India’s TB nutrition scheme is a lifeline, but payment delays and small amounts hold it back

A new systematic review has synthesized what tuberculosis patients in India actually experience when they receive support from the Nikshay Poshan Yojana, the government’s direct benefit transfer program that provides ₹500 per month for nutritional assistance. The review, published in BMC Health Services Research, concludes that patients value the scheme as a crucial support system, but that its effectiveness is significantly hindered by systemic and operational obstacles, most notably the perceived inadequacy of the payment amount and delays of several months in disbursement.

The review team, led by Urvish Joshi and colleagues, carried out a qualitative systematic review with meta-synthesis in accordance with a pre-registered protocol on the Open Science Framework and reported it in line with the PRISMA 2020 statement. They searched PubMed, Scopus, Embase and grey literature for qualitative and mixed-methods studies published from 2017 to June 2025, with the last search conducted on 3–4 June 2025, seeking studies exploring patient perspectives on the scheme in India.

Thirteen studies fulfilled the criteria for inclusion. The methodological quality of the included studies was evaluated using the CASP, MMAT and NOS tools, and the researchers conducted a thematic synthesis of the qualitative findings before assessing confidence in those findings using the GRADE-CERQual approach.

The thematic analysis indicated that patients appreciated the scheme for three main reasons. It facilitated the purchase of healthy food, it offered some financial relief, and it served as a form of psychosocial support that promoted adherence to tuberculosis treatment.

However, the advantages of the scheme were consistently and significantly hindered by two main obstacles. The first was the perceived inadequacy of the financial amount to satisfy actual nutritional requirements, a concern given that undernutrition greatly worsens India’s tuberculosis burden. The second was considerable, often multi-month, delays in payment distribution, which undermined the reliability of the support patients depended on during treatment.

Beyond these two central barriers, the synthesis identified additional significant challenges that were operational in nature. These included the absence of bank accounts among some patients, a lack of information about the scheme, and confidentiality concerns related to stigma, which could affect whether patients were willing to engage with the program at all.

The authors conclude that a two-fold approach is necessary: ensuring the assistance is both sufficient and prompt, while drastically streamlining administrative procedures. They also note that the shift towards hybrid models, such as the community-led Nikshay Mitra initiative that offers in-kind aid, deserves further investigation as India progresses towards its tuberculosis eradication targets.

The review was published as an open access article on 29 October 2026 and is currently available as an accepted manuscript version that is subject to further edits before the final version of record. The authors emphasize that ongoing research focused on these evolving patient-centered support systems is vital as the country’s elimination strategy advances.

For policymakers, the synthesis offers a patient-side account of a scheme that has previously been assessed mainly through quantitative studies. The review’s stated aim was to synthesize the perspectives of tuberculosis patients in India on the program, including its perceived benefits, the barriers to receiving and using it, and their suggestions for improvement, in order to inform policy decisions. The findings suggest that the scheme’s value to patients is real but conditional on fixing how and when the money arrives.

Subject of Research: Patient experiences with India's Nikshay Poshan Yojana tuberculosis nutrition support scheme

Article Title: A valued lifeline with critical gaps: a qualitative systematic review with meta-synthesis of the Nikshay Poshan Yojana for TB patients in India

Article References: Joshi, U., Sheth, Z., Baisil, S., Unadkat, S., Kini, B. S., & Modi, B. (2026). A valued lifeline with critical gaps: a qualitative systematic review with meta-synthesis of the Nikshay Poshan Yojana for TB patients in India. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15896-y

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15896-y

Keywords: tuberculosis, Nikshay Poshan Yojana, India, nutrition support, systematic review, qualitative research, meta-synthesis, direct benefit transfer, payment delays, health policy, treatment adherence, stigma