Annual Report 2013-14 - NGO Advisor · 2016-06-06 · Annual Report 2013- 14 OVERVIEW Operation...

Annual Report 2013- 14

www.opasha.org

Annual Report

2013-14

OperatiOn aSHa

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www.opasha.org

Letter from the Founders

Dear friend,

The 2013-14 fiscal year saw Operation ASHA rise to the forefront of tuberculosis (TB) treatment in India and Cambodia through its growing impact, innovation and excellent results. OpASHA not only treats more TB patients than any other non-governmental organisation (NGO) in India, it enrolls the third highest number of patients among all NGOs across the world.

OpASHA became the first organisation in the world to use fingerprint biometric devices to ensure full integrity of DOTS by ensuring that every dose is tracked through fingerprints of patients. This technology has been rolled out in India and Cambodia. Not only that, it has been replicated in Uganda and the Dominican Republic. Replication in Kenya is expected early next year as well as in many other countries in future.

OpASHA’s innovative model continued to produce outstanding results, including an exceptionally high treatment success rate and extremely low loss to follow-up and mortality rate. At the end of the year, OpASHA was operating 213 TB treatment centres in India, up from 205 a year ago.

OpASHA has enrolled 7,884 patients in free comprehensive TB treatment and counseling, at a cost to OpASHA of only US$89 per patient. This includes detection, treatment, education, awareness, technology, research, advocacy and every other activity OpASHA carries out. Basically, this figure is derived by dividing the annual budget by the number of patients enrolled.

OpASHA has also developed strong research partnerships with leading organisations across the world. The first randomised controlled trial on the impact of incentive salaries on improving detection and reducing loss to follow-up and turning the tap off on Multi Drug Resistant (MDR)TB has been completed. Interim results indicate that incentives can improve detection at a very low cost: less than US$5 per detection. This is hundreds of times less than the cost incurred by other organisations. Complete results will be available soon. The second randomised controlled trial on the efficiency of eCompliance technology is in progress. Results of a small pilot to incentivise patients to refer symptomatics and improve detection, again at a very low cost, have been encouraging. This will also be developed into a randomised controlled trial. This will help us improve TB control across the world, not just in India. Huffington Post rightly mentioned that eCompliance means better TB care and TB follow-up rates worldwide.

Each of these achievements would not have been possible without your support and generosity. OpASHA raised INR 31,944,556 this year.

We hope that the information in this report conveys the vital importance of OpASHA’s work in fighting TB and providing other services, and the life-saving impact that each one of you has.

Sincerely,

Shelly Batra President and Co-Founder

Sandeep Ahuja CEO and Co-Founder


OVERVIEWO p e r a t i o n A S H A

Sandeep Ahuja CEO and Co-Founder

MissionExpand access to services and products of a high quality at affordable prices to

disadvantaged communities worldwide with a focus on delivery of health services.

We do this by providing the last mile connectivity, i.e., service delivery at the

doorsteps of the under-served.

VisionOur vision is of a healthy society, where preventable diseases & infant and maternal

mortality have been significantly decreased, and healthy lifespan extended to all by

curtailment of disease.

PhilosophyOur Overarching Principles: OpASHA exists to serve its patients. Our

philosophy is:

d To improve the health of disadvantaged tuberculosis patients.

d To provide other health services and products to the disadvantaged and the

bottom of the pyramid markets.

d To maintain total transparency at all times.

d What gets measured, gets done. Measurement of outcome is an integral part

of our methodology.

d Our management information systems include continuous monitoring and

rigorous reporting.

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Operation ASHA’s goal was to develop a pipeline to pump in services and products to the most disadvantaged

History

Dr. Shelly Batra and Sandeep Ahuja founded OpASHA in 2006 with a compelling vision: to

improve the lives of the disadvantaged. The first step in this fight is to eradicate TB and then

add other products and services to the delivery pipeline of OpASHA. Their clear-sighted goals

and unwavering dedication prompted policy-makers, health practitioners and investors to join

from both sides of the Atlantic.

A doctor and a former government official, Dr. Shelly Batra and Sandeep Ahuja, were unlikely

partners but, in 1998, they teamed up to finance Dr. Batra’s free treatment and surgeries for

patients who came to her, unable to afford life-saving procedures. An obs and gyne surgeon,

Dr. Batra worked out of her house or Delhi’s Batra Hospital and performed countless life-

saving operations and infant deliveries for free to disadvantaged patients. The only obstacle

was funding the incidentals such as antiseptics, fluids and anesthetics necessary to carry out

these operations. She called her friends and family to ask for donations, but her most regular

contributor after 1998 was Sandeep Ahuja.


Mr. Ahuja organised a group of friends, relatives and colleagues who supported Dr. Batra’s work

regularly. She could perform as many as 70 surgeries a year, without having to worry about

funds and focusing on work only, unlike earlier.

In 2006, Dr. Batra and Mr. Ahuja founded OpASHA. They decided to focus their fledgling

organisation on developing a pipeline to pump in services and products to the most

disadvantaged. They decided to focus on a single issue until the pipeline became fully reliable.

This issue is eradication of TB. India tops the world’s high-burden TB list. TB is India’s most

urgent public health concern. Their vision attracted people to join from around the world, and

an advising and fundraising group grew in the US to form Operation ASHA, USA.

OpASHA began with TB but believes its

model can be used for any issue that requires long-term adherence

to treatment and accountability

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The United Nations (UN) declared TB a global emergency in 2003 and numbers of infected TB

patients have reached epidemic proportions in India in the last decade. In OpASHA’s first year,

2.2 million new TB cases and 400,000 TB deaths were recorded in India.

OpASHA began with one TB treatment centre in September 2006 and enrolled 26 new

patients within three months. Today, OpASHA provides tuberculosis treatment and education

services in 3,000 slums and villages in nine Indian states and two provinces in Cambodia. It is the

exclusive provider of TB treatment to nearly 6 million Indian citizens. With a successful model

in place, OpASHA continues to grow and expand beyond India’s borders to Southeast Asia and

Africa, where millions more suffer from TB.

