Annual TB Report 2013, Government of India). The impact of treating TB patients includes average gain to each patient of 4.6 additional years of life. Thus Operation ASHA’s treated patients have benefitted by $1.3 billion, and the countries have saved $1.1 billion.
• Having built the last mile of the delivery pipeline, Operation ASHA is also working in non-communicable diseases such as diabetes, heart disease and haemophilia, and distributing millions of iron, calcium and vitamin tablets, as wells as protein supplements.
(Dr Shelly Batra is the President and Co-Founder of Operation ASHA. She is also an Ashoka Fellow. Views are personal.)

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