“I have not told the owner that I have been diagnosed with TB. How will I look after my family if I don’t work,” asks Rajendra (name changed), who was diagnosed with tuberculosis eight months ago. Rajendra, a cook at a hotel in Pimpri, has four children. Rajendra says he is grateful, however, for the monthly cash incentive of Rs 500 given to TB patients under a central government scheme. “At times, I do buy two or three eggs, few fruits and some almonds, not just for me but my family as well. But I earn only Rs 8,000 per month and perhaps the government can also provide some nutritious meals while dispensing free-of-cost tablets,” he says.
Rajendra receives the incentive under the Nikshay Poshan Yojana (NPY), a direct benefit transfer scheme to provide nutritional support to tuberculosis patients, launched by the Centre in April last year. With a budgetary allocation of Rs 600 crore, the scheme aims to provide nutritional support for all TB patients by giving them Rs 500 per month for the entire duration of the treatment. A total of 8.78 lakh beneficiaries have availed the benefits of the scheme across India. In Maharashtra, nearly 70,000 beneficiaries have been enrolled under the scheme, and Pune and Pimpri-Chinchwad have approximately 1,900 beneficiaries.
In the Pune Municipal Corporation limits, a total of 984 beneficiaries have availed of the scheme and a total of Rs 20.56 lakh has been spent since its launch, said Dr Vaishali Jadhav, city tuberculosis officer. In areas under Pimpri-Chinchwad Municipal Corporation, a total of 950 beneficiaries have been enrolled under the scheme. “By the end of March, we have to enroll a total of 1,100 beneficiaries,” said Dr B Hodgar, Pimpri-Chinchwad Tuberculosis Control Officer.
Some states, however, have said they will prefer nutritional support in the form of meals, instead of a cash incentive, due to concerns about whether the beneficiary will actually end up using the financial assistance for nutritional inputs. While the scheme has helped patients like Rajendra, experts say it is too early to arrive at any conclusion on whether providing nutritional meals would be more helpful. “The scheme is yet to be evaluated. It is challenging to provide nutritional meals under the TB control programme, and patients have not denied the financial aid,” officials working in the TB control programme of the state government told The Indian Express.
“It is too early to gauge if the money is being utilised to buy nutritious food, but at least we find that patients are adhering to treatment,” says Dr Hodgar.
In 2016, TB affected over 1 crore people globally and claimed 17 lakh lives. India alone shoulders a quarter of the global TB burden, with 28 lakh active infections and 4,23,000 deaths occurring annually. Studies on the nutritional status of TB patients in the country have shown high levels of moderate to severe undernutrition in both women and men. Data from the Centre’s TB division reveals that the median weights in male and female TB patients were 43 and 38 kg respectively.
For patients with active TB, a protein intake of 1.2 to 1.5 g per kg of ideal body weight is recommended per day. Patients also require a daily intake of micronutrients, apart from a diet that should include cereal, milk powder, groundnut and pulses, among other items. In the absence of nutritional support, undernourished patients with TB get stuck in a vicious cycle of worsening disease and undernutrition,
which can be detrimental and even fatal. Food insecurity increases the risk of contracting TB for those who are in household contact of TB patients in India, said officials with the Union government’s Central TB division.