Dr. Shelly Batra is one of three experts contributing to a conversation about improving access to medicines through innovations in information and communications technologies (ICT), hosted by The World Bank's online forum, Striking Poverty. Dr. Batra is the president of Operation ASHA, a SEAD Innovator Operation and non-profit organization providing tuberculosis treatment to over 2,000 villages and slums in India and Cambodia. She discusses the innovative technologies Operation ASHA uses to improve the TB treatment: increasing drug adherence, accountability, and transparency within the organization.

"[The eCompliance system] facilitates providing accessible services and alleviates many of the boundaries between patients and them receiving treatment."

Operation ASHA's technology initiative, eCompliance, is a biometrics terminal which uses an android phone connected to a fingerprint reader. When patients come to treatment centers to take a dose, their fingerprint is taken. When they miss a dose, an SMS notification goes to community health care workers called Providers, who follow up with those patients at their homes, bringing with them a similar eCompliance unit. The system helps ensure both accessibility and complete adherence to the drug regiment, which is critical for preventing the development of drug-resistant TB due to incomplete treatment. The system also prevents Providers from gaming the system to take advantage of incentives given for following up with a patient.

"An important aspect of any technology device is its ability to 'fit' into the socio-cultural environment where it shall be used."

Dr. Batra makes the above statement and goes on to discuss how the eCompliance innovation is particularly effective in the regions Operation ASHA services. In her meetings with Microsoft Research, the developer of the eCompliance system, Dr. Batra stressed the importance of an inexpensive device with easy-to-replace parts.  She notes that technologies must be financially viable to be effectively scaled. The system design features a color coded interface and minimal text, requiring minimal training. This makes the innovation adaptable to other cultures and languages, so it can be scaled to other countries around the world. The eCompliance system takes advantage of widespread network coverage in India by depending on SMS, which has a negligible cost.

"Technology empowers community health workers in more ways than one. It adds to their respect in the community, makes work simpler, prevents human errors, saves time, and most important, prevents the dreaded Drug Resistant TB, which occurs because of incomplete treatment."

Operation ASHA's successful eCompliance system can serve as a model for developing health innovations around the world. Read the full discussion, including the comments, to learn more about information and communication technologies and creative solutions for addressing access and scaling challenges.

This post was originally posted on OpAsha.org under the title "September 4, 2013: Dr. Shelly Batra, Operation ASHA president was invited to speak at Speaker’s series of USAID." To read the original post, click here. 

USAID organizes a monthly talk named Speaker’s series where they discuss about health, education, water & sanitation related issues and find out the best approach to solve them.

Dr. Shelly Batra was invited by Madhumita Gupta, Chief Economist of USAID mission to present Operation ASHA’s game changing innovations at the Speaker’s Series, organized at the USAID mission office on September 4, 2013.

Officials from USAID Afganistan and USAID Cambodia also attended the discussion through video conference and took a lot on interest in Operation ASHA’s work. They discussed about Operation ASHA’s model and how Operation ASHA achieved this stability and success.

Next discussion will take place on October and the topic will be Leveraging partnership for better health.

To download the presentation as PDF, click here

Duke-Engineering World Health Summer Institute is a two month program (May 23rd to July 28th) in a developing country, which consists of fixing broken medical equipments in hospitals as well as training the technicians in the use of these equipments. I am going to share my summer experience in Nicaragua. We spent the first month in Granada. We had four hours of intense Spanish classes in the morning followed by Medical Instrumentation lecture and lab in the afternoon. There were five levels in the Spanish class and students were placed in them according to their expertise. I was placed in the first level (beginners). We also had weekly presentations in Spanish. Another unique experience in this program is staying with a local family. This is something I really enjoyed since it gives an opportunity to explore and learn a new culture. My homestay partner Mark and I stayed with Maria and Raquel. They own a hardware store in the city. We used to discuss different topics like the political history of Nicaragua with them in Spanish during dinner. This improved our Spanish and also helped us to know more about the country. I used to play ping pong and soccer with the kids in the night.

