Operation ASHA’s low-cost, high-impact, replicable model serves slum dwellers, who are internally displaced due to natural disasters, economic reasons, or conflict. Government collaboration provides free medicines, diagnostics and physicians services. We hire and train local people as Community Health Workers(CHWs). TB patients must go daily for 6 months to a designated centre and take every dose under supervision. Our doorstep delivery model establishes treatment centres in shops, clinics, religious centres etc, open at convenient hours so no-one has to miss work and wages. CHWs carry out awareness, counselling, and address stigma/myths. They carry sputum samples for testing from people with symptoms of TB. They use eCompliance, (biometric fingerprinting) at the time of every dose, to ensure adherence and prevent ‘drop-out’. This prevents Drug-Resistant TB. Technology ensures accuracy; a fingerprint cannot be fudged. CHWs belong to the communities they serve, they speak the same language, eat the same food, and worship in the same way. They get market salaries and tremendous respect.
Technology: We implement the following applications:
1. eCompliance: This was created by Microsoft Research. Fingerprinting is done at the time of each dose. eCompliance terminals are kept in treatment centres and also carried by CHWs. Missed doses trigger a text alert to the CHW, who must visit the patient within 24 hours, give medicine, and take the fingerprint as proof of visit. Terminals consist of low-cost, off-the-shelf components: Android Tablet and a Fingerprint Reader. Terminals work offline. Data is encrypted to ensure patient privacy.
2. eDetection: This is a screening application on the same tablet, with a series of questions based on the symptoms of TB. CHWs screen contacts of existing patients, and also go door to door in slums. This improves detection and productivity. A Government of India evaluation found that our detection rate is 2.4 times higher than others, and all patients were started on treatment, with zero initial default, so no-one can infect others. (Initial default across India is 18% according to a paper co-authored by Deputy Director-General, WHO)
3. Counselling videos: We have 24 animation videos for comprehensive education. These also prevent stigma and discrimination.
Our results that far exceed country averages, as shown by third party evaluations, at a cost that is 32 times less than others.
This model can be replicated for displaced populations anywhere. TB is rampant in these people due to overcrowding, fear, isolation, and stigma.
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