Table 5.

Challenges in implementation of direct benefit transfer (DBT) scheme for patients with tuberculosis and suggestions to solve them as perceived by key informants in City TB Centre, Vadodara, India, 2018

Themes	Subthemes	Suggested solutions
System level challenges
Issues with nikshay software	Frequent updates Slow performance of software Entered data not reflected in software DBT beneficiary list was based on notifying facility earlier rather than current treatment facility Difficulty in finding transferred patients	Latest nikshay software update Change to current treatment facility-based DBT beneficiary list
Issues with PFMS	Difficulty to trace beneficiary in public financial management system (PFMS) generated sheet due to the absence of nikshay ID Manual preparation of beneficiary list due to error in nikshay-PFMS link Delay in approval	PFMS data also to capture nikshay id Direct nikshay-based payment Direct district level DBT payment
Issues with banks	Not inclined to open zero balance accounts Rural and cooperative banks are not on PFMS	Bank to facilitate the process of opening zero balance account
Provider level challenges
Manpower involved in implementation	Lack of communication of information to beneficiaries Overburdened with work Lack of feedback to treating physician about patients’ cash incentive receipt status
Private doctor related	Not obtaining complete patient details Reluctance to avail benefit for notification Busy/time constraints	Encourage private providers to link patients with public sector staff for document procurement and processing
Patient level challenges
Bank account	Lack of necessary documents Migrants and homeless patients Inability to maintain minimum balance Dormant bank account Unwillingness to pay account opening deposit	Tie up with bank to open account on the basis of treatment card in Vadodara city Senior treatment supervisor (STS) accompanies patient for opening account in Vadodara city Allow relatives bank account Raise public awareness about zero balance accounts facility from government
Lack of awareness	About the DBT scheme benefits About documents required for enrolment	Information education and communication (IEC) about documents required and benefits of scheme
Unwilling to share details (in private sector patients)	Doubts on confidentiality Lack of trust Uninterested in availing benefit	Involve private doctors to obtain necessary details of their patients Provide DBT information and contact person details card to private doctors for distribution to their patients