OpASHA provides TB treatment and education services in 3,000 slums and villages in 9 Indian states and 2 provinces in Cambodia


Chhattisgarh

Madhya Pradesh

Maharashtra

Delhi NCR

Odisha

Jharkhand

Rajasthan

Uttar Pradesh

Karnataka

Phnom PenhTakeo

Cambodia

India

Where We OperateCountries We Serve: India and Cambodia

d We have successfully treated 32,600 patients in India and Cambodia.

d We serve more than 3,000 disadvantaged communities,

including urban slums and villages.

d We serve a total population of 6 million people.

Areas Served by OpASHA

We have successfully treated 32,600 patients in India and Cambodia

Note: Over 3,000 slums and villages served in India and Cambodia


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Urban and Rural Models Operation ASHA follows the World Health Organization’s DOTS (Directly Observed Therapy,

Short-course) model, whereby the patient takes the appropriate medicines in the presence of a

healthcare worker to ensure adherence to the TB regimen. OpASHA uses two different DOTS

models according to the urban or rural setting of the population.

Our Model

OpASHA uses two different DOTS models according to the urban or rural setting of the population

OpASHA’s unique 13-point model1. WHO sponsored DOTS treatment regimen

2. Close coordination with National TB Programme

3. Door delivery of medicine, diagnostics and education

4. Active case finding and contract tracing with support of a software application

5. Rapid response testing and de-stigmatisation/education of patients’ immediate circle

6. Well-trained corps of community health workers

7. Amelioration of side-effects and camouflage

8. Performance based remuneration

9. Robust feedback loop

10. Stringent quality control

11. Very low cost operating model

12. Biometric devices to track compliance

13. Franchise-like operation for easy replication


Urban model

d In urban areas, each OpASHA’s DOTS centre treats between 5 and 75 patients at

any given time. The centres serve a population between 2,000 and 30,000 within a 1.5

kilometre radius, with the average population served by each centre being 25,000.

d On average, a centre treats 24 patients annually.

Rural model

d In rural areas, OpASHA uses mobile DOTS, where a community

health worker travels from village to village on a motorcycle/

scooter carrying with him strips of anti-TB drugs and other

supplies. The community health worker gives the medicine to

each patient at her/his house, or a mutually convenient place;

15% of centres in India and all centres in Cambodia, except one,

follow this pattern.

d On average, a mobile community health worker treats 60

patients annually.

Treatment Centres

On average, a mobile community health worker treats 60 patients annually

Karnataka

Dominican Republic

Jharkhand

Odisha

Chhattisgarh

Madhya Pradesh

Uttar Pradesh

Haryana

Kenya

Uganda

Cambodia

Maharashtra

Rajasthan

Punjab

Delhi NCR

Q4

2006

Q1

2007

Q2

2007

Q3

2007

Q4

2007

Q1

2008

Q2

2008

Q3

2008

Q4

2008

Q1

2009

Q2

2009

Q3

2009

Q4

2009

Q1

2010

Q2

2010

Q3

2010

Q4

2010

Q1

2011

Q2

2011

Q3

2011

Q4

2011

Q1

2012

Q2

2012

Q3

2012

Q4

2012

Q1

2013

Q2

2013

Q3

2013

Q4

2013

Q1

2014

Q2

2014

Q3

2014

300

190

97

24

11

284

279

250

200

150

100

50

0

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eCOMPLIANCE

The biometric eCompliance system, initially developed in partnership with Microsoft Research,

tracks every dose taken by every patient. This is a necessity because of the tedious and difficult

regimen prescribed under the DOTS therapy in which a TB patient must take up to 75 doses

over six to nine months under observation.

eCompliance software is loaded on a seven-inch tablet, which has a SIM card. This connects

the tablet to a server through Internet or text messages. The tablet updates the server every

20 minutes. Once TB is detected in a patient, eCompliance advises the health worker to carry

out pre-treatment counselling whereby the patient is registered with his/her fingerprints in

the eCompliance system and the first dose is dispensed. Thereafter, every time the patient

has to take the medication, both counsellor and the patient have to give their fingerprints

simultaneously. This generates irrevocable evidence that the meeting took place, every time, and

the medicine was taken under observation. If a dose is missed, eCompliance issues an alert to

the patient, health worker and his supervisor. The health worker has to meet the patient within

24-48 hours, provide further counselling, deliver the dose and ensure that the patient re-joins

the therapy. This meeting is also evidenced with a fingerprint. Thus, no fudging or manipulation

can take place. This helps achieve a very high adherence and treatment success rate.

eCompliance has been rolled out for nearly 9,000 TB patients so far in India, Cambodia,

Uganda, Dominican Republic and Kenya. It has already recorded over 400,000

transactions. Nearly 185 eCompliance units are now functional.

OpASHA combines community

empowerment, biometric technology

and fingerprint identification to track TB

treatment

Focus on TechnologyeCompliance, eDetection and Lab Alert System

eCompliance has been rolled out for nearly 9,000 TB patients so far in India, Cambodia, Uganda, Dominican Republic and Kenya


eDetection

Contact tracing is the identification and diagnosis of persons who may have come into contact

with an infected pulmonary positive TB patient. The software works in two modes – Contact

Tracing and Active Case Finding. In both modes, a TB suspect goes through a set of questions;

if the answer to any of the questions is yes, the health worker enters the contact details of

the TB suspect. After the suspect’s details are saved, the system keeps track of the suspect

through each stage of diagnosis namely – Sputum Result Pending, Antibiotics Medication,

Repeat Sputum Result Pending, X-ray Result Pending. The diagnosis of a suspect is termed as

‘Completed’if the diagnostic results are indicative of TB. If diagnostic results are negative, the

suspect is ‘Archived’ into the system. This whole process lets health workers realise the contact

tracing methodology more efficiently.

