Need for operational simplicity and timely disbursal of benefits-a qualitative exploration of the implementation of a direct benefit transfer scheme for persons with tuberculosis in India.

BACKGROUND: Ni-kshay Poshan Yojana (NPY) is a direct benefit transfer scheme of the Government of India introduced in 2018 to support the additional nutritional requirements of persons with TB (PwTB). Our recent nationwide evaluation of implementation and utilization of NPY using programmatic data of PwTB from nine randomly selected Indian states, reported a 70% coverage and high median delay in benefit credit. We undertook a qualitative study between January and July 2023, to understand the detailed implementation process of NPY and explore the enablers and barriers to effective implementation and utilization of the NPY scheme. METHODS: We followed a grounded theory approach to inductively develop theoretical explanations for social phenomena through data generated from multiple sources. We conducted 36 in-depth interviews of national, district and field-level staff of the National Tuberculosis Elimination Programme (NTEP) and NPY beneficiaries from 30 districts across nine states of India, selected using theoretical sampling. An analytical framework developed through inductive coding of a set of six interviews, guided the coding of the subsequent interviews. Categories and themes emerged through constant comparison and the data collection continued until theoretical saturation. RESULTS: Stakeholders perceived NPY as a beneficial initiative. Strong political commitment from the state administration, mainstreaming of NTEP work with the district public healthcare delivery system, availability of good geographic and internet connectivity and state-specific grievance redressal mechanisms and innovations were identified as enablers of implementation. However, the complex, multi-level benefit approval process, difficulties in accessing banking services, perceived inadequacy of benefits and overworked human resources in the NTEP were identified as barriers to implementation and utilization. CONCLUSION: The optimal utilization of NPY is enabled by strong political commitment and challenged by its lengthy implementation process and delayed disbursal of benefits. We recommend greater operational simplicity in NPY implementation, integrating NTEP activities with the public health system to reduce the burden on the program staff, and revising the benefit amount more equitably.

Estimation of channel parameters and background irradiance for free-space optical link.

Free-space optical communication can experience severe fading due to optical scintillation in long-range links. Channel estimation is also corrupted by background and electrical noise. Accurate estimation of channel parameters and scintillation index (SI) depends on perfect removal of background irradiance. In this paper, we propose three different methods, the minimum-value (MV), mean-power (MP), and maximum-likelihood (ML) based methods, to remove the background irradiance from channel samples. The MV and MP methods do not require knowledge of the scintillation distribution. While the ML-based method assumes gamma-gamma scintillation, it can be easily modified to accommodate other distributions. Each estimator's performance is compared using simulation data as well as experimental measurements. The estimators' performance are evaluated from low- to high-SI areas using simulation data as well as experimental trials. The MV and MP methods have much lower complexity than the ML-based method. However, the ML-based method shows better SI and background-irradiance estimation performance.