The program- Incentives
Operation ASHA hires community-based health workers, who are each responsible for operating two DOTS centers. During the first three months, CHWs all receive a fixed salary. Indeed, centers often take a slow start, irrespective of the involvement of the CHW. This initial 3-month period also enables the CHWs to get their bearings in a new place and for the center to be identified by the population. The experiment starts after the initial three months of a center lifespan. Between 3 and approximately 9 months, CHWs have to grow their center until they have reached the optimal size (not more than 50 patients), where they are cost-effective and where patients can be effectively followed-up. Half of the CHWs, randomly chosen, receive a fixed component and a variable amount based on their performance regarding detection of new patients, while the other half receives a fixed salary.
After nine months of work, CHWs should focus on preventing defaults. The CHW's compensation scheme is randomized again. Half of them receive a fixed salary for the following 6 months of their contract while the other half receive an incentivized scheme where the variable component no longer depends on the number of detections, but on the number of defaults they prevent. If the number of patients keeps growing, Operation ASHA opens a new center and the detection work is taken over by another CHW operating that newly open center.
These incentives (for detection) or penalties (for default) come in addition to a base salary, that guarantees the health workers that they will get a minimum amount for their work, whatever happens, and thereby contains the amount of risk and stress they are facing. The introduction of financial incentives explicitly linked to the outcome of their counselling work is aimed at increasing their motivation, effort, and performance, and in turn their impact on TB treatment in slums.
The Program- Biometrics
Additionally, there is a second intervention designed to enhance treatment compliance: biometric devices enabling to monitor the absenteeism of Operation ASHA’s health workers, as well as the pills intake by the patients, patient satisfaction, and patient health outcomes.Operation Asha (OA), developed a biometric identification system, eCompliance, based on a fingerprint scanner connected to a low-end computer and cellphone, which were randomly assigned to each counselor.