Howell Embry, Dammala Rama Rao, Pandey Pratibha, Strouse Darcy, Sharma Atul, Rao Neeta, Nadipally Sudheer, Shah Amar, Rai Varsha, Dowling Russell
Urban Institute, 500 L'Enfant Plaza SW, Washington, DC, 20024, USA.
ChildFund India, 22, Museum Road, Bengaluru, Karnataka, 560001, India.
BMC Glob Public Health. 2023 Sep 4;1(1):13. doi: 10.1186/s44263-023-00013-6.
Reducing malnutrition through food supplementation is a critical component of the WHO End Tuberculosis (TB) strategy. A results-based financing (RBF) initiative in Madhya Pradesh, India-called Mukti-introduced an intensive nutrition intervention, including home visits, counseling, food basket distribution, and assistance in obtaining government benefits. Phase 1 of the program (Dhar District), implemented by ChildFund India (ChildFund) and funded by USAID, coincided with the COVID-19 lockdown in 2020. Under an RBF reimbursement scheme, ChildFund was paid based on treatment retention for 6 months and weight gain of 6 kg for adults.
The evaluation used a mixed methods approach. Qualitative components included interviews with key informants and focus groups with program participants. Quantitative components included an analysis of program data (i.e., patient demographics, receipt of program services, and weight gain). An impact analysis of retention in treatment used data from a government database. A difference-in-differences model was used to compare results from baseline data and the program period for Dhar District to similar data for the adjacent Jhabua District.
The program was well implemented and appreciated by patients and providers. Patients received an average of 10.2 home visits and 6.2 food baskets. While all age and sex groups gained weight significantly over their 6-month treatment period, there was no program impact on treatment retention. Seventy-six percent of patients achieved both outcome goals. And though average program costs were under budget, ChildFund experienced a loss in the results-based financing scheme, which was covered by USAID to continue program expansion.
Implementing a nutrition supplementation and education program for TB patients in India is feasible. The intervention improved weight gain despite COVID-19-related lockdowns. The Mukti program did not impact treatment retention, which was already high at baseline. Program costs were modest, but the results-based financing reimbursement scheme resulted in a loss for the implementer. Overall, the RBF model led to an increased focus on outcomes for program staff and other stakeholders, which led to more efficient service delivery. Future research should examine total costs (including donated staff time) more extensively to determine the cost-effectiveness of Mukti and similar interventions.
通过食物补充来减少营养不良是世界卫生组织终止结核病战略的关键组成部分。印度中央邦一项名为“解脱”（Mukti）的基于结果的融资（RBF）倡议引入了强化营养干预措施，包括家访、咨询、分发食物篮以及协助获取政府福利。该项目的第一阶段（达尔区）由印度儿童基金会（ChildFund）实施，由美国国际开发署（USAID）资助，与2020年的新冠疫情封锁期重合。根据基于结果的融资报销计划，ChildFund根据成人6个月的治疗留存率和6千克的体重增加量获得报酬。
评估采用了混合方法。定性部分包括对关键信息提供者的访谈以及与项目参与者的焦点小组讨论。定量部分包括对项目数据（即患者人口统计学信息、项目服务的接受情况和体重增加）的分析。对治疗留存率的影响分析使用了来自政府数据库的数据。采用差异中的差异模型将达尔区基线数据和项目期间的数据结果与相邻的贾布瓦区的类似数据进行比较。
该项目实施良好，受到患者和提供者的赞赏。患者平均接受了10.2次家访和6.2个食物篮。虽然所有年龄和性别组在6个月的治疗期内体重均显著增加，但该项目对治疗留存率没有影响。76%的患者实现了两个结果目标。尽管项目平均成本低于预算，但ChildFund在基于结果的融资计划中出现了亏损，由美国国际开发署弥补以继续项目扩展。
在印度为结核病患者实施营养补充和教育项目是可行的。尽管有与新冠疫情相关的封锁，该干预措施仍改善了体重增加情况。“解脱”项目对治疗留存率没有影响，而基线时留存率就已经很高。项目成本适中，但基于结果的融资报销计划导致实施者出现亏损。总体而言，基于结果的融资模式使项目工作人员和其他利益相关者更加关注结果，从而提高了服务提供效率。未来的研究应更广泛地审查总成本（包括捐赠的工作人员时间），以确定“解脱”项目及类似干预措施的成本效益。
