Dr. D.Y. Patil Medical College, Hospital & Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India.
Dr. D.Y. Patil Medical College, Hospital & Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India.
Indian J Tuberc. 2024 Jul;71(3):284-290. doi: 10.1016/j.ijtb.2023.05.014. Epub 2023 May 27.
Food insecurity and undernutrition both contribute to the large tuberculosis burden in India. Indian government rolled out the direct benefit transfer (DBT) programme "Nikshay Poshan Yojana" on a national scale on April 1, 2018 largely to provide nutritional support. Hence, it was proposed to take up this study in Western Maharashtra (Pune district) to study the coverage, delays and implementation challenges of 'Direct Benefit Transfer' in the National Tuberculosis Elimination Programme as there have only been a limited number of studies conducted regarding the same.
This mixed methods study was conducted at Tuberculosis Units (TUs) under District Tuberculosis Officer (DTO) in Western Maharashtra (Pune district) for the duration August 2020 to September 2022. A total of 3373 participants were included for the quantitative component. For qualitative component In-depth interviews of key informants (healthcare providers involved in the implementation of Direct Benefit Transfer) and Focus Group Discussion (FGD) for patients and care givers was done and explored using thematic analysis.
The total coverage was found to be 76.81%. The health providers reported staff related challenges (overburden and non-cooperative staff), bank related issues (local and cooperate banks not involved in the Public Financial Management System (PFMS) loop and lack of bank account), patient related issues (fear of being scammed), the DBT process (lengthy and complex) and software related issues as major hurdles involved in the scheme's implementation. The challenges to the implementation of DBT reported by the beneficiaries (TB patients) were lack of awareness and disbelief about the scheme, bank related issues (lack of bank account and necessary documents to open account), financial challenges (job insecurity, loans), physical challenges (weakness) and delays in delivering the benefit due to software errors.
In the present study the DBT coverage was very encouraging. The common challenges identified by the staff members and patients in the implementation of the scheme were lack of awareness about the scheme, bank related issues and software issues. To increase the coverage of DBT, it is vital that these issues be resolved.
在印度，粮食不安全和营养不足都导致了结核病负担沉重。印度政府于 2018 年 4 月 1 日在全国范围内推出了直接福利转移（DBT）计划“Nikshay Poshan Yojana”，主要提供营养支持。因此，建议在马哈拉施特拉邦西部（浦那区）开展这项研究，以研究“国家结核病消除计划”中“直接福利转移”的覆盖范围、延迟和实施挑战，因为关于这方面的研究数量有限。
这项混合方法研究于 2020 年 8 月至 2022 年 9 月在马哈拉施特拉邦西部（浦那区）的结核病单位（TU）和区结核病官员（DTO）下进行。定量部分共纳入了 3373 名参与者。在定性部分，对参与直接福利转移实施的卫生保健提供者进行了关键信息提供者的深入访谈（INFORMANTS）和患者和护理人员的焦点小组讨论（FGD），并使用主题分析进行了探索。
总覆盖率为 76.81%。卫生保健提供者报告了与工作人员相关的挑战（负担过重和不合作的工作人员）、与银行相关的问题（地方和合作银行未参与公共财政管理系统（PFMS）循环以及缺乏银行账户）、与患者相关的问题（担心受骗）、DBT 流程（冗长复杂）和软件相关问题是该计划实施中涉及的主要障碍。受益人（结核病患者）报告的 DBT 实施挑战包括对该计划缺乏认识和不信任、与银行相关的问题（缺乏银行账户和开户所需的文件）、财务挑战（工作不稳定、贷款）、身体挑战（虚弱）以及由于软件错误导致福利延迟交付。
在本研究中，DBT 的覆盖率非常令人鼓舞。工作人员和患者在实施该计划时发现的共同挑战是对该计划缺乏认识、银行相关问题和软件问题。为了提高 DBT 的覆盖率，必须解决这些问题。
