New Delhi: A health ministry proposal to provide a monthly cash benefit of Rs500 to all tuberculosis (TB) patients for nutritional support is facing resistance from within the government, with the objections ranging from duplication of benefits for TB patients to too much aid being released.
Under the Revised National Tuberculosis Control Program (RNTCP), the health ministry has proposed direct benefit transfer (DBT) to TB-affected families, especially BPL (below poverty line) families, as TB patients fall short of money to get nutritious food due to substantial out of pocket expenditure due to the disease.
“Some states are providing financial support to TB patients (Rs500-1,000) per month. Similar support can be extended to all TB patients and their families which can be covered under the ambit of DBT using Aadhaar. But the authorities have put forth a disagreement to this proposal stating that most of the TB patients, falling under the BPL category, are already availing several benefits under government’s TB control programme and schemes under women and child development ministry," a senior health ministry official said on condition of anonymity.
The proposal is yet to reach the finance ministry for approval.
“We have been asked to furnish a reply to this argument. The proposal will require approval from Empowerment Program Committee (EPC), Empowered Finance Committee (EFC) and Mission Steering Group (MSG) under National Health Mission (NHM) before finally going to the finance ministry," the official said.
TB is inextricably linked to determinants of health such as malnutrition and low immunity due to social deprivation and marginalization. Currently, Project Axshya is being implemented in 300 districts across 19 states in India for TB patients. The project aims at helping vulnerable and marginalized groups at high risk of TB by educating and linking them with diagnostic and treatment services available under the programme.
The government is also running social protection schemes related to TB programmes such as sickness insurance, disability grants, other conditional or unconditional cash transfers, food assistance, travel vouchers and other support packages.
Public health experts say that while social protection has been long recognized for its capacity to address TB-related vulnerabilities, globally national programmes largely continue to focus on the medical aspect of disease prevention and control.
India currently does not have an over-arching mechanism in place to provide social and nutritional support to all TB patients. A few states such as Kerala, Chhattisgarh, Maharashtra and Uttarakhand have implemented measures including cash benefits, nutritional supplementation and counselling to assist patients in the fight against the disease.
The government has recently declared its vision to eliminate TB by 2025. The draft National Strategic Plan for TB Elimination (2017-2025) (NSP) provides for a comprehensive strategy to ensures access to quality TB care and social protection for all patients.
Of the proposed NSP budget, 22% has been allocated for patient support systems. The draft NSP states, “To address financial and nutritional hardship the patient and family undergoes due to TB and to reduce catastrophic cost to patient due to TB, cash incentive of Rs2,000 will be provided for every TB patient through DBT."
“TB patients apart from taking regular medicines also need high protein and high calorie diet. The cash benefit can be used for procuring nutritious food that will improve health. However, the cash through DBT scheme will be for all TB patients, but this will largely benefit BPL families," said Jagdish Prasad, director general of health services (DGHS), ministry of health and family welfare.
The total allocation for RNTCP for 2017-18 is Rs1,840 crore.
“The proposal has not come to us so far. TB is a curable disease and if giving money can help reduce the TB burden, there shouldn’t be a problem in allocating money. But the authorities will need to implement the scheme wisely. In case we fall short of finances, we may ask them to implement in phases," said Kavita Singh, director (finance), National Rural Health Mission.