RT Journal Article
SR Electronic
T1 Cash transfer scheme for people with tuberculosis treated by the National TB Programme in Western India: a mixed methods study
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e033158
DO 10.1136/bmjopen-2019-033158
VO 9
IS 12
A1 Bharatkumar Hargovandas Patel
A1 Kathiresan Jeyashree
A1 Palanivel Chinnakali
A1 Mathavaswami Vijayageetha
A1 Kedar Gautambhai Mehta
A1 Bhavesh Modi
A1 Paragkumar Dhirajlal Chavda
A1 Paresh V Dave
A1 Chintu Chhitabhai Zala
A1 Hemant Deepak Shewade
A1 Dipak M Solanki
A1 Ajay M V Kumar
YR 2019
UL http://bmjopen.bmj.com/content/9/12/e033158.abstract
AB Objectives This study aimed to assess the coverage and explore enablers and challenges in implementation of direct benefit transfer (DBT) cash incentive scheme for patients with tuberculosis (TB).Design This is a mixed methods study comprising a quantitative cohort and descriptive qualitative study.Setting The study was conducted in City TB Centre, Vadodara, Western India.Participants We used routinely collected data under the National TB Programme (NTP) on patients with TB notified between April and September 2018 and initiated on first-line anti-tuberculosis treatment (ATT) to assess the coverage of DBT. We interviewed NTP staff and patients to understand their perceptions.Primary and secondary outcome measures The study outcomes are receipt of DBT (primary), time to receipt of first instalment of DBT and treatment outcome.Results Among 1826 patients, 771 (42.2%) had received at least one instalment. Significantly more patients from the public sector had received DBT (at least one instalment) compared with those from private sector (adjusted relative risk (adjRR)=16.3; 95% CI 11.6 to 23.0). Among public sector patients, 7.3% (49/671) had received first instalment within 2 months of treatment initiation. Median (IQR) time to receipt of first instalment was 5.2 (3.4, 7.4) months. Treatment in private sector, residing outside city limits and being HIV non-reactive were significantly (p<0.001) associated with longer time to receipt. Timely and sufficient fund release, adequate manpower and adequate logistics in TB centre were the enablers. Inability of patients to open bank accounts due to lack of identity/residence proof, their reluctance to share personal information and inadequate support from private providers were the challenges identified in implementation.Conclusion During the early phase of DBT implementation, the coverage was low and there were delays in benefit transfer. Facilitating opening of bank accounts for patients by NTP staff and better support from private providers may improve DBT coverage. Repeat assessment of DBT coverage after streamlining of implementation is recommended.