Published in Indian Express | By Abantika Ghosh |On December 27, 2017
The Expenditure Finance Committee (EFC) has approved an incentive of Rs 500 a month for all tuberculosis patients for the duration of the treatment, irrespective of their income level.
The money is for nutrition support, as TB is known to be a disease of undernutrition. The incentive amount, though, is a fourth of what was envisaged in the National Strategic Plan for TB Elimination released earlier this year with the aim of eliminating the disease by 2030. That deadline has since been revised by Prime Minister Narendra Modi.
The total annual expenditure sanctioned by the committee of the department of expenditure, which has to vet all scheme spending before the schemes get final approvals, is Rs 900 crore for 26 lakh patients. The original incentive bill had been Rs 4,000 crore, and the money was the primary reason why the TB plan was stuck for several months.
“A system will be put in place to provide incentive/enablers to patients for validated services via Aadhaar-enabled Direct Benefit Transfer (DBT). All patients, irrespective of their place of treatment, will be linked to applicable social support schemes for ensuring adherence and successful completion of treatment. To address financial and nutritional hardship the patient and family undergoes due to TB and to reduce catastrophic cost to patient due to TB, cash incentive of Rs 2,000 will be provided for every TB patient through Direct Benefit Transfer,” says the National Strategic Plan for TB Elimination.
India is the country with the largest TB burden in the world. The bacterial infection kills an estimated 4.80 lakh Indians every year and more than 1,400 every day. India also has more than a million ‘missing’ cases every year that are not notified (despite a government directive on mandatory notification of TB cases) and most remain either undiagnosed or unaccountably and inadequately diagnosed and treated in the private sector.
It is partly for the purpose of identifying these missing cases and partly to supplement the income of a family in which the breadwinner is suffering from the disease or to subsidise the high cost of nutrition that the strategic plan envisages an incentive, not just for doctors in the private sector but also for patients.
A joint monitoring committee set up to evaluate the TB programme had singled out fund constraint as a major challenge. The strategic plan, too, recognises this when it says: “The JMM 2015 observed that the implementation of the NSP for 2012-2017 did not achieve the projected increase in case detection by the RNTCP. In addition, the ambitious expansion of resources planned under the NSP, 2012-2017 will have tripled the expenditure of the prior plan, but has not been matched by allocations. While RNTCP expenditure has increased 27% since 2012, there is a growing gap between the allocation of funds and the minimum investment required to reach the goals of the Plan.”
The EFC in its meeting on Friday also approved raising the incentive for Kala Azar (KA) patients from Rs 500 to Rs 2,000 per month with a view to elimination, and that of Post Kala Azar Dermal Leishmaniasis (PKDL) patients from Rs 2,000 to Rs 4,000. PKDL is a skin condition associated with patients recovering from KA.