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Lab Alert Application

The Lab Result Alert System is used for timely delivery of laboratory results to community

health workers and their supervisors. The system can be installed on any tablet and kept in a

lab. End-users, mainly lab technicians, enter contact details of patients along with patient lab

results. After the entered details are saved into the terminal, the information is sent through

the internet to a central reporting system. An SMS gateway sends SMS messages to concerned

health workers. This system allows for a decrease in turnaround time to deliver laboratory test

results to the TB suspect/patient and to the concerned health staff. It also decreases the delay

in enrolling patients in DOTS, which minimises chances of transfer of infection.


eCompliance has already recorded over 400,000 transactions.

Nearly 185 eCompliance units are

now functional

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1. Health Servicesd Detection, treatment, education and raising awareness about TB including drug resistant

forms: MDR, XDR and XXDR/ TDR.

d Testing for HIV.

d Detection, management and raising awareness of Diabetes, especially among TB patients.

d Detection, management and raising awareness about Heart diseases.

d Detection, management and raising awareness about Haemophilia.

d Social marketing of high quality contraceptives and reading glasses at affordable prices.

d Distribution of analgesic, antacid, antiemetic, iron & calcium tablets, condoms, Oral

Rehydration Salt (ORS), protein supplements, non-perishable food, clothes and blankets.

d Detection of mental health problems.

Services Provided

2. Job CreationOpASHA provides jobs to disadvantaged youths who work as health workers and community

partners. Two–thirds of OpASHA’s staff is semi-literate/ illiterate.

Two-thirds of OpASHA’s staff is

semi-literate/illterate


3. Other ServicesThese are provided mostly for TB patients

d Vocational training for female TB patients who are threatened with eviction by their

families. This way, the patients can start earning so families agree not to abandon them.

d Counselling of employers to prevent patients from being terminated because of TB.

Legal recourse to Labour Court is also taken if needed.

4. Computerisation/Software Applications

d OpASHA has become a supplier of choice for technology to TB control NGOs in

the world. We helped Millennium Villages and Columbia University replicate our

methodology in Uganda with superlative results: 100% treatment success rate.

d Clinica de Familia, a local NGO, which works with Columbia University, Medical School,

replicated our technology in the Dominican Republic.

d Millennium Villages and Columbia University

have also decided to replicate our

technology in Kenya.

d Public Health Foundation of India is

in discussions to hire OpASHA as a

technology consultant to track HIV

patients and sex workers.

OpASHA has become a supplier of choice for technology to TB

control NGOs accross the world

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d Very low default of up 3% default rate in treatment of

DST TB, compared to 32% in a triangulation study

in India.

d Treatment success rate goes up to 87%.

d Increase of detection rate of TB by 50-400% within six to18

months of starting work in any area.

d Over 38,000+ patients of normal/ DST TB, 100 patients

of MDR TB and one patient of XXDR/ TDR have been

treated.

d 24 female TB patients were provided vocational training to

prevent them from being abandoned by families.

d Jobs of six TB patients saved by providing counselling to

employers.

d Distribution of 5.5 tonnes of non-perishable food to TB

patients and their families.

d 600 persons have been tested for mental health status.

d 180 TB patients were tested for diabetes. Those who tested

positive are being linked with physicians and trained to

manage diabetes successfully in a market sustainable way.

Our Impact

We have very low default rates up to

3 per cent in treatment of DST TB


d 190 disadvantaged persons have been provided dignified work.

d Income of 178 micro-entrepreneurs in disadvantaged localities, who work as our partners,

has been enhanced substantially.

d After treatment, patients earn an additional US$13,935 (Rs. 8.36 lakh) in their lifetime

through reinstated productivity, on average (Annual TB Report 2013, Government of

India). Thus, our treated patients have benefited by US$530 million (Rs 3,176 crores).

d With treatment of each patient, the economy saves US$12,235 in indirect loss (Annual

TB Report 2013, Government of India). So, the Indian and Cambodian economies have

saved US$465 million (Rs 2,789 crores).

d Distribution of millions of analgesic, antacid and anti-emetic tablets to TB patients to

prevent side effects of TB drugs and to entire communities to camouflage our work as

primary health care.

d Distribution of thousands of ORS sachets to prevent diarrhoea and consequent

dehydration deaths.

d Distribution of 4,000 blankets in disadvantaged communities.

With treatment of each patient, the economy saves US$12,235 in

indriect losses; Indian and Cambodian economies

have saved US$465 million

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eCompliance has been rolled out for nearly 9,000 TB patients so far in India, Cambodia, Uganda,

Dominican Republic and Kenya. It has already recorded over 400,000 transactions. Nearly 185

eCompliance units are now functional.

Replication

Third Party Replication in India

Primary health clinic of Sugar Plant of Jubilant Organosys in Hapur, UP

SMK, an NGO in Jaipur, Rajasthan, funded by GLRA

Dominican Republic

Uganda

IndiaCambodia

Kenya

Replication completedWork in progress

Replication of Operation ASHA’s model across the world.

OpASHA’s model has been replicated by

third parties in Kenya, Uganda and the

Dominican Republic


Revised National Tuberculosis Control Programme (RNTCP),

Government of India

The National Centre for Tuberculosis and Leprosy Control (CENAT),

Government of Cambodia

United States Agency for International

Development (USAID)

International Finance Cooperation (IFC)

and the World Bank Group

Jameel Poverty Action Lab, an affiliate

of Massachusetts Institute of Technology (JPAL)

Harris School of Public Policy,

University of Chicago

Booth School of Business,

University of Chicago

Johns Hopkins

University

The International Partnership for

Innovative Healthcare Delivery (IPIHD)

Center for Health Market Innovations (CHMI)

PartnershipsOpASHA strives to establish successful partnerships that result in a collective impact to improve health and welfare of the disadvantaged. We would like to thank our generous donors and loyal partners for joining us in reaching the last mile in healthcare delivery. A list of partners is given below.

