New Delhi: Across India, over the last few weeks, lakhs of tuberculosis patients have been unable to access the Rs 500 that is due to them for their nutrition from the government.
As The Wire found out, the government stalled all bank transfers to about 26 lakh TB patients when it began to notice suspicious transactions. One official said that the system was restored by September 13 “after removal of software bugs”.
In 2018, the Modi government had introduced the cash for nutrition scheme – the ‘Nikshay Poshan Yojana’. Under it, the government said that all TB patients would get the Rs 500 upon submitting their Aadhaar numbers. It was thought that giving TB patients food directly was prone to corruption, thus the government surmised that giving them cash via bank accounts linked to Aadhaar numbers would make the system fool-proof.
Many public health watchers said that in their unwell state, TB patients would find it very difficult to get an Aadhaar, withdraw money from a bank and then go and buy food with the money. Some public health practitioners proposed that TB patients should simply be given the food in kind – perhaps at hospitals itself when they come for treatment.
The Wire has found that the Union health ministry has stopped transferring the money over the past few weeks and has written to all states asking them to study their data and submit reports if they suspect there are any cases of fraudulent or improper transfers of money. The Wire confirmed various details of this story with health officials from Delhi, Chhattisgarh, Karnataka, Maharashtra and Manipur.
“What we have observed is there are a few bank accounts which are linked with more than one beneficiary,” said a senior official in the Union health ministry. He explained that the money that is to be sent to several different patients is landing up in accounts of one person instead of reaching each person separately. This raised a red flag with government authorities as it could indicate that either the patients are false, or that they are not getting their money due to a middle-man.
“Money is disbursed via states. We have written to them to enquire and let us know if any issues. I have not heard back from the states yet,” says Kuldeep Sachdeva, deputy director general for TB in the Union health ministry.
It is important for TB patients to receive adequate nutrition during their treatment as it speeds up their recovery. Well-nourished people are also less likely to get TB. India has the world’s highest burden of TB in the world and the Modi government has pledged to eliminate the disease by 2025 despite the global goal being 2030.
A government official said that this situation of the money of different TB patients landing up in the same bank account has happened in about 2,300 cases out of the approximately 26 lakh patients eligible under the scheme. “So the total amount of these transactions is less than 0.1% of the total amount paid to patients for their nutrition supplement,” he said.
According to government data, between April 2018 and July 2019, Rs 377.25 crore was given to 24.46 lakh TB patients for their nutritional support. In the 2018-2019 budget, Rs 600 crore was allocated in the union budget for the Nikshay Poshan Yojana.
As of January 2019, only about 52% of all registered TB patients have actually submitted their valid bank account details for the transfer of money and 45% of patients (9.47 lakh) have received benefits under this scheme. This means that many are not getting money for nutritional support. Patients who are getting the money and those who are not, may both be struggling to get nutrition and recover from TB.
“In the public sector, 90-95% TB patients are getting their money for nutrition supplements,” claims the government official.
The official said that they are not sure as of now whether this manipulation has occurred because of fake patients, or because government staff were involved in the manipulation, or because data was duplicated and then not cleaned up – or a combination of multiple factors. The tip-off about these anomalies came from various sources.
One medical officer in a Delhi TB clinic said that part of this problem is occurring because many economically marginalised TB patients thought they had bank accounts via the government’s Jan Dhan scheme – but because those were empty bank accounts, they were soon closed. The health ministry official said that this used to be a problem with Jan Dhan accounts but there are not too many cases of this anymore. The government also used to see cases where patients did not have bank accounts at all, but this problem has also reduced.
Government officials in various states also confirmed to The Wire that TB patients have not been able to access money. A senior official in Chhattisgarh said that they have been asked to submit reports of any suspicious transactions but have not found any so far in the state.
One official in Manipur said that even when the government is able to transfer money, patients in hilly and remote areas have been unable to access banks and withdraw it. So in some cases, the state government officials take the money into their accounts and distribute the cash when they visit these patients once every few weeks.
It is not clear whether this is permissible according to the government’s ‘Revised National Tuberculosis Plan’ as it could be misused. However, the lack of access for TB patients in remote parts of India is very much a reality.
The cash benefit of Rs 500 was also envisioned by the government to be an incentive for TB patients and doctors to report cases of TB – largely because it was found a few years ago that India was under-reporting TB by many millions.
Note: This article was updated on September 16 with an official quote that the system was restored on September 13.