UPSC Editorial Analysis: India’s Fight Against Tuberculosis
Kartavya Desk Staff
*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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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)
• 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)
• 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.
• 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
• Urban slum residents
• Migrant workers
• 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.
• 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.
• 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.
• India’s 2025 target was ambitious but not supported by adequate: Funding Inter-sectoral coordination Community engagement Social interventions
• 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
Strategic Pillar | Progress | Gaps / Challenges
- 1.Detection | • AI-based screening tools, rapid molecular tests, and mobile diagnostic vans enhanced early detection. | • Rural diagnostic infrastructure remains weak. • Quality and reliability of private-sector diagnosis vary widely.
- 2.Treatment | • Free drug regimens available under NTEP. • Adherence technology (99DOTS, MERM) improved monitoring. • Nutrition support through Direct Benefit Transfers improved compliance. | • MDR-TB cure rates remain low. • Patients often drop out due to stigma, long treatment duration, and side effects.
- 3.Prevention | • Preventive therapy for household contacts and vulnerable groups expanded. • Increased awareness and community-level outreach. | • Poor housing, crowding, and inadequate ventilation continue. • Nutrition programmes lack adequate and sustained funding.
- 4.Health System Strengthening | • Digital surveillance via Ni-kshay improved tracking and reporting. • Strong political and administrative commitment to TB elimination. | • Persistent shortage of trained health workers. • Fragmented coordination between Union, state, and municipal agencies. • Limited investment in public health laboratories and infrastructure.
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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
Q. India has one of the highest burdens of Tuberculosis (TB) globally, and ensuring an adequate supply of quality-assured drugs is crucial for effective treatment. Examine the major impediments to ending TB in India. – INSIGHTS IAS – Simplifying UPSC IAS Exam Preparation (250 words)