Barriers and Facilitators in Implementation of Nutritional Benefit Transfer to Tuberculosis Patients

Abstract Background Malnutrition & Tuberculosis (TB) form a vicious cycle. Nikshay Poshan Yojana (NPY) is a key strategy for a TB free India, that seeks to provide financial assistance for nutritional support to TB patients. The study is a qualitative study to identify operational challenges and facilitators in implementation of NPY Methods In Depth Interview (IDI) of 18 Senior Treatment Supervisor (STS) at Tuberculosis Unit (TU) and 19 Tuberculosis Health Visitor (TB HV) at Designated Microscopy Centre’s (DMC) was done. For further insights, the STS, at District Tuberculosis Centre, Lucknow was also interviewed. Informal discussion was done with about 50 Tuberculosis patients. We explored providers perspective on impact of NPY on other duties/services, case load, hours dedicated to NPY, practice protocols, record keeping and data management, compliances, capacity building needs, quality protocols, key enablers, motivating factors, challenges, best practices and beneficiary’s perspectives on quality of life, facilitators and challenges in availing services. Results Motivating leadership, supportive staff, good working relationship and seamless communication, teamwork, use of technology, supportive supervision & collaboration and support of NGO for private sector were the key facilitators. Barriers comprised system level barriers (Budget constraints, issues with NIKSHAY software and bank account), provider level barriers (shortage of human resource, nonfunctional tablets) and patient level barriers (stigma and bank account related challenges). The encouraging finding was majority of recipients, responding that they used the incentive to purchase ration, vitamin supplements etc. Conclusions NPY is having its intended benefit but there are barriers that need to be resolved for successful roll out. The study yield suggestions for removing barriers and found a set of innovations that can be replicated across other settings with high Tuberculosis burden Key messages • Malnutrition and Tuberculosis form a vicious cycle. Nutritional support to TB patients improves treatment outcome and can save lives. • Operational research on implementation of NPY offers insights for successful roll out of this key initiative across other resource limited settings in developing countries.