Fighting Tuberculosis with Innovation and Collaboration

Sandeep Ahuja is the CEO and co-founder of Operation ASHA, a non-governmental organization (NGO) that provides treatment, counseling, education, and supportive services to Tuberculosis patients in India and Cambodia. Ahuja holds a Master of Public Policy from the University of Chicago Harris School of Public Policy as well as a Certificate in Health Administration and Policy from the University of Chicago Graduate Program in Health Administration and Policy. Before founding Operation ASHA, Ahuja served as a Commissioner for the Indian government.

Operation ASHA’s mission is to eliminate tuberculosis (TB) among disadvantaged communities. Why did you choose to focus on TB as opposed to other infectious diseases that affect similar populations?

Before founding Operation ASHA, I collaborated with Dr. Shelly Batra, Operation ASHA co-founder, in organizing free consultations and surgeries for women in disadvantaged communities in South Delhi. Since beginning these services in 1998, we noticed that surgeries benefit the concerned persons and family greatly but have little advantage for the society at large in terms of positive externalities. This prompted our interest in pursuing a public health issue that would benefit both the individuals in question as well as the community at large.

Thus, when we founded Operation ASHA, the obvious choice was to focus on one big public health issue and tackle it comprehensively. There are a number of well-known public health issues plaguing the developing world. The first one that comes to mind is AIDS/HIV, but there are many large nonprofits and foundations that are focused on combating HIV, so Operation ASHA’s impact would have been more limited. Another major public health issue is Polio, which Rotary International has been working on it since the 1980s and has done an excellent job. Malaria is more of a sanitation issue, and, similarly, many outstanding organizations are hard at work to address this challenge.

Unfortunately, TB is a huge issue in India that not only has a tremendous adverse impact on the poor but has also been traditionally neglected because it is a disease of the poor. Noble Laureate Desmond Tutu calls TB “the child of poverty.” After conducting further research, we made the decision that Operation ASHA would focus on prevention and treatment of TB. In 2005, we founded Operation ASHA with the vision of a TB-free India.

How does Operation ASHA collaborate with other actors, such as the Indian government?

Operation ASHA works closely with the Indian government to fulfill our mission. In our early meetings with government officials, senior officers of the Ministry of Health stated their willingness to provide free anti-TB drugs to NGOs. In addition, TB patients are entitled to free tests and consultations at most government health facilities across the country. This was manna from heaven; the government was offering to cover two-thirds of the cost of TB treatment forever. What else could you ask for from a donor or partner?

On top of medicines and facilities, the government would also give service providers a small cash grant. With my experience within the government, I knew grants would take a long time to come, but I also knew that we would get them eventually. The government grant is an additional financial bonus and adds to long term financial sustainability of our programs.

We are also fortunate to collaborate with actors outside of India. For example, the Abdul Latif Jameel Poverty Action Lab (JPAL) at the Massachusetts Institute of Technology is currently conducting an independent evaluation of our treatment and operations model. We also partner with Microsoft Research to develop biometric devices to track patient compliance and consistency of treatment. These partnerships have helped Operation ASHA thrive.

Operation ASHA currently works in both India and Cambodia. How does your approach to addressing TB change in different national and cultural contexts? In what ways do challenges differ or remain consistent across different countries?

Our treatment model was developed in disadvantaged communities in South Delhi in 2006-07. I was personally involved with the entire process. Then, we expanded to states of Uttar Pradesh and Punjab in 2008, where again I was involved. Eventually, we also expanded into the states of Madhya Pradesh, Rajasthan, and Chhattisgarh. Through this process we discovered how replicable the treatment model could be, even in different geographic and cultural contexts.

It may be surprising, but the model is strikingly similar in both India and Cambodia. Even we are amazed how well Operation ASHA’s model has fit in Cambodia and delivered dramatic results. In 2010 we opened our first center in Cambodia. Today, Operation ASHA serves over one million disadvantaged people in 1,283 villages in Phnom Penh and Takeo.

I think it comes back to the comprehensive community involvement that the model is built on. Once you employ local youths, involve local leaders, use local resources, and instill the basic philosophy and scientific knowledge among them, they can address changes in national, cultural, social, and economic contexts. It also bears mentioning that of the nearly sixty-five people who make up the Operation ASHA staff in Cambodia, all except one are Cambodian.

Operation ASHA’s first seven years have been tremendously successful. How do you intend to build on this success and continue to combat TB?

We will start work in Vietnam in a few months, where the entire staff will be Vietnamese. The project will be headed by a Vietnamese professional who has worked with Operation ASHA in India for slightly more than a year.

We have found that Operation ASHA’s treatment model is highly amenable to replication. I dare say, it might be the easiest model to replicate anywhere in the world. It is no wonder that other organizations in Asia and Africa show interest in replicating our model.

Our hope is that Operation ASHA’s model and best practices will be adopted by hundreds of organizations across the world to improve results of TB treatment and simultaneously reduce costs. This is the best way to achieve the World Health Organization’s goal of TB eradication by 2050.

Feature photo: cc/bbaunach