This article is part of the UPSC Daily Editorial Analysis, covering The Hindu editorial – “The need for universal and equitable health coverage," published on 24th March, by the best UPSC coaching in Kolkata.
Syllabus: Indian Polity and Governance (Government policies & interventions for development in various sectors)
India has advanced in Tuberculosis (TB) care by adopting innovative strategies for detection, treatment and prevention of TB. Key initiatives include the expansion of molecular testing for rapid detection of TB and drug resistance, the introduction of the shorter BPaLM regimen, an increase in nutritional support under the Nikshay Poshan Yojana (NPY) and the expansion of TB preventive therapy. Community engagement has also been strengthened by involving TB survivors and Champions. These efforts have led to a 17.7% decline in TB incidence, from 237 per 1,00,000 population in 2015 to 195 per 1,00,000 in 2023 alongside a 21.4% reduction in TB-related deaths.
TB is an infectious disease that mainly affects the lungs. The ‘Mycobacterium tuberculosis’ bacteria causes TB which spreads when an infected person coughs or sneezes.
Most people infected with the bacteria that cause tuberculosis don't have symptoms. When symptoms occur theyinclude: cough (sometimes blood-tinged), weight loss, night sweats and fever.
Patients who have active symptoms will require a long course of treatment involving multiple antibiotics.
Since Independence India has implemented vertical health programmes to tackle diseases, including TB. The National Tuberculosis Elimination Programme (NTEP) has played a central role in delivering TB control services. The vertical approach has enabled focused interventions but it has also led to challenges in integration with the broader health system. The need of the hour is: universal health coverage (UHC) and integrating TB services with general healthcare infrastructure for equitable access to treatment.
India has made progress in its mission to eliminate TB. India has achieved a 17.7% decline in TB incidence from 2015 to 2023, more than twice the global average decline of 8.3% (WHO Global Tuberculosis Report 2024). This achievement shows the impact of India’s National Tuberculosis Elimination Programme (NTEP) that integrates early diagnosis, preventive care, patient support and cross-sector partnerships to meet the target of TB elimination by 2025.
India aims to eliminate TB five years ahead of the global Sustainable Development Goal (SDG) 3.3 deadline of 2030. For this key target include:
Prime Minister Narendra Modi first announced the goal to eliminate TB by 2025 at the ‘End TB Summit’ in 2018, reaffirmed at the ‘One World TB Summit’ in 2023. India is also a signatory to the Gandhinagar Declaration which aligns with WHO’s regional strategy to end TB by 2030.
The NTEP has intensified efforts post-COVID-19 making significant strides in early diagnosis and treatment:
The Ayushman Bharat National Health Protection Scheme which was launched in 2018 aims to provide universal health coverage (UHC) to the Indian population. TB services have been integrated within both key components of Ayushman Bharat:
By integrating TB services at the primary healthcare level Ayushman Arogya Mandirs function as sputum collection centres facilitating early diagnosis. Plus, people diagnosed with TB at secondary or tertiary care facilities can now receive treatment closer to their homes reducing both time and financial burden. Efforts are also being made to train community health officers to monitor and support TB patients during the crucial initial months of treatment.
India has involved TB survivors and trained them as TB Champions to raise awareness and fight stigma. Meghalaya for instance, has initiated re-skilling programmes for TB survivors, empowering them to assist in TB control efforts.
Despite advancements in TB care, social stigma remains a major challenge. Studies indicate that women working in multinational corporations (MNCs) face a higher risk of TB due to work-related stress and poor nutrition. Furthermore, gender disparities in healthcare access disproportionately affect women, LGBTQIA+ persons and other marginalized groups. The National TB Elimination Programme (NTEP) has introduced a gender-responsive approach acknowledging that women, men and LGBTQIA+ persons experience TB differently.
