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RCA for low performance of Percentage of Eligible Beneficiaries Paid under Ni-kshay Poshan Yojana
Learning ObjectivesRoot cause analysis for low performance of Percentage of Eligible Beneficiaries Paid under Ni-kshay Poshan Yojana the suggested solutions
Root Cause Analysis for Low Performance in the Percentage of Eligible Beneficiaries Paid under Ni-kshay Poshan Yojana
Low performance means the notified TB cases have not received even the first payment through Direct Benefit Transfer (DBT) under the Ni-kshay Poshan Yojana (NPY) as desired.
Obtain the data from Ni-kshay and analyse it in terms of:
- Who all have not received the payment (Person analysis)? - Any specific pattern? Patients notified from the public sector/ private sector, specific age group (paediatric or elderly), a specific gender, specific group (migrant labourers), or those without a bank account.
- Whether the problem is more in a specific geography (Place analysis)? - Is the issue bigger in a particular TB Unit (TU)/ Peripheral Health Institute (PHI), in any population group residing in a specific area (e.g., hard-to-reach pockets)?
- Is the low performance specific to any time period (Time analysis)? - Is the performance the same throughout the year or was it low in a particular time period (e.g., April, May due to shortage of funds)?
The Process of DBT
- Entry of each TB patient with a bank account and Aadhaar in Ni-kshay and its follow-up details (at PHI level)
- Preparation of beneficiary list (at PHI level)
- Checking of beneficiary details (at TU level)
- Approval of beneficiary list with details (at district level)
- Processing of payment (Public Financial Management System - PFMS portal) (at district level)
A breach in any of the processes will lead to the non-delivery of DBT.
Discussion with beneficiaries and health providers, and verification of source records would be helpful for further analysis.
Possible Causes | Suggested Solutions | |
Are the bank account and Aadhar details entered in Ni-kshay? If No |
Deficient knowledge of provider (public/ private) No bank account or Aadhar card for TB patients Not willing to share bank account details or Aadhar details due to lack of awareness or confidentiality issues |
Provider-oriented Information, Education and Communication (IEC) and capacity building.
Patient-oriented IEC. |
Was there any delay in the preparation checking and approval of the list? If Yes |
Shortage of Human Resources (HR) Deficient knowledge of staff Technical problems |
Take steps to provide adequate HR/ optimise available HR through redistribution/ train available HR. Address the gaps in training. Take measures such as proper monitoring/ training of staff/ sorting out internet issues. |
Was there any delay in processing the payment? If yes |
Technical issues at Ni-kshay - PMFS interface Shortage of HR |
Take measures such as proper monitoring/ training of staff/ sorting out internet issues/ network issues. Take steps to provide adequate HR/ optimise available HR through redistribution/ train available HR.
|
Is it due to patient refusal of DBT?
|
Confidentiality issues Salaried and rich may deny DBT |
IEC to address confidentiality issues. Document "refusal".
|
Is it due to other causes? | Lost to follow-up (LFU)/ Death/ Transfer out |
Measures to minimise LFU. Document "death". Coordinate closely with the concerned TU/ district/ state to prevent duplicate entry and proper transfer systems through Ni-kshay. |
Resources
- India TB Report, CTD, MoHFW, GoI, 2022.
- Training Modules (5-9) for Programme Managers and Medical Officers, Central TB Division, MoHFW, GoI, 2020.
Assessment
Question | Option 1 | Option 2 | Option 3 | Option 4 | Correct answer | Correct explanation | Page ID | Pre-test | Post-test |
Which of the following is not a cause of low performance in Ni-kshay Poshan Yojana? | No bank account for beneficiaries | Denial of DBT | Good adherence to drugs | Technical difficulties | 3 |
No bank account for beneficiaries, denial of DBT and technical difficulties - all are causes of poor performance. |
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