The program coordinator organised a hospital visit on every Friday. Our technical instructor showed a demonstration of the different medical equipments in the hospital. These hospital visits were very helpful and supplemented well with the medical instrumentation lectures. Mark and I travelled quite a bit during the weekends to explore the country. We visited the Ometepe islands, Masaya volcano, Matagalpa and Esteli. My favourite among them was Matagalpa which is very famous for its organic coffee. Matagalpa is one of the most beautiful cities in Nicaragua and is known as the “Pearl of the North” and “Land of Eternal Spring”. The weekends were generally very relaxing.

A recent study by the Public Health Foundation of India reveals that India faces a critical shortage of over 6.4 million healthcare workers. Even with medical supplies and technology available, it is impossible to have a working health system without dedicated doctors and nurses to provide care. Low-income countries or rural regions face particular challenges recruiting and retaining healthcare workers, which only serves to exacerbate health care disparities.

SEAD Innovator Vaatsalya is a network of primary and secondary care hospitals providing affordable healthcare in semi-urban and rural areas of India.  As Vaatsalya works towards its goal of expanding to 20 hospitals in southern India, the organization understands that the key to success lies in low employee turnover and well-trained workers.

A blog post by the International Partnership for Innovative Healthcare Delivery (IPIHD) identifies five barriers to employee retention faced by organizations: relationship with the manager, respect in the workplace, satisfaction with compensation, interest in living in a rural area, and opportunities for learning.

IPIHD Project Manager Anne Katharine Wales met with Vaatsalya's new human resource director to learn about the strategies they are using to overcome these challenges. The HR team identified three key company values which improve employee satisfaction, translating into better healthcare services for their patients:

• Ensure that all employees feel valued and understand how their work contributes to excellent patient care.
  
• Motivate employees through attainable future growth opportunities within the organization.
  
• Provide a highly transparent organizational structure.
  

Vaatsalya's new system provides an inspiring model for keeping costs low and retaining motivated employees. 

In a speech at Duke University's Sanford School of Public Policy, Administrator of the U.S. Agency for International Development, Dr. Rajiv Shah, highlighted the Social Entrepreneurship Accelerator at Duke (SEAD), Duke, and the Research Triangle Park as one of the hubs working to solve global challenges through innovative and entrepreneurial solutions. To read his full remarks, click here, or watch the video below. 

Andrea Coleman and her husband, Barry Coleman, witnessed firsthand the upsetting reality of an inefficient healthcare delivery system when they watched a hemorrhaging patient be transported to the clinic in a wheelbarrow. On their visit to Somalia in 1986, the Colemans took note of the transportation challenges they saw and returned to England committed to improving the situation.

Inspired by Andrea's interest in racing motorcycles, the Colemans developed an innovative solution to bridge the gap between communities and health care services. Riders for Health manages a fleet motorcycles, ambulances, and other vehicles and provides training and vehicle maintenance services.  Their organization builds a reliable and scalable  delivery system operating in seven African countries and reaching more than 12 million people. The impact is astounding; in Zimbabwe, malarial mortality rates in districts served by Riders for Health programs dropped over 60%.

Jeff Skoll and Sally Osberg, authors of the CNN article linked below, "Social entrepreneurs dare to change the world," point to SEAD Innovator Riders for Health as a prime example of the difference that social entrepreneurs make. The Skoll Foundation praises and supports the work of creative and dedicated innovators who engage citizens, businesses, and governments to develop sustainable solutions to the world's problems. 

Last spring I attended a lecture given by a successful social entrepreneur in the space of global health. During his presentation he showed a picture similar to this:

The presenter, in his Lincolnshire accent, explained that this sheep is far-welted.  With a heavy coat of wool, once turned over the sheep cannot get back up. It will remain like this until it dies. The presenter then likened this far-welted sheep to UN organizations. And the sheep in the background looking on, he said, represent other UN agencies and NGOs, interested, even concerned, but idling.

