STLS: Treatment Support

A person affected by TB requires support throughout the course of treatment and beyond that. The support to a TB patient is essential to ensure that s/he completes the treatment without affecting her/his quality of life (QoL). Keeping the patient as the central figure in the continuum of care, and ensuring social and personal circumstances are supportive (not only meeting immediate requirements of medical treatment) is the key to treatment support.

 

Figure: Key Components of Treatment Support

 

Resources

National Strategic Plan for Tuberculosis Elimination 2017–2025, RNTCP, 2017.

A Patient-centred Approach to TB Care, WHO, 2018.

 

Assessment

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​
DOT is the only treatment support provided to TB patients.	True	False			2	Ensuring social and personal circumstances are supportive for treatment adherence and not just medical requirement is the key to treatment support.

 

In order to achieve TB treatment success, a good treatment support plan for the patients is essential.  The National TB Elimination Programme (NTEP) recommends developing a treatment support plan for each patient at the time of treatment initiation. A holistic Treatment Support Plan (TSP) must include the following:
 

1) Treatment Supporter (TS) for each patient

• A Treatment Supporter (TS) who is acceptable and accessible to the patient and accountable to the health system (healthcare worker/ community volunteer/ private practitioner/ family member) identified in mutual consultation with the patient and provider during pre-treatment evaluation. 
• The assigned TS should be able to receive training on drug administration, adherence monitoring, Adverse Drug Reaction (ADR) referrals etc., and perform these functions.
   

2) Periodic review of patient’s treatment

• Treatment Initiation counselling and monthly or need-based (in high TB burden areas) follow-up counselling to all TB patients and their family members must be included through staff who have expertise in the same, to address both bio-medical and psycho-social issues that could impact treatment.
• The TSP must also include a protocol for the field monitoring staff to capture each instance of treatment interruption and Adverse Drug Reactions, so that they can be effectively addressed before the patient turns lost to follow-up.

 

3) Psychosocial Support to TB patients and their families

• Counselling to the patients experiencing stigma, discrimination, marital/family discords, substance users etc. by the trained staff, and appropriate referrals for psychiatric ,de-addiction support etc. should be offered whenever required.
• The focus should be on observing, identifying and capturing above mentioned factors during treatment initiation as well as in each follow up visit.
• Home visit follow ups with consent from the patients must also be included in the TSP which may allow for better understanding and management of psycho-social issues.
• As an extension of TSP, community engagement activities which includes key persons such as politicians, religious leaders, self-help groups, TB champions etc by the TB staff is recommended to raise awareness and sensitise the communities about TB and also articulate a whole-of-society approach to ending TB.
   

4) Referral linkages for needy TB patients - to central and state government’s various social welfare and protection schemes and additional nutrition support services

• With the aim to eliminate catastrophic expenditure due to TB, the Government of India (GoI) has insisted on linking TB patients and households to the applicable government social welfare and protection schemes.
• The treatment supporters and the health systems staff who are in regular contact with the patients (Senior Treatment Supervisors, TB Health Visitors, District Programme Supervisors) should be trained in referral linkages so as to enable further support to the patients and their family members to avail the benefits under schemes.
• The GoI has rolled out a Direct Beneficiary Transfer (DBT) mechanism to support TB patients' nutrition (Ni-kshay Poshan Yojana) and travel during treatment whereas several state governments have also initiated certain state-specific schemes for TB patients across the country.
• Further as a part of patients treatment support, the GoI has initiated the ‘Nikshay Mitra’ campaign under the ‘Pradhan Mantri TB Mukth Bharat Abhiyan’ where in persons/companies/societies can adopt an entire block/ward to provide nutrition support to TB patients for a specific treatment period.
   

5) Treatment Completion Counselling

The TSP must include an end of treatment counselling for all patients, on the importance of post treatment follow ups and holistic self-care approach for leading an overall healthy life and also the ability to focus on life after TB treatment completion.

Resource

• Training Modules (1-4) for Programme Managers & Medical Officers, NTEP, 2020.
• National Strategic Plan for Tuberculosis Elimination 2017-2025, RNTCP, 2017.
• Pradhan Mantri TB Mukt Bharat Abhiyaan - Guidance Document,  CTD, India, 2022.

