The Hindu Editorial Analysis- 24th March 2025 | Current Affairs & Hindu Analysis: Daily, Weekly & Monthly - UPSC PDF Download

The Need for Universal and Equitable Health Coverage

Why in News?

•  India has made significant progress in the areas of tuberculosis (TB) detection, treatment, and prevention. 
•  However, further strengthening of equitable and decentralized TB care is crucial for achieving universal health coverage and eliminating TB. 

 Key Achievements in TB Care 

• Rapid molecular testing has been expanded to detect TB and drug-resistant TB more quickly. 
•  A new shorter, all-oral treatment regimen known as BPaLM has been introduced for drug-resistant TB. 
•  The monthly entitlement under the Ni-kshay Poshan Yojana (NPY) for nutrition support has been doubled to ₹1,000. 
• TB preventive therapy has been rolled out to help prevent the spread of the disease. 
• TB survivors and Champions now play a larger role in raising awareness and improving treatment outcomes. 

 Impact of These Measures 

•  TB incidence in India has declined by 17.7%, from 237 per 1,00,000 population in 2015 to 195 per 1,00,000 in 2023. 
•  TB-related deaths have reduced by 21.4% during the same period. 

 Integration of TB Care into the Public Health System 

•  India’s public health system has traditionally operated through vertical disease-specific programs like the National Tuberculosis Elimination Programme (NTEP). 
•  While this focused approach has brought benefits, integrating TB services within a broader health system is essential for achieving universal health coverage (UHC). 

 Decentralization of TB Care 

•  The Ayushman Bharat scheme, launched in 2018, aims to provide UHC and has integrated TB care into its two main components: 
• Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). the world’s largest insurance scheme. 
• Ayushman Arogya Mandirs (AAMs). health and wellness centres that provide primary healthcare. 
• Benefits of Decentralization:
•  People with TB symptoms can provide sputum samples at AAMs for testing. 
•  Those diagnosed at higher-level hospitals can access treatment closer to home. 
•  Community health officers at AAMs are trained to refer weak TB patients for admission during the first two months of treatment when mortality rates are highest. 

 Challenges in Private Sector TB Care 

•  Despite free TB services in the public system, 50% of patients seek care in the private sector, leading to: 
• Delayed diagnosis due to inconsistent standards of care. 
• High out-of-pocket expenditure (OOPE) for patients. 
•  Strengthening referrals from private to public healthcare is crucial, ensuring free and quality treatment for all. 
• AB-PMJAY must provide full insurance coverage for TB treatment in both private and public sectors, especially for severe cases. 

 Steps to Achieve Equitable TB Care 

 1. Strengthening Person-Centered Care

•  Several states have successfully implemented targeted interventions. 
•  Programs focusing on tribal communities, migrants, and homeless populations have shown positive results. 
•  Investments in healthcare infrastructure, human resources, and supplies are necessary for better service delivery. 

 2. Recognizing Intersectionalities in TB Care

•  Factors like gender, age, caste, disability, and socio-economic status affect TB diagnosis and treatment outcomes. 
•  A gender-responsive approach has been introduced to address disparities. 
•  Understanding the link between TB and disability is essential for improving care. 

 3. Providing Integrated Healthcare

•  TB care should be combined with screening for chronic diseases like COPD, asthma, depression, and hypertension. 
•  AI-powered chest X-rays and molecular tests can improve early detection. 

 4. Reducing Financial Burden on Patients

•  Ni-kshay Poshan Yojana (NPY) helps ease financial strain by supporting nutrition needs. 
•  Initiatives like the ‘100 Days’ campaign help detect cases early, reducing OOPE. 
•  Future steps: 
• Extending nutrition support to families of TB patients. 
• Introducing wage-loss schemes for TB patients during treatment. 
• Creating livelihood programs for TB survivors. 

 5. Spreading Awareness and Reducing Stigma

•  Public awareness campaigns are needed to improve TB knowledge, similar to COVID-19 communication strategies. 
•  Misinformation and stigma prevent people from seeking timely diagnosis and treatment. 
•  Educating communities about drug-resistant TB and antimicrobial resistance (AMR) is crucial. 

 Conclusion 

•  India’s response to TB is setting global benchmarks in treatment, prevention