Nikshay Poshan Yojana – Objectives, Benefits, Eligibility, Achievements

Introduction: The Nikshay Poshan Yojana, initiated by the Ministry of Health, Government of India in April 2018, is a program designed to support Tuberculosis patients. As part of this initiative, each TB patient will receive a monthly cash incentive of Rs 500, facilitated through Direct Benefit Transfer, to address their nutritional requirements. This financial support will continue throughout the duration of their TB treatment. The scheme is centrally sponsored by the government and falls under the National Health Mission (NHM), serving as a crucial component in the syllabus for the UPSC IAS exam, particularly in the Indian Polity section of the UPSC Prelims syllabus.

What is Nikshay Poshan Yojana?

The Nikshay Poshan Yojana, launched by the Prime Minister of India in April 2018, is a centrally sponsored scheme operating under the National Health Mission (NHM). As part of this initiative, each Tuberculosis patient is entitled to a monthly cash incentive of Rs 500, disbursed through Direct Benefit Transfer (DBT). Eligibility for the scheme’s benefits extends to all TB patients registered or notified through the NIKSHAY portal after 1 April 2018.

• The DBT (Direct Benefit Transfer) system oversees the operation of the scheme, facilitating incentives in either cash or kind.
• Cash incentives are exclusively provided to Aadhar-enabled bank accounts.
• In-kind benefits necessitate a monthly food basket value surpassing Rs 500.
• States offering in-kind benefits must secure permission from the Ministry of Health and Family Welfare.
• The Nikshay Poshan Yojana extends its coverage nationwide, encompassing states and Union Territories.
• Ni-kshay Mitras, a group comprising NGOs, individuals, corporations, cooperatives, and political parties, can volunteer to assist TB patients.
• These volunteers contribute supplements, nutritional care, vocational aid, etc.
• The e-Nikshay platform, a collaborative effort involving the Union Health Ministry, the National Informatics Centre (NIC), and the World Health Organization (WHO), is maintained by the Central TB Division (CTD).
• Registration on this portal is mandatory for all TB patients, irrespective of whether they are in public or private hospitals.

Objectives of Nikshay Poshan Yojana

1. Establishing a platform dedicated to Tuberculosis treatment, patient monitoring, and providing financial assistance to fulfill nutritional needs.
2. Recording the data of notified patients by relevant Central government departments.
3. Ensuring patients can afford high-quality, nutritious food throughout their treatment.
4. Enhancing the success rates of TB treatment and significantly reducing mortality rates.
5. According to the World Health Organization, more than two-thirds of the global burden of TB cases is concentrated in eight countries, including India.
6. In 2021, India alone accounted for over 28% of TB cases worldwide.
7. Given that TB is a curable disease, the high prevalence of infections is attributed to insufficient nutritional support, impacting the effectiveness of treatment medications.

Benefits of Nikshay Poshan Yojana

• Financial aid amounting to Rs 500 per month is allocated to each notified TB patient throughout their anti-TB treatment.
• The assistance extends until the patient concludes the anti-TB treatment.
• Existing patients as of April 1, 2028, are also eligible for financial assistance, provided their remaining treatment spans at least one month.
• The scheme operates within the DBT (Direct Benefit Transfer) system, granting states the flexibility to assist in the form cash or in-kind.
• Incentives are disbursed for full months of treatment, and partial months are not considered.
• States previously offering in-kind assistance may continue, but the cumulative value of the monthly food basket should be no less than Rs 500.
• States extending support through a food basket must obtain prior approval from the Union Health Ministry, Government of India.

Eligibility for Nikshay Poshan Yojana

Here are the eligibility criteria for the Nikshay Poshan Yojana (NPY):

1. The scheme caters to children aged 6 months to 6 years.
2. Eligibility is extended to children whose weights fall below -3 SD of the WHO Child Growth Standards.
3. Presently, the scheme is operational in 12 states and 2 union territories.
4. Beneficiary families must not exceed an annual income of ₹1 lakh.
5. The National Nutrition Mission includes the following categories of eligible children:
   a. Children from families with at least one undernourished child.
   b. Children from tribal families.
   c. Children from SC and ST families.

Response to Nikshay Poshan Yojana

• Launched in April 2018, the Nikshay Poshan Yojana has gained substantial praise nationwide, receiving overwhelmingly positive feedback from citizens.
• Survivors Against TB, a patient advocacy group, has actively appealed to the government, urging an extension of the scheme’s benefits to enhance its appeal and contribute to a further decline in mortality rates.
• Despite the predominantly positive reception, a notable drawback surfaced in 2018 when the enrollment from the state of Assam did not meet anticipated levels.

About E-Nikshay Platform

• Nikshay, short for ‘eliminate Tuberculosis,’ is a web portal designed for the management of TB patients.
• Operating under the National Tuberculosis Elimination Program (NTEP), this web platform is developed and overseen by the Central Tuberculosis Division (CTD) of the Union Health Ministry, Government of India.
• The e-Nikshay platform is a collaborative effort involving the Union Health Ministry, the National Informatics Centre (NIC), and the World Health Organization (WHO).
• Key functions of the e-Nikshay platform include:
  – Utilized by healthcare workers in both public and private sectors across India.
  – Recording and registering cases under their supervision.
  – Ordering test reports from various labs nationwide.
  – Recording treatment details.
  – Monitoring the progress of treatment.
  – Facilitating the transfer of cases between different healthcare providers.
• Additionally, the platform serves as the Tuberculosis Surveillance Platform of India, offering the Government of India access to diverse surveillance data related to TB.

Performance of Nikshay Poshan Yojana

• The India TB Report of March 2022, released by the Union Health Ministry, sheds light on the performance of the Nikshay Poshan Yojana.
• In 2021, out of the total 21 Lakh registered TB cases in the country, only 62.1% received at least one payment under the scheme.
• Launched in April 2018, the scheme has provided incentives worth Rs 1,488 crore to approximately 57.3 Lakh registered patients until February 2022.
• Delhi bears the highest TB burden per Lakh population, with 747 cases, and only 30.2% of patients in the city received at least one payment through Direct Benefit Transfer (DBT).
• Poor-performing states include Punjab (31.8%), Jharkhand (40.1%), Maharashtra (46.6%), Bihar (45.8%), Rajasthan (55.9%), and Uttar Pradesh (58.7%).
• Manipur (4.2%) and Meghalaya (23.7%) emerge as the worst-performing states in the Northeast.
• These data reveal bottlenecks in the scheme aimed at combating one of India’s most serious health crises.
• According to the World Health Organization (WHO), undernutrition is a major risk factor associated with TB, affecting nearly 34% of all cases.
• Challenges such as non-availability of bank accounts or Aadhar linkage are key issues faced by patients and health workers, as highlighted in a survey of 119 notified TB patients in Delhi.
• Multiple studies, including one published in the Journal of Family Medicine and Primary Care, emphasize critical issues related to the scheme, including lack of communication, illiteracy, disease stigma, and complex approval processes.
• TB, a disease that predominantly affects the poorest populations, underscores the inefficiency of public expenditure on diagnostic treatment without addressing the nutritional needs of the underprivileged, as patients cannot combat TB on an empty stomach.

About Nikshay Mitras

• The Pradhan Mantri TB Mukta Bharat Abhiyan and the Ni-kshay 2.0 portal, aiming to eliminate Tuberculosis from India by 2025, were inaugurated by the President of India.
• A key component of this Abhiyan is the Nikshay Mitra initiative, encouraging community participation.
• A primary goal of the initiative is to eradicate the social stigma attached to TB.
• Community entities, including individuals, Self Help Groups, Industrial units, cooperative societies, or political parties, can adopt TB patients under this initiative, ensuring their proper treatment.
• These community entities can register on the Nikshay platform to become ‘Nikshay Mitra,’ with a minimum commitment of one year and a maximum of three years.
• The initiative also provides an opportunity to leverage Corporate Social Responsibility (CSR).
• Patients under this program will receive assistance at three levels: nutritional support, additional diagnostics, and vocational aid.

Challenges Towards Nikshay Poshan Yojana

Challenges Facing the Nikshay Poshan Yojana (NPY):

1. Lack of awareness among many TB patients about the scheme or how to apply for it poses a significant obstacle to them accessing the benefits.
2. Some TB patients either lack bank accounts or have accounts not linked to their Aadhaar card, hindering them from receiving scheme benefits through Direct Benefit Transfer (DBT).
3. The reporting formats for the scheme are intricate, presenting a challenge for health providers.
4. The scheme has heightened the workload for health providers, requiring them to monitor the progress of TB patients and ensure they receive the scheme’s benefits.
5. There is a potential risk of fraud within the scheme, with individuals attempting to claim benefits to which they are not entitled.

What is Tuberculosis/TB?

Tuberculosis (TB) is an infectious disease caused by the Mycobacterium tuberculosis bacteria. Although the lungs are the most common site of infection, TB can also impact the brain, spine, and kidneys. The transmission of TB occurs through the air when an infected person coughs, sneezes, or talks. Notably, the bacteria can linger in the air for hours, enabling transmission without close contact. There are two primary forms of TB:

• Latent TB infection: In this state, an individual is infected but remains symptom-free and non-contagious.
• Active TB disease: In this form, the bacteria multiply, leading to the manifestation of symptoms. If left untreated, active TB can pose a life-threatening risk.

The symptoms of TB vary based on the specific body part affected by the infection.

Status of TB in India

• India holds the highest global burden of TB, comprising 28% of all TB cases and 25% of worldwide TB-related deaths in 2020.
• Despite a decline in TB incidence from 256 per 100,000 in 2015 to 194 per 100,000 in 2020, India must expedite this reduction to achieve its 2025 TB elimination target.
• Challenges hindering TB elimination efforts in India include TB-associated stigma, a scarcity of trained health workers, and substandard healthcare services.
• Government initiatives, such as the Nikshay Poshan Yojana providing nutritional support and the Revised National Tuberculosis Control Program improving TB care quality, aim to address these challenges.
• Anticipated factors like population growth, an aging demographic, and the spread of HIV/AIDS may contribute to an increase in TB cases in the future.
• To combat TB effectively, the Indian government needs to intensify investments in prevention and control, ensuring improved access to diagnosis and treatment, reducing TB-related stigma, and enhancing overall healthcare service quality.

Global and India’s Initiatives to Tackle TB

Here are some international and national initiatives aimed at eliminating TB:

Global Efforts

• WHO’s End TB Strategy: Introduced at the 67th World Health Assembly in 2014, this strategy aims to eliminate TB globally, striving for a world free of TB-related deaths and suffering. The target includes a 95% reduction in TB-related deaths and a 90% decrease in new cases by 2035.
• Find.Treat.All #ENDTB: A collaborative initiative involving WHO, the Global Fund, The Stop TB Partnership, numerous countries, and other partners. This initiative focuses on achieving universal access to care and preventing tuberculosis.

Global Tuberculosis Report: Published by WHO, this report provides comprehensive information on the global TB scenario, offering insights into the current state of the disease worldwide.

National Efforts

• National Strategic Plan for TB Elimination (2017-25)
• Nikshay Poshan Yojana
• Nikshay Ecosystem (web-enabled platform)
• TB Haarega Desh Jeetega Campaign
• Saksham Project: initiated by TISS (Tata Institute of Social Sciences)
• India has formulated two tuberculosis prevention vaccines: Mycobacterium Indicus Pranii and Vakzine Projekt Management (VPM-1002), both currently undergoing Phase 3 clinical trials.

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