eCompliance has dramatically increased adherence among tuberculosis (TB) patients who have to take up to 75 doses under observation of a health worker, over 6 months.

eCompliance consists of a 7” Android tablet connected to a commercial finger print reader. The tablet has a SIM card, which communicates data to a server every 20 minutes, which then collates it in an Electronic Medical Record System (EMR).

Every patient is registered in the tablet with fingerprints. The entire treatment algorithm is built in the tablet. When a patient misses a scheduled meeting with the health worker, an alert is sent to everyone including the patient (with prior permission), health worker and supervisor. The worker has to phone or meet the patient within 48 hours, provide the dose, provide further counseling and convince the patient to re-join the therapy. This meeting is recorded with simultaneous fingerprints of the patient and worker. eCompliance also records worker attendance and eliminates absenteeism. It also records geo-locations of patients/ workers. EMR collates all data and generates all reports automatically.

eCompliance can be applied to any disease that needs long term care.

Adherence is a key issue in managing many health issues like HIV/ AIDS, ante-natal care, vaccination, diabetes, heart care, hemophilia and more so TB. In the case of TB, a lack of adherence leads to the dreaded forms of Drug Resistant TB, which is becoming a serious epidemic.

“We are on the brink of another epidemic, and it has no treatment. If Totally Drug Resistant TB spreads, we will go back to the Dark Ages” TIME, March 04, 2013

TB kills one person every 20 seconds and is no more the problem of the poor, that it was supposed to be. It also ravages the developed countries now, from where it had nearly been eradicated 50 years ago. TB also causes serious human rights violations, with hundreds of thousands of female patients abandoned by families to die of disease and starvation. Millions of children join labor annually to support parents suffering from TB. This is the reason why eCompliance had originally been  designed to tackle TB. Its upgrade to other diseases is planned.

The cost of hardware & installation for each eCompliance unit is $222. For this, the life of a tablet has been assumed as 18 months. Usually the tablets last a little longer. So, theactual cost may be a little lower.

The cost of internet connection & maintenance / trouble shooting is $276 for the life of the unit (18 months). This brings the total cost to $498. Based on actual patient load in Operation ASHA, the cost of treating each patient for DST/normal TB is $14. This is a tiny fraction of the cost incurred by most organizations treating a patient (which was $2,458 is a recent study: Kranzer et al, (2012), PLoS Med, as an example).

eCompliance also increases productivity of field/ management staff. In Operation ASHA, this saves $694 per unit. Thus, the proper use of eCompliance not only improves adherence, reduces default in TB treatment, improves treatment success rate, it also reduces cost and improves financial sustainability. A win-win situation for all.

Stage of development: ready for serial production

Operation ASHA was called ‘Microsoft’ of the NGO World by Country Director of the World Bank. In an earlier occasion, he had said that if Operation ASHA’s “model could be rolled out everywhere where there is TB, we could stop multi-drug-resistant TB and save so many lives. …ASHA means hope. Hope for millions of TB patients. But it can be even more: hope for millions of others who need services, all over the world” .

Key Facts

Organization: Operation ASHA
Contact person: Sandeep Ahuja
Used in: India, Uganda, Dominican Republic, Cambodia, Kenya

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