How do innovators build networks and leverage them for impact? To answer this question, we spoke with Dr. Shelly Batra, co-founder and president of Operation ASHA, an NGO based in New Delhi, India that is transforming the way tuberculosis (TB) treatment is delivered—and winning the battle against drug-resistant TB as a result. Operation ASHA was recently granted $100,000 as part of the World Bank’s Development Innovation Award and was also nominated for The Rockefeller Foundation’s Next Century Innovators Award.
Operation ASHA’s model: Working with Governments and Technology to Fight TB on a Community Level
Operation ASHA is working with the governments of India and Cambodia to make TB treatment accessible to the poorest of the poor. Worldwide, TB kills 1.4 million people annually, and India alone carries 25 percent of the world’s total burden. The Indian government distributes free TB medicine, but patients must travel to treatment centers to take their medicine on the spot, a part of the World Health Organization’s recommended treatment strategy, called Directly Observed Therapy (DOTS).
However, poor patients are often located long distances from these treatment centers, and completing the full course of treatment requires 40 trips over a six-month period. Faced with the choice between earning money to feed their families or spending time and resources to travel long distances to receive their medication, many poor patients simply choose not to travel. Missing doses at any point in the treatment risks the development of multi-drug resistant TB (MDR-TB), or even a “super strain” of TB with no known cure.
Operation ASHA is tackling this problem by helping the medications reach the patients where they work and live, enabling patients to fully complete the DOTS therapy protocol. Operation ASHA has established a dense network of TB treatment centers within the existing infrastructure of slums and villages, local level networks of temples, community clinics, and shops that are within a 10-minute walking distance for patients allow easy access to the needed medication. In rural areas, a mobile provider on motorcycle (or in a boat, as in the case of some areas in Cambodia) visits patients individually and administers each dose. A key component of ensuring these local networks are reliable, Operation ASHA’s eCompliance system, which uses biometric technology, records the patient’s fingerprint every time he or she receives a dose of TB medication.
Tapping Local Networks to Create Effective Solutions on the Ground
As a networked innovator, Operation ASHA relies upon local contacts to grow its solutions from within the communities it serves—a must for creating sustained impact and for replicating its solution in new regions. Working with community leaders allowed Operation ASHA to gather the contextual knowledge needed to replicate its initial pilot center to serve more than 3,000 communities across eight states in India, as well as two provinces in Cambodia.
“Our DOTS providers and program managers are hired from the communities we serve, because they understand the people and the environment.”
Each community presents a unique context with unique needs for making TB treatment as accessible as possible. Local networks provide such critical knowledge so that Operation ASHA can innovate according to the needs of its beneficiaries.
“Our DOTS providers and program managers are hired from the communities we serve, because they understand the people and the environment,” said Batra. “Without this understanding, we would not be able to find sustainable, effective solutions tailored to that particular community.”
Trusted local providers also have the ability to detect and refer new cases for diagnosis, speak to families about TB, and to decrease its stigma so that patients get the support they need. Furthermore, locals have the unique geographical familiarity needed to navigate slums and remote villages, where house numbers or marked streets are often absent.
Operation ASHA’s ground level networks also include government staff, such as lab technicians and district TB officers, as well as WHO experts, who provide auditing and feedback on best practices. Thus, Operation ASHA’s vast field network is a valuable resource for both solution execution and understanding problems, needs, and opportunities for expansion or improvement.
Tapping Global Networks to Leverage Strengths and Expand Opportunities
Like many other networked innovators, Operation ASHA isn’t just tapped into support and feedback systems on the ground. It also nurtures relationships with other organizations that support its impact in a variety of ways. The governments of India and Cambodia provide critical resources—TB medication, diagnostics, and medical services. Microsoft Research helped develop Operation ASHA’s biometric eCompliance technology, while USAID and MIT conducted randomized controlled studies that have confirmed the effectiveness of Operation ASHA’s model. Network partners like the World Bank have provided funding that has helped Operation ASHA to further strengthen its network. (A complete list of partners that have been critical to Operation ASHA’s impact can be found here.)
“We have been able to acquire funding, because we believe in measurements. If we do not measure results, we cannot anticipate needs, nor make correct decision.”
Because Operation ASHA could document its outcomes through its eCompliance system, it was able to tap into donor partners who wanted measurable impact. “We have been able to acquire funding, because we believe in measurements. If we do not measure results, we cannot anticipate needs, nor make correct decisions,” Batra said.
Collaborating with Networks for Future Growth
Looking forward, Batra envisions collaborating with other NGOs as the next step toward replicating Operation ASHA’s model in other countries and for other health applications. Researchers from Columbia University’s Earth Institute have already piloted Operation ASHA’s model and reported promising results.
“Whether we are working in TB, education, or nutrition, the end goal is ultimately the same–to provide comfortable, healthy, happy, lives and livelihoods. Once we accept that, there should be no difficulty in partnering with each other.”
“I envision sharing our best practices and our model with other NGOs across the world so that they can achieve our results using their own personnel,” Batra said.
Batra also sees an opportunity for organizations like The Rockefeller Foundation to work together and promote best practices across the globe. “Because to fight TB, we don’t need a new discovery at this point—we need a large scale implementation of existing technology and funding so that low-cost, high impact models can replicate.”
We asked Batra if she found it difficult to partner with other organizations. Her response was that collaboration was simply part of Operation ASHA’s DNA. “We believe in collaboration, and that working with other like-minded people enables you to leverage your own strengths, as well as those of others,” Batra said. “Collaboration creates better value for the dollar.”
Her advice for seeding partnerships? Focus on the commonality of each organization’s goal. “Whether we are working in TB, education, or nutrition, the end goal is ultimately the same–to provide comfortable, healthy, happy, lives and livelihoods. Once we accept that, there should be no difficulty in partnering with each other. Let’s focus on the person who needs our help. The work is unlimited.”
Learning From Operation ASHA, a Networked Innovator
Operation ASHA maintains a robust network of diverse players, each of whom helps the organization achieve its mission in a unique way. Here are some key steps that you might follow to leverage networks to create greater impact:
- Prioritize working with networks and build a collaboration model, or the co-creation of new solutions, into your strategy for achieving impact.
- Build a diverse network with a wide array of expertise, and frequently canvass your network in order to tap experts who can fill your gaps in knowledge, capacity, or resources.
- Nurture both ground-level partnerships, as well as larger strategic partnerships. The deep contextual knowledge for successful solution implementation can be coupled with extended access to resources, and beyond.
- Seek frequent feedback from your networks to gain valuable insight from diverse vantage points. Consider hosting a peer review to generate in-depth discussion about specific questions you need answered. Then act on the results.