How the Model Works
In India, we provide access to tuberculosis treatment for 4.8 million people living in hard-to-reach communities, primarily urban slums and villages. When our founders, Shelly and Sandeep, devised their strategy for TB treatment, they knew they wanted to have the most impact possible. In India, the infectious nature of TB makes it a threat in rural areas, but a rampant epidemic in urban areas. However, it is also possible to provide treatment to hundreds of individuals with just one center in urban areas due to the population density, sometimes upwards of 9,000 people per sq. kilometer according to Census data from 2010. Part of the effectiveness of our model is due to strategic center locations and the densely populated nature of the urban communities we serve.
Each one of our urban treatment centers serves anywhere from 5,000-25,000 patients within a 1.5 km radius of the center. Our centers are placed so that no patient has to walk more than 10 minutes to reach the center.
TB treatment in India has been administered by government clinics located far outside of the communities where the majority of patients live. Community-based health workers and NGOs have made attempts to administer treatment but capacity is always an issue, and demand is invariably greater than supply. Our model is uniquely replicable and standardized, enabling us to grow from one center in 2006, to 209 in just five years.
We evaluate the impact we can have before we establish our centers in a given location, but that’s not the only key to our success; we establish a relationship with the communities we serve. Our treatment centers are in places our patients are familiar with and staffed by people they know and trust, primarily locals from their communities. A “provider” and a counselor staff each treatment center. The “provider” is a local entrepreneur running a tiny business. The business can be a shop, clinic providing traditional or other medicines, or even temple/ church. The provider keeps the treatment center open when the counselors are out in the field, finding new TB infections, facilitating patient diagnosis, or providing counseling. The presence of the provider allows each treatment center to stay open well past normal business hours, sometime round the clock, so the patients don’t have to miss work to receive their medication.
Most other DOTS treatment centers mostly stay open an average of 4 to 6 hours between 10 a.m. and 4 p.m. during the day. OpASHA centers open early in the morning until late in the evening.
The Indian government’s national TB program has made significant progress in treating TB, but lacks the resources to reach the vast population continuing to suffer from TB. We partner with both the government and the private sector and support them on four issues:
1. The failure of private healthcare providers in treating TB properly.
2. Enhance the government’s capacity and reach disadvantaged communities.
3. Combat stigma and indifference to the TB problem.
4. Eliminate default (or patients who fail to finish treatment).
In addition to the provider, OpASHA employs a counselor, usually an individual from the local community. They travel to OpASHA’s main office in New Delhi for two weeks of exhaustive training on tuberculosis treatment. Training includes education on recognizing symptoms, the dangers of failing to finish treatment, types of medication and dosing, tracking the patients, and other health issues that are critical to disadvantaged communities and overall health. The counselor then returns to his or her community and takes charge of two treatment centers where he or she administers medication, provides education and awareness to the community about tuberculosis, and monitors the patients to ensure they are on track with their treatment. In the event that a patient misses a dose, the counselor immediately visits that patient at home to reinforce the need to finish a full course of treatment, and of course, ensure that the patient takes the missed dose.
Another key activity of counselors is active case finding, or identifying potential cases of TB in the community, encourage TB suspects to go for testing, and enroll those found positive in a treatment program. Forty percent of our counselors’ time is dedicated to this activity.
The counselors are the backbone of OpASHA, and more than half of our resources are used to identify, train and pay their salaries . Through education and awareness, our counselors help to reduce the stigma that communities associate with tuberculosis. In many areas served by our counselors, the detection rate has more than doubled over the past few years.
Our model is simple, but its simplicity is the key to its success. By making TB treatment easy and accessible, the number of patients who fail to finish treatment (the default rate) is less than 3 percent.
Another key aspect to the OpASHA treatment model is rigorous patient tracking, and following up with patients who have missed a scheduled dose. We’ve partnered with Microsoft Research to develop the most efficient way of tracking and monitoring patients, a biometric system called eCompliance.