UPSC Editorial Analysis: India’s Fight Against Tuberculosis

General Studies-2; Topic: Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.

Introduction

• Tuberculosis (TB) remains the leading infectious killer in India, causing nearly 5 lakh deaths every year, which is about one-third of global TB deaths.
• The WHO Global Tuberculosis Report 2025 highlights both India’s significant progress and persistent challenges.
• Although India recorded the world’s highest decline in TB incidence, it still accounts for 25% of the global TB burden, reflecting the scale of the challenge.

About India’s Fight Against Tuberculosis

• India has reduced TB incidence and improved diagnosis, yet remains the world’s highest-burden country. MDR-TB, undernutrition, missing cases, and health system gaps hinder elimination goals.

India’s Progress in Reducing TB Burden

• Incidence Reduction
  • TB incidence declined from 237 per lakh (2015) to 187 per lakh (2024).
  • Annual average decline is 3%, among the fastest globally.
• Mortality Reduction
  • Mortality fell from 28 per lakh (2015) to 21 per lakh (2024) due to better diagnostic tools and treatment access.
• Improved Diagnostics
  • Usage of rapid molecular tests such as CBNAAT, TrueNat, and Line Probe Assay expanded.
  • AI-based chest X-ray interpretation improved early detection, especially in rural and tribal districts.
  • Portable diagnostic tools supported last-mile reach.
• Record Case Notification
  • India diagnosed over 26 lakh cases in 2024, the highest ever, reflecting improved surveillance.
  • Private-sector notification improved due to the Ni-kshay portal and mandatory reporting.
• Better Treatment Coverage & Outcomes
  • Treatment success is higher than the global average due to free drugs, counselling, and community support models.
  • The Nikshay Poshan Yojana DBT scheme enabled food supplementation and improved adherence.
• Digitisation and Monitoring
  • Ni-kshay platform streamlined tracking, patient follow-up, and real-time reporting.

Persistent and Emerging TB Challenges

• India Still Bears the Highest Burden

• • One in every four TB patients globally lives in India.
  • TB remains the top cause of preventable infectious deaths.

• Multi-Drug Resistant TB (MDR-TB)

• • India accounts for 32% of global MDR-TB cases, higher than its share in regular TB.
  • MDR-TB outcomes are poorer due to:
    • Drug toxicity
    • Longer treatment duration
    • Higher dropout
    • Limited access to newer regimens (BPaL, Bedaquiline-based therapy)

• Missing and Undiagnosed Cases

• • India still reports about 1 lakh ‘missing’ cases annually, the largest globally.
  • These cases are common among:
    • Urban slum residents
    • Migrant workers
    • Tribals
    • Poor and undernourished populations
  • Missing cases sustain community transmission.

• Social and Economic Determinants

• • TB is closely linked to poverty and undernutrition.
  • Undernutrition is the single largest risk factor, contributing to nearly 40% of TB cases.
  • Overcrowded housing, indoor air pollution, alcoholism, and smoking increase vulnerability.

• Health System Gaps

• • Shortage of trained personnel for outreach and counselling.
  • Inadequate integration with private sector and AYUSH providers.
  • Inconsistent availability of drugs in some districts.

• Unattainable 2025 Elimination Target

• • India’s 2025 target was ambitious but not supported by adequate:
    • Funding
    • Inter-sectoral coordination
    • Community engagement
    • Social interventions
  • The COVID-19 pandemic also disrupted surveillance and treatment continuity.

Evaluation of the National Strategic Plan (NSP) 2017–2025

Way Forward

• Strengthen Primary Healthcare

• • Increase funding for diagnostic labs and molecular technologies.
  • Ensure availability of trained counsellors and field workers.
  • Integrate TB services with general health and insurance systems.

• Improve MDR-TB Management

• • Expand access to WHO-approved shorter regimens such as BPaL.
  • Strengthen drug-resistance surveillance and genomic sequencing.
  • Ensure availability of newer anti-TB drugs like bedaquiline and pretomanid.

• Address Social Determinants

• • Expand nutrition support through timely DBT and food kits.
  • Improve housing, ventilation, clean cooking fuel, and workplace safety.
  • Introduce community kitchens in high-burden districts.

• Boost Prevention Strategies

• • Scale up preventive therapy for household contacts and vulnerable groups.
  • Strengthen awareness campaigns in schools and urban slums.

• Expand Use of Technology

• • AI-based chest X-rays for mass screening.
  • Telemedicine for follow-up consultations.
  • Mobile-based reminders for adherence.

• Strengthen Public–Private Partnership

• • Standardise treatment protocols across private hospitals.
  • Provide incentives for private-sector notifications.
  • Ensure free drugs and diagnostics for private patients.

• Empower Communities

• • Involve TB survivors as “TB Champions” for counselling.
  • Build village-level TB committees under Panchayati Raj Institutions.
  • Strengthen civil society partnerships for stigma reduction.

Conclusion

• TB elimination requires stronger health systems, improved nutrition, addressing social determinants, and community-driven models.
• To achieve the global target of 2030 and move closer to national aspirations, India must adopt a whole-of-government, whole-of-society approach.