Fondation Pierre Fabre

Expand access to health services and products of a high quality at affordable prices to disadvantaged communities worldwide

Main beneficiary countries:
India - Cambodia - Tanzania - Afghanistan - Peru - Uganda - Dominican Republic - Kenya - United States

About the sponsor

Operation ASHA (OA)

Operation ASHA has developed a local, deep, low cost, last mile delivery system that is replicable worldwide. It serves 15.6 million people, living in over 5000 slums, villages and tribal areas across India and Cambodia with its own staff. Its model has also been replicated by third parties in India and seven other countries: Afghanistan, Tanzania, Peru, Uganda, Kenya, Dominican Republic and Cambodia. Operation ASHA’s CHWs raise awareness, scour the communities for symptomatics, ensure testing, link them to high quality medical practitioners and finally provide treatment and ensure adherence. Operation ASHA works in collaborations with private sector hospitals as well as governments/ public health departments, which provide medicines, diagnostics and physicians’ services mostly for free. CHWs are supported heavily with technology applications, including the world renowned eCompliance. Its first version was built with support from Microsoft Research. The partnership was tweeted by Bill Gates on Dec 7, 2012. The technology also produces accurate and reliable data, which is collated into an electronic medical record system and produces reports at the click of a button. In addition, Operation ASHA has developed applications for detection, management of lab results and accounting of user fee. Baxter, a multinational pharma company, Columbia University, USA and German Leprosy & TB Relief Association have taken licenses. Operation ASHA serves the poorest It currently covers five areas: Tuberculosis, HIV/ TB Co-infection, Haemophilia, Diabetes, Heart Diseases and Adolescent Health. Testing for blood sugar with glucometer is also provided. The idea is to ultimately develop Operation ASHA into a comprehensive pipeline that can deliver all health and related services and products to the Bottom of the Pyramid market. In terms of number of patients served, Operation ASHA is a big TB control NGO in India. It achieves a good treatment success rate, at a low cost. Simultaneously, CHWs deliver many products like ORS, contraceptives, Iron and Calcium tablets, nutritional supplements, and non-perishable food. In the delivery process, Operation ASHA has generated employment for nearly 200 semi-literate disadvantaged youths. It has also trained 4000 village youths in Cambodia on detection, prevention and treatment of TB.

Sector: Organizational: Communities, public authorities, NGOs, associations, foundations, etc.

Country of origin: India

The organisation has:

193
Full-Time Equivalents
193
Employees
4000
Volunteers
86
Service providers

Initiative overview

Healthcare themes targeted

  • Infectious diseases
  • Access to quality medicines/pharmacies
  • Chronic diseases
  • Mobile ambulances

Stage of development:

  • Routine project/operational

Area where initiative is utilised

  • International (in several countries)

Initiative start date

  • 05/05/2017

Initiative end date

  • 12/31/2018

Financing

Financing method

  • Public (grant/subsidies, call for proposals/call for tender, etc.)
  • Private (private investors, crowdfunding, philanthropy, etc.)
  • NGO
  • Government agency (i.e AFD, USAID, etc.)
  • Intergovernmental or international agency

Economic model(s)

  • Subsidies
  • Sales of data analysis
  • Donations
  • Licensing and development of software

About the initiative

The problem of tuberculosis.

The proposed solution is law cost. For example, for TB, Operation ASHA’s drop-out rate for TB patients in India is 5 times lower that the national average of 20%. Its detection rate is also higher than national average.

