TB and Equitable Health Coverage

Syllabus: Health

Source:  TH

Context:  India has made commendable progress in tuberculosis (TB) care through new strategies including molecular testing, shorter BPaLM regimen, nutrition support via Ni-kshay Poshan Yojana (NPY), and community engagement.

 Key Developments in TB Care:

• Decline in TB incidence: India reduced TB incidence by 17.7% from 2015 to 2023, showing progress from 237 to 195 cases per lakh population.
• New interventions: Introduction of the BPaLM regimen and ₹1,000/month nutritional support under Nikshay Poshan Yojana have strengthened treatment.
• Community involvement: TB survivors are now engaged as TB champions to spread awareness and promote treatment adherence at the grassroots level.
• Integration with Ayushman Bharat: TB services are integrated into PMJAY and Ayushman Arogya Mandirs, ensuring accessibility at primary healthcare centres.
• Improved diagnostics: Sample collection and rapid molecular testing have been optimised at primary care levels for faster and accurate detection.

Different Initiatives to Combat TB:

1. Global Efforts:

1. 1. Find. Treat. All. #EndTB Initiative: Launched by WHO with the Global Fund and Stop TB Partnership to ensure universal access to TB care and treatment by 2030.
   2. Global Tuberculosis Report: An annual report by WHO that tracks TB incidence, mortality, funding, and progress toward elimination targets.

2. India’s Efforts:

1. 1. Pradhan Mantri TB Mukt Bharat Abhiyan: A community-driven initiative encouraging public participation and nutritional support for TB patients to achieve TB elimination by 2025.
   2. National Strategic Plan (NSP) for Tuberculosis Elimination (2017-2025): A comprehensive roadmap focusing on early detection, universal treatment, public-private partnerships, and social support.
   3. TB Harega Desh Jeetega Campaign: A national awareness campaign that promotes early diagnosis, treatment adherence, and community participation in TB eradication.
   4. Nikshay Poshan Yojana: A direct benefit transfer scheme offering ₹1,000 per month to TB patients for nutritional support during treatment.

Challenges in Achieving Equitable TB Care:

• Vertical program limitations: Current TB services are siloed; integration into the broader healthcare system is needed for universal reach.
• Private sector dependency: Over 50% of TB patients opt for private care, resulting in diagnostic delays and higher out-of-pocket expenses.
• Intersectional barriers: Gender, caste, income, and disabilities influence healthcare access and TB outcomes in diverse population groups.
• Integrated care gaps: Simultaneous screening for TB, COPD, diabetes, and mental health issues is lacking in the current system.
• Stigma and misinformation: Widespread myths and social stigma deter timely testing, diagnosis, and successful TB treatment.

Way Forward (Recommendations):

• Person-centred care: Adopt models like Tamil Nadu’s TN-KET to prioritise care for the most vulnerable and critically ill patients.
• Address intersectionality: Implement gender-responsive and disability-inclusive approaches to remove social barriers in TB care.
• Integrated screening: Introduce combined TB and NCD screenings using AI-based diagnostics for comprehensive community health checks.
• Financial protection: Expand wage-loss support, nutrition schemes, and livelihood initiatives for TB-affected families to reduce financial strain.
• Communication and awareness: Launch large-scale, multi-platform public education campaigns to dispel TB myths and encourage early treatment.

Conclusion:

India’s TB elimination goal aligns with UHC and requires person-centric, equitable, and integrated health strategies. Strengthening public health, addressing vulnerabilities, and community-led awareness can position India as a global leader in TB elimination efforts.

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