Assessment

Question	Answer 1	Answer 2	Answer3	Answer 4	Correct Answer	Correct explanation
Only health workers can become treatment supporters for a TB patient.	True	False			2	Factors like acceptability, accessibility to the patient, and accountability to the health are taken into consideration when a treatment supporter is identified, and family members can also be treatment supporters and provided training by a health worker.
Referral linkages for needy TB patients - to central and state government’s various social welfare and protection schemes and additional nutrition support services is part of  holistic Treatment Support Plan (TSP)	True	False			1	With the aim to eliminate catastrophic expenditure due to TB, the Government of India (GoI) has insisted on linking TB patients and households to the applicable government social welfare and protection schemes.

A Treatment Supporter can be any person such as a Medical Officer, MPWs, community volunteers working with the program etc. Even a patient’s relative or family member can be a Treatment Supporter.

 

As per NTEP guidelines, salaried NTEP/General Health System staff may also be assigned as treatment supporters for a patient.  However, they will not be eligible for any honorarium.

 

A patient can only be linked to one treatment supporter at a time in Nikshay.

 

At treatment initiation a suitable Treatment Supporter has to be identified and assigned to the Patient.

How to identify a Treatment supporter for a patient 

• The Treatment Supporter has to be acceptable and accessible to the patient and accountable to the health system.
• Should be identified in mutual consultation with the patient and provider, during pre-treatment evaluation.
• The Treatment Supporter can either be a healthcare worker, community worker/ volunteer, private practitioner or family member.
• Should be able to receive training on drug administration, adherence monitoring, ADR referrals etc., and perform these functions. 

Assigning a Treatment Supporter to a Patient 

Once the Treatment Supporter is identified, the patient records (Ni-kshay & treatment card) have to be updated by assigning the treatment supporter (prior registration in Ni-kshay is a pre-requisite) to the patient. See the steps below to assign a Treatment Supporter to the episode of a patient.

Treatment Supporters are eligible to receive the Treatment Supporters Honorarium as a Direct Benefit Transfer. However, to receive the DBT he/she should not be a salaried government employee.

NOTE:

1. Only one Treatment Supporter can be assigned to an episode with status "OnTreatment" of the patient
2. Treatment Supporters can be assigned by both the current PHI/ TU user.
3. If required, a Treatment Supporter can be removed/ replaced by another Treatment Supporter anytime during the treatment.

 

 

Resources

• Direct Benefi­t Transfer Manual for National Tuberculosis Elimination Programme, Central TB Division, Ministry of Health & Family Welfare, India, 2021.
• Training Modules (5-9) for Programme Managers and Medical Officers, Central TB Division, Ministry of Health & Family Welfare, India, 2020.

 

Assessment

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
When should a treatment supporter be identified assigned to a patient episode ?	While declaring treatment outcomes	Any time while the patient is on treatment	At treatment initiation	When the patient is transferred	2	Treatment Supporters are to be identified and assigned to a patient at the time of treatment initiation. Treatment Supporters can be assigned or re-assigned anytime during treatment, but this is in-case it has not been assigned before	​	Yes	Yes
A TB-HV acting as a Treatment Supporter can receive the Treatment Supporters Honorarium.	TRUE	FALSE			2	TB HV is a Salaried Government Employee and hence cannot receive the Treatment Supporters Honorarium.		Yes	Yes
To assign a Treatment Supporter to a patient, which of the following are True?	The Treatment Supporter needs to be registered on Ni-kshay	The Treatment Supporter should be acceptable to the patient	Should be able to record and monitor adherence, ADR, administer drugs, refer to the nearest Health Facility	All of the above	4	Treatment Supporter needs to fulfill all the mentioned criteria.

Treatment Support Groups play an important role in providing treatment support to TB patients. It has been envisioned as a non-statutory body of socially responsible citizens and volunteers to provide social support to TB patients. This group goes beyond just providing treatment-related support as it also helps the community in accessing information, free and quality services and linkage to social welfare programmes without compromising confidentiality and respecting the dignity of the patient.

A good treatment support group creates a conducive environment for TB patients to access complete care without experiencing stigma and incurring out-of-pocket expenditures.

 

Figure: Schematic representation of the concept of treatment support groups.

