Our Core Methodology
We adhere to standards and methods that make our treatment model successful. In 14 points, you can find out just how and why OpASHA works successfully.
1. We follow DOTS (Directly Observed Therapy, Short Course). DOTS is a treatment method approved by the World Health Organization in 1993 and implemented by governments across the world.
2. We work in close collaboration with the National TB Program. We receive all anti-TB drugs, diagnostic and physicians’ services, and hospital care from the government. In addition, the Indian government also provides a grant covering recurring expenses for treatment centers in India after two years of operation. It’s our goal to use resources that are already available and easily accessible. In other words, the government provides the resources, and we increase their capacity in distributing TB treatment in India’s most inaccessible slums and villages.
3. We employ trusted community leaders. Our counselors and providers are employed from directly within the community where we establish a treatment center. That way, the employee’s neighbors and friends feel comfortable and more likely to approach them for treatment.
4. Rapid-response testing and education for patients and their immediate families and friends: The counselor ensures that members of the patient’s family are tested within two weeks of diagnosing the patient with TB. The counselor also looks for suspects in the neighborhood and at the workplace and refers them for testing. We collect and transport sputum samples in order to make diagnosis more convenient and private for patients who are reluctant to get tested. Anyone who tests positive is prescribed treatment with Operation ASHA or the treatment provider of their choice.
5. Well-trained corps of local counselors: We employ nearly 100 local individuals to serve as counselors for OpASHA. Each counselor is brought to the main office in New Delhi for two weeks of intensive training. After completing the training, they must pass a written and a verbal test to become eligible for employment. Those who pass the test are employed full time as OpASHA counselor in the community where they’re from. The slums where we operate are difficult to negotiate for anyone but a local, making our counselors invaluable assets to detecting new TB cases and administering treatment the local community. Each counselor educates patients and families about TB, including how to prevent infecting others, the importance of completing treatment to prevent MDR-TB, and decrease stigma against TB so that patients receive the necessary care and support from their families.
6. Over-the-counter drugs: OpASHA also provides medicines to counteract some of the side-effects of TB medication and help reduce the number of missed doses due to a patient reacting poorly to the TB meds. Pain medications and antacids are distributed to anyone who needs them, apart from the enrolled TB patients within the local community. This way, the community thinks of OpASHA centers as health centers, not TB treatment centers. This provides camouflage and helps decrease the stigma attached to a TB center.
7. Skilled field staff: Our staff requires minimal supervision from the central office in New Delhi. Patient treatment and enrollment is kept track of electronically and verified against records from government labs, hospitals and medicine warehouse. Staff counselors receive bonuses and increased pay as they enroll, and successfully complete treatment for, more patients.
8. Robust feedback: Regular feedback is taken from OpASHA’s program managers and quality auditors as well as government staff: treatment supervisors, laboratory technicians, district TB officers and WHO consultants. The government and WHO staff is encouraged to visit our centers and provide feedback, which is used to improve the program delivery.
9. Strict quality control: This is carried out at two levels. The first level is the regular staff like program managers, senior program managers and COO. The second level is quality auditors, who visit every center at random and report directly to the CEO so they cannot be influenced by the line staff.
10. Low-cost operating model: Our model is well-suited to operate with the limited resources developing countries have, especially in the countries’ most poverty-stricken communities. We don’t require more or new resources. We use ones that are already there. For example, we establish centers in existing corner shops, community health clinics, and temples. We hire locals who own the buildings to support our full-time staff counselors in administering medication and running the distribution centers, and refer patients to government facilities and medical professionals for diagnosis and emergency treatment. The local employees we hire as counselors do not generally hold advanced degrees, and receive intensive training at our main office in Delhi when they are hired.
11. Sustainability: In India, a government grant pays for recurring expenses two years after work is started in any city, thus making the program financially self-sufficient after two years. Donor funding is necessary only for first two years of recurring expenses and one-time expenses.
12. eCompliance: This is the single most effective innovation by OpASHA. Using SMS and biometric technology, the system alerts counselors and program managers whenever a patient misses a dose, ensures that the counselor visits the patient within 48 hours, generates all reports automatically, eliminates human error, improves transparency and reliability, increases productivity and reduces recurring costs.
13. Easy expansion: Centers can operate independently of daily oversight from the main office. Senior program managers and program managers oversee individual cities and districts and ensure quality control, implementation of best practices, cost-effectiveness, and focus on reaching daily and monthly targets for detecting and treating TB within a community. We have standard training procedures, a clear managerial hierarchy, and rigorous reporting system that are all easily replicated wherever we choose to expand.
14. Urban and Rural Methods:
a. In urban slums: A dense network of community centers is established so that no patient has to walk for more than 10 minutes to obtain the drugs. The centers are located in the premises out of which a local entrepreneur is carrying out his business like a grocery shop, phone booth or even a temple/ church. In India, nearly 85% of OpASHA’s centers are located in slums and follow this pattern. The rest are in rural areas, which follow a different model.
b. In rural areas: We use mobile DOTS, where a counselor travels from village to village on a motorcycle/scooter, carrying with him strips of anti-TB drugs and other supplies. The counselor gives the medicine to each patient at her house or a mutually convenient place, and observes them swallow the dose. Fifteen percent of centers in India and 90% in Cambodia follow this pattern.