PYQ Relevance:Question: Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.’ Analyse (UPSC IAS 2021) Reason: A strong primary health structure, as highlighted in this question, is fundamental for achieving equitable access to healthcare. It serves as the first point of contact and helps in early detection and management of health issues across all sections of society. |
Mentor’s Comment: UPSC usually focuses on the primary health structure in 2021 and Public healthcare system in 2024.
India has made significant progress in TB care by expanding rapid molecular testing, introducing the shorter all-oral BPaLM regimen, increasing Ni-kshay Poshan Yojana support to ₹1,000 per month, and strengthening community involvement. These efforts led to a 17.7% drop in TB incidence and a 21.4% decline in TB deaths between 2015 and 2023.
Today’s editorial highlights significant advancements in tuberculosis (TB) care and their impact. This information is valuable for GS Paper 2 and 3 in UPSC Mains answer writing.
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Let’s learn!
Why in the News?
Integrating TB services into the public health system is essential for ensuring fair and universal healthcare for everyone in India.
What are the key advancements India has made in tuberculosis (TB) care?
- Expansion of Molecular Testing for Rapid Detection: India has significantly expanded molecular testing, enabling faster and more accurate diagnosis of TB and drug-resistant TB. Example: Introduction of CBNAAT (Cartridge-Based Nucleic Acid Amplification Test) and TrueNat machines in primary health centers for early detection.
- Improved Drug Regimens & Shorter Treatment Duration: Newer drug combinations have reduced treatment duration for drug-resistant TB, increasing patient compliance. Example: The shorter BPaL regimen (Bedaquiline, Pretomanid, and Linezolid) has improved MDR-TB cure rates and reduced mortality.
- Better Access to Free & Effective Treatment: Government programs like the National TB Elimination Programme (NTEP) provide free TB medicines, improving adherence and reducing deaths. Example: MDR-TB patients receiving Bedaquiline and Delamanid have better survival rates compared to traditional toxic injectable treatments.
- Enhanced Nutritional and Financial Support: The Ni-kshay Poshan Yojana (NPY) doubled financial assistance from ₹500 to ₹1,000 per month for TB patients to ensure proper nutrition. Example: Over 40 lakh patients have benefited from direct benefit transfers under this scheme.
- Integration of TB Services with Primary Healthcare: TB care is now incorporated into the Ayushman Bharat scheme, linking it with Health and Wellness Centres (Ayushman Arogya Mandirs). Example: These centers serve as sputum collection points and treatment hubs, improving accessibility for rural and urban populations.
- Community Engagement and Preventive Strategies: Expansion of TB preventive therapy and involvement of TB survivors as “TB Champions” to promote awareness and early detection. Example: The “100 Days” campaign aims to improve case detection and ensure early intervention for high-risk populations.
How have these advancements contributed to a decline in TB incidence and mortality rates?
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Who are the most vulnerable groups affected by TB?
- People with Weakened Immune Systems: Individuals with HIV/AIDS, diabetes, malnutrition, or chronic illnesses are more susceptible due to weaker immunity. Example: TB is the leading cause of death among people with HIV, as their immune system cannot effectively fight the infection.
- Low-Income & Undernourished Populations: Malnutrition and poverty increase TB risk by weakening immunity and limiting access to healthcare. Example: In India, undernourished populations, especially in tribal and slum areas, have higher TB incidence due to poor living conditions.
- Migrants, Prisoners, and Urban Slum Dwellers: Overcrowded and poorly ventilated environments increase TB transmission. Example: Migrant workers living in congested dormitories or prison inmates are at a higher risk of infection due to close contact with infected individuals.
