This section collates recent developments impacting the health sector in India.
In May 2020, during India’s nationwide COVID-19 lockdown, 34-year-old Raghunath (who goes by just one name) was diagnosed with tuberculosis (TB), a deadly but curable disease that infects 2.6 million and kills more than 400,000 Indians every year. When his weight dropped to 75 lb (34 kg) and his health deteriorated rapidly, Raghunath’s family sent him to live with his elderly parents. Although they did their best to care for their son, they lacked money for medicine and had little knowledge of TB treatment and care, and hence Raghunath faced a grim future.
Raghunath lives in Madhya Pradesh, the state with the third-largest number of TB cases in the country, but also where USAID is pioneering the innovative Mukti (it means “freedom” in Hindi – in this case, freedom from TB).
TB and Nutrition Impact Bond, a “pay for performance” (P4P) financing mechanism designed to improve health outcomes for TB patients. Luckily for Raghunath, he was able to enroll in the Mukti program, which focuses on improving the nutrition of individuals with TB. Better nutrition can significantly improve outcomes and lower the risk of relapse, infection with the deadlier multi-drug-resistant TB, and death.
In a twist on traditional development financing, where implementers are paid for their efforts to accomplish results, Mukti pays upon accomplishment of results. USAID, IPE Global, and ChildFund India, with support from the National Health Mission, the Government of Madhya Pradesh, and the Government of India’s Central TB Division, designed Mukti to leverage private capital to fund an initial investment that is returned by USAID only when specific goals are achieved. ChildFund India distributes nutritious food to TB patients; provides counseling; and helps connect enrolled patients to government nutrition support plans and direct cash benefits. USAID reimburses ChildFund India if patients complete their treatment and gain a predetermined amount of weight. “Today, I am completely healthy and ready to fulfill my needs and the needs of my family,” he says proudly.
After eight months, Raghunath, now 92 lb (42 kg) and fully recovered from TB, reflects on his recovery: “When my family had given up hope about my life and we had no money for a cure, ChildFund’s staff provided us support, nutrition, and counseling. They cared for me like a family member.” Raghunath was able to invest in a milk cow, and has been doing steady business.
Raghunath has also become a vocal “TB Advocate.” While once his family kept his illness a secret due to fear of ostracization and stigma, Raghunath is now raising awareness about TB and encouraging community members to talk openly about the disease and seek timely diagnosis and treatment.
Ninety-two percent of those who completed the treatment were TB free and 65 percent had gained 6 kg or more during the intervention. Following this initial success, the Government of Madhya Pradesh is now interested in supporting the expansion of the program across the state.