New Delhi: The centre’s proposal of providing nutritional support of 500 per month to tuberculosis patients lacks clarity about how disbursal of the money will be effected through direct benefit transfer (DBT), according to state tuberculosis officers (STOs).

The food packages also cost more than the amount provided, these officers said.

STOs have raised concerns about providing entitlements to beneficiaries who do not possess Aadhaar cards or have bank accounts. Therefore cash transfers may not be the most efficient method, they said in the document titled State Initiatives on Patient Support Systems for TB Elimination in India. The document, compiled by the central TB division under the ministry of health and family welfare, explains the challenges that states would face in tackling the disease.

Many states have been providing food packets to TB patients but it is not proving to be cost effective. The states have pointed out that the unit cost of food packages across states is higher than 500.

In Telangana, food packages under Aasara (a pension scheme by the Telangana government) costs 978 per patient per month and 725 under Axshya, a programme for TB patients. In Jharkhand, it is 700 per patient per month and in states such as Kerala and Bihar, the amount is 900-1,000.

Therefore, when it comes to procuring in-kind food support, they are spending more than the 500 per patient per month.

“At the same time, according to the document, state TB programmes cannot, admittedly, devote their limited infrastructure, resources and manpower to roll out supplementary nutrition. The responsibility for deciding the type of food to be provided, as well as ensuring procurement, storage, delivery, and quality, requires dedicated resources at every stage of the supply chain," the state officers said.

Interestingly, the Union health ministry observed that patients who are against seeking treatment have been seen to come around when monthly food kits are offered. DBT, in comparison, “does not provide the benefit of human intervention, which helps adherence," the officers said.

“First, we are not disturbing the ‘kind mode’ that states are following because it has a positive impact on the overall health of patients. Second, as far as the higher amount spent by states on nutritional support for TB patients is concerned, we have also given them a flexibility to switch to the DBT mode and transfer only 500," said Sanjeeva Kumar, additional secretary and director general of the Revised National Tuberculosis Control Programme (RNTCP), of the Union health ministry.

“For smooth disbursal of 500 to a patient, we have also proposed a provision to transfer money to any account of his/her family member. With this, we can overcome problems of bank accounts and the linking of Aadhaar cards. The onus of judicious use of the money will certainly be on the patient," he said.

According to the World Health Organization’s Global Tuberculosis Report 2017, India has the highest number of TB cases in the world. In 2016, there were an estimated 10.4 million new TB cases worldwide. In India, an estimated 2.79 million people were suffering from TB in 2016 and as many as 423,000 patients were estimated to have died from the disease during the year.

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