 

Treatment Support Group (TSG): Example from Kerala

The initiative in the Pathanamthitta district of Kerala demonstrated that treatment support groups helped in minimising the loss-to-follow-up cases and better treatment outcomes. The group supported the patients in accessing information, free and quality services and social welfare programmes, thereby empowering the patients to complete the treatment successfully.

Resources

National Strategic Plan for Tuberculosis Elimination 2017–2025, RNTCP, 2017.

Guidance Document for the Peoples’ Movement Against Tuberculosis in Kerala, Kerala TB Elimination Mission, 2017.

 

Assessment

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​
What is a treatment support group?	A group of treatment supporters in the community	A group of TB patients in the community	A non-statutory body of citizens and volunteers to provide social support to TB patients	All of the above	3	A treatment support group is a non-statutory body of citizens and volunteers to provide social support to TB patients.

 

Nutrition constitutes an important part of TB Treatment. Undernutrition increases the risk of Tuberculosis (TB), and in turn, TB can lead to malnutrition. It has been demonstrated that undernutrition is a risk factor for progression from TB infection to active TB disease, and undernutrition at the time of diagnosis of active TB is a predictor of increased risk of death and TB relapse. There is, as yet, little evidence showing that additional nutrition support improves TB-specific outcomes, but low body mass index, as well as lack of adequate weight gain during TB treatment, are associated with an increased risk of TB relapse and death.

The following table illustrates the effect of undernutrition on outcomes in TB.

Effects on disease	Increased severity of disease Increased risk of death
Effects on treatment	Delayed sputum conversion Risk factor for drug-induced hepatotoxicity Malabsorption of rifampicin Reversion of positive cultures in Multidrug-resistant (MDR) -TB
Effects on long-term outcomes	Increased rate of relapse
Effects on contacts	Increased incidence in undernourished contacts

 

The basic recommendations to address the nutritional needs of TB patients are discussed below.

1. Conducting an initial nutrition assessment of TB patients with further monitoring
2. Providing ongoing counselling for patients on their nutritional status; Diet for TB patients starting treatment should include: cereals (maize, rice, sorghum, millets, etc.), pulses (peas, beans, lentils, etc.), oil, sugar, salt, animal products (canned fish, beef and cheese, dried fish), and dried skimmed milk
3. Managing severe acute malnutrition according to national guidelines and WHO recommendations
4. Managing moderate undernutrition for TB patients who fail to regain normal Body Mass Index (BMI) after two months of TB treatment or appear to lose weight during TB treatment and evaluating for proper treatment adherence and other comorbidities. If indicated, these patients should be provided with locally available nutrient-rich or fortified supplementary foods.
5. Special categories of TB patients, such as:

• Children who are less than 5 years of age should be managed as any other children with moderate undernutrition.
• Pregnant women with active TB and patients with MDR-TB should be provided with locally available nutrient-rich or fortified supplementary foods.

     6. Micronutrient supplementation for all pregnant women as well as lactating women with active TB. These women should be provided with iron and folic acid and other vitamin and minerals to complement their maternal micronutrient needs. In situations when calcium intake is low, calcium supplementation is recommended as part of antenatal care.

To achieve the above objectives, the guidelines for nutrition for TB patients are available and a mobile application (N-TB) is available for decision-making on nutritional support for TB patients.            

Improving nutritional status at a population level is important for TB prevention which should be part of broader actions on social determinants. All efforts should be made to link TB patients for nutritional support which can be done through the existing public distribution system, local self-government or Non-governmental Organisations (NGOs)or donor agencies or through the corporate sector under Corporate Social Responsibility (CSR).

 

Resources

• Guideline: Nutritional Care and Support for Patients with Tuberculosis, WHO, 2013.
• Guidance Document: Nutritional Care and Support for Patients with Tuberculosis in India, MoHFW, WHO, CTD, 2017.
• Training Modules (1-4) For Programme Managers & Medical Officer NTEP, CTD, WHO, MoHFW, 2020.
• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, MoHFW, WHO, 2021.

 

Assessment

Question 1	Answer 1	Answer 2	Answer 3	Answer 4	Correct Answer	Correct Explanation	Page id	Part of Pre-Test	Part of Post-Test
Undernutrition doesn’t affect the outcomes of TB.	True	False			2	Undernutrition affects the outcomes of TB in terms of treatment.

