India is strengthening TB care through equity

Source: The post India is strengthening TB care through equity has been created, based on the article “The need for universal and equitable health coverage” published in “The Hindu” on 24th March 2025

UPSC Syllabus Topic: GS Paper2- Governance- Issues relating to development and management of Social Sector/Services relating to Health.

Context: India has made significant progress in Tuberculosis (TB) care through new detection, treatment, and prevention strategies. The focus is on decentralising care, integrating TB services into the broader health system, and ensuring equity to achieve TB elimination and universal health coverage (UHC).

For detailed information on India’s progress in fighting tuberculosis read this article here

Progress in TB Care in India

1. India has enhanced TB detection with expanded molecular testing for rapid identification and drug resistance assessment.
2. The introduction of the BPaLM regimen, a shorter, all-oral treatment, utilizes four drugs: Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin.
3. Nutritional support under the Nikshay Poshan Yojana (NPY) has doubled to ₹1,000 per month.
4. TB preventive therapy has been initiated alongside expanded community involvement through TB Champions.
5. Significant results include a 17.7% decline in TB incidence, from 237 per 100,000 population in 2015 to 195 in 2023.
6. TB-related deaths have decreased by 21.4%, reflecting the impact of these comprehensive strategies on public health outcomes.

Integration and Decentralisation of TB Services

1. TB services are integrated into Ayushman Bharat’s Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and Ayushman Arogya Mandirs (AAMs), providing comprehensive care.
2. AAMs act as sputum collection centers, facilitating accessible diagnostics and treatment near patients’ homes, improving convenience and reducing travel.
3. Decentralization allows for treatment at primary care levels, crucial during the initial two months of treatment when patients are most vulnerable.
4. Over 50% of TB patients initially seek treatment in the private sector, highlighting the need to strengthen referral systems to public facilities to ensure equitable care.

Steps Towards Equitable and Person-Centred TB Care

1. Person-Centred Interventions: States like Tamil Nadu have implemented the Tamil Nadu Kasanoi Erappila Thittam (TN-KET) to reduce TB deaths. It identifies vulnerable patients and ensures hospital referrals. Other states have targeted tribal, migrant, and homeless populations. Strengthening infrastructure, staff, and medicine supply is crucial.
2. Recognising Intersectionality: Multiple social factors such as gender, age, caste, disability, and occupation influence TB outcomes. The National TB Programme now includes a gender-responsive approach. Early work on understanding TB and disability has also begun and needs further support.
3. Integrated Health Services: People with TB symptoms must also be checked for other illnesses like COPD, asthma, hypertension, and depression. Community screening models should include AI-enabled chest X-rays and monitoring of blood pressure, sugar levels, and BMI.
4. Reducing Financial Burden: Schemes like NPY and the 100 Days campaign help reduce direct costs. However, families still face indirect costs. India should expand social support—like nutrition aid to families, wage-loss schemes, and livelihood support for TB survivors.
5. Effective Communication and Awareness: Public knowledge of TB remains low. During COVID-19, science-based communication quickly reached everyone. Similar efforts are needed for TB. Awareness about drug-resistant TB and reducing stigma are essential for early care-seeking and successful treatment.

Way Forward

India’s TB response now focuses on equity, person-centred care, and integration with general health services. Continued investment in primary care, digital tools, social protection, and awareness campaigns can strengthen these efforts. Applying an equity lens will accelerate the path toward TB elimination and universal health coverage.

Question for practice:

Examine how India’s TB response incorporates equity, decentralisation, and integration with general health services to move towards TB elimination and universal health coverage.