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Eli Lilly and Company

The Stop TB Partnership

BiGTech

GuideStar India

GlobalGiving

Australian High Commission in India

State Government of Rajasthan

State Government of Delhi

State Government of Maharashtra

State Government of Madhya Pradesh

State Government of Uttar Pradesh

State Government of Chhattisgarh

State Government of Jharkhand

State Government of Punjab


1. 48th among Top 100 NGOs of the world in 2013, The Global Journal

2. Nominet Trust 100: Top 100 Technologies for Social Change

3. Exemplary Performance Award, Delhi Government

4. Social Entrepreneur of the Year, 2014, Schwab Foundation

5. India Development Marketplace, World Bank- 2013 & 2011

6. Wall Street Journal Technology Innovation Award 2012

7. Financial Times/ IFC Transformational Business Award, Finalist, 2014

8. The Tech Award, 2014

9. Americares Spirit of Humanity Award, 2012 & 2011

10. University of Chicago, Public Service Award

11. Mint Strategy Award 2014

12. Ashoka Changemakers: Patients Choices Empowerment Competition Winners

13. Vodafone Mobiles for Good Award 2014

14. Award for Exemplary Performance, City of Indore, Madhya Pradesh, India

15. Award for Exemplary Performance, City of Bhopal, Madhya Pradesh, India

16. Manthan Award 2011: e-Health category

17. 3rd India Digital Awards, 2013,

18. Innovations in Mobile Health Technology Award 2013 & 2011

19. eNGO Challenge Award

20. mHealth Alliance and Rockefeller Foundation: Top 30 innovations

21. Innovation and Entrepreneurship Award 2013

22. mBillionth 2010: Innovation in Mobile Technology

Awards and Honours

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This year, leading Bollywood actor Aamir Khan who hosts the famous television show Satyamev Jayate (Truth Shall Prevail) focused on TB, and included OpASHA’s path breaking work in saving lives and treating patients.

In the Media


Dr. Shelly Batra President of Operation ASHA

We are on the brink of another epidemic, and it

has no treatment. If TDR spreads, we will go back to the

Dark Ages.

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Television1. SatyamevJayate, Star TV, Oct 26, 20142. BBC World News, Horizons, Nov 24, 20123. ABC Nightline, Dec 17, 20104. ABC World News, Dec 23, 20105. Voice of America, Feb 26, 20136. CNBC TV18: Accelerate India, Dec 20, 20147. Reuters, March 23, 20138. TV Asia, date (3 times)

Print Media1. TIME Magazine, March 4, 20132. The Lancet, “Tuberculosis control needs a complete and

patient-centric solution”, March 24, 20143. WHO Bulletin, Feb 21, 20124. United Nations Report on Millennium Development

Goals, Sept 20125. Public Health England: Annual TB Update 2014,

March, 20146. Stanford Social Innovation Review, “The Future of Health

Care Access”, Fall 20137. Stanford Social Innovation Review, second publication8. “mHealth to Improve TB Care”, Stop TB Partnership &

Interactive Research and Development (IRD), May 27, 2012

9. Teaching Case Study, Ross School of Business, University of Michigan

10. The National Bureau of Asian Research, “Matching Realism with Aspiration-Challenges and Successes in the Use of Technology for Global Health”, Dec. 2011

11. Cambridge University, Centre for Technology Management, Social Ventures as Innovators at the Base of the Pyramid, Working Paper No:2012/02, May 2012

12. University of Oxford, Identifying Replicable Healthcare Delivery Models with Significant Social Benefit, May 2013

13. Institute of Medicine, USA, INSA and ICMR, India, Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop, April 2012

14. Times of India, April 8, 201115. Hindustan Times16. The Hindu, 17. New York Times, 18. The Guardian, Dec 5, 2012 & Nov 23, 201119. Financial Times, Mar 21, 201320. Business Standard, 21. Die SeiteDrei, “An der front”, November 8, 201322. Deutsche Welle-World, Dec 14, 201123. DainikJagran, TB patients kiaasha”, November 6, 201324. University of Chicago: The Harris View, “Doc Hunt”,

Spring 201125. Harvard Global Health Review, Sept. 19, 200926. Chicago Policy Review, Mar 20, 201327. Phnom Penh Post, Aug 9, 201328. South East Asia Globe

In the Media29. Air India Inflight Magazine, “A new word for the new

age”, Jan, 201330. Civil Society “OpASHA has tech for TB patient

compliance”, August 201331. India Post, Jan 1, 201232. Neighborhood Flash, April 29, 200733. Orissa Post

RadioNational Public Radio USA, Worldview Program, Global Activism Series, WBEZ 91.5 FM1. Global Activism: “Operation ASHA wants to stop

Tuberculosis from making a comeback” Jan 10, 20132. Global Activism: “Operation ASHA expands its TB

treatment program to Cambodia” May 26, 20113. Global Activism: “Fighting Tuberculosis in India an

Update from Operation ASHA” May 13, 20104. Global Activism: “Treating Tuberculosis in India”

February 21, 20085. Best of Global Activism: “Treating Tuberculosis in India”

December 18, 2007

Reach MD International1. “Treating Multidrug Resistant TB Within and Beyond

India’s Borders” February 4, 20132. “Taking TB Treatment to India’s Doorsteps: Progress

from Operation ASHA” December 24, 20123. “Stopping the Tuberculosis Epidemic in India” J

anuary 14, 20084. “Tuberculosis: Better Treatment Access in India”

June 9, 20085. “Treating Outcasts Where the Caste System has been

Outlawed” June 23, 20086. “Operation ASHA & Treating Slum Dwellers in India”7. “Women’s Role in the Control of TB In India”

