A vociferous proponent of doling out cash for nutritional support of tuberculosis-afflicted patients, the Centre, in its latest report, has recommended that the cash support should be supplemented by food provision to patients.
Rethinking its existing policy of disbursing ₹500 a month to a TB patient, the Union Ministry of Health and Family Welfare (MoHFW) notes in the report: “While cash support via Direct Benefit Transfer (DBT) is proposed under the NSP, States have expressed a preference for in-kind nutrition support due to an existing concern about whether the beneficiary will use this monetary assistance toward nutrition. While cash transfers are believed to be the most feasible intervention, further evidence is needed on its efficacy and impact.”
The Centre launched the DBT programme in April.
Of the 36 States and Union Territories reviewed, only 16 — Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Delhi, Goa, Gujarat, Himachal Pradesh, Jharkhand, Kerala, Maharashtra, Meghalaya, Madhya Pradesh, Punjab, Tamil Nadu, and Telangana — have some kind of a Patient Support System (PSS) like nutrition or travel support or linkage to social welfare schemes, over and above the Central support, the report notes.
After conducting interviews in these States, the Ministry said patients prefer in-kind provision and have expressed a ‘feel good factor’ when consuming items that are otherwise out of their reach such as egg, milk powder, peanuts, and soyabean oil.
Evaluation mechanism
The Ministry has now recommended that a monitoring and evaluation mechanism be put in place to track progress and compare DBT versus in-kind support to understand which intervention works best. The dissatisfaction with implementation of the DBT has been immense, said a senior Ministry official.
The latest available numbers, accessed by BusinessLine, reveal a grim picture of poor implementation of the DBT. While 14,29,591 TB patients are eligible to receive ₹500 a month, the total number of beneficiaries who did get it between April and October was 2,69,942. “The major issue is that most patients do not have bank accounts, and opening new ones takes a few months,” the official said.
For 2018-19, ₹600 crore has been allocated for the DBT to TB patients registered for treatment with the Ministry. Official data show only ₹27 crore has been utilised in the past six months.
India alone shoulders a quarter of the global TB burden, with 28 lakh active infected patients and 4,23,000 deaths annually. Of these only close to 14 lakh patients have been captured by the system.
The report also raises a red-flag indicating that 11 of the 14 States providing nutrition receive support from external agencies. Only Chhattisgarh, Himachal Pradesh and Maharashtra run patient-support mechanisms without external fund support, with limited funds,” it observes.
Also it observes that only Telangana supports children afflicted with TB and is the only State to use the Integrated Child Development Service (ICDS) scheme to provide double ration to children below the age of six suffering from TB.