Coverage and utilization of Nikshay Poshan Yojana among patients with tuberculosis: Exploring patterns and influencing factors

Abstract

BackgroundIndia bears a burden of tuberculosis (TB) and undernutrition, both of which are interconnected, as undernutrition increases the susceptibility and affects the outcome of TB infection. To address this, government of India introduced Nikshay Poshan Yojana in 2018 to provide nutritional support to patients with TB. However, the end-usage and barriers of the monetary benefit under this scheme have not been extensively studied. ObjectiveTo address these gaps, our study aimed to estimate Nikshay Poshan Yojana coverage among patients with tuberculosis in the Ballabgarh tuberculosis unit, explore end-usage patterns, and identify facilitators and barriers for availing the monetary benefit. MethodsWe conducted a mixed-methods study in Ballabgarh tuberculosis unit (TU) in Faridabad district of Haryana state, India. To assess the coverage, we randomly selected patients treated under the Ballabgarh TU between January 2019 and December 2021. We conducted telephonic interviews using a semi-structured questionnaire and collected data on the coverage and end usage of the Nikshay Poshan Yojana scheme. Descriptive analysis was conducted using R software. We conducted in-depth interviews with a senior treatment supervisor and a district tuberculosis officer and two focus group discussions with tuberculosis patients. Thematic analysis was used to identify the factors of end usage, facilitators, and barriers of the use of monetary benefits under the scheme. ResultsAmong the 251 patients with TB enrolled in the study, 60.6% received at least one and 22.3% received all instalments. The median amount received was INR 2500 (USD 31.2), with 90.9% of the funds being spent on purchasing food items. Fruits and milk were the main food items purchased. Factors influencing the end usage included personal or family needs, awareness of the nutritional benefits in addressing the disease, advice from parents and Directly Observed Treatment Short-course (DOTS) providers, and the need for diagnostic tests or medications. Facilitators for utilization included assistance in creating bank accounts, centralized monitoring, and the flexibility of receiving the monetary benefit through parents' or family members' accounts. The barriers for utilization of Nikshay Poshan Yojana were non-availability of bank account, dormant bank account, delay due to bank related issues or administrative procedures. ConclusionThe findings revealed a substantial partial coverage and poor full coverage of Nikshay Poshan Yojana. The monetary benefit received was primarily utilized for purchasing food items, indicating adherence to the intended purpose.