October 1, 20078. “Making a Difference in India“ October 1, 2007

Online Media1. Government of India, Governance Knowledge Center,

Case Study, July 20112. Government of India, Ministry of External Affairs,

ASHA’s Shelly Batra, Mann Deshi’sChetna Sinha recipients of Schwab Foundation’s Social Entrepreneur awards, March 27, 2014

3. Government of India, The Governance of Knowledge, India, Eliminating Tuberculosis: Need for appropriate partnerships, July 26, 2011

4. World Bank, India: Battling TB in India’s slums, May 9, 2013

5. The World Bank Blogs, The Last Mile, at Last?, OnnoRuhl, Country Director, India, Apr 23, 2013

6. The World Bank Blogs, What does innovation look like?, AleemWalji, Director, Innovation Lab, The World Bank, May 16, 2012

7. The World Bank Blogs, Biometrics for Tuberculosis Management, Nov 17, 2011


8. USAID, Fingerprinting in the Fight against Tuberculosis, Mar 21, 2013

9. Associated Press: The Big Story, India wages hi-tech war on ancient TB scourge Nov 10, 2012

10. The Times of India, Biometric way to tame Tuberculosis, May 26, 2013

11. Indian Express, India wages hi-tech war on ancient TB scourge, Nov 2012

12. Huffington Post, a. Harnessing New Technologies to Tackle an Old

Disease, Mar 23, 2013b. India wages hi-tech war on ancient TB scourge,

Nov 2012c. World Health Organization Reports, May 03, 201213. Washington Post, India wages hi-tech war on ancient

TB scourge, Nov 201214. New York Times, India wages hi-tech war on ancient

TB scourge, Nov 201215. World Economic Forum, Introducing the Schwab

Foundation’s Social Entrepreneur of the Year 2014 Awardees, March 2014

16. Boston Globe, India wages hi-tech war on ancient TB scourge, Nov 2012

17. ABC News Videos Online, War Against Tuberculosis: Quack doctors fuel the reemergence of TB in India’s children, Dec. 17, 2010

18. The Guardian, Social enterprise: can it succeed where traditional development has failed?, February 25, 2014

19. ABC News & Global Giving, Featured on: Be the Change, Save a Life Initiative

20. The Hindu, World Bank picks 20 projects for $1,00,000 grant, May 2, 2013

21. Economic Times, Two Indian social entrepreneurs Shelly Batra and Chetna Vijay Sinha recognised by Schwab Foundation, March 24, 2014

22. Business Standard, 2 Indian social entrepreneurs recognised by Schwab Foundation, March 24, 2014

23. The Tribune, India, Tobacco, TB and Female Mortality, Dec 16, 2014

24. Discovery News, Excellent Idea of the day: TB Tracker Halts Disease’s Spread, Nov 29, 2012

25. FoxNews.com, India wages hi-tech war on ancient TB scourge, Nov 2012

26. Fox10tv.com, India wages hi-tech war on ancient TB scourge, Nov 2012

27. Digital World-LiveMint.com, The Wall Street Journal, Using cellphones to track public services, Jul 17, 2011

28. The Age (Australia), India wages hi-tech war on ancient TB scourge, Nov 2012

29. Itaa New Agency (China), India wages hi-tech war on ancient TB scourge, Nov 2012

30. Khaleej Times (Dubai), India wages hi-tech war on ancient TB scourge, Nov 2012

31. Dubaimoon.com, UAE, India wages hi-tech war on ancient TB scourge, Nov 2012

32. Dawn (Pakistan), India wages hi-tech war on ancient TB scourge, Nov 2012

33. Modern Ghana, World TB Day: 24 March….Tuberculosis Control Needs A Complete And Patient-Centric Solution, March 24, 2014

34. Bill & Melinda Gates foundation, Informal Health Providers Treating TB Are Here to Stay, So How Do We Work with Them?, Mar 28, 2013

35. Rockefeller Foundation, Leveraging Networks to Create Impact, July 24, 2013.

36. Michael & Susan Dell Foundation, The urban poverty paradox: It’s good for you. Why won’t you do it?, By Urvashi Prasad, May 30, 2013

37. Next Billion, Like other business models, tuberculosis control needs a complete, patient-centric solution, March 24, 2014

38. Next Billion, From Operating Rooms to Dust Tracks, Part 1: How a doctor found the ‘invisible poor,’ then founded an organization to help them, February 26, 2014, Part 2: How Operation ASHA moved beyond rhetoric to action, February 27, 2014