The salient features of OA’s model :

  • Use of algorithms approved by Governments and WHO
  • Close coordination with Government and other stakeholders
  • Empowerment of target communities and well-trained corps of community health workers 
  • Active case finding and contact tracing with support of a software application for TB.
  • Rapid response testing and education of patients’ immediate circle
  • Door delivery of medicine, diagnostics and education 
  • Amelioration of side-effects, de-stigmatization and camouflage
  • Performance based remuneration of CHWs
  • Biometric devices to track compliance and other technology applications to track staff movement, communication of lab results and payment to village workers
  • Franchise-like operation for easy replication
  • low cost operating model
  • Advocacy with stakeholders and governments to improve policy and financial sustainability

Impact:

  • OA’s model has been replicated in Uganda by the Millennium Villages and Columbia University, Earth Institute. They are also using OA’s eCompliance technology in Kenya, Peru, Dominican Republic, Tanzania and Afghanistan.
  • Achievement of low default of up to 3.1% in TB treatment. Treatment success rate goes up to 88.3%.
  • OA increases detection rate of TB by 50-400% within 6-18 months of starting work in any area.
  • 75719 patients of normal/ DST TB, 366 patients of MDR TB have been enrolled, one patient of XDR has been treated and three patients of XDR are under treatment.
  • Elimination of out of pocket expenses for patients by door-step delivery of services including collection of samples
  • 24 Female TB patients were provided vocational training to prevent them from being abandoned by families.
  • 342 Haemophilia patients detected and started on treatment
  • 10,000 TB patients were tested for diabetes. Those who tested positive are being linked with physicians and trained to manage diabetes successfully in a market sustainable way
  • 195 disadvantaged persons have been provided dignified work.
  • 93 patients’ jobs have been saved by counsellors who convinced their supervisors, not to terminate them
  • Income of 124 micro-entrepreneurs in disadvantaged localities, who work as partners of OA, has been enhanced substantially.
  • On treatment, patients earn an additional $13,935 (Rs. 8.36 Lakh) through reinstated productivity in their lifetime, on an average (Annual TB Report 2013, Government of India). Thus, treated patients have benefited by a whopping $ 959 million (Rs 6,330.1 crores).
  • With treatment of each patient, the economy saves $12,235 (Rs 7.34 Lakh) in indirect loss (Annual TB Report 2013, Government of India). So the Indian and Cambodian economies have saved $ 842 million (Rs 5,557 crores) for patients who have successfully completed the treatment.
  • OA has detected and is helping with management of diabetes, heart disease, hemophilia and depression for thousands.
  • OA has distributed millions of analgesic, antacid, antiemetic, iron and calcium tablets.
  • OA has also distributed condoms, Oral Rehydration Salt, protein supplements, 8 tons of food and 9000 blankets. Thus, OA’s delivery model is truly turning into a delivery pipeline for disadvantaged areas/ Bottom of the Pyramid markets. Monitoring and Evaluation: “What gets measured, gets done” - is part of the Philosophy of OA. In this spirit, OA tracks the following key performance indicators.

Evaluation Measures for Program: Following key performance indicators are collated, tracked and reviewed monthly on a routine basis. This will be done for the Proposed Project also.

Field report of the initiative

Fields of application:

Information, education and communication for behaviour change (IEC) - Patient monitoring and medical data

Target audience

  • Entire population
  • Sick people
  • Pregnant women
  • Children - adolescents (ages 6-18)
  • Young children (0-5 years)
  • Patient family/entourage
  • Health workers, Government's public health department

Initiative objectives

  • Decreased mortality
  • Decreased morbidity
  • Reduced suffering
  • Improved treatment
  • Improve productivity and earning of patients and families; Provide jobs to semi-literate or illiterate youths

Key figures

7000000 Number of beneficiaries since launch

384000 Number of users per Year

Materials used

  • Cellular (mobile) phone
  • Tablet
  • Computer

Technologies used

  • Mobile telecommunications (without data connection)
  • Internet
  • Geolocation
  • Mobile app (Android, iOS, Windows Phone, HTML5, etc.)

Offline use

Yes

Open Source

No

Open Data

No

Independent evaluation

Yes
evaluated independently

Partners

Governments' public health department at national, state and local level

Health: Healthcare professionals and structures

JPAL

Academic entities: Universities, research laboratories, etc.

University of Chicago, School of Medicine

Health: Healthcare professionals and structures

Duke University Medical School, Innovations in Healthcare

Organizational: Communities, public authorities, NGOs, associations, foundations, etc.

Partners

Collaborators

startupBrics