Nutritional Counselling begins with the nutritional assessment of TB patients by

• Nutritional Status: Assessing the height, weight and BMI of the TB patient

• Diet and Preference food for TB patients

• Current appetite and food intake of TB patients

 

Based on the nutritional assessment, following information can be conveyed to TB Patients

• Patients with TB should be encouraged to have frequent food intake in the form of three meals and three snacks.

• Attempts should be made to increase the energy and protein content in the meals and snacks without increasing its volume.

• The addition of oil, butter or ghee to the chapati or rice can increase the energy content of the diet.

• Pulses in other forms, e.g. sprouts, roasted Chana, groundnuts, can be taken as snacks in either fried or in roasted form. Milk and eggs to be included in the diet.

• The use of easily available nutritious foods based on vegetarian/non-vegetarian preferences of the patients must be emphasized.

• Information about NFSA (National Food Security Act) and Poshan abhiyan should be given.

Figure: Healthy diet for TB Patients

 

Resources:

• Guidance Document: Nutritional care and support for patients with Tuberculosis in India

 

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Yoga

• Yoga aims at holistic functioning of the mind and body. It consists of various exercises and specific body positions and movements(yoga asana) which can be learnt and performed under the supervision of a yoga teacher.
• Yoga will help to clean the upper respiratory tract and the sinuses. The breathing exercise or pranayama induce relaxation and help to reduce the stress levels of the patients considerably.

 

Meditation

• Meditation is a practice where an individual uses a technique – such as mindfulness, or focusing the mind on a particular object, thought, or activity – to train attention and awareness, and achieve a mentally clear and emotionally calm and stable state.

 

Exercise

• Exercise is being recognized as an important modality for gaining good health and recovering from illness and disease.
• Exercise like cycling and walking are great ways to make sure that the TB infection that was once in your system has been completely eradicated. Once recovered, it is a good idea to keep up the exercise, as this is a factor in stopping the TB from returning at a later date.

• Rehabilitation Service to TB Patients

• Emotional support must be provided to patients with TB and their families during illness. Receiving TB diagnosis is often regarded by patients as a real stigma that isolates them from their family and society. Psychologists can support patients to help reduce misconceptions and socially integrate former patients.

 

• TB is a contagious disease that induces fear and social isolation and needs a long period of drug administration, sometimes with adverse effects. Therefore, therapeutic education is very important, which serves the purpose of explaining to patients and their families about the condition of the disease, the risks of contagiousness, the stages of treatment and prognosis.

 

• Exercise may be light initially, followed by assisted and active exercise. Once the patient’s condition is stable, a 6-minute walk test may be done in the room or corridor. The intensity should be progressively increased, depending on the patient’s tolerance.

 

• Nutrition: Weight loss is associated with fatigue and decreased exercise capacity. There is a risk for the patient not recovering body weight at the end of drug therapy, despite receiving correct TB treatment. Nutritional supplementation may play a positive role in the recovery of these patients.

 

• Tuberculosis Drug side effects: A proactive clinical approach is required to replace/stop the use of the concerned drugs.

 

• Providing Assistive devices Hearing aids, cochlear implants, tinnitus-masking devices, mobility aids, and prosthetic/orthotic devices improve the quality of life of patients.

 

• Corrective Surgery: May be required in TB of the bones, spine etc.

 

• Community and home-based care: This becomes important in severe neuromuscular deficits and movement disabilities.

 

• Physiotherapy: A trained physiotherapist may help through:
  • Sputum clearance technique for reduced sputum quantity, better ventilation and relief of symptoms
  • Cough education involving body positioning during coughing, control of breathing in coughing to achieve mobilization and secretions

 

• Counselling: Psychological support is required for facing long-term/permanent disabilities like loss of vision and hearing loss as side effects of the drugs, paralysis in TB meningitis, infertility in genital TB etc.

 

• Livelihood options: NGOs and support groups can create such options and/or facilitate treated patients to find various livelihood options

Substance use has been one of the major reasons for non-adherence to TB treatment and therefore, the National TB Elimination Programme (NTEP) has implemented several initiatives for control and de-addiction of substance use in association with various other health programmes like the National Tobacco Control Programme (NTCP), Drug De-Addiction Programme (DDAP), etc.

NTEP has also included referral services to de-addiction facilities for TB patients as a part of the ‘Standards for TB Care in India (STCI)'.

