Source: This post on India’s approach to end TB has been created based on article “ India’s winding road to ‘#EndTB’” published in The Hindu on 24th January 2025.
UPSC Syllabus topic: GS Paper 2- Issues Relating to Development and Management of Social Sector/Services relating to Health, Education, Human Resources.
Context: This article delves into India’s ongoing battle against tuberculosis (TB) and its efforts to achieve the ambitious ‘End TB’ targets by 2025. Despite TB being a curable disease, it remains the leading infectious killer globally, with India contributing 26% of the global TB burden. The COVID-19 pandemic significantly hindered India’s progress toward its TB elimination goals, set ahead of the global 2030 target.
Why is TB a global concern, and what are the End TB targets?
- TB remains the leading infectious disease killer globally.
- End TB targets aim for a 90% reduction in TB deaths, an 80% reduction in new cases, and zero catastrophic costs for TB-affected families by 2030.
- India pledged to achieve these targets by 2025 but faces setbacks due to the COVID-19 pandemic.
What is India’s current status in TB burden and drug-resistant TB?
- According to the Global Tuberculosis Report 2024, India:
- Accounts for 26% of global TB cases.
- Is a hub for drug-resistant TB (DR-TB) and TB-related deaths.
- Ground realities need better understanding to make national policies effective.
Who are the vulnerable groups affected by TB in India?
- High-risk groups include:
- People exposed to dust (e.g., miners, stone carvers).
- Those suffering from undernutrition, overcrowding, and diabetes.
- Migrant workers who lack access to consistent healthcare.
- Contributory factors like silicosis and poor living conditions exacerbate TB risk.
How effective is India’s treatment system for TB?
- India’s National Tuberculosis Elimination Programme (NTEP) ensures free and effective drugs, achieving 95% treatment initiation for notified cases.
- However, in 2023, supply chain disruptions caused:
- Drug shortages, forcing patients to buy medicines from private sources.
- Higher risk of antibiotic resistance and catastrophic health expenses.
What is extrapulmonary TB, and why is it often neglected?
- Extrapulmonary TB (EP-TB) affects organs other than the lungs, such as the lymph nodes, kidneys, brain, and bones.
- EP-TB constitutes 24% of notified TB cases, but:
- Symptoms are often vague and mimic other diseases.
- There is a lack of focus on EP-TB in NTEP’s screening algorithms.
- Experts emphasize training general practitioners and frontline workers to improve early diagnosis.
What challenges exist in diagnosing TB?
- Studies show:
- Only 35% of private practitioners and 75% of government doctors can correctly diagnose classical TB symptoms.
- Molecular tests (e.g., CBNAAT, Truenat) are available mostly at the district level, causing delays and extra costs.
- Key challenges include:
- A shortage of trained human resources.
- Dependence on specialists for diagnosis.
- Reluctance among private practitioners to notify TB cases.
What successful initiatives can India learn from?
- Idukki district, Kerala:
- Partnered with Kudumbashree women’s self-help groups to achieve TB elimination targets through community participation.
- Vietnam: Demonstrated the effectiveness of active case finding among high-risk populations for better-targeted interventions.
What are the key takeaways for India’s fight against TB?
- Multisectoral action is needed to address region-specific challenges.
- Strengthening the supply chain is crucial to prevent treatment disruptions.
- Advocacy by political leaders and active community involvement can drive progress.
- Restructuring conventional frameworks and adopting best practices from other countries is essential.
Is there any progress toward achieving the End TB goals?
Despite challenges, there is hope:
- India’s TB case notification reached the highest level ever.
- TB deaths declined by 24% compared to 2015, surpassing the global decline.
What needs to change for India to achieve its targets?
- Ownership and accountability at all administrative levels.
- Focus on early diagnosis, active case finding, and comprehensive training.
- Improved access to diagnostic tools like CBNAAT and Truenat at local levels.
- A shift in approach to address geographical and social disparities
