How Delhi-based NGO Operation ASHA is helping over one lakh underprivileged individuals fight tuberculosis
Sixty-one-year-old Mahmood Khairati used to spend his day pulling a rickshaw through the perennially congested lanes of Rajasthan amidst grubby buses, swanky cars, and noisy motorbikes. With no other source of income except for the passenger fare, he was barely able to make ends meet.
A few months ago, Khairati began suffering from cough, repeated fever, and unexplained sweating towards the evening. With no other choice, he had to stay indoors and rest. He kept battling the symptoms for a considerable amount of time since he was not in a position to afford medical assistance. However, in 2014, Operation ASHA stepped in to provide the required relief.
An individual identified with tuberculosis by Operation ASHA.
“One of the health workers from the NGO visited me, recognised my health condition, and suggested a tuberculosis test. When the results turned out to be positive, they provided me with the right medication, as well as treatment, for around 180 days free of cost. Today, I have recovered and regained all my strength, so much so, that I can continue to earn as a rickshaw puller,” Mahmood Khairati shares.
India is known to have the highest instance of tuberculosis cases in the world, amounting to 27 percent. According to a report released by the Union Ministry of Health and Family Welfare, more than 2.4 million Indians have suffered from the illness in 2020.
Intending to manage the anti-tuberculosis activities in the country, the Indian government launched the National TB Elimination Programme (NTEP) in 1962. Recently, this initiative was strengthened and renamed as Revised National TB Control Programme (RNTCP), in line with the Prime Minister’s goal of eliminating the bacterial infection by 2025, five years ahead of the global target of 2030.
However, despite all the efforts put forth towards identification, early diagnosis, and medical care, a lack of awareness as well as inaccessibility to healthcare facilities, has stood in the way of eradication. And, Operation ASHA is attempting to tackle that.
Sandeep Ahuja, Co-founder of Operation ASHA along with some of the patients.
Founded by Dr. Shelly Batra and Sandeep Ahuja in 2006, the non-governmental organisation is fighting to eliminate TB as a whole, by providing good quality treatment regimens at the doorsteps of the underprivileged and marginalised.
“Tuberculosis has been around for a very long time, and it is a disease that affects the poor the most. Though it is completely curable, it has led to the loss of several lives. We wanted to offer a scalable, low-cost solution to deal with this, and Operation ASHA was a result of that,” Sandeep Ahuja, Co-founder, Operation ASHA tells SocialStory.
The initial phase
Sandeep says that the idea to kick off an initiative to root out tuberculosis sprung when he was pursuing his Masters in Public Policy from the University of Chicago. South African President Nelson Mandela’s quote, “Tuberculosis is the child of poverty,” made him realise the severity of the disease and the suffering it brought with it.
While completing his education, Sandeep started researching on the disease, including a model to curtail its spread.
Immediately after, he went on to work with Bharat Petroleum Corporation as a Marketing Manager and even served as part of the Indian Revenue Service (IRS) in 1991. In 2007, after Sandeep stepped down from the IRS, he set up Operation ASHA along with Dr. Shelly Batra, a renowned Gynecologist and Obstetrician, who he met at a hotel during an event.
Dr Shelly Batra, Co-founder, Operation ASHA.
Dr. Shelly is known for her efforts in helping the impoverished by providing free consultations and performing pro-bono surgeries, all her career.
“Since both of us were on the same page when it came to fighting against TB, we started Operation ASHA together. We managed to garner Rs 5 lakh from friends and relatives to commence the groundwork. Our first project was implemented at a slum in Delhi, which was home for thousands of trash pickers. Initially, the government collaborated with the organisation to identify the areas for intervention, and later they became financial partners too,” explains Sandeep.
One of the health workers interacting with children.
Providing medical care to the needy
Operation ASHA works at the community level to identify, detect, and treat people infected with tuberculosis. The NGO has a dedicated team of health workers who conduct door-to-door surveillance in slums and other semi-urban areas. They work at the grass-root level, and button-down on individuals facing the symptoms of the disease by engaging them in conversations.
Once they identify a particular person suffering from fever, cough, exhaustion, or any other similar pattern of illness, the workers collect the required samples, and send them to the nearest diagnostic lab for clinical examination. If the result turns out to be positive, they also deliver medicines and administer treatment to the affected for the prescribed time right at their doorstep.
Asha Negi gathering the details of a patient with TB.
Asha Negi is a health worker who has been working with Operation ASHA since 2008. She is known to have offered care and assistance to over a thousand people in their battle against TB at Nainital, Uttarakhand.
“When I was selected to become a health worker as part of the NGO, I was really excited. I went through a whole lot of training before I started. There is always some amount of stigma associated with tuberculosis in the Indian community. And, that is when I try to have a conversation with the concerned individual, casually ask him or her about the symptoms, show them a few videos about the disease, and finally, convince the person to undertake treatment if diagnosed with TB,” Asha notes.
Today, over 50 workers are part of Operation ASHA’s mission, all of whom receive an incentive-based monthly salary. Some of the key areas where the NGO has been making an impact include Delhi, Gwalior, Bhubaneswar, Bhiwandi, and Vasai.
Medicines being administered to a patient.
When it comes to major cities and metropolitans, Operation ASHA has adopted a different approach for treatment and cure.
“In urban areas, we take on the WHO-recommended method of DOTS (Directly Observed Therapy, Short-Course), where small clinics are set up in existing and accessible locations of the society such as businesses, temples, and pharmacies where trained staff members themselves supervise treatment. Well, the idea behind this is to enable people to escape the stigma around TB which makes them uncomfortable in visiting hospitals or healthcare centres,” says Sandeep.
Leveraging technology to track progress
Operation ASHA uses technology to ensure increased efficiency and accuracy throughout the process.
Every health worker is given a tablet and encouraged to download eDetection — an algorithmic questionnaire designed to help detect tuberculosis. The app analyses the individual’s responses to track possible carriers of the disease, based on which the person can be further tested. Not only does this put positive patients on the geo map using GPS, but eDetection also locates communities with greater risk of infections.
A health worker showing short videos about tuberculosis to spread awareness in the community.
e-Compliance is another tool that the NGO has been relying on to monitor the progress of TB patients.
“We created a biometric terminal that works as a fingerprint reader and an iris scanner. Both the patient and the health worker register with e-Compliance. Using an alert system, it drops reminders about medications to be taken and also missed doses. This, in turn, spurs more people to stick with the treatment regimen, and enables better monitoring of the progress being made,” Sandeep adds.
Fingerprints of a TB patient being captured as part of e-Compliance.
Since its inception, the organisation has touched the lives of 1.05 lakh people with a treatment success rate of over 85 percent, and a loss to follow up of less than five percent. This number is much lower than the programmes which are being run elsewhere in the globe. In the process of doing this, Operation ASHA has screened nearly 7.7 million individuals.
(Edited by Suman Singh)