MOBILE BANKING IN TUBERCULOSIS DETECTION - BANGLADESH C. Kliesch
Demographics Population (in millions) 10 159 307 US Bangladesh North Carolina 0 100 200 300 400 www.cia.gov/ Census www.mapsof.net
Social Determinants GDP per capita - 2010 (US $) 673 9216 0 20000 40000 47184 Bangladesh World US Malnourished children under 5 (%) People in poverty (%) 40 57.8 World Bank, World Development Indicators Human Development Report 2011, United Nations Development Programme
Social Determinants Population density - 842 persons per sq. km Dhaka, Bangladesh, is estimated to grow to 50 million by 2015, with 21 million living in urban slums. Literacy rate- 34.6% Improved sanitation - 53% Prone to natural disasters Newborn care practices among slum dwellers in Dhaka, Bangladesh - BMC Pregnancy and Childbirth 2009, 9:54 Food and Agriculture Organization of the United Nations WHO / UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation
TB Incidence In 2008, the World Health Organization (WHO) ranked Bangladesh sixth among the world s 22 high-burden TB countries The TB mortality rate (45 /100,000) in Bangladesh is 45 percent higher than the Southeast Asian region average (31 /100,000). There are an estimated 426 TB infections per 100,000 people among a population of 148 million. 65,000 people die annually.
BRAC World s largest NGO with operations in 10 countries 1972 BRAC 1984 - BRAC started community-based health care 1994 added the National Tuberculosis Program in the implementation of DOTS Operates in 298 sub-districts (out of 483) with a population of 94 million, 85,000 shasthya shebikas (volunteer CHWs) Innovative Added 24 DOTS corner model, Programs in prisons and garment factories offers HIV screening tests for TB patients in some DOTS corners In 2010, BRAC treated 95,124 TB patients with a treatment success rate of 93%
BRAC's TB program Part of the Essential Health Care program Education, referrals and free treatment (DOTS) Incentive program: patient gives 200 Taka to CHW returned on successful completion of TB treatment CHW receives 150 Taka subsequent to successful treatment of a TB patient (approx $2.00)
TB treatment outcomes http://www.searo.who.int
TB detection rates Tuberculosis case detection rate (%, all forms) Why is detection so important? 64 62 Death Further spread of disease Economic impact 50 44 World Health Organization, Global Tuberculosis Control Report. Catalog Sources World Development Indicators
Challenges to detection Stigma Fear of losing job Marriageability Lack of knowledge Belief that TB is hereditary Belief that TB is fatal Lack of knowledge - doctors TB symptoms (especially in women) DOTS treatment
Mobile technology for detection A solution? Promising new practice Indus Hospital in Pakistan with support from Stop TB s TB REACH program Doctors and CHW are rewarded for screening patients and referring to TB centers, and for positive TB cases. Cell phones and mobile banking are used to track referrals and make monthly reward payment. Launched in January 2011, TB detection rates doubled in the first quarter of program implementation: From 200 cases to 420
Mobile Phone Subscribers in Bangladesh in millions 90 80 70 60 50 40 30 2027.72 34.37 43.7 44.64 46.69 52.43 59.98 68.65 76.43 82.44 10 0 Bangladesh Telecommunication Regulatory Commission 2011
Mobile banking bkash launched July 21, 2011
bkash Cash In Cash Out Payment Send Money Token
M-health & CHW Pilot program in July 2009 involved outfitting CHW with mobile phones and and included 18,000 households and 2000 pregnant women in Dhaka. Expanding to the entire city of Dhaka, and rural areas of BRAC Maternal Child Health programs.
Points of referral into TB treatment Village Doctors/ Pharmacists Community Health Workers shasthya shebikas (80,000) Private/public doctors FormerTB TBpatients patients Former Information $
Return on Investment Cost of DOTS treatment per patient < $100 For every 10 additional cases detected, an estimated 5 lives are saved and 100 infections are prevented.
Further uses of mobile tech Incentives to participants as a means to reduce stigma and increase treatment seeking Food for school program Distribute aid that supports local economy Haiti T-Cash mdots video compliance HIV/AIDS treatment adherence
Bangladesh can lead the way Bangladesh has so much to teach the world. United Nations Secretary General, Ban Ki-Moon