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Integrate TB services with primary health system: Lancet

Integrate TB services with primary health system: Lancet


What to study?

For Prelims and Mains: TB related facts, concerns for India and what needs to be done to achieve the proposed target?


Context: Lancet study on TB.


Key findings:

  1. Compared with 2015 data, 57% reduction in incidence and 72% reduction in mortality will been seen only by 2035 in three countries including India.
  2. Strengthening the care cascade could reduce cumulative TB incidence by 38% in the case of India.
  3. India has to adopt measures to prevent TB on a population level to eliminate the disease in the coming decades.
  4. Diagnosis and treatment for drug-sensitive and drug-resistant TB need improvement.
  5. Modelling suggests that lives of eight million (28%) people with TB can be saved over the next 30 years if tests are subsidised and patients are supported to complete the treatment.
  6. India should scale up access to TB services for all those seeking them, optimise engagement of private sector providers and guarantee universal access to drug susceptibility testing and second line TB drugs.



Of the 10 million new tuberculosis (TB) cases reported globally in 2017 by the World Health Organisation, 74 million were from India, showing a marginal reduction from 2.79 million in 2016.

Despite TB incidence in the country being 204 cases per 1,00,000 in 2017, the government has set a highly ambitious target of “eliminating TB by 2025”, five years ahead of the Sustainable Development Goals (SDGs) target.



  • India has set an ambitious goal of eliminating TB by 2025, but integration of TB services with the primary health system to reduce diagnostic delays is not happening.
  • Patients are not diagnosed and treated at the primary level, which is the first point of contact. Only this will lead to early diagnosis and help cut the transmission cycle.


Why is Tuberculosis a major cause of concern?

  • TB is one of the leading causes of death worldwide and the leading cause from a single infectious agent, ranking above HIV/AIDS.
  • TB is an infectious disease caused by the bacillus Mycobacterium tuberculosis.
  • It typically affects the lungs (pulmonary TB) but can also affect other sites.
  • The disease is spread when people who are sick with pulmonary TB expel bacteria into the air, for example by coughing.
  • Broader influences on the TB epidemic include levels of poverty, HIV infection, under nutrition and smoking.
  • Diagnostic tests for TB disease include – Rapid molecular test, Sputum smear microscopy, Culture-based methods
  • Without treatment, the mortality rate from TB is high.



The consolidated goal on health is SDG 3. One of these targets, (Target 3.3), explicitly mentions TB.

SDG 3 also includes a target (Target 3.8) related to universal health coverage (UHC) in which TB is explicitly mentioned. This includes an indicator on the coverage of essential prevention, treatment and care interventions.


Sources: the hindu.