Gender & Tuberculosis: Challenges, Data, and Solutions
| Category | Challenges | Data & Examples | Solutions |
| Women & TB | Social Stigma and Fear of Isolation | 60% of women diagnosed with TB in India face stigma (REACH, 2022). | Community awareness campaigns like “TB Mukt Mahila” in Uttar Pradesh. |
| Misdiagnosis & Underreporting | Only 34% of TB cases in women are officially diagnosed (WHO, 2019). | Gender-sensitive diagnostic protocols in PHCs. Routine TB screening during maternal health checkups (Rajasthan model). | |
| Limited Healthcare Access | 50% of rural women delay TB treatment due to financial dependence (Global TB Report, 2023). Example: Bihar’s ASHA workers report women refusing solo hospital visits, delaying treatment. | Mobile TB clinics and door-to-door screenings. | |
| Higher Risk of Malnutrition | 45% of women with TB suffer from malnutrition (NFHS, 2023). Example: 80% of TB-infected women in Jharkhand lack protein-rich diets, increasing dropout rates. | Ni-kshay Poshan Yojana benefits for women, with an extra ₹500 allowance in Madhya Pradesh. | |
| Children & TB | Non-Specific Symptoms & Misdiagnosis | 60% of childhood TB cases present with fever and weight loss, not cough (IAP, 2022). | AI-based diagnostic tools like Bihar’s AI-assisted TB detection, which increased early diagnosis by 28%. |
| Sputum Test Ineffectiveness | 40-50% of children’s TB cases are undetectable using standard sputum tests (WHO, 2023). Example: Delhi’s AIIMS introduced stool-based PCR testing, increasing childhood TB detection by 25%. | Nationwide adoption of stool-based PCR tests. | |
| Late Detection in Infants | 30% of TB meningitis cases in infants are fatal due to delayed screening. | Routine TB screening during childhood immunizations. | |
| Malnutrition & Weak Immunity | Malnourished children are six times more likely to develop TB (WHO, 2023). Example: 90% of TB-infected children in Jharkhand were also undernourished. | Integrate TB screening with anganwadi nutrition programs. | |
| Exposure to Household TB | 50% of children living with TB-infected adults develop latent TB, but only 15% receive preventive therapy (Nikshay Portal, 2023). Example: Kerala’s preventive therapy program reduced childhood TB cases by 40%. | Preventive therapy for all children in TB-affected households. | |
| Lack of Awareness Among Parents | 70% of parents believe TB only affects adults (UP survey, 2023). Example: Schools in Gujarat introduced annual TB screening camps, improving early detection. | Mandatory TB screening in schools and anganwadis. Maharashtra’s “TB-Free Schools” program detected 5,000 hidden cases in 2023. |
Why is the integration of TB services within the broader public health system crucial for achieving Universal Health Coverage (UHC) in India?
- Ensures Comprehensive and Equitable Healthcare Access: Integrating TB services into primary healthcare allows early detection and treatment for all, especially marginalized populations. Example: Including TB screening in Ayushman Bharat-Health and Wellness Centres (HWCs) improves outreach in rural areas.
- Reduces Financial Burden on Patients: Universal Health Coverage (UHC) aims to provide affordable treatment and minimize out-of-pocket expenses for TB care. Example: Linking TB care with PM-JAY (Ayushman Bharat) ensures free diagnostic and treatment services, reducing financial distress.
- Improves Early Detection and Treatment Outcomes: Strengthening public health infrastructure with integrated screening programs improves early diagnosis and treatment adherence. Example: Nikshay Poshan Yojana provides nutritional support to TB patients, improving recovery and treatment success rates.
- Addresses Co-Morbidities and Holistic Patient Care: TB patients often suffer from HIV, diabetes, or malnutrition; integration helps manage co-existing diseases efficiently. Example: Co-treatment of TB and HIV in ART (Antiretroviral Therapy) centers ensures better health outcomes.
- Strengthens Disease Surveillance and Data Management: A unified health system enhances TB monitoring, tracking drug resistance, and controlling outbreaks. Example: The Nikshay portal helps track patient progress and ensures adherence to treatment regimens.
How does the Ayushman Bharat scheme contribute to decentralizing TB care?
What role do Ayushman Arogya Mandirs (AAMs) play in this process?
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Way forward:
- Strengthen Multi-Sectoral Collaboration: Enhancing partnerships between healthcare, nutrition, and social welfare sectors can ensure a holistic approach to TB care. Example: Expanding Nikshay Poshan Yojana with additional dietary interventions can improve patient recovery.
- Leverage Technology for TB Surveillance & Treatment: Expanding AI-driven diagnostic tools and digital adherence tracking can improve early detection and treatment success. Example: Scaling up the use of AI-based X-ray screening in rural areas can enhance case detection rates.
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