Beating TB Through Nutrition

Geeta, a 12-year-old resident of Gandhwada Village, in Dhar District, Madhya Pradesh, contracted Tuberculosis (TB) from her father when she was 10 years old.

The burden of the disease along with poor nutrition took a heavy toll on her health and education. Her father succumbed to the disease and her responsibility fell on her 70-year-old grandfather, a daily wage laborer who could barely manage to make ends meet for the family. The financial burden along with absolutely no knowledge about the disease, left Geeta with little hope for recovery, leave alone ever getting back into mainstream schooling. This was the time when undernutrition took a toll on Geeta's health, and her weight reduced to a measly 24 kilos.

Patients like Geeta suffer heavily due to the bidirectional relationship between undernutrition and TB. According to the Central Tuberculosis Division, an estimated 55% of annual TB incidence in India is attributable to undernutrition, an established risk factor for progression of latent TB cases to active TB.

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“For many TB patients the time to full nutritional recovery can be long, leaving them undernourished after TB treatment is completed. Therefore, there is a need for providing proper nutritional care that improves nutritional recovery for people who are undernourished and ensuring proper treatment, reducing future health risks,” says Neelam Makhijani, Country Director & CEO, ChildFund India.

Shared Value Partnership towards TB Elimination

The Government of India (GOI) has pledged its commitment at the highest levels to eliminate TB by 2025 and has launched a bold National Strategic Plan for TB elimination (NSP). Towards this end, ChildFund India, United States Agency for International Development (USAID) and IPE Global Limited, have come together to complement the GOI’s priorities towards strengthening TB elimination efforts by accelerating adoption of innovative financing instruments, such as Development Impact Bonds or Pay-for-Performance Instruments, that will lead to a paradigm shift in bringing more efficiencies in program delivery as well as catalyze new pools of private capital for TB elimination.

Last year, ChildFund India, in collaboration with USAID and IPE Global, signed a Memorandum of Understanding (MoU) with the Department of Health and Family Welfare, National Health Mission (NHM), Government of Madhya Pradesh, to improve nutrition status of TB patients in the state of Madhya Pradesh in a phased manner.

As a part of the program, an 6-month long pilot provided nutrition support to 300 TB patients in 6 locations of Dhar District. The evidence generated from the pilot revealed that over 80% patientsgained more than 6 kgs of weight as compared to just 3% in neighboring non-intervention area. The findings revealed the median weight gain of the 300 patients was 8 kg, a significant 2.5x jump from the current levels.

Road to Recovery.

As part of the pilot intervention, Geeta received personalized counseling at home, treatment adherence support, and a protein-rich food basket every month from ChildFund India. The community mobilizers from ChildFund India visited her and offered counselling around consumption of a healthy balanced diet to achieve the desired energy and protein intake, monitored her health and ensured Geeta participated in the project group sessions to bring about a change in her understanding of TB. The intervention also connected her with the Government’s Direct Benefit Transfer (DBT) scheme which provides INR500 to all TB patients. As a result of the support received through the intervention, Geeta has now recovered from TB and have made significant gains around her weight. She gained 9 kg due to the nutrition support and her weight increased to 33 kg.

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Scaling up the Impact

Based on the evidence generated from the pilot study, the intervention is now being implemented across various districts in Madhya Pradesh through world’s first pay-for-performance financing instrument focused on improving Nutritional Status and Treatment Outcomes of TB patients. To tackle the problem at scale, USAID/India's innovation in financing program PAHAL, in partnership with the Government of Madhya Pradesh (NHM-MP) and ChildFund India, has aligned stakeholders and structured an intervention called the Mukti Impact Bond- (so named for the Hindi meaning' salvation or deliverance from harm').

“PAHAL is looking to promote innovation and blended finance models that can drive efficiency and unlock new pools of capital to solve health problems for underserved communities. These financial instruments can optimize risk reward mechanisms to improve outcomes and drive sustainable impact. They also stand to generate scientific evidence for policy making and scale up by the government,” says LM Singh, Head USAID PAHAL program and Impact Investments at IPE Global. The intervention “Mukti Impact Bond” targets a weight gain of greater than 6 kgs and treatment success for ~10,000 TB patients in a phased manner across several districts of Madhya Pradesh. Intervention in each district will be a separate intervention and will be for a period of 12 months.

With timely intervention, the Mukti Impact Bond Team can bring back the smile in many homes.

About PAHAL: PAHAL is USAID and IPE Global’s flagship innovative financing project which is looking to promote innovative health financing models and market-based approaches to address key health challenges for the poor and vulnerable communities. It seeks to improve access to affordable and quality healthcare solutions for underserved communities with a particular focus on Tuberculosis, Maternal and Child Health, Nutrition and WASH. PAHAL is the Co-Creation and Structuring Advisor for the Mukti Impact Bond.

About ChildFund: ChildFund, a child development organization, has been working with underprivileged children, youth and families from the most remote, extremely backward and hard-to-reach areas in India, since 1951. ChildFund annually reaches nearly 3.5 million children, youth, and their families, from 3200 communities in 85 districts across 15 states in India, through its long and short-term programs by integrating health, nutrition, sanitation, gender equality, disability, education, skill training, livelihoods, child protection and humanitarian relief work.