ArticleBMC global and public health2023
Evaluation of a results-based financing nutrition intervention for tuberculosis patients in Madhya Pradesh, India, implemented during the COVID-19 pandemic.
Article in BMC global and public health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Article
- Qualitative Study of Nutritional Support-Related Perceptions and Preferences Among Persons Affected by TB, Family Caregivers, and Healthcare Providers in India.Tropical medicine and infectious disease · 2025Article
- Qualitative study of acceptability, benefits, and feasibility of a food-based intervention among participants and stakeholders of the RATIONS trial.PLOS global public health · 2025Article
- The prevalence of undernutrition and associated risk factors in people with tuberculosis in Lao People's Democratic Republic.PloS one · 2025Article
- Global efforts to identify and support people with tuberculosis.BMC global and public health · 2024Article
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Authors and funding
10 authors.
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Abstract
backgroundReducing malnutrition through food supplementation is a critical component of the WHO End Tuberculosis (TB) strategy. A results-based financing (RBF) initiative in Madhya Pradesh, India-called Mukti-introduced an intensive nutrition intervention, including home visits, counseling, food basket distribution, and assistance in obtaining government benefits. Phase 1 of the program (Dhar District), implemented by ChildFund India (ChildFund) and funded by USAID, coincided with the COVID-19 lockdown in 2020. Under an RBF reimbursement scheme, ChildFund was paid based on treatment retention for 6 months and weight gain of 6 kg for adults.
methodsThe evaluation used a mixed methods approach. Qualitative components included interviews with key informants and focus groups with program participants. Quantitative components included an analysis of program data (i.e., patient demographics, receipt of program services, and weight gain). An impact analysis of retention in treatment used data from a government database. A difference-in-differences model was used to compare results from baseline data and the program period for Dhar District to similar data for the adjacent Jhabua District.
resultsThe program was well implemented and appreciated by patients and providers. Patients received an average of 10.2 home visits and 6.2 food baskets. While all age and sex groups gained weight significantly over their 6-month treatment period, there was no program impact on treatment retention. Seventy-six percent of patients achieved both outcome goals. And though average program costs were under budget, ChildFund experienced a loss in the results-based financing scheme, which was covered by USAID to continue program expansion.
conclusionsImplementing a nutrition supplementation and education program for TB patients in India is feasible. The intervention improved weight gain despite COVID-19-related lockdowns. The Mukti program did not impact treatment retention, which was already high at baseline. Program costs were modest, but the results-based financing reimbursement scheme resulted in a loss for the implementer. Overall, the RBF model led to an increased focus on outcomes for program staff and other stakeholders, which led to more efficient service delivery. Future research should examine total costs (including donated staff time) more extensively to determine the cost-effectiveness of Mukti and similar interventions.
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