Creating a risk-pooling benefits model for those diagnosed with TB

India accounts for over 26% of global tuberculosis cases, with more than 25 lakh annual notifications. Achieving the WHO End TB Strategy target of zero catastrophic costs requires eliminating health expenditures that exceed 20% of household income, which standard health economics calculations define to include indirect wage loss. A study across 1482 DS-TB patients noted that factoring in lost income within the total treatment costs elevates the total treatment cost to ~Rs. 30,000-60,000, causing catastrophic costs among 56-61% of patients (1). Furthermore, evidence suggests that loss of wages accounts for 83% of total indirect costs (2). Some PwTB are also forced to take up a lesser paying job due to TB symptoms, adding to lost income. Since a sizable Indian working population (over 43 crores) are employed in the informal sector with little sick leave or insurance benefits, the indirect cost of TB is assumed to be higher in this segment.

The economic shock is concentrated among vulnerable breadwinners, as over 75% of TB patients in India fall within the primary working age group of 15 to 45 years. While the National Tuberculosis Elimination Program provides free diagnostics and nutritional support through the Nikshay Poshan Yojana at ₹1,000 per month, there is scope to leverage new sources of funding to support TB patients.

The purpose of this activity is to demonstrate a pooled financial benefits model that secures patients. Risk-pooling and insurance mechanisms offer a viable strategy to tap into funding channels beyond primary government health budgets, such as building and construction worker welfare funds, corporate social responsibility grants, and employer co-contributions, safeguarding livelihoods and supporting complete treatment adherence.

indicates a required field.

Section I: Contact Details

Organization name

Organization’s registered address

Applicant type:

Indian nongovernmental organization legally registered with FCRA.

International organization legally registered in India.

For-profit organization with mandatory registrations (PAN, TAN, GST number) and fulfilling all statutory criteria to receive foreign funds.

Foreign Contribution Regulation Act number

Goods and Services Tax number, if applicable.

Unique Entity Identifier (UEI) number, if available (guidance for creating a UEI number to be provided).

Name and title of point of contact for applicant.

Mailing address of point of contact.

Telephone number of point of contact.

Email address of point of contact.

Confirm email

Name and title of authorized signatory for grant.

Section II: Organizational Eligibility

Note your organization’s ability to meet the following:

The chief executive of the organization is willing to sign an agreement and receive funds from JSI, the Washington-based partner.

Yes

Describe your organization’s recent (last 3 years) experience managing interventions aligned with the proposed scope of work or a similar scope of work.

(1,000-character limit)

Describe your recent experience (last three years) in providing services to the Government of India, specifying any previous work with national programmes at the central, state, or district level, particularly the National Tuberculosis Elimination Programme (NTEP) and the Rashtriya Bal Swasthya Karyakram (RBSK).

(2,000-character limit)

Section III: Proposal Description

Statement of the organization’s overall strategy for implementing the activities outlined in the scope of work, considering the proposed goals, sample activities, key performance indicators within a 4-5 month execution window. Highlight your specific roles, key deliverables, measurable outcomes, and critical institutional learnings from previous risk-pooling, financial protection, or TB interventions.

(3,000-character limit)

Describe your technical approach and methodology for identifying, engaging, and securing formal buy-in from high-risk employment sites (e.g., construction sites, logistics/trucking hubs, manufacturing units, and gig-worker networks). Detail your strategy for enrolling informal workers and conducting integrated Active Case Finding (ACF) and Non-Communicable Disease (NCD) screening camps to achieve 85% screening coverage without disrupting daily work operations. Outline the referral and tracking protocols you will establish to ensure 90% of presumptive TB cases receive quality-assured diagnostics (NAAT/X-ray), are registered on the Ni-Kshay portal, and are linked to public health facilities.

(3,000-character limit)

Detail your strategy for refining, validating, and driving the uptake of a risk-pooled financial benefit and insurance package tailored for informal workers diagnosed with TB. Explain how you will partner with underwriter insurers and leverage existing IRDAI-approved mechanisms to deliver direct benefit transfers (DBT) upon Ni-Kshay verification. Outline your step-by-step process for establishing beneficiary enrollment campaigns, tracking insurance claim uptake, gathering user feedback, and iteratively refining the insurance product to cover out-of-pocket indirect costs and lost wages.

(3,000-character limit)

Describe your approach to establishing operational linkages with existing government platforms (such as Ni-Kshay, state Building and Other Construction Workers (BOCW) Welfare Boards, e-Shram, and PM-JAY). Detail how you will structure a co-financed, sustainable insurance premium model that transitions away from donor seed funding by securing long-term commitments from reliable channels, such as employer co-contributions, state welfare boards, and corporate social responsibility (CSR) funds. Outline your plan to synthesize implementation findings into a cost, policy-ready roadmap for national replication and convergence.

(3,000-character limit)

Describe your organization’s experience in executing complex health financing, social protection, or urban/worksite health interventions. Detail your existing working relationships and liaison capabilities with the Central TB Division (CTD), State TB Cells, District TB Officers, State Labour/Welfare Boards, and industrial employer associations across the proposed target geographies.

(2,000-character limit)

Describe your immediate operational readiness to launch within 15 days of the award and achieve key performance indicators within the accelerated timeframe. Outline your proposed team structure and key technical roles, including health financing specialists, insurance/actuarial experts, field operations leads, and M&E managers, highlighting their relevant experience. Detail the inter-departmental governance and oversight mechanisms you will establish with State NTEP and labor authorities. Conclude with a risk mitigation matrix and adaptive management framework addressing major execution bottlenecks, such as complex multi-stakeholder co-financing negotiations, underwriter delays, and high worker mobility.

(2,000-character limit)

Download RFA

Creating a risk-pooling benefits model for those diagnosed with TB (PDF, 783.36 KB)