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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 

 

  1. Entry of each TB patient with a bank account and Aadhaar in Ni-kshay and its follow-up details (at PHI level)
  2. Preparation of beneficiary list (at PHI level)
  3. Checking of beneficiary details (at TU level)
  4. Approval of beneficiary list with details (at district level)
  5. 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.

  • Volunteer groups can be created to help illiterate and elderly to get Aadhar card/ bank account 
  • If the problem is in a particular group of the population like:
    • Migrant labourers - coordinate with the labour department
    • Tribal population - coordinate with the tribal promoter.
    • Destitute - establish a system with volunteers/ NGO 

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

 

 

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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