39. Nextbillion.net, New Techniques, Technology Helping Operation ASHA to Expand, May 13,2011

40. University of Chicago, Fighting Tuberculosis in India’s slums, Apr. 11, 2011

41. PrabhatKhabar, SaamajikKaryon me Mahilayenbhiaage, October 29, 2013

42. CMAJ, Fingerprinting used to combat drug-resistant TB in India, Cambodia, Aug 16, 2013

43. AshokaChangemakers, Demanding Reliable Results from Tuberculosis Treatment, August 17, 2011

44. SOCAP RECAP, Adapting Tech for Local Needs, September 27, 2011

45. New Day – New York, USA, India wages hi-tech war on ancient TB scourge, Nov 2012

46. San Francisco Chronicle, India wages hi-tech war on ancient TB scourge, Nov 2012

47. All Voices, San Francisco, USA, India wages hi-tech war on ancient TB scourge, Nov 2012

48. The Palm Beach Times, India wages hi-tech war on ancient TB scourge, Nov 2012

49. Miami Herald, India wages hi-tech war on ancient TB scourge, Nov 2012

50. Herald Tribune, Florida, USA, India wages hi-tech war on ancient TB scourge, Nov 2012

51. The Tribune, California, USA, India wages hi-tech war on ancient TB scourge, Nov 2012

52. The SacramentoBee, India wages hi-tech war on ancient TB scourge, Nov 2012

53. Denver Post, India wages hi-tech war on ancient TB scourge, Nov 2012

54. Daily Herald, Illionois, USA, India wages hi-tech war on ancient TB scourge, Nov 2012

55. Star Tribune, Minneapolis, USA, India wages hi-tech war on ancient TB scourge, Nov 2012

56. Charlotte Observer, North Carolina, USA, India wages hi-tech war on ancient TB scourge, Nov 2012

57. The News Tribune, Tacoma, Washington, USA, India wages hi-tech war on ancient TB scourge, Nov 2012

58. The State, Columbia, South Carolina, USA, India wages hi-tech war on ancient TB scourge, Nov 2012

59. The Alternative.in, How Operation ASHA is tackling TB worldwide at 1/19th the cost, July 3, 2014

60. SeatlePi.com, India wages hi-tech war on ancient TB scourge, Nov 2012

61. Philly.com, India wages hi-tech war on ancient TB scourge, Nov 2012

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62. Kentucky.com, India wages hi-tech war on ancient TB scourge, Nov 2012

63. I-genius, Operation ASHA, Dec 201464. Paul Pollack, Out of Poverty Blog, Viva La Revolución!,

Oct. 6, 201165. The Global Urbanist, a. NGOS and governments in India Must Work

Together, Nov 8, 2011b. Keeping Track of Urban Poverty, Nov 1, 201166. Center for Health Market Innovationsa. Spotlight on M&E: Operation ASHA,

Sep. 14, 2011b. Operation ASHA: Going the Last Mile,

Nov. 15, 2010c. Reaching the missing 3 million: Exploring the evidence

behind efforts to harness informal health providers and fight TB, March 31, 2014

d. Tuberculosis control needs a complete and patient-centric solution, March 2014

67. Beyond Profit, Twitter Social Enterprise of the day, July 13, 2010

68. Global Health Delivery Project Online, Operation ASHA: Fighting Tuberculosis in India, Dec. 09, 2008

69. Exchange Magazine, Schwab Foundation for Social Entrepreneurship Announces Social Entrepreneurs of 2014″, March 24, 2014

70. KNN India, Two Indians among social entrepreneurs of 2014″, March 24, 2014

71. Stars Foundation, Treating TB in Urban India and Rural Uganda, March 24, 2014

72. Sarah Haykel, Soul conversation featuring Dr. Shelly Batra of Operation ASHA, March, 2014

73. Media for freedom, Tuberculosis control needs a complete and patient-centric solution, March 24, 2014

74. Citizen News, Tuberculosis control needs a complete and patient-centric solution, March 24, 2014

75. India Medical Times,Tuberculosis control needs a complete and patient-centric solution March 24, 2014

76. Journalists against TB, Tuberculosis control needs a complete and patient-centric solution, March 24, 2014

77. Ennovent, Social enterprise: can it succeed where traditional development has failed?, February 25, 2014

78. Money control.com, Change Agents: Social entrepreneur of the year 2013, November 12, 2013

79. Mumbai Mitra, November 9, 201380. Ekdin, November 9, 201381. International Partnership for Innovative Healthcare

Deliverya. TB or Not TB: Extensions of Operation ASHA’s Care

Delivery Model, Sept 19, 2014b. Over the River and Through the Woods: Reaching

Remote TB Patients, Aug 19, 2014c. When a Cure Isn’t Enough: Exploring the Challenges

of Tuberculosis Treatment, Aug 6, 2014

d. Worried about the spread of TB? Me,too. Here is one solution, July 22, 2013

e. News from the Network, May 16, 201382. Civil Society Online, A World Bank bazaar, June, 201383. Partnership for Maternal, Newborn& Child Health (PMNCH):

Member spotlight, Operation ASHA: Delivering last mile in service delivery, June, 2013

84. The Financial, World Bank Group Awards $2 Million to Social Enterprises in the States of Madhya Pradesh, May 1, 2013

85. The World Bank, World Bank Group Awards $2 Million to Social Enterprises in the States of Madhya Pradesh, Chhattisgarh, and Jharkhand, May 1, 2013

86. The Sentinel Project, Stories of Children with Drug-Resistant TB: Mustkeen, 12 years old, India, Mar 21, 2013

87. UnitedHealth Group, WHCC Health Innovations, Operation ASHA: Using Biometrics to Prevent MDR

88. Health Works Collective, Mobile Health Around the Globe: India- Using eCompliance to Control Tuberculosis, Nov 26, 2012

89. Microsoft Research News Center, Battling Tuberculosis Through Microsoft Technology, Dec 03, 2012

90. New York Times’ Opinionator Blog, What Makes Community Health Care Work?, Feb 18, 2011

91. The Stop TB Partnership, a. eCompliance technology gains new ground to help in patient

identification, July, 24, 2014b. Operation ASHA wins Spirit of Humanity Award,

April 2, 201192. CNS Stop-TB Initiative website, NGO uses biometrics to

monitor TB patients, April 201193. AboutIndia.com, India wages hi-tech war on ancient TB

scourge, Nov 201294. Docspoke.com, India wages hi-tech war on ancient TB

scourge, Nov 201295. JoLee, India wages hi-tech war on ancient TB scourge,

Nov 201296. 360*news.com, India wages hi-tech war on ancient TB

scourge, Nov 201297. Topnes Today – USA, India wages hi-tech war on ancient

TB scourge, Nov 201298. MedicalExpress.com, India wages hi-tech war on ancient

TB scourge, Nov 201299. The Review.com, India wages hi-tech war on ancient

TB scourge, Nov 2012100. Newsvine.com, India wages hi-tech war on ancient

TB scourge, Nov 2012101. Newsmicromedia, India wages hi-tech war on ancient

B scourge, Nov 2012102. Zimbio.com, India wages hi-tech war on ancient TB scourge,

Nov 2012103. 15minutenews.com, India wages hi-tech war on ancient

TB scourge, Nov 2012104. ChritianChat.com, India wages hi-tech war on ancient

TB scourge, Nov 2012105. CheerfulSnake.com, India wages hi-tech war on ancient

TB scourge, Nov 2012106. And many more


Though more than 3,500 people worldwide died of tuberculosis (TB) today, you won’t see it reported in headlines of any major American newspaper. Neither will you see that March 24 is World TB Day simply because for many Americans it is a disease that doesn’t hit home, but this could quickly change.

