MUMBAI, May 15 -- A 32-year-old woman from a Worli slum is battling tuberculosis (TB) for the second time. A few months ago, she was diagnosed with drug-resistant TB-a more severe and harder-to-treat version of the disease. She lacks a crucial component in her treatment regimen - one no doctor can provide. The truth is, adequate nutrition alone would greatly raise her chances of recovery. Studies have shown that malnutrition fuels deaths and drug resistance in TB patients, undermining efforts to treat patients with all forms of the disease. On the other hand, a nutrient-rich diet significantly enhances positive outcomes. Part of the reason the woman is malnourished is that, for the last four months, she has not received the Rs.1,000 monthly nutritional support under the government's Nikshay Poshan Yojana. The sum, recently doubled, is meant to help TB patients afford the bare essentials of a recovery-friendly diet. "My monthly food expenses are around Rs.2,000. So I skip the Rs.700 protein powder prescribed by my doctor," she told HT. The woman from the Worli slum was one of 2,800 people diagnosed with drug-resistant TB in Mumbai in 2024. That year, Mumbai recorded 60,051 TB cases-averaging 164 new cases diagnosed each day. In Maharashtra, TB detection rose marginally, by 2% in 2024 - 2,28,877 cases were reported, or 627 cases a day. In 2024, Mumbai alone witnessed 2,264 TB-related deaths-averaging over six deaths a day. Parel recorded the highest toll - 377 deaths, according to data obtained through the Right to Information Act, 2005. Health activists say that when designing welfare schemes for TB patients, the government should consider food a medical necessity. Ganesh Acharya, a health activist working with TB patients in Mumbai, said, "The Rs.1,000 support should be raised to at least Rs.2,500 if we want patients to recover." His concerns are reflected in the findings of the RATIONS trial-a study (conducted between 2019 and 20-22, and published in The Lancet in 2023) in Jharkhand, where TB-affected families were provided macronutrient-rich food baskets. The trial showed significantly improved treatment outcomes and a reduction in TB incidence among contacts. Based on this, a modelling study published in The Lancet Global Health (March 2025) estimated that providing food and supplements to just 50% of India's TB-affected households could prevent 361,200 deaths and 880,700 new TB cases between 2023 and 2035. Dr Finn McQuaid, one of the RATIONS researchers, told HT, "My understanding is that (Rs.1,000) is a big step in the right direction but it's not quite there yet. Another issue is that the composition of food baskets is important (they must contain sufficient proteins and micronutrients), which cash support alone may not address." Dr Pranay Sinha, assistant professor at the Boston University School of Medicine, said implementation, not just policy design, is the bigger challenge. "Lack of access to banking and other logistical delays prevent persons with TB from receiving the money at the most critical juncture of their treatment. We need some operational innovations to ensure that PWTB get the money as soon as possible post-diagnosis." BMI is a key clinical indicator in TB outcomes-lower BMI increases mortality risk. However, McQuaid cautions against targeting support based on BMI. The RATIONS trial showed benefits even in patients with normal BMI, he underscores. On the flipside, Dr Pranay Sinha points out, even TB patients with normal BMI may suffer micronutrient deficiencies. Experts feel it is not wise to lean too heavily on government schemes for nutritional support, an issue the Ni-kshay Mitra scheme hopes to address. A government scheme, it aims to enhance community involvement in the fight against TB by linking patients with supporters, or 'mitras', who provide assistance. Pulmonologist Dr Vikas Oswal said, "The Ni-kshay Mitra enables individuals and organisations to sponsor patients and provide regular food baskets."However, patients from high-burden areas such as Govandi and Dharavi told HT that this support too is inconsistent. According to the Ni-kshay Mitra dashboard, Maharashtra currently has 1,50,579 people undergoing TB treatment. While 14,194 donors have registered under the scheme-and 83.2% committed to providing food baskets for at least six months-coverage remains patchy....