Background Tuberculosis(TB)remains a major public health problem in Nepal,high in settings marked by prevalent gender and social inequities.Various social stratifiers intersect,either privileging or oppressing individ...Background Tuberculosis(TB)remains a major public health problem in Nepal,high in settings marked by prevalent gender and social inequities.Various social stratifiers intersect,either privileging or oppressing individuals based on their characteristics and contexts,thereby increasing risks,vulnerabilities and marganilisation associated with TB.This study aimed to assess the inclusiveness of gender and other social stratifiers in key health related national policies and the Health Management Information System(HMIS)of National Tuberculosis Programme(NTP)by conducting an intersectional analysis of TB cases recorded via HMIS.Methods A desk review of key policies and the NTP’s HMIS was conducted.Retrospective intersectional analysis utilized two secondary data sources:annual NTP report(2017-2021)and records of 628 TB cases via HMIS 6.5 from two TB centres(2017/18-2018/19).Chi-square test and multi-variate analysis was used to assess the association between social stratifers and types of TB,registration category and treatment outcome.Results Gender,social inclusion and concept of intersectionality are incorporated into various health policies and strategies but lack effective implementation.NTP has initiated the collection of age,sex,ethnicity and location data since 2014/15 through the HMIS.However,only age and sex disaggregated data are routinely reported,leaving recorded social stratifiers of TB patients static without analysis and dissemination.Furthermore,findings from the intersectional analysis using TB secondary data,showed that male more than 25 years exhibited higher odds[adjusted odds ratio(a OR)=4.95,95%confidence interval(CI):1.60-19.06,P=0.01]of successful outcome compared to male TB patients less than 25 years.Similarly,sex was significantly associated with types of TB(P<0.05)whereas both age(P<0.05)and sex(P<0.05)were significantly associated with patient registration category(old/new cases).Conclusions The results highlight inadequacy in the availability of social stratifiers in the routine HMIS.This limitation hampers the NTP’s ability to conduct intersectional analyses,crucial for unveiling the roles of other social determinants of TB.Such limitation underscores the need for more disaggregated data in routine NTP to better inform policies and plans contributing to the development of a more responsive and equitable TB programme and effectively addressing disparities.展开更多
Background Ni-kshay Poshan Yojana(NPY)is a direct benefit transfer scheme of the Government of India introduced in 2018 to support the additional nutritional requirements of persons with TB(PwTB).Our recent nationwide...Background Ni-kshay Poshan Yojana(NPY)is a direct benefit transfer scheme of the Government of India introduced in 2018 to support the additional nutritional requirements of persons with TB(PwTB).Our recent nationwide evaluation of implementation and utilization of NPY using programmatic data of PwTB from nine randomly selected Indian states,reported a 70%coverage and high median delay in benefit credit.We undertook a qualitative study between January and July 2023,to understand the detailed implementation process of NPY and explore the enablers and barriers to effective implementation and utilization of the NPY scheme.Methods We followed a grounded theory approach to inductively develop theoretical explanations for social phenomena through data generated from multiple sources.We conducted 36 in-depth interviews of national,district and field-level staff of the National Tuberculosis Elimination Programme(NTEP)and NPY beneficiaries from 30 districts across nine states of India,selected using theoretical sampling.An analytical framework developed through inductive coding of a set of six interviews,guided the coding of the subsequent interviews.Categories and themes emerged through constant comparison and the data collection continued until theoretical saturation.Results Stakeholders perceived NPY as a beneficial initiative.Strong political commitment from the state administration,mainstreaming of NTEP work with the district public healthcare delivery system,availability of good geographic and internet connectivity and state-specific grievance redressal mechanisms and innovations were identified as enablers of implementation.However,the complex,multi-level benefit approval process,difficulties in accessing banking services,perceived inadequacy of benefits and overworked human resources in the NTEP were identified as barriers to implementation and utilization.Conclusion The optimal utilization of NPY is enabled by strong political commitment and challenged by its lengthy implementation process and delayed disbursal of benefits.We recommend greater operational simplicity in NPY implementation,integrating NTEP activities with the public health system to reduce the burden on the program staff,and revising the benefit amount more equitably.展开更多
