Mentor’s Comment: UPSC mains have always focused on Healthcare Interventions (2018) and Emergence of Drug resistant Diseases in India (2014).

From 2015 to 2022, India experienced a 16% decline in TB incidence and an 18% reduction in TB deaths. But during 2023, India saw an unexpected rise in the cases and hence actions are necessary for strengthening diagnostic infrastructure, enhancing training for healthcare providers, integrating EP-TB into routine screening protocols, and increasing community awareness about TB symptoms.

Today’s editorial discusses the challenges and current state of tuberculosis (TB) elimination efforts in India. This content can be used for presenting the challenges in the Indian Health Care System esp with respect to TB.

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Let’s learn!

Why in the News?

According to the World Health Organization’s Global Tuberculosis Report 2024, India has the highest TB burden globally, accounting for 26% of all cases and deaths related to TB. 

• Despite ambitious national policies, there is a need to better understand the on-ground realities in India to implement effective interventions for TB elimination.

Key Highlights by WHO 2024 Report on India’s TB Burden: • High Burden: India accounted for 26% of the global TB burden in 2023, maintaining its position as the country with the highest number of TB cases and deaths. • Decline in Incidence: India achieved a notable 17.7% decline in TB incidence from 2015 to 2023, which is significantly higher than the global average decline of 8.3% during the same period. • Treatment Coverage Improvement: The treatment coverage for TB in India increased to 89% in 2023, up from 72% in 2015, indicating improved access to care and support for patients. • Multidrug-Resistant TB: India ranks first globally in the burden of multidrug-resistant (MDR) and Rifampicin-resistant TB, highlighting ongoing challenges in managing drug resistance.In 2023, India recorded approximately 27 lakh (2.7 million) TB cases, with around 25.1 lakh individuals diagnosed and beginning treatment. • Challenges to Elimination Goals: Despite progress, India is unlikely to meet the WHO’s End TB Strategy milestones, which require a reduction in TB deaths by 75% and incidence by 50% from 2015 levels by 2025. • Demographic Insights: The report notes that 55% of TB cases occurred in men, 33% in women, and 12% in children and young adolescents, indicating a need for targeted interventions across different demographics.

What are the current challenges hindering TB elimination in India?

• Socio-Economic Barriers: Many patients come from marginalized communities with limited resources, which affects their ability to seek timely diagnosis and treatment. Secondly, There is still considerable stigma associated with TB, which can discourage individuals from seeking help or disclosing their condition.
• Healthcare System Challenges: The Indian healthcare system faces issues such as inadequate infrastructure, a shortage of trained healthcare professionals, and disparities in healthcare access across different regions. These challenges hinder effective case detection and management.
• Impact of COVID-19: The COVID-19 pandemic has disrupted TB control programs, leading to delays in diagnosis and treatment. Vulnerable populations have been disproportionately affected.
• Need for Enhanced Engagement with Private Sector: A significant number of TB patients seek treatment from private healthcare providers, which often leads to inconsistent reporting and adherence to national guidelines. Engaging effectively with the private sector is crucial for comprehensive TB management.

National Tuberculosis Elimination Programme • In 2020, the RNTCP was renamed as the National TB Elimination Program (NTEP) to emphasize the aim of the Government of India to eliminate TB in India by 2025, 5 years ahead of the global targets of 2030. • The SDG targets with regard to TB (baseline 2015) are: 80% reduction in incidence; 90% reduction in mortality; Zero TB patients and their households face catastrophic costs as a result of TB disease. • The programme has been guided by the National Strategic Plan 2017-2025, and the key programme activities are implemented under 4 strategic pillars – “Detect – Treat – Prevent – Build” (DTPB).

How effective are the current strategies and initiatives under the NTEP?

• Reduction in TB Incidence and Mortality: From 2015 to 2022, India experienced a 16% decline in TB incidence and an 18% reduction in TB deaths.
  • This progress indicates that the NTEP is making strides towards its goal of eliminating TB by 2025, which is five years ahead of the global target.
  • The NTEP has successfully notified 24.2 lakh TB cases in 2022 (increase of over 58%), with notifications increasing to 25.5 lakh in 2023. 
• Engagement with the Private Sector: There has been a sevenfold increase in TB case notifications from the private sector over the past eight years, with private notifications accounting for 30% of total cases in 2022 and rising to 33% in 2023 (proven effective in reaching more patients).
• Treatment Success Rates: The treatment success rate for TB has consistently remained above 80%, reaching 87.6% in 2023. This high success rate reflects the effectiveness of the treatment protocols implemented under the NTEP.
• Infrastructure Development: The program has expanded its diagnostic infrastructure significantly, with a 80% increase in Designated Microscopy Centers (DMCs) and the establishment of numerous molecular diagnostic laboratories. In 2023, approximately 1.89 crore sputum smear tests and 68.3 lakh nucleic acid amplification tests (NAAT) were conducted.
• Addressing Drug-Resistant TB: The NTEP diagnosed 63,939 cases of multidrug-resistant TB (MDR-TB), highlighting its commitment to tackling drug resistance effectively through targeted treatment regimens.

What role do public-private partnerships play in achieving TB elimination goals?

• Increased Case Notification: Collaborations between public health programs and private healthcare providers have led to higher case notification rates which is essential for effective management and treatment.
• Enhanced Treatment Outcomes: Studies indicate that private providers participating in these collaborations often exceed the national treatment success rate target of 85% for new TB patients, demonstrating the effectiveness of these partnerships in delivering quality care.
• Comprehensive Care Models: The Patient Provider Support Agency (PPSA) model has been scaled up across numerous districts and states, enhancing the capacity of the NTEP to manage TB effectively.
• Training and Capacity Building: The NTEP provides training and supervision to private healthcare providers to align their practices with national TB guidelines.
  • This capacity-building effort ensures that private practitioners are equipped to deliver high-quality TB care and adhere to standardized protocols.

https://www.thehindu.com/opinion/lead/indias-winding-road-to-endtb/article69133029.ece#.