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Governance Knowledge CentrePromoted by Department of Administrative Reforms and Public GrievancesMinistry of Personnel, Transparency Public Grievances and Accountabilityand PensionsGovernment of IndiaCase StudyHealthTreating Tuberculosis: Operation AshaJune 2011Objective• Provide intensive education on TB to patients, families and spread awareness of thedisease through trained counsellors.• Ensure TB patients visit a counselling /treatment centre 60 times in 6 months to getmedication and control default rate• Monitor patients’ ts’ treatment via biometric attendance system so that they adhere to theregimen and take medicines under supervision on a regular basis.Working DesignOperation Asha’s TB treatment strategy as compared to convention DOTS treatment yieldsbetter results due to the following components:Education and TB awarenessThe counsellors carry out thorough education of patients and their families. They explain thatTuberculosis is a bacterial infection, fully curable, provided one gets the complete treatment.Once patients realise that missing doses can lead to Multi-Drug-Resistant Tuberculosis, whichis difficult and expensive to treat, they are much more motivated to adhere to the treatment.Counselling to patients, family members and communityThe counsellors are chosen from the community so that they can connect with the local peopleand TB patients would not be intimidated. There are 75 counsellors in total that perform therole of tracking patients and distribute medicines on a regular basis in 135 centres across thecountry.Two week training is provided to all counsellors in the head office on the disease and ways ofcounselling patients and observing patients in compliance with WHO recommended DOTSstrategy.They are stationed in the treatment centres 6 days a week to observe patients, distributemedicines and check default cases with the help of biometric attendance system. Those centresthat do not have biometric devices have to fill out a standard form designed by GOI with thefollowing details: Patient’s name, Phase of treatment (weeks/months) and Medicineprescription (number of dosage).4Researched and documented byOneWorld Foundation India

Governance Knowledge CentrePromoted by Department of Administrative Reforms and Public GrievancesMinistry of Personnel, Transparency Public Grievances and Accountabilityand PensionsGovernment of IndiaCase StudyHealthTreating Tuberculosis: Operation AshaJune 2011There are two ways that counsellors find TB patients. Firstly, Operation Asha has linked itsproject with dispensaries and government hospitals through which they can be monitored andcontacted. Secondly, the counsellors physically interact with people that carry symptoms suchas coughing for three weeks, fatigue, weight loss etc; and bring them to the hospital for TBsputum testing. If tested positive then he/she is brought to the centre for DOTS treatment andcarefully observed till he/she is fully compared.Counsellors advise patients’ family members to love and care for them; and give propernutrition. Patients are taught how to prevent infection to others by simple precautions. Theyare reminded that to take immediate action when they miss a single dose. The counsellor visitsthe patient’s house to repeat the education. They are also told about the side- effects of themedicines, and how it can be minimised.All counsellors lors visit patients daily, explaining to people what the disease is, how the treatmentworks and that there is a complete solution available. They tell them where they can find DOTStreatment locally through Operation ASHA. The treatment centres are placed within thecommunities where the patients live and due to easy accessibility to medical treatment, thedetection rate has increased substantially and the dropout rate has reduced by 20-30 times.As of now, counsellors of few centres are being paid Rs 3300 per month for their services andthe rest are getting incentive based salary. This is a pilot test conducted by MIT social researchinstitute to find out which type of payment will improve counsellors performance: a basicsalary or an incentive salary. The incentive salary will be paid based on performance wherethey will get a bonus for each new patient detected, and a bonus for zero default.Figure 1: Counsellor Jyoti with TB patient.Source: http://opasha.org/5Researched and documented byOneWorld Foundation India

Governance Knowledge CentrePromoted by Department of Administrative Reforms and Public GrievancesMinistry of Personnel, Transparency Public Grievances and Accountabilityand PensionsGovernment of IndiaCase StudyHealthTreating Tuberculosis: Operation AshaJune 2011of the project.2. Free services: TB treatment is continuous for 6 months and every patient is to be physicallyobserved to avoid defaults or else there is a possibility to contract MDR-TB that is anti-drugresistant and not easy to cure. This is not possible for those that are poor and OperationAsha has provided all services: sputum testing, DOTS services and medicines free of costfor all urban slum dwellers.3. Easy accessibility: All DOTS treatment centres are owned by community persons andcounsellors are chosen from the community hence, TB patients do not hesitate to visitthem. They feel comfortable and connect to them at ease. This approach has broken downbarriers between the patient and other community members where by the patient doesn’tfeel victimised or discriminated in society.4. Automated patient attendance and treatment monitoring: Currently the Delhi treatmentcentres are supported with biometric attendance system to ensure 100% patientscompliance to the treatment. Every day after the medicinal dosage, the patient scanshis/her finger on the scanner connected to the netbook that comprises of patient database.The names of unattended patients listed via SMS is sent to the counsellor’s mobile phoneconnected to the netbook. This helps the counsellors to follow up with the absentees attheir homes, give them medicines and scan their fingers on the system. This processenables the centres to keep a complete check on the patients on real time basis treatmentand fully cure them.ConclusionTuberculosis is rampant in the world and is most prominent in urban slums in India. Althoughthe costs are very low, Operation Asha is required to scale up operations and build capacity torun the project in other states as well. It also has to fully prepare to overcome two challenges: a)TB infection can spread to 12 people and b) MDR-TB is difficult to treat and expensive too.To overcome these challenges, the organisation is moving forward in spreading TB awarenesswith its community based efforts and supervising patients’ treatment at the local level. Withsimilar level of commitment and dedication to the cause, we can hope Operation Asha toalleviate the poor from this deadly disease.sResearch was carried out by OneWorld Foundation India (OWFI), Governance Knowledge Centre (GKC) team.Documentation was created by Research Associate, Attrika HazarikaFor further information, please contact Naimur Rahman, Director, OWFI, at owsa@oneworld.net8Researched and documented byOneWorld Foundation India

Governance Knowledge CentrePromoted by Department of Administrative Reforms and Public GrievancesMinistry of Personnel, Transparency Public Grievances and Accountabilityand PensionsGovernment of IndiaCase StudyHealthTreating Tuberculosis: Operation AshaJune 2011• Community centres infrastructure• Medicines• Counsellors salary• Biometric devices• Otherb. Are services provided under Operation Asha affordable? If so, how much dothey cost?4. The project has been launched in 14 cities and 6 states. How many TB patientshave been treated by Operation Asha to date? Per month?5. In what ways is the project successful? What is particularly unique about thismodel of addressing TB?6. Were there any challenges faced during project implementation? If yes, then whatwere they and how were they overcome?7. What is the strategy for further promotion of awareness/upscaling of the project?10Researched and documented byOneWorld Foundation India