CDST_LT: Public health actions for TB

Public Health Action is conducted under the NTEP programme to support and prevent further health complications among TB patients after diagnosis.

 

Figure: Various activities under Public Health Action

 

 

Contact tracing is a process to identify people who are  at a high risk of developing TB due to their contact with a known TB case.

The aim of contact tracing is to find other people with TB disease and those infected with TB

All close contacts, especially household contacts of a Pulmonary TB patient, should be screened for TB. 

In paediatric TB patients, reverse contact tracing for the search of any active TB case in the child's household must be undertaken.

Particular attention should be paid to contacts with the highest susceptibility to TB infection.

Figure: Contacts to be Prioritized for contact TB screening

 

Direct Benefit Transfer (DBT) is a major initiative of Government of India (GoI) whereby any government subsidy or benefit is to be transferred directly into the beneficiary's bank accounts. Intermediary government agencies only manage the process of payments, without handling actutal money.

NTEP is one of the first health programmes in India to use a fully adopt DBT. It uses an end to end electronic system, to digitise beneficiary information and transfer monetary benefits. In NTEP to process benefits, two electronic systems are used, Ni-kshay (operated by NTEP) and PFMS (Public Finance Management System, operated by the Ministry of Finance). Ni-kshay enables Direct Benefit Transfer by digitizing the beneficiaries(bank account details of patients, treatment supporters and providers) and calculates of incentives/ benefits (eligible payment) and processes them for payment through PFMS under various schemes. The various schemes operational under NTEP are:

• Nikshay Poshan Yojana(NPY)
• Tribal Support Scheme
• Treatment supporter’s Honorarium
• Incentive for Notification and Outcome

The government of India introduced Direct Benefit Transfer (DBT) to ensure that the benefits and subsidies are reaching the beneficiaries directly and to fasten the process. Through the process, money is directly transferred to the beneficiaries' bank account keeping the intermediary agencies and stakeholders only to manage the process of payment.

 

National TB Elimination Programme (NTEP) transfers all benefits to patients using the two systems:

• Nikshay
• Public Finance Management System (PFMS)

 

DBT Schemes available in the NTEP

 

Nikshay Poshan Yojana (NPY)

Objective: To provide nutritional support to TB patients at the time of noti­fication and subsequently during the course of treatment.

Beneficiary: All unique TB patients noti­fied on or after 1st April 2018 (including all existing TB patients under treatment for at least one month from this date).

Benefit Amount: Rs. 500 for a treatment month paid in instalments of up to Rs. 1000 as an advance.

 

Transport Support for TB patients in Notified Tribal Areas

Objective: To provide ­financial support as transport allowance for TB patients belonging to notifi­ed tribal areas (in addition to the nutritional support provided under NPY).

Beneficiary: All noti­fied TB patients from notifi­ed tribal areas.

Benefit Amount: Rs. 750 as a one-time payment at the time of notifi­cation.

 

 

Incentives for Private Sector Providers and Informants

Objective: To provide ­financial incentives for noti­fication and subsequent follow-up until completion of treatment of TB patients who are diagnosed/ treated by a private provider.

Beneficiary: Private providers (private practitioner, hospital, laboratory and chemist) who notify TB patients to NTEP on Nikshay.

Incentive Amount: Rs. 500 as a one-time payment on noti­fication and Rs. 500 to a private practitioner or hospital for updating the patient’s treatment outcome.

 

Treatment Supporters’ Honorarium

Objective: To provide an honorarium to the treatment supporters for supporting TB patients.

Beneficiary: Community Treatment Supporters who support patients during treatment, leading to a successful outcome (cured or treatment completed).

Incentive Amount: Rs. 1,000 as a one-time payment on the update of outcome for drug-sensitive TB patients and Rs. 2,000 on completion of Intensive Phase (IP) and Rs. 3,000 on completion of Continuation Phase (CP) of treatment for drug-resistant TB patients.

 

Criteria/ Pre-requisites for Availing the Benefits in NTEP

 

• All benefits are processed for the respective beneficiary base on the rules and eligibility criteria defined above except for the treatment supporter, which needs to be manually uploaded by the TB Unit (TU) level staff.
• Beneficiary ID in Nikshay will be assigned to all patients which are unique. The benefits processed will be tracked under this ID. All beneficiaries need to register their bank details in Nikshay to enable DBT.

 

Treatment Supporter

 

A trained treatment supporter, who can be a health worker or community volunteer, will assist the patient to adhere to the drugs, provide counselling support, nutritional support, screen for adverse reactions, psycho-social support, comorbidity management and follow-up laboratory investigations.

 

The Treatment Support Honorarium is available as per the following eligibility:

• The treatment Supporter must be registered in Nikshay and designated as the primary Treatment Supporter.
• The linked patient must complete treatment or has to be cured.
• The treatment Supporter should not be a salaried government employee.

 

 

Resources

Direct Benefi­t Transfer Manual for National Tuberculosis Elimination Programme, CTD, 2020.

 

Assessment

Question	Answer 1	Answer 2	Answer 3	Answer 4	Correct Answer	Correct Explanation
Only patients and treatment supporters seeking treatment in the public sector are eligible for DBT benefits.	True	False			2	Private providers are eligible for financial incentives for noti­fication and subsequent follow-up until completion of treatment of TB patients who are diagnosed/ treated by them.