 

Deaddiction Services and Linkages

1. Brief substance use counselling during the pre-treatment, treatment initiation and regular follow-up counselling sessions by the trained NTEP staff.
2. Referral to National Tobacco Quitline provides telephonic counselling via the toll-free number in English and Hindi languages 8 a.m. to 8 p.m. between Tuesday to Sunday.
3. Referral to mCessation Programme provides evidence-based behavioural change Short Text Messages (SMSs) in English and Hindi languages on mobile phones, which include health information on tobacco use hazards, tips on quitting, and encouragement for those attempting to do so.
4. Referral to nearest Tobacco cessation clinics/ centres in the government facilities.
5. Referral under the Drug De-Addiction Programme (DDAP) wherein affordable, easily accessible and evidence-based treatment for all substance use disorders are provided through the government health care facilities of the Ministry of Health and Family Welfare, viz., All India Institute of Medical Sciences (AIIMS), New Delhi; Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh; National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bengaluru; Dr Ram Manohar Lohia (RML) Hospital, New Delhi; AIIMS, Bhubaneswar; and Central Institute of Psychiatry (CIP), Ranchi.

 

Resources

• National Strategic Plan 2017-2025 for TB Elimination in India, MoHFW, India, 2017.
• National Framework for Joint TB-tobacco Collaborative Activities, MoHFW, India, 2017.

Assessment

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
What service does the National Tobacco Quitline provide?	Telephonic counselling	Face-to-face counselling	None of the above	Both 1 & 2	1	National Tobacco Quitline: Telephonic counselling via the toll-free number in English and Hindi languages.	​	Yes	Yes

Eliminating the catastrophic expenditure on TB patients and their families has been an important goal of the World Health Organisation's (WHO’s) END TB strategy.

The National TB Elimination Programme (NTEP) has also attempted the same through various partnerships and one of the action plans under this strategy was to provide transport allowance to cover the TB treatment-related travel costs of the TB patients as well as their attendants.

Travel cost for Drug-resistant TB (DR-TB) patients

• Travel costs are reimbursed for DR-TB patients travelling to District or Nodal DR-TB Centre for initiation/ follow-ups/ adverse reaction management during the treatment, along with one accompanying person/ attendant.
• The reimbursement is as per actual cost per visit through public transport with a limit of up to Rs. 400 per visit within the district and up to Rs. 1000 per visit for outside district travel.

Travel cost for TB Patients in tribal/ hilly/ difficult areas

• TB Patients from tribal /hilly/difficult areas are provided with an aggregate amount of Rs. 750 as transport allowance to cover patients and the attendants' travel costs.
• Rs. 750 as a one-time payment at the time of noti­fication.

Travel cost for Presumptive TB patients to visit District TB Centres (DTC)/ collection centres for testing

• Presumptive TB patients travelling to DTC/ collection centre are reimbursed as per actual cost with public transport.

Resources

• Guidelines on Programmatic Management of Drug-resistant TB (PMDT) in India, 2021, CTD, MoHFW, India.
• Direct Benefi­t Transfer Manual for National Tuberculosis Elimination Programme. Central TB Division, Ministry of Health & Family Welfare, India, 2021.

Assessment

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
How much amount is provided as transport allowance to tribal/ hilly area patients and their attendants during their TB treatment	Rs.250	Rs.500	Rs.750	Rs.1000	3	Rs. 750 is provided as transport allowance to Tribal/ hilly area patients and their attendants during their TB treatment.	​	Yes	Yes

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.

In the National Sample Survey Office (NSSO) 68th round 2011-2012, India was reported to have the highest out-of-pocket expense on healthcare, of which over 67% was spent on drugs. Recognising the importance of essential drugs being available and accessible to the general public, the Ministry of Health & Family Welfare, Govt. of India, implemented the Free Drugs Service Initiative (FDSI) under the National Health Mission (NHM) in 2015.

Objectives

• To ensure that a set of essential drugs is made available free of cost to all those who access public health care facilities.
• To reduce the Out-of-Pocket Expenses (OOPE) of patients to support their treatment and adherence to medication.

Under this initiative, provision for obtaining free of cost essential medicines is made available through public health facilities under the National Health Mission at Primary Health Centres (PHCs), Community Health Centres (CHCs), Sub Divisional Hospitals (SDH) and District Hospitals (DHs).