Drug-resistant strains of TB, the most deadly and costly form of the illness, had a brief moment in the spotlight in 2007 when an American lawyer made headlines after making several international trips while infected with multidrug-resistant TB (MDR-TB), a strain of TB resistant to the two most potent TB antibiotics. Drug resistant TB, like drug susceptible TB, is spread through the respiratory system simply by breathing the infectious particle coughed by a sick patient. It was a worrisome situation for the hundreds of people who were exposed to the drug-resistant strains while travelling on the same airplanes as the MDR-TB patient.

Just last month, the CDC was searching for more than 4,500 people in the LA area that had been exposed to the disease. In 2011, there were nearly 11,000 reported cases of TB in the U.S., and 1.3 percent of these cases were multidrug resistant. Despite this, tuberculosis and tuberculosis resistance is not considered a major issue in the United States.

Drug-resistant TB cases are on the rise: the World Health Organization predicts that by 2015, there could be as many as 2 million drug resistant cases around the world. Drug resistance occurs when patients are not compliant with their drug regimen. But patients are often not to blame for TB drug resistance. Drug resistance regularly occurs by the failures of resource strained health care systems to ensure treatment completion. Drug susceptible TB requires a six-month minimum treatment time, during which the patient must take a daily cocktail of drugs with several unpleasant side effects. Following only a few months of the treatment, usually as early as two months, the symptoms of tuberculosis tend to wane off -- but the side effects of the drugs remain. This leads patients to discontinue treatment early in the absence of a strong health care support system to ensure their follow-up. While there are drugs on the horizon that promise a shorter treatment time, they are still currently not available for use. Drug resistance cannot wait and requires an immediate response.

This problem is particularly poignant in resource-limited settings where TB is most prevalent. In the developing world, most of the medical record systems are still in paper-based formats. Human error and omissions in the paper records provide ample opportunity to lose patients to follow-up, especially during treatment times of six months as required for TB patients.

So how do we fix this?

Operation ASHA, an NGO based in New Delhi, India has developed one solution called eCompliance, an electronic, biometric tool to ensure that health workers can accurately follow-up with all TB patients. It is comprised of a software system on a simple notebook computer combined with a fingerprint scanner, all for a low cost of less than U.S. $250 per clinic.

eCompliance works by using the patient’s fingerprints to record daily visits each time the patient comes to the clinic for a dose of medication. When the health worker observes a dose, they scan the patient’s finger and the visit is automatically entered into a simple compliance log that allows healthcare workers to not only view each

Harnessing New Technologies to Tackle an Old Disease

Posted: 03/23/2013 4:32 pmDr. Yanis Ben Amor Sarah and Snidal HeadshotSarah Snidal

Page 1 of 2

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patient’s history, but also to easily access a list of patients that have missed a daily dose. Health workers do not have to waste time thumbing through individual records of each patient. Instead, they easily find their patients, administer therapy, and provide the educational support that is need.

The system has already been proven to work effectively and efficiently in dense New Delhi slums. Operation ASHA has 26 clinics utilizing the system and less than three percent of patients are lost to follow-up. But is this successful system transferable when the distance between the healthcare worker and the patient’s home is more than one kilometer?

A team from Columbia University’s Earth Institute decided to test this exact question by taking the system to the opposite extreme of the India model. We adapted the Operation ASHA strategy for a rural African setting in Uganda. In that context, patients no longer go to the clinic while on TB treatment, but rather a community health worker goes to the patient’s home with an eCompliance system to observe the patient taking the drugs and record the drug intake.

Our team implemented three systems (notebook + fingerprint scanner) in theMillennium Villages Project in Ruhiira, in the rural southwest of Uganda and trained three community health workers (CHWs) on the process of eCompliance. Some changes in the system were necessary to adapt to local constraints. For example, unlike urban India where the systems were clinic-based, the CHWs have to ensure the system’s battery is always fully charged since electricity access is often not readily available and road quality or lack thereof means travel can be long and difficult.

Yet, even with these added challenges, the system has proven to be successful. Now the CHWs are able to easily and accurately identify when a patient has missed a dose and have a conversation with them to ensure that they do complete treatment, instead of missed doses going unnoticed and resulting in loss to follow-up. That is not to say that a patient never misses a meeting for observation, it is impossible to avoid all obstacles in a six-month plus period; events such as funerals or patient travel occasionally lead to a missed record.

The results in Ruhiira are a staggering improvement. The cluster of villages has a population of about 50,000. In 2011, the most recent year with full data, there were 52 TB cases diagnosed and placed on treatment and eight patients died. The eCompliance compliance system was implemented in July 2012; since then, 31 patients have been enrolled in the system, none of those patients have been lost to follow-up, and none have died.

Perhaps more importantly, the community and the patients are excited about the system. When the project was first implemented, the mother of one patient said she could not thank the eCompliance team enough for taking care of her son. She insisted that they take a few valuable pineapples as a gesture of her appreciation. Another health worker reported that community members told him how much they appreciated both him and the system. Now they can rely on him to always check on the health and treatment status of patients. In areas of the cluster where the system doesn’t yet reach, patients are asking when they will get the new technology.

These results are remarkable, and mean better TB patient care not only for the Ruhiira village cluster, but also for TB follow up rates worldwide. If systems like eCompliance work in areas as different as dense urban Indian slums and sprawled rural Ugandan villages, we may be able to halt the increased incidence of drug resistant cases.

