The Team at OperationASHA apply Biometrics to manage Tuberculosis Medication in Slums and demonstrate a dramatic impact in reducing instances of multi drug resistant TB.

Guest Post by Dr. Shelly Batra, Founder and President, OperationASHA

“There is a tide in the affairs of men, which taken at the flood, leads on to fortune,” so said Shakespeare, believing, as I do, that one can bring about a change by acting as a catalyst. There are a lot of things that exist disparately, which, when combined at the right time by the right people, create a revolution.

I have worked as a medical specialist for several years. Over the years, I have witnessed every kind of human misery. I have worked under challenging conditions in understaffed, overcrowded public hospitals, where life was a constant war against infection and anemia. I have even performed emergency Caesarian sections by candlelight! The worst cases were those where because of an ailment, indignities would be heaped upon the patient, and social discrimination would raise its ugly head. These were truly those who suffer, for they would have no food, no shelter, no family, no treatment, only pain and suffering. Tuberculosis (TB) is one such disease where patients have to face horrifying discrimination and violation of human rights.

Operation ASHA (ASHA = ‘hope’ in Hindi) is a Nonprofit that works towards eliminating tuberculosis, a deadly but treatable disease. Currently, Operation ASHA provides treatment, comprehensive education, and counseling services to 4.5 million slum and village-dwellers in India and Cambodia.

As the largest nonprofit provider of TB treatment in India, our unique model works at the grassroots level to bring health and economic benefits to disadvantaged communities. Our TB treatment centers, also known as DOTS (Direct Observed Treatment Short course) centers, are established near or in convenient locations such as religious centers, bus stops, and stores within disadvantaged communities.  They are open early morning and late evening. Thus, patients can procure medication conveniently without wasting time and money on transportation, or losing wages from missed work.

Operation ASHA also creates jobs or augments the income of people from disadvantaged communities. Young men and women from slums and villages receive training and a salary from Operation ASHA to serve as counselors. 80% of our budget goes towards paying salaries of these people.  By placing treatment centers within the heart of underserved communities and by employing locals, Operation ASHA’s TB detection rate has increased substantially and the treatment default rate has decreased several times.

In an attempt to improve patient monitoring and further decrease the treatment default rate, Operation ASHA has partnered with the Microsoft Research to develop biometric technology. This low-cost technology tracks TB patients’ compliance with their treatment regimens. When a patient initially registers at a treatment centre, his or her fingerprint is recorded on a biometric device. Each time that patient revisits the DOTS centre to take his or her medication an electronic record is created when their fingerprint is scanned. At the end of each day, a list is generated and reviewed by a supervisor. Those counselors with patients who missed a dose are notified and given 24 hours to administer the treatment. Missed doses can have catastrophic consequences. Missing medication can lead to Multidrug resistant TB (MDR-TB) and extensively drug resistant TB (XDR-TB), which are global concerns. Operation ASHA reduces drug resistance in our patients by ensuring that they take their treatment regularly for the full 6 – 9 months.

Our biometric technology is currently used in 17 centers in the heart of Delhi’s urban slums, and more than 1300 patients have been registered on the biometrics. The precise tracking and monitoring that can be achieved with biometrics has reduced our default rate to much less than 3% – a number previously considered impossible to achieve in slum areas.

Our low-cost biometric technology has not only ‘turned the tap off’ on MDR TB, it also reduces the cost of treatment per patient, improves productivity of staff, prevents ‘gaming’ of the system, and ensures total transparency. It also streamlines our reporting system by electronically generating monthly reports, thus proving environmentally friendly and time saving. More funding is required to extend this technology to our other existing centers in India and Cambodia.

Tuberculosis eradication needs all hands on deck. This can happen in our lifetimes, but only if we intensify efforts, focus on prevention of MDR TB, and fight the disease with all our resources and all our might. Let’s now make a resolution to combat TB on a war footing. The fight goes on………..

OperationASHA are winners of the 2011 India Development Marketplace, organized by the World Bank and IFC South Asia and plan to use the grant funding to increase the reach of their programme by training more local counselors to help the communities in need.

For more information about Operation ASHA and its success visit the Website or email Dr. Shelly Batra at shelly.batra@opasha.org. You can also follow updates on the work of the Team on twitter @OperationASHA

All photographs copyright: Operation Asha and Keiran Oudshoorn, 2010.