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. 2019 Dec 29;9(12):e033158.
doi: 10.1136/bmjopen-2019-033158.

Cash transfer scheme for people with tuberculosis treated by the National TB Programme in Western India: a mixed methods study

Bharatkumar Hargovandas Patel  1 , Kathiresan Jeyashree  2 , Palanivel Chinnakali  3 , Mathavaswami Vijayageetha  4 , Kedar Gautambhai Mehta  5 , Bhavesh Modi  6 , Paragkumar Dhirajlal Chavda  5 , Paresh V Dave  7 , Chintu Chhitabhai Zala  8 , Hemant Deepak Shewade  9   10 , Dipak M Solanki  11 , Ajay M V Kumar  9   10   12
Affiliations

Cash transfer scheme for people with tuberculosis treated by the National TB Programme in Western India: a mixed methods study

Bharatkumar Hargovandas Patel et al. BMJ Open. .

Abstract

Objectives: This study aimed to assess the coverage and explore enablers and challenges in implementation of direct benefit transfer (DBT) cash incentive scheme for patients with tuberculosis (TB).

Design: This is a mixed methods study comprising a quantitative cohort and descriptive qualitative study.

Setting: The study was conducted in City TB Centre, Vadodara, Western India.

Participants: We used routinely collected data under the National TB Programme (NTP) on patients with TB notified between April and September 2018 and initiated on first-line anti-tuberculosis treatment (ATT) to assess the coverage of DBT. We interviewed NTP staff and patients to understand their perceptions.

Primary and secondary outcome measures: The study outcomes are receipt of DBT (primary), time to receipt of first instalment of DBT and treatment outcome.

Results: Among 1826 patients, 771 (42.2%) had received at least one instalment. Significantly more patients from the public sector had received DBT (at least one instalment) compared with those from private sector (adjusted relative risk (adjRR)=16.3; 95% CI 11.6 to 23.0). Among public sector patients, 7.3% (49/671) had received first instalment within 2 months of treatment initiation. Median (IQR) time to receipt of first instalment was 5.2 (3.4, 7.4) months. Treatment in private sector, residing outside city limits and being HIV non-reactive were significantly (p<0.001) associated with longer time to receipt. Timely and sufficient fund release, adequate manpower and adequate logistics in TB centre were the enablers. Inability of patients to open bank accounts due to lack of identity/residence proof, their reluctance to share personal information and inadequate support from private providers were the challenges identified in implementation.

Conclusion: During the early phase of DBT implementation, the coverage was low and there were delays in benefit transfer. Facilitating opening of bank accounts for patients by NTP staff and better support from private providers may improve DBT coverage. Repeat assessment of DBT coverage after streamlining of implementation is recommended.

Keywords: bank account; cash transfer; nikshay poshan yojana; operational research; private healthcare sector.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Process of approval and transfer of cash incentive to patients with tuberculosis under the direct benefit transfer (DBT) scheme in India, 2018.
See this image and copyright information in PMC

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