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”

Document Type : Commentary


1 Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA

2 Center for Tuberculosis, University of California-San Francisco, San Francisco, CA, USA


Addressing the social and structural determinants of tuberculosis (TB) through social protection programs is a central feature of global public health policy and disease elimination strategies. However, how best to implement such programs remains unknown. India’s direct benefit transfer (DBT) program is the largest cash transfer program in the world dedicated to supporting individuals affected by TB. Despite several studies aimed at evaluating the impact of DBT, many questions remain about its implementation, mechanisms of action, and effectiveness. Dave and Rupani’s mixed-methods evaluation of this program previously published in this journal offers valuable insights into the strengths and limitations of the DBT program in improving TB treatment outcomes. Their results also provide an opportunity for demonstrating how systematically collected data may be further analyzed and presented using implementation science, a field of study using methods to promote the systematic uptake of evidence-based interventions to support sustainable program scale-up.


  1. The End TB Strategy. World Health Organization; 2015. p. 20. https://www.who.int/publications/i/item/WHO-HTM-TB-2015.19.
  2. Transforming Our World: The 2030 Agenda for Sustainable Development. United Nations General Assembly; 2015. p. 35. https://documents-dds-ny.un.org/doc/UNDOC/GEN/N15/291/89/PDF/N1529189.pdf?OpenElement.
  3. Nutritional Support to TB patients (Nikshay Poshan Yojana). https://tbcindia.gov.in/WriteReadData/l892s/6851513623Nutrition%20support%20DBT%20Scheme%20details.pdf. Accessed July 29, 2022.
  4. Dave JD, Rupani MP. 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. Int J Health Policy Manag. 2022;11(11):2552-2562. doi:34172/ijhpm.2022.5784
  5. Global Tuberculosis Report 2021. https://www.who.int/publications-detail-redirect/9789240037021. Accessed July 29, 2022.
  6. Patel BH, Jeyashree K, Chinnakali P, et al. Cash transfer scheme for people with tuberculosis treated by the National TB Programme in Western India: a mixed methods study. BMJ Open. 2019;9(12):e033158. doi:1136/bmjopen-2019-033158
  7. Nirgude AS, Kumar AMV, Collins T, et al. 'I am on treatment since 5 months but I have not received any money': coverage, delays and implementation challenges of 'Direct Benefit Transfer' for tuberculosis patients–a mixed-methods study from South India. Glob Health Action. 2019;12(1):1633725. doi:1080/16549716.2019.1633725
  8. Kumar R, Khayyam KU, Singla N, et al. Nikshay Poshan Yojana (NPY) for tuberculosis patients: early implementation challenges in Delhi, India. Indian J Tuberc. 2020;67(2):231-237. doi:1016/j.ijtb.2020.02.006
  9. Rohit A, Kumar AMV, Thekkur P, et al. Does provision of cash incentive to HIV-infected tuberculosis patients improve the treatment success in programme settings? A cohort study from South India. J Family Med Prim Care. 2020;9(8):3955-3964. doi:4103/jfmpc.jfmpc_474_20
  10. Richterman A, Steer-Massaro J, Jarolimova J, Luong Nguyen LB, Werdenberg J, Ivers LC. Cash interventions to improve clinical outcomes for pulmonary tuberculosis: systematic review and meta-analysis. Bull World Health Organ. 2018;96(7):471-483. doi:2471/blt.18.208959
  11. World Health Organization (WHO). Guidelines for Treatment of Drug-Susceptible Tuberculosis and Patient Care, 2017 Update. WHO; 2017. https://apps.who.int/iris/handle/10665/255052. Accessed August 13, 2022.
  12. Boccia D, Pedrazzoli D, Wingfield T, et al. Towards cash transfer interventions for tuberculosis prevention, care and control: key operational challenges and research priorities. BMC Infect Dis. 2016;16:307. doi:1186/s12879-016-1529-8
  13. Narayan J, John D, Ramadas N. Malnutrition in India: status and government initiatives. J Public Health Policy. 2019;40(1):126-141. doi:1057/s41271-018-0149-5
  14. Eccles MP, Mittman BS. Welcome to implementation science. Implement Sci. 2006;1(1):1. doi:1186/1748-5908-1-1
  15. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. doi:1186/1748-5908-4-50
  16. Waltz TJ, Powell BJ, Matthieu MM, et al. Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study. Implement Sci. 2015;10:109. doi:1186/s13012-015-0295-0
  • Receive Date: 22 September 2022
  • Revise Date: 25 January 2023
  • Accept Date: 28 January 2023
  • First Publish Date: 31 January 2023