76% of TB patients received payment for nutritional support Premium

Analysis of Ni-kshay Poshan Yojana direct benefit transfer program for TB patients in India, highlighting delays and improvements.

If in 2022 only 1.6 million (66%) of the 2.4 million notified TB cases received at least one month’s payment of ₹500 under the Ni-kshay Poshan Yojana direct benefit transfer programme for nutritional support as per the India TB report 2023, a study that analysed the data of nine States found that in 2022 76.1% of TB patients received at least one month’s payment, up from 56.9% in 2018. Though the time taken to receive the first payment has reduced since 2018, more than 50% of patients had to wait for over three months in 2022 to receive the first instalment. The study which analysed the data from 2018 to 2022 of nine randomly selected States — Tamil Nadu, Telangana, Odisha, Bihar, Gujarat, Rajasthan, Uttarakhand and Meghalaya — were published recently in the journal BMC Public Health. The study was conducted by researchers at the Chennai-based National Institute of Epidemiology. 

The States were classified as high, medium and low based on the overall performance of the NTEP in the given State. States with a TB score of over 80 were grouped under high, while those with a TB score between 60 and 80 were classified as medium, and States with a score of less than 60 were clubbed under low. Three States from each category were randomly selected. Delhi, Rajasthan and Bihar had TB scores less than 60, while Uttarakhand, Telangana and Tamil Nadu had medium TB scores, and Meghalaya, Odisha and Gujarat had high TB scores of over 80.

In 2022, Delhi (67.2%) followed by Tamil Nadu (45.3%) and Gujarat (45.2%) recorded the most improvement in cash disbursement at the end of five years. Odisha and Uttarakhand, which had a high TB score of 85.1% and 72.9% respectively in 2018, reported a further 10% increase in performance in 2022.

If the median time to receive the first instalment was 200 days in 2018, it reduced to 91 days in 2022. TB patients in Odisha and Tamil Nadu experienced the shortest delay of 63 and 68 days, respectively, in receiving the first instalment, while TB patients in Delhi experienced the longest delay of 136 days. TB patients from the private sector experienced a longer waiting time of about 107 days. Similarly, HIV-reactive (either HIV positive or false positive), those with drug-resistant TB, and undetermined diabetes experienced longer delays of 103.7, 104.6 and 115.3 days, respectively.

The study notes that two-thirds of the patients with unfavourable treatment outcomes received their first instalment after the outcome was declared. The very purpose of the programme is to improve treatment outcomes by providing better nutrition thereby improving immunity, ability to tolerate anti-TB drugs and therefore improve adherence. By delaying the disbursement till treatment failure sets in, the very purpose of the cash transfer programme for nutritional support stands defeated. “It is possible that these unfavourable outcomes could have been prevented by timely disbursal of benefits. The delay can also push them into financial catastrophe,” the authors write.

Under the Ni-kshay Poshan Yojana programme, Rs.500 per month is credited into the account of a person with TB for the duration of treatment. Among those who received at least one instalment, the percentage of patients who received ₹3,000 or more in 2018 was 64.6%, which increased to 76.8% in 2021, and 67.5% in 2022.

“NTEP has to focus on timely transfer of benefits to enable patients to meet their additional nutritional demands, experience treatment success and avoid catastrophic expenditure,” they write.