2017年-世界发展银行全球_OpASHA___Improving_Tuberculosis_Treatment_and_Outcomes_32页_766kb

OpASHA: Improving Tuberculosis Treatment and Outcomes Summary

Core Content

Operation ASHA (OpASHA) is a social enterprise in India that addresses the challenge of tuberculosis (TB) treatment and prevention by focusing on the "last-mile" delivery. It leverages existing government infrastructure and community engagement to provide accessible, effective, and sustainable TB care.

Main Challenges

• High TB Burden in India: India accounts for over 30% of the global TB burden, with 2.8 million cases in 2013. TB is a leading cause of death and disability, especially among the economically disadvantaged.
• Poor Treatment Adherence: Inaccessibility of treatment centers and lack of supervision lead to high default rates. Missing doses can result in relapse or drug-resistant TB (MDR-TB).
• Social Stigma and Economic Barriers: TB patients face discrimination, which hinders detection and treatment. The cost of treatment and time spent on visits create economic and social challenges.
• Ineffective Monitoring: Traditional methods lack reliable tracking and data collection, leading to inaccurate records and poor follow-up.

OpASHA's Innovation

OpASHA was founded in 2006 by Dr. Shelly Batra and Sandeep Ahuja, aiming to eradicate TB in India. It uses two models for treatment delivery:

• Urban Model: Decentralized treatment centers are set up in community locations like shops, temples, and homes, reducing stigma and improving accessibility.
• Rural Model: Mobile DOTS (Directly Observed Therapy Short-course) teams, consisting of community health workers (CHWs), travel to villages to provide treatment, observe dosages, and collect samples.

OpASHA also employs eCompliance, a biometric system that records patient and CHW fingerprints to ensure adherence. It uses a tablet-based system with a web-based medical records platform for automated data collection. eDetection, a decision-based algorithm, supports active case finding and contact tracing.

Implementation

OpASHA works closely with the Indian government's Revised National Tuberculosis Control Program (RNTCP) and receives free drugs, diagnostics, and physician services. It trains and employs local community members, including former TB patients, as CHWs. These workers are incentivized based on performance, ensuring motivation and accountability.

• CHWs: Provide detection, treatment, and education. They are trained for two weeks and are paid based on detection and treatment completion rates.
• Program Managers: Oversee the setup of treatment centers, recruit and monitor CHWs, and manage financial aspects. They are paid a monthly salary of around USD 170.
• DOTS Providers: Local entrepreneurs (e.g., doctors, shopkeepers) who host treatment centers. They are compensated based on patient load, typically USD 6–12 per month.

Impact

• Treatment Success: Achieved an 87% success rate in TB treatment.
• Low Default Rate: Approximately 3% default rate, significantly lower than traditional models.
• Detection Improvement: Increased detection rates by 40–400% within 6–12 months.
• Cost Efficiency: Treatment costs per patient are around USD 80, making it affordable and scalable.

Sustainability and Scale-Up

• Government Funding: Covers 60–75% of OpASHA's costs through grants and reimbursements.
• Private Funding: Supports one-time expenses, technology development, and expansion into new areas.
• Replication: The model has been replicated in Uganda, Kenya, and the Dominican Republic, and is also active in Cambodia.
• Technology Licensing: OpASHA licenses its eCompliance and eDetection systems to other organizations, enhancing financial sustainability.

Lessons Learned

• Community Engagement: Involving local community members as CHWs improves trust and adherence.
• Technology Integration: Biometric tools like eCompliance and eDetection enhance monitoring and data accuracy.
• Incentive-Based Model: Performance-based compensation motivates CHWs and ensures quality service delivery.
• Need for Integration: Better integration with government programs and clearer demonstration of results are essential for long-term success.

Key Information

• Founded: 2006 by Dr. Shelly Batra and Sandeep Ahuja.
• Focus: Last-mile delivery of TB treatment and prevention.
• Partnerships: Collaborates with RNTCP, Microsoft Research, and other international organizations.
• Coverage: Serves 10 million people in nine Indian states and 2.2 million in Cambodia.
• Financial Model: Relies on a mix of government grants and private donations, with a focus on cost-effective and scalable operations.
• Technology: eCompliance and eDetection systems are core to its model, ensuring adherence and accurate data collection.

Conclusion

OpASHA has successfully improved TB treatment outcomes in India and beyond by combining community-based care, innovative technology, and government collaboration. Its model emphasizes accessibility, accountability, and sustainability, making it a replicable solution for TB control in low-resource settings.