TB services are provided free of cost in the public health system. However, over 50% of TB patients seek care from the private sector. The lack of standardised care and high out-of-pocket expenditure (OOPE) in private healthcare settings often lead to delayed diagnosis and poor treatment outcomes. Strengthening referral mechanisms between the private and public sectors is essential to ensure that all patients receive quality care without financial hardship. If AB-PMJAY insurance coverage is expanded to include TB treatment in both public and private healthcare facilities would further reduce economic barriers.
To accelerate progress towards TB elimination and universal health coverage (UHC) India must adopt a five-pronged strategy:
Expanding person-centered care approaches is critical to reducing TB mortality. The Tamil Nadu Kasanoi Erappila Thittam (TN-KET), or TB death-free project, has successfully identified high-risk TB patients and provided early intervention, reducing mortality. Similar targeted interventions should be implemented for tribal communities, migrants and homeless populations.
Health-seeking behavior is influenced by multiple social determinants, including gender, age, caste, disability, socio-economic status as well as occupation. Its important to addess these intersectional vulnerabilities to improve TB outcomes. Ongoing efforts to understand the relationship between TB and disability must be strengthened to ensure inclusive healthcare services.
Another major challenge in India’s healthcare system is lack of integration between TB and other health services. Screening TB patients for chronic obstructive pulmonary disease (COPD), asthma, depression and hypertension would ensure comprehensive healthcare. Use of Artificial Intelligence (AI)-enabled chest X-rays and upfront molecular testing could also enhance early TB and COPD detection.
Reducing financial barriers is essential for ensuring continued treatment adherence. While schemes like the Ni-kshay Poshan Yojana (NPY) provide ₹1,000 per month for nutritional support additional measures such as wage-loss compensation and livelihood programs for TB survivors should be explored. Initiatives like the ‘100 Days’ campaign, which focuses on active case-finding can further help in early diagnosis and reducing OOPE.
Public awareness about TB transmission, treatment and drug resistance remains still low. The rapid public messaging campaigns used during COVID-19 could be replicated to improve TB awareness. Additionally, educating communities about drug-resistant TB and its implications for anti-microbial resistance (AMR) is quite essential.
To sustain momentum, India is implementing innovative interventions, including:
India’s multifaceted TB elimination strategy has brought results with notable declines in TB incidence and a strengthened health response framework. Through sustained cross-sector collaborations, technological innovations and community-driven efforts, India is on track to achieve TB-free status by 2025.
India has demonstrated substantial progress in TB control by expanding molecular testing, integrating TB care within primary health services, increasing community engagement and enhancing financial support for patients. However, challenges such as healthcare disparities, social stigma, high OOPE and weak public-private collaboration must be addressed in order to ensure equitable access to quality TB care.
An equitable TB programme must provide person-centered care, address socio-economic disparities and integrate TB care with general healthcare services. By applying an equity lens India can accelerate progress towards TB elimination and set global benchmarks in TB care.
|
PRACTICE QUESTION Q.India aims to eliminate TB by 2025—critically analyze the progress, challenges and the way forward. |
1. What are India’s major achievements in tuberculosis elimination efforts?
India is advancing towards TB elimination by 2025 with expanded rapid molecular testing, shorter drug regimens and enhanced preventive therapy under NTEP.
2. How does the Nikshay Poshan Yojana (NPY) support TB patients?
NPY provides ₹1,000/month to TB patients for nutritional support, with ₹2,781 crore disbursed to nearly 1 crore beneficiaries.
3. How is India improving tuberculosis diagnosis and treatment?
India is scaling up molecular diagnostics, introducing shorter oral MDR-TB/XDR-TB regimens and integrating TB care into Ayushman Arogya Mandirs.
4. What role does community engagement play in TB elimination?
Initiatives like PMTBMBA and Ni-kshay Mitras offer patient support, while TB Champions help reduce stigma and spread awareness.
5. How is India reducing the financial burden of TB treatment?
Through Ayushman Bharat PM-JAY, public-private partnerships and reduced out-of-pocket expenditure, ensuring affordable TB care.
© 2025 iasgyan. All right reserved
