Note4Students
From UPSC perspective, the following things are important :
Mains level: Tuberculosis cases in India;
Why in the News?
Tuberculosis cases in India dropped from over 237 per lakh people in 2015 to below 200 per lakh in 2022, showing a 16% decrease.
What has been the percentage decline in TB incidence and mortality in India since 2015?
What factors led to a decline in TB incidence and mortality?
Note: Despite progress, drug-resistant TB (MDR-TB, XDR-TB) remains a major issue, with low treatment success rates. Example: While overall TB mortality is declining, severely drug-resistant TB still has a treatment success rate of only 45% in India (2021). |
Why is the treatment success rate for severely drug-resistant TB lower than other forms of TB?
- Limited Effective Drugs & High Toxicity: Severely drug-resistant TB is resistant to isoniazid, rifampicin, fluoroquinolones, and at least one second-line injectable drug. This leaves fewer treatment options, and the available drugs often have severe side effects like organ damage. Example: Patients with Pre-XDR-TB (resistant to fluoroquinolones) have a success rate of only 68%, while MDR-TB (less resistant) has a success rate of 74%.
- Longer & More Complex Treatment Regimens: Treatment can take 18-24 months with a combination of multiple drugs. Many patients fail to complete treatment due to the high cost, side effects, or lack of adherence. Example: A patient with XDR-TB (extensively drug-resistant TB) may require daily injections and strong antibiotics, leading to dropout and failure.
- Weaker Immunity & Higher Mortality Risk: Severely drug-resistant TB is harder to treat in patients with weaker immune systems, such as those with HIV, diabetes, or malnutrition. Example: In India, a significant number of TB patients suffer from poor nutrition, making them more vulnerable to severe drug-resistant TB and treatment failure.
Where does India rank among lower-middle-income countries in terms of catastrophic health expenditure due to TB?
- Third Highest Among Lower-Middle-Income Countries: Over 10% of India’s population faces catastrophic health expenditure due to TB. Catastrophic health spending is defined as exceeding 10% of a household’s income or consumption. Example: Among 14 lower-middle-income countries with a high TB burden, India ranks third in terms of the population facing financial strain due to TB treatment.
- Despite High Health Coverage, Costs Remain High: Around 60% of India’s population has some form of health coverage, making it the third highest among these countries. However, out-of-pocket expenses remain high, leading to significant financial distress for many TB patients. Example: Even with government schemes like PM-JAY (Ayushman Bharat), many TB patients still bear steep medical and non-medical costs (e.g., travel, and nutrition).
Who are the top-performing and bottom-performing states in India’s fight against TB according to the TB index?
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Way forward:
- Strengthen Drug-Resistant TB Management: Expand access to newer, effective TB drugs (e.g., Bedaquiline, Pretomanid) and ensure adherence through shorter, less toxic treatment regimens. Example: Scaling up all-oral MDR-TB regimens can improve treatment success rates.
- Reduce Financial Burden on TB Patients: Enhance direct benefit transfers for nutrition and support under schemes like Nikshay Poshan Yojana and integrate TB care with Ayushman Bharat for full cost coverage. Example: Covering non-medical costs (e.g., travel, nutrition) can reduce catastrophic health expenditure.
Mains PYQ:
Question: “In a crucial domain like the public healthcare system, the Indian State should play a vital role to contain the adverse impact of marketisation of the system. Suggest some measures through which the State can enhance the reach of public healthcare at the grassroots level” (2024)
Reason: This question relates to strengthening the public health system, which is crucial for TB control and treatment success.
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