基金funded by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases(TDR),World Health Organization,Geneva,Switzerland(Reference 2019/980668-1)
文摘Background Tuberculosis(TB)remains a major public health problem in Nepal,high in settings marked by prevalent gender and social inequities.Various social stratifiers intersect,either privileging or oppressing individuals based on their characteristics and contexts,thereby increasing risks,vulnerabilities and marganilisation associated with TB.This study aimed to assess the inclusiveness of gender and other social stratifiers in key health related national policies and the Health Management Information System(HMIS)of National Tuberculosis Programme(NTP)by conducting an intersectional analysis of TB cases recorded via HMIS.Methods A desk review of key policies and the NTP’s HMIS was conducted.Retrospective intersectional analysis utilized two secondary data sources:annual NTP report(2017-2021)and records of 628 TB cases via HMIS 6.5 from two TB centres(2017/18-2018/19).Chi-square test and multi-variate analysis was used to assess the association between social stratifers and types of TB,registration category and treatment outcome.Results Gender,social inclusion and concept of intersectionality are incorporated into various health policies and strategies but lack effective implementation.NTP has initiated the collection of age,sex,ethnicity and location data since 2014/15 through the HMIS.However,only age and sex disaggregated data are routinely reported,leaving recorded social stratifiers of TB patients static without analysis and dissemination.Furthermore,findings from the intersectional analysis using TB secondary data,showed that male more than 25 years exhibited higher odds[adjusted odds ratio(a OR)=4.95,95%confidence interval(CI):1.60-19.06,P=0.01]of successful outcome compared to male TB patients less than 25 years.Similarly,sex was significantly associated with types of TB(P<0.05)whereas both age(P<0.05)and sex(P<0.05)were significantly associated with patient registration category(old/new cases).Conclusions The results highlight inadequacy in the availability of social stratifiers in the routine HMIS.This limitation hampers the NTP’s ability to conduct intersectional analyses,crucial for unveiling the roles of other social determinants of TB.Such limitation underscores the need for more disaggregated data in routine NTP to better inform policies and plans contributing to the development of a more responsive and equitable TB programme and effectively addressing disparities.
基金funded by the United States Agency for International Development(USAID)supported by Tuberculosis Implementation Framework Agreement(TIFA),implemented through John Snow Research&Training Institute Inc(JSI).
文摘Background Ni-kshay Poshan Yojana(NPY)is a direct benefit transfer scheme of the Government of India introduced in 2018 to support the additional nutritional requirements of persons with TB(PwTB).Our recent nationwide evaluation of implementation and utilization of NPY using programmatic data of PwTB from nine randomly selected Indian states,reported a 70%coverage and high median delay in benefit credit.We undertook a qualitative study between January and July 2023,to understand the detailed implementation process of NPY and explore the enablers and barriers to effective implementation and utilization of the NPY scheme.Methods We followed a grounded theory approach to inductively develop theoretical explanations for social phenomena through data generated from multiple sources.We conducted 36 in-depth interviews of national,district and field-level staff of the National Tuberculosis Elimination Programme(NTEP)and NPY beneficiaries from 30 districts across nine states of India,selected using theoretical sampling.An analytical framework developed through inductive coding of a set of six interviews,guided the coding of the subsequent interviews.Categories and themes emerged through constant comparison and the data collection continued until theoretical saturation.Results Stakeholders perceived NPY as a beneficial initiative.Strong political commitment from the state administration,mainstreaming of NTEP work with the district public healthcare delivery system,availability of good geographic and internet connectivity and state-specific grievance redressal mechanisms and innovations were identified as enablers of implementation.However,the complex,multi-level benefit approval process,difficulties in accessing banking services,perceived inadequacy of benefits and overworked human resources in the NTEP were identified as barriers to implementation and utilization.Conclusion The optimal utilization of NPY is enabled by strong political commitment and challenged by its lengthy implementation process and delayed disbursal of benefits.We recommend greater operational simplicity in NPY implementation,integrating NTEP activities with the public health system to reduce the burden on the program staff,and revising the benefit amount more equitably.