Under this scheme, National TB Elimination Programme (NTEP) recommended Fixed-Dose Combination (FDC) anti-TB medicines are also available for both paediatric and adult TB patients. While most of these medicines are procured centrally, few loose drugs, especially for prophylaxis, are allowed to be procured at the state or district level at times when central supply is short. 

NHM has dedicated funding for free drugs, and various levels, including Peripheral Health Institutions (PHI), are allotted preset budgets under this scheme. PHIs are supposed to procure essential drugs which are not supplied by the government-owned "General Medical Stores" from this budget. Although most of the drugs are readily provided to the PHIs, some subsidiary drugs and supplements, which are required in TB care, can be made available under this scheme. For example drugs required to treat minor adverse drug reactions, vitamins, protein supplements, expectorants, antitussives, etc. 

 

Resources

• Operational Guidelines - Free Drugs Service Initiative, MoHFW, GoI.

• National Strategic Plan for Tuberculosis Elimination 2017–2025, RNTCP, CTD, 2017.

• Essential Medicine List for SHC & PHC Level, Ayushman Bharat - Health and Wellness Centre, 2020.

 

Assessment

Question	Answer 1	Answer 2	Answer 3	Answer 4	Correct Answer	Correct explanation
To reduce the Out-of-Pocket Expenses (OOPE) of patients.	True	False			1	Free drug service initiative under NHM aims to reduce the Out-of-Pocket Expenses (OOPE) of patients.

 

Figure: Components of Ayushman Bharat Yojana

Pradhan Mantri Jan Arogya Yojana (PM-JAY) is one of the two key components of the Ayushman Bharat Yojana launched by the Government of India as part of the National Health Policy 2017. It is one significant step toward achieving Universal Health Coverage (UHC) and Sustainable Development Goal - 3 (SDG3): Good health and well-being.

Aim

To provide health protection cover to poor and vulnerable families against financial risk arising from catastrophic health episodes.

Provisions

• Financial protection (Swasthya Suraksha) to 10.74 crore poor, deprived rural families and identified occupational categories of urban workers’ families as per the latest Socio-Economic Caste Census (SECC) data (approx. 50 crore beneficiaries). It will offer a benefit cover of Rs. 5,00,000 per family per year (on a family floater basis).
• Cover medical and hospitalisation expenses for almost all secondary care and most of the tertiary care procedures. PM-JAY has defined 1,350 medical packages covering surgery, medical and daycare treatments, including medicines, diagnostics and transport.
• To ensure that nobody is left out (especially girl child, women, children and the elderly), there will be no cap on family size and age.
• Cashless & paperless at public hospitals and empanelled private hospitals.
• Beneficiaries are not required to pay any charges for hospitalisation expenses.
• Benefit also includes pre and post-hospitalisation expenses.
• The scheme is entitlement based; the beneficiary is decided based on the family being figured in the SECC database.

Benefits for the Health Care System of the Country

• Helps to achieve UHC and SDG.
• Ensures improved access and affordability of quality secondary and tertiary care services through a combination of public hospitals and well-measured strategic purchasing of services in health care deficit areas from private care providers, especially the not-for-profit providers.
• Significantly reduces out-of-pocket expenditure for hospitalisation. Mitigates financial risk arising out of catastrophic health episodes and consequent impoverishment for poor and vulnerable families.
• Acts as a steward, align the growth of the private sector with public health goals.
• Promotes the use of evidence-based health care and cost control for improved health outcomes.
• Strengthens public health care systems through the infusion of insurance revenues.
• Enables the creation of new health infrastructure in rural, remote and under-served areas.
• Increases health expenditure by the government as a percentage of Gross Domestic Product (GDP).

Resource

• National Health Portal

 

Assessment

Question	Answer 1	Answer 2	Answer 3	Answer 4	Correct answer	Correct explanation	Page id	Part of Pre-test	Part of Post-test
PM-JAY benefits can be redeemed only from government hospitals.	True	False			2	PM-JAY provides cashless & paperless benefits at public hospitals and empanelled private hospitals. It ensures improved access and affordability of quality secondary and tertiary care services through a combination of public hospitals and well-measured strategic purchasing of services in health care deficit areas from private care providers, especially not-for-profit providers.		Yes	Yes