Did they receive it? Direct Benefit Transfer to tuberculosis patients in Raigarh district, Chhattisgarh, India - A mixed methods study

Background: Nutrition support plays critical role in patient centered care of TB. India launched a direct benefit scheme Nikshay Poshan Yojana (NPY) in 2018. However, there is sparse evidence of its implementation status in Chhattisgarh. Objectives: To determine the proportion receiving the NPY incentives, its timeliness and factors associated with non-payment and delays, and to assess utilization patterns of Direct Benefit Transfer (DBT) among the beneficiaries. Methods: It was a mixed-method study, with quantitative component of (Cross-sectional) followed by qualitative component (Descriptive). The data of all tuberculosis patients notified during April 2021toMarch 2022 in Raigarh, Chhattisgarh, India, were extracted from Nikshay-Portal. Beneficiaries registered for treatment in last quarter of 2021-2022, were also contacted to assess the utilization patterns of DBT. Eighteen health care providers (HCPs) were interviewed one-on-one to assess their perception regarding challenges in implementation of NPY and possible solutions. Results: Of 2161 TB patients started on TB treatment, 1912(88.8 %) received at least one benefit. More than half (59.6 %; 1140/1912) of the TB patients who received at least one benefit, received their first benefit within 56 days of notification. Among 255 who responded for utilization pattern of DBT, nearly one third (n = 73,28.6 %) reported to have utilized DBT for buying food. The main challenges for non-receipt/delay in benefits were: difficulty opening bank accounts; "dormant" account policy; changing of Indian Financial System Code (IFSC) of rural and nationalized merged banks; poor internet connectivity; and shortage of human resources or workforce not distributed according to geographic location. Conclusion: Nearly nine out of ten patients received at least one benefit under NPY. However, its utilization for treatment purposes was limited. Bank related, patient related and provider related factors posed major challenges in smooth implementation of the scheme. To improve the scheme's coverage, flexible account opening policies with offline Nikshay-Portal features are required.