Operation ASHA is an organization that works in India and Cambodia to eradicate tuberculosis. Through effective implementation of a last-mile service model, Operation ASHA has managed to serve millions of at-risk people and has treated over 32,000 tuberculosis patients. In Cambodia they work in 8 provinces, 18 operational districts, and serve approximately 20% of the total population.
The tragic legacy of the Khmer Rouge regime continues to trouble Cambodia. With the highest rates of TB infection in the world, Cambodia has a weak healthcare system that is unable to adequately cope with the TB crisis. As a result of this reality, there is ample room for Operation ASHA to grow its TB treatment program and broaden its services to address deficiencies in fields like maternal health care and microfinance. Their efficient and effective TB program puts Operation ASHA in a strong position to expand into these new fields, serving both current and new populations in many ways.
At Operation ASHA we conducted research on the expansion of current services. A survey was administered to 5 operational districts in Phnom Penh and resulting research focused primarily on maternal and child health and microfinance opportunities. We aided in the development of a series of TB education and awareness videos for indigenous populations in Cambodia’s Mondulkiri province. We interviewed film studios, drafted the tender offer document, and created a draft of the script. This research yielded data in two forms. Quantitative data was collected from the potential services survey that was automatically analyzed through the data collection software Magpi. Qualitative data was collected from interviewing field staff, film studios, and field notes taken in Mondulkiri, Phnom Penh, and Sihanoukville provinces. This data was used to develop the infographic and the video series.
Patients of OpASHA typically experience shorter time between infection and the start of treatment, a treatment that is entirely free of charge, management of treatment side-effects, lower default rates, and, as a result shorter treatment courses than patients in Cambodia’s National TB Program. OpASHA is able to provide these benefits through 3 main channels: active and enhanced case-finding, reducing patient interaction with government entities, and providing patients with support for treatment side effects. OpASHA’s model has these advantages over Cambodia’s National TB Program, increasing its value, both as an organization and for patients.
OpASHA is in a strong position to expand its services beyond just TB care. Our research showed two main avenues for expansion that are both feasible given OpASHA’s core competencies and necessary, based on the needs of the communities they serve: Microfinance and Maternal and Child Health. OpASHA’s model is unique due to the strength of its relationships with the communities it serves. It has already built up trust within these communities, which gives the organization the ability to easily expand into new ventures. The effectiveness of its community-based TB education and awareness meetings show that it would be able to transfer this model into new health topics, particularly maternal and child health.
Maternal Health Care Survey and Grant Proposal
Our survey identified gaps in rural health services, which we then matched with services Operation ASHA could provide. We determined maternal healthcare was an area that could be targeted effectively, develop several potential interventions, and wrote a proposal for a grant that would fund Operation ASHA’s maternal health project pilot.
USAID Video Request for Proposal
The USAID Video RFP is a 10 page document that provides the details for the production of several TB education videos. This document contains an overview of effective techniques to raise TB awareness among indigenous populations, the evaluation criteria for potential bids, FAQs, and a draft of the film’s script. It is intended for film studios that would like to produce this series of videos for Operation ASHA.
Best Practices for Reducing Missing Cases
TB has many behavioral and biomedical risk factors, some of which are overlooked in current screening guidelines. We researched and developed a new set of guidelines that account for these risk factors. The end product of this analysis is a set of screening practices that Operation ASHA could implement to find and treat more TB patients.
OpASHA’s Program vs. Cambodian National TB Program Infographic
This infographic allows readers to guide themselves through two potential TB treatment programs, Operation ASHA’s model and the national TB program. Readers are shown the outcomes of each option and the value-added by Operation ASHA’s model.