The SHOPS Plus team in India signed a contract with the pharmaceutical company Medlife International Private Ltd to launch an innovative, drug-to-doorstep e-pharmacy model to help the fight against tuberculosis (TB). The service delivery model was designed by the SHOPS Plus project as part of its work with the government of India to strengthen TB services through an e-pharmacy platform. The team developed an innovative e-pharmacy approach to provide doorstep delivery of anti-TB drugs and diagnostic services with the goal of increasing the use among the urban poor. The pilot with Medlife is being rolled out in the city of Jabalpur, with plans to expand throughout the state of Madhya Pradesh.
While the TB epidemic is declining in India, the country still holds the largest number of TB patients in the world, and half a million cases that go undiagnosed each year. Major barriers such as high costs and traveling long distances prevent patients from seeking proper care. Another barrier for patients who seek care is being sent to multiple facilities before receiving the correct diagnosis.
Role of the private sector
Over 80% of early care-seeking for TB occurs in the private sector. Because of this, and as part of its pledge to eliminate TB in India, the government of India has committed to providing free diagnoses and drugs for patients seeking care in both public and private facilities. However, private sector patients experience barriers to accessing the TB support provided by the government. SHOPS Plus is working to reduce these barriers by using technology to provide diagnosis and treatment support services to patients’ doorsteps, through an e-pharmacy model. This will help to increase access of TB services to patients in the private sector.
In the e-pharmacy model private providers can prescribe home sputum testing materials to presumptive TB patients. The test is completed in the comfort of the patient’s own home, and e-pharmacy agents will pick up the materials and deliver them to the lab facility. The lab uploads the results to the platform, where providers can view results and prescribe treatment electronically. Once verified by the e-pharmacy, agents will deliver the drugs directly to the patient’s home. The platform also features communication technology to follow up with patient’s treatment adherence and future orders.
Through the e-pharmacy pilot, SHOPS Plus is applying technology to increase access of TB services to patients in the private sector. By working closely with the state government of Madhya Pradesh since the beginning of this pilot, it has ensured that the e-pharmacy model fits the local context and has local government buy-in. Preliminary results of the pilot are being documented through observation and interviews in the field. One area where both providers and patients have seen important benefits of the e-pharmacy model is its ability to help overcome barriers to care caused by stigma. Aspects of the model such as at home sputum testing, private notification, and follow up messaging to ensure adherence to treatment help ensure patients who would not otherwise seek treatment for fear of being stigmatized by others in their community are still able to receive these life-saving services. The partnership created between Medlife and the government will be vital in scaling up this pilot in other states of India.