India’s 2025 TB Elimination Target: Challenges, Initiatives, and the Way Forward

NewsDecode | Health & Governance | Mains Paper 2: Issues Relating to Development and Management of Social Sector/Services in Health

For Students:

From a UPSC perspective, focus on India’s healthcare challenges, government initiatives in TB elimination, and the public health policy approach.

Why in the News?

A recent report reveals that India is likely to miss its target to eliminate tuberculosis (TB) by 2025. The target, part of the National Strategic Plan for TB Elimination (2017-2025), was set to achieve a TB-free India five years ahead of the UN Sustainable Development Goal (SDG) timeline of 2030. This setback underscores the challenges in addressing public health crises within India’s healthcare system.

Challenges to TB Elimination in India

High Burden of TB: India has the highest TB burden in the world, accounting for over 25% of global TB cases. High population density, socioeconomic disparities, and limited healthcare accessibility contribute to the endemic nature of TB in the country.
Drug-Resistant TB (DR-TB): The rise in multi-drug-resistant (MDR) and extensively drug-resistant (XDR) TB is a major challenge. Treating these resistant strains requires longer and more complex treatment regimens, increasing the cost and strain on healthcare resources.
Underreporting and Diagnostic Gaps: Many cases go undiagnosed or unreported, especially in rural and underserved areas. Lack of access to diagnostic tools and delays in testing hinder timely intervention, worsening TB transmission and mortality rates.
Stigma and Awareness: Social stigma around TB prevents many patients from seeking timely treatment, and there is often a lack of awareness about symptoms, free treatment options, and the importance of adherence to the treatment regimen.

Government Initiatives and National Strategic Plan (NSP) for TB Elimination

National Strategic Plan for TB Elimination (2017-2025): The NSP aims to reduce the TB incidence rate by 80% and the mortality rate by 90% by 2025. Key components include early diagnosis, universal access to treatment, and social support mechanisms.
Nikshay Poshan Yojana: This scheme provides monthly nutritional support to TB patients, addressing one of the root causes of TB vulnerability—malnutrition.
Nikshay Ecosystem: A digital initiative, the Nikshay system, facilitates tracking and monitoring of TB cases nationwide. It aims to integrate private and public sector reporting to ensure comprehensive data collection.
Partnerships with Private Sector: The Patient Provider Support Agency (PPSA) model engages private healthcare providers to ensure that TB cases treated outside government systems are also reported and monitored.
Awareness Campaigns: The government has launched various awareness campaigns to reduce stigma, promote early detection, and encourage adherence to treatment. However, there is a need for more robust and sustained community engagement.

Reasons for Missing the 2025 Target

Resource Constraints: Although significant resources have been allocated, the scale of India’s TB burden requires greater funding and resources, especially in light of rising DR-TB cases.
COVID-19 Impact: The pandemic diverted health resources, disrupted TB services, and led to significant backlogs in diagnosis and treatment. This setback intensified the TB burden, with delayed diagnosis leading to higher transmission.
Gaps in Primary Healthcare Infrastructure: India’s primary healthcare system, particularly in rural areas, often lacks necessary diagnostic facilities and trained personnel to manage TB effectively, leading to treatment delays.
Inadequate Follow-Up and Treatment Adherence: Many TB patients discontinue treatment prematurely due to side effects or stigma, leading to a rise in DR-TB. Ensuring adherence to the six-month TB regimen requires consistent follow-up, which remains challenging in India’s healthcare infrastructure.

Global Context and Comparative Analysis

Global Targets: The UN’s SDG Target 3.3 aims to eliminate TB by 2030. Many other high TB-burden countries face similar challenges in achieving these targets, with health infrastructure and funding constraints being common barriers.
Best Practices from Other Nations: Countries like Vietnam and Brazil have adopted community-based interventions and mobile clinics to reach underserved populations. Implementing similar strategies in India could help address diagnostic and treatment accessibility gaps.

Way Forward

Increased Investment in Diagnostics and Treatment: Expanding access to rapid diagnostic tools like GeneXpert machines and funding second-line drugs for DR-TB can improve early detection and treatment outcomes.
Strengthening Public-Private Collaboration: Improving engagement with the private sector to ensure comprehensive TB reporting and tracking can help capture a larger number of cases and reduce underreporting.
Community-Based TB Programs: Training local health workers to provide support and follow-up for TB patients can improve treatment adherence and minimise the stigma associated with the disease.
Enhanced Awareness and Education: Launching robust campaigns that target awareness about TB symptoms, treatment options, and the importance of completing the treatment regimen is essential for prevention and control.
International Collaboration for DR-TB Drugs: Strengthening partnerships with international organizations to secure affordable access to newer TB drugs for treating DR-TB cases can improve patient outcomes.

Mains PYQ

Q. India’s public health system has faced several challenges in addressing infectious diseases. Discuss the role of government initiatives in managing the TB epidemic and suggest improvements for achieving the elimination target. (UPSC IAS)