More than two million people affected by TB in India will benefit from new support measures

Changes to social protection measures introduced by the Indian government following research conducted by The George Institute will help people with tuberculosis cover the initial costs of treatment and ensure they can afford the nutritious diet required while taking medication. The new measures will improve recovery and reduce recurrent cases – cutting the overall health and social protection costs incurred by states, government and health providers.

The challenge

India has the highest level of tuberculosis (TB) in the world, with nearly 2.5 million people affected by the disease in 2022. TB is most virulent in crowded and poorly ventilated living conditions and disproportionally affects communities at socio-economic disadvantage. Those affected often experience social stigma and are unable to work, affecting family incomes.

India has signed up to the World Health Organization’s ‘End TB Strategy’, which aims to reduce TB deaths by 90% and eliminate ‘catastrophic’ treatment costs (more than 20% of household annual income) by 2030. The government therefore provides free diagnosis and treatment, and a social protection grant (Nikshay Poshan Yojana – NPY) for those affected, previously paid part-way through treatment.

The research

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The Indian government proposed the introduction of the NPY grant in 2018, but we realised there was no comprehensive evidence about the cost of treatment to inform the level and timing of the grant. We therefore decided to work with them to secure this evidence.’

By: Dr Susmita ChatterjeeProgram Head, Health Economics at The George Institute in India

The research, conducted from 2018 to 2024 in collaboration with the Ministry of Health and Family Welfare’s Central TB Division, followed almost 1500 people with TB – coming from tea garden families, urban slum dwellers, and the general population – in four Indian states. It is the longest follow-up of TB-affected households from different population groups done to date.

Total treatment costs for study participants:

On average, patients experienced a nine-week delay from symptom onset to diagnosis, made 12 visits to different providers before receiving a diagnosis, and spent money out-of-pocket on consultations, non-TB drugs and tests, travel expenses, and managing side-effects during treatment.

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‘We were shocked and surprised to find that more than 60% of study participants were incurring ‘catastrophic costs’ during treatment. TB is primarily a disease affecting poor communities, who are often reliant on daily wages from only one earner. Reduced income and the high costs of treatment meant those taking medication could not afford the high-quality diet recommended; and that households were unable to cover other basic living costs such as school fees, household bills, and food for other family members.’^{iii iv v}

By: Susmita ChatterjeeProgram Head

Policy response and impact

Research findings were shared with the Ministry of Health throughout the study and the final report recommended changing the timing and amount of the NPY grant. In January 2024, the Indian government announced that in future half the grant would be paid at the time of treatment registration to help defray early costs. In October 2024 they announced that the grant would double from INR 500 to INR 1000.^vi

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We were delighted that the government was able to move so decisively and effectively to address the issue of the timing and level of the NPY grant. The changes, once fully implemented, will make a real difference to millions of people affected by TB.

Hopefully it will ensure that those undergoing treatment can afford a diet high in protein and fresh vegetables which will boost immunity and lead to better recovery, as well as being able to better manage other household expenses. Over time, as people recover quicker and relapse less often, it should also reduce health and welfare costs for states, governments and health providers.

We’re now discussing with tea garden managers the possibility of paid leave and alternative work opportunities for employees undergoing TB treatment, so workers do not experience a loss of income. And we’re planning to work with communities to raise symptom awareness, to ensure people with concerns seek diagnosis and treatment as soon as possible, which again will assist recovery and help reduce relapse.

By: Dr Sumita ChatterjeeProgram Head

Sharing the research

The research was shared in a series of workshops attended by government officials, tea garden managers and medical officers, and representatives from various organisations concerned with TB.

The research was also presented in major international conferences and gained significant media coverage in India and further afield.