Need for operational simplicity and timely disbursal of benefits—a qualitative exploration of the implementation of a direct benefit transfer scheme for persons with tuberculosis in India  

作　　者：Malu Mohan Jeromie W.V.Thangaraj Sumit Pandey G.Sri Lakshmi Priya Sivavallinathan Arunachalam Rahul Sharma Hemant Deepak Shewade B.Aishwarya K.Afeeq Afsana Khatoon B.Gokulvijay Gude Sireesha Kavita Chandra S.Nandhakumar Prince Samuel C.Nanditha Viswanathan Devika Shanmugasundaram Raghuram Rao Manoj V.Murhekar Kathiresan Jeyashree 

机构地区：[1]Indian Council of Medical Research-National Institute of Epidemiology,R-127,TNHB,Ayapakkam,Chennai,Tamil Nadu 600077,India [2]TB Support Network,WHO Country Office for India,New Delhi,India [3]Central Tuberculosis Division,Government of India,New Delhi,India

出　　处：《Infectious Diseases of Poverty》2024年第3期58-72,共15页贫困所致传染病（英文）

基　　金：funded by the United States Agency for International Development(USAID);supported by Tuberculosis Implementation Framework Agreement(TIFA),implemented through John Snow Research&Training Institute Inc(JSI).

摘　　要：Background Ni-kshay Poshan Yojana(NPY)is a direct benefit transfer scheme of the Government of India introduced in 2018 to support the additional nutritional requirements of persons with TB(PwTB).Our recent nationwide evaluation of implementation and utilization of NPY using programmatic data of PwTB from nine randomly selected Indian states,reported a 70%coverage and high median delay in benefit credit.We undertook a qualitative study between January and July 2023,to understand the detailed implementation process of NPY and explore the enablers and barriers to effective implementation and utilization of the NPY scheme.Methods We followed a grounded theory approach to inductively develop theoretical explanations for social phenomena through data generated from multiple sources.We conducted 36 in-depth interviews of national,district and field-level staff of the National Tuberculosis Elimination Programme(NTEP)and NPY beneficiaries from 30 districts across nine states of India,selected using theoretical sampling.An analytical framework developed through inductive coding of a set of six interviews,guided the coding of the subsequent interviews.Categories and themes emerged through constant comparison and the data collection continued until theoretical saturation.Results Stakeholders perceived NPY as a beneficial initiative.Strong political commitment from the state administration,mainstreaming of NTEP work with the district public healthcare delivery system,availability of good geographic and internet connectivity and state-specific grievance redressal mechanisms and innovations were identified as enablers of implementation.However,the complex,multi-level benefit approval process,difficulties in accessing banking services,perceived inadequacy of benefits and overworked human resources in the NTEP were identified as barriers to implementation and utilization.Conclusion The optimal utilization of NPY is enabled by strong political commitment and challenged by its lengthy implementation process and delayed disbursal o

关 键 词：National Tuberculosis Elimination Programme Nutritional status Direct benefit transfer IMPLEMENTATION Cash transfer scheme Grounded theory INDIA 

分 类 号：R52[医药卫生—内科学]