Stopping the incidence of drug resistance in India or Uganda may seem like an issue that is not relevant to those of us in the United States. But today it is more true than ever that TB anywhere means TB everywhere. The American lawyer likely picked up MDR-TB while doing development work. But the transfer of TB can be even more indirect. As globalization grows, and the number of people travelling increases, it is more important than ever to stop TB drug resistance and stop the spread of this deadly epidemic.

Moreover, the benefit of eCompliance is not limited to tuberculosis alone. There are other medical issues where the largest challenge to success is ensuring patient follow-up, particularly in resource-scarce settings. Other opportunities include ensuring delivery of consistent antenatal care to pregnant women, recording childhood vaccinations, and aiding prevention of HIV transmission from mother to child. eCompliance may be just the assistant that overworked doctors and health workers in disadvantaged areas need to easily, efficiently, and successfully care for all of their at-risk patients, including in the United States.

With a solution available, why are we continuing to ignore the problem?


The Last Mile, at Last? Submitted by Onno Ruhl On Tue, 04/23/2013 - 08:57

http://blogs.worldbank.org/endpovertyinsouthasia/last-mile-last

It looked like an ordinary little drugstore. A reasonable supply of medication on the right, and man behind a small desk in the middle.

But what was on the desk was not ordinary: a netbook laptop and a fingerprint scanner. And on the left were boxes, all the same medication, with names written on them. “Try it,” Neema said. “Scan your finger.” I did and the screen turned yellow. “You have never been here yet” said Neema, “I cannot give you any medication.”

I was in a poor neighborhood, some would say slum, near Okhla in Delhi. Neema is the agent for Operation Asha. She serves two little drugstores and a total of 12 patients and makes a decent living doing so. Almost 90% of her patients will be cured and will not develop drug resistant TB. Yes, Operation Asha does TB. It specializes in identifying TB patients and delivering the government-sponsored free drugs to them until they are cured. And yes, it uses advanced technology, both to monitor the patients and to incentivize workers like Neema. Its success rate is almost 90% and it is 19 times cheaper than its nearest competitor in India! The screen on the computer could also have turned green, to give me the medication, or red, if

I had missed a dose. And if red, it would have sent me an SMS to remind me.

Operation Asha’s office is pleasant but small and in an inexpensive location. It looks nothing like your typical international NGO’s office, let alone like the offices of international organizations like the World Bank and the United Nations. The office is full of young people, all of whom seem to feel that they are better off than before they had the job. Highly motivated and smart. The place packs a training room, an IT center and the administrative office in as little space as a single meeting room in my own office. And Operation Asha now works in eight states in India, plus Cambodia and Uganda. Oh yes, and nobody from Operation Asha has yet been to Uganda. The assistance is all virtual.

I was fascinated: If this could be rolled out everywhere where there is TB, we could stop multi-drug-resistant TB and save so 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 programs 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? 90% efficiency and 19 times cheaper? It would be incredible!

For those of you who don’t know, Asha means hope. Hope for millions of TB patients. But to me it can be even more: hope for millions of others who need services, all over the world. Our last miles must become cheaper and more efficient. Asha’s results in applying the science of delivery give rise to real hope that this can happen.

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Total BudgetOperation ASHA receives substantial value in goods and services in kind. Details and value of these goods and services is given below.

Note: For calculation, the exchange rate taken is 1 US$ = INR 57

Financials 2013-14

O p e R A t I O N A S H A

partiCULarS india (US$) Cambodia (US$) total (US$)

Anti tB drugs for DSt/ normal tB 608,589 552,772 1,161,361

Anti tB drugs for drug resistant tB 60,965 N/A 60,965

Auxiliary drugs/supplies 2,250 N/A 2,250

educational material & others 1,625 N/A 1,625

physicians/diagnostics for DSt/

normal tB

221,305 204,605 425,910

physicians/ diagnostics and initial

work up in hospital for drug resistant

tB patients

37,895 N/A 37,895

Management 336,842 N/A 336,842

Google Apps and Ad words 13,166 N/A 13,166

Airfare and hotel charges 5,545 N/A 5,545

Total 1,288,182 757,377 2,045,559

Operating expenditure $749,155 $272,393 $1,021,548

Grand total $2,037,337 $1,029,770 $3,067,107

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Operation ASHAD- 156, Sarita ViharNew Delhi, India

Country Offices:phnom penh, CambodiaChicago, IL, USA

please visit us at: http://www.opasha.org

Experts across the world are deeply impressed with our impact.

Accolades

If Operation

ASHA could be rolled out everywhere where there is TB, we

could stop multi-drug-resistant TB and save so 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 programs 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.”

Onno Ruhl Country Director, World Bank, India

Results in Uganda are a staggering improvement. eCompliance means better TB

care.. and TB follow up rates worldwide…. Benefit of eCompliance is not limited

to tuberculosis…. Other opportunities are delivery of antenatal care to pregnant

women, childhood vaccinations, and prevention of HIV transmission. eCompliance

may be just the assistant that overworked doctors and health workers in

disadvantaged areas need to successfully care for all patients, including in the US.

Professor Yanis Ben Amor, Columbia University, Huffington Post

Operation ASHA is the

Infosys and Microsoft of the

NGO world.

Onno Ruhl Country Director, the World

Bank, India

Operation ASHA’s work involves all kinds of innovations. Their service provider is not a doctor, but a

community health worker, which dramatically reduces the cost of treatment. They have non-descript

clinics without signs that mention TB to reduce social stigma, which makes it safer, particularly for

women, to seek treatment. They’ve also identified ways to increase treatment compliance for a disease

that is traditionally difficult to treat because people don’t constantly take their medication for the

necessary six to nine months. These are powerful innovations”

Aleem Walji Director, Innovation Lab, the World Bank

Microsoft Research has

teamed up with Operation

ASHA to fight TB in India.

Better data = better outcomes,

Bill Gates

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