This summer as a Duke Global Health Fellow and recipient of the SEAD Global Governance and Policy Scholarship, I have been interning at the World Health Organization in the Department of Public Health Innovation, and Intellectual Property and Trade, where I have been testing first-hand the analogy of the far-welded sheep.

My first exposure to Global Health Policy in Geneva was at the World Health Assembly (WHA). This WHO annual meeting brings country delegates together to define the organization’s annual agenda.  Not just a logistical challenge, the WHA is an amazing exercise in diplomacy, negotiation and networking. Each resolution passed must receive a unanimous vote of approval.

Watching the delegates spend hours debating single phrases, “work vs. mandate” or “transform versus establish” tested my own patience. It also meant a lot of time was spent with very little output. The process certainly seemed to resemble the far welded sheep, legs kicking, but going nowhere. Moreover, I was surprised that the Secretariat (the WHO employees who live these issues everyday) were relegated to the role of onlooker. They uphold the parent-child ultimatum,  “Do not speak unless spoken too.” This is part of their mandate as international civil servants. UN employees are “prohibited from any action or influence that would suggest affiliation with a government or organization.” Does that mean they really are the on-looking sheep?

From the outside the far-welted analogy was looking all too accurate.

At the conclusion of the WHA, I became emerged in my work. My project was to collect research priorities and prioritization methods from across the organization. This information would feed into the larger effort (a Consultative Executive Working Group report) of incentivizing research into neglected areas through innovative partnerships and financing methods.

This assignment was an incredible opportunity to see how the WHO directs and coordinates international health.

1. Shaping the Research Agenda: Research Priorities

I attended parts of a 3-day Tuberculosis research priority-setting meeting.  As I read through the program, I was impressed by the guest list of star-studded TB experts, including academics, executives from Product Development Partnerships (a type of public–private partnerships that focuses on drug, device, and vaccine development), Non-Governmental Organizations, governments and civil society (activists) representatives. For three days, these experts presented, discussed and developed a list of high priority research needs for the areas of basic science, product development, and health system strengthening, focusing on the most urgent research needed to eradicate TB.

The WHO’s power to convene the best minds to address health challenges is incredible and perhaps, unsurpassable. This meeting was just one of many that convened during my time at the WHO.

This summary provided by SEAD Student Assistant Lizzy Knippler, Duke '16.

Changamka Microhealth is revolutionizing the way clients can save money for health services.
In 2008, founders Zack Oloo and Sam Agutu launched Changamka Microhealth, an integrated health financing company that utilizes an electronic platform accessible by mobile phones, to facilitate the financing of healthcare services for the working poor in Kenya.

Their "smart card" allows Kenyans to set aside small amounts of money over time to cover the costs of outpatient services, drug prescriptions, and consultations when health issues arise. The company also offers a separate maternity card and a family health care plan; to date they have sold 3,000 maternity plans and 12,000 family health plans.

Oloo and Aguto spoke with BBC journalist Jonathan Kalan about Changamka's success and their hopes to reach more of Kenya's uninsured.

This summer, funded by SEAD, I participated in Duke’s Global Health Fellows program in Geneva, Switzerland. As part of the fellowship, I interned at the World Health Organization (WHO), took coursework on Global Health Policy and Governance, and met a variety of leaders actively engaged in international health. 

Nearly three years ago I applied to the Health Sector Management program at Duke’s Fuqua School of Business School and wrote in my application essay about my “long-term goal of working with a multinational aid organization, such as the World Health Organization” and how I hoped a Duke education would prepare me for such a role.

You can imagine my excitement, as I boarded a plane for Geneva, Switzerland (home to the World Health Organization) this past spring, only two days after graduating from Duke’s Fuqua School of Business.

As a business student, I had worked with social entrepreneurs and global health projects in Rwanda, India and Ecuador. In these roles, I encountered many international NGOs and their easily identified white, 4X4 vehicles. Previously, as a pediatric nurse, I had looked to the same organizations for advice and guidelines on particular health topics. Nonetheless, my understanding of these large organization’s function and purpose was limited. As I looked to create a career in Global Health, I felt I needed a more comprehensive understanding of global health policy. So, while the rest of my classmates enjoyed post-graduation celebrations, I happily journeyed to Geneva.

Interning at the WHO:

 I arrived two days before the annual World Health Assembly (WHA) conference during which delegates from every country descend on Geneva to set the WHO’s work agenda for the upcoming year – and, hopefully, follow these mandates with financial donations to cover their cost.

The WHA was an eye-opening experience in diplomacy, negotiation and international relations. Each resolution requires unanimous approval - approval that is usually preceded by long discussions to ensure accurate wording, integrity to political aims, and equity in delivery. The output creates a framework to guide the Secretariat (i.e. WHO employees), ministries of health, and other public health organizations.

During the WHA lunch breaks, side meetings and evening events, I enjoyed meeting delegates from all over the world and discussing their countries’ health concerns. One discussion I had was with the US health attaché, Colin McIff. From him I learned about the challenge of making sure all parties in a negotiation have something to show for their effort. Mr. McIff also said that lack of agreement isn’t always a loss, as it provides valuable insight into understanding other’s views.

Below is a recap of this year’s Global Health Fellows Program provided by Anthony So and Will Woodhouse, and summarized by SEAD Student Assistant Lizzy Knippler: 

This year's Global Health Fellows program class of 23 fellows was our largest class ever. It included 3 current and former Duke students, partially supported by USAID grants, including a Master of Science in Global Health student and a Sanford and DGHI graduate.

Our fellows kicked off the summer in mid-May, when many arrived in Geneva to take part in the 66th World Health Assembly (WHA). The fellows worked in a broad range of internships, including the World Health Organization, World Trade Organization, GAVI Alliance, World Heart Federation, UNAIDS, UN Development Program, UN Environment Programme, International Organization for Migration, and UN High Commission for Refugees. 

Once in Geneva, the Program made special arrangements to host President Richard Brodhead with a reception overlooking Lake Léman at the home of a Duke Alumna. Duke graduate students, faculty, and alumni were also in attendance.  Additionally, Sanford Director of Graduate Studies, Mac McCorkle attended events throughout the week, including our course seminars and site visits.

Our staff led the one week capstone course, "Health Policy in a Globalizing World." The course included 15 expert seminars on topics such as Innovation + Access, a new international R&D framework, Global Mental Health, Noncommunicable diseases, and Human Resources for Health. Alongside the seminars, the program organized 10 site visits to organizations in Geneva, including GAVI, MSF, WHO SHOC room and World Polio Eradication Initiative. 

The fellows also met with many of Geneva's leading policymakers during mentorship dinners, including TDR Director (John Reeder), Executive Director of UNITAID (Denis Broun), Silas Holland (Duke graduate and Global Fund Specialist), and Nina Schwalbe (Managing Director of GAVI Alliance Policy and Performance Unit). 

 The week was capped off by our participation in the Trilateral Symposium on Medical Innovation- New Business Models, hosted by WHO, WTO, and WIPO. All three Director Generals spoke to the symposium, which provided another unique opportunity for our fellows to learn and interact with lead policymakers in the field. Duke Professor Anthony So presented at the Symposium on the need for innovative business models through the lens of Antibiotic Resistance, highlighting the reasons for the current dearth of novel antibiotics in the pharmaceutical pipeline currently and providing a framework for rethinking the models of antibiotic R&D. His talk generated much interest and was picked up by many outlets, including the White House Office of Science and Technology Policy, which contacted the Program last week for guidance on how to move forward with federal action on antibiotic innovation.

For those interested, the full symposium program, including video and slides, can be found here.