Does Direct Benefit Transfer Improve Outcomes Among People With Tuberculosis? – A Mixed-Methods Study on the Need for a Review of the Cash Transfer Policy in India

Document Type : Original Article


1 Department of Respiratory Medicine, Government Medical College Bhavnagar, Maharaja Krishnakumarsinhji Bhavnagar University, Bhavnagar, India

2 Department of Community Medicine, Government Medical College Bhavnagar, Maharaja Krishnakumarsinhji Bhavnagar University, Bhavnagar, India

3 Division of Clinical Epidemiology, ICMR-National Institute of Occupational Health (NIOH), Ahmedabad, India


A direct benefit transfer (DBT) program was launched to address the dual epidemic of under-nutrition and tuberculosis (TB) in India. We conducted this study to determine whether non-receipt of DBT was associated with unfavorable treatment outcomes among patients with TB and to explore the perspectives of patients and program functionaries regarding the program.

We conducted a retrospective cohort study among 426 patients with drug-sensitive pulmonary TB on treatment during January-September 2019 to determine the association between non-receipt of DBT and unfavorable treatment outcomes, which was followed by in-depth interviews of 9 patients and 8 program functionaries to explore their perspectives on challenges and suggestions regarding the DBT program. Multivariate logistic regression was applied to determine whether non-receipt of DBT was independently associated with unfavorable treatment outcomes, while the in-depth interviews were transcribed to describe them as codes and categories.

Among the 426 patients, 9% of the patients did not receive DBT and 91% completed their treatment. Non-receipt of DBT was associated with a 5 (95% CI: 2-12) times higher odds of unfavorable treatment outcomes on multivariable analysis. Patients not owning a bank account was the primary challenge perceived by the program staff. The patients perceived the assistance under DBT to be insufficient to buy nutritious food throughout the course of treatment. The program functionaries as well as the patients suggested increasing the existing assistance under DBT along with the provision of a monthly nutritious food-kit.

DBT improved the treatment completion rates among patients with TB in our setting. Provision of a monthly nutritious food-kit with an increase in the existing assistance under DBT might further improve the treatment outcomes. Future research should determine the long-term financial sustainability for ‘DBT plus food-kit’ vs. universal cash transfers in India.



Commentaries Published on this Paper


  • Closing the Evidence Gap of Cash Transfer for Tuberculosis-Affected Households; Comment on “Does Direct Benefit Transfer Improve Outcomes Among People With Tuberculosis? – A Mixed-Methods Study on the Need for a Review of the Cash Transfer Policy in India”

        Abstract | PDF


  • Conditional Cash Transfer to Improve TB Outcomes: Necessary but Not Sufficient; Comment on “Does Direct Benefit Transfer Improve Outcomes Among People With Tuberculosis? – A Mixed-Methods Study on the Need for a Review of the Cash Transfer Policy in India”

        Abstract | PDF


  • Evaluating Social Protection Policies With an Implementation Science Framework: India’s Direct Benefit Transfer for Tuberculosis; Comment on “Does Direct Benefit Transfer Improve Outcomes Among People With Tuberculosis? – A Mixed-Methods Study on the Need for a Review of the Cash Transfer Policy in India”

        Abstract | PDF


  • Challenges and Strategic Solutions to Guarantee Last Mile Reach for an Indian TB Patient’s Nikshay Poshan Yojana; A Conditional Cash Transfer Scheme; Comment on “Does Direct Benefit Transfer Improve Outcomes Among People With Tuberculosis? – A Mixed-Methods Study on the Need for a Review of the Cash Transfer Policy in India”

        Abstract | PDF


Authors' Response to the Commentaries


  •  Advancing Social Protection and Tuberculosis Elimination in India – Beyond Cash Transfers and Towards Addressing Social and Structural Determinants for a Healthier Future; A Response to the Recent Commentaries

          Abstract | PDF



  • epublished Author Accepted Version: January 9, 2022
  • epublished Final Version: January 30, 2022


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Volume 11, Issue 11
November 2022
Pages 2552-2562
  • Receive Date: 11 December 2020
  • Revise Date: 05 January 2022
  • Accept Date: 08 January 2022
  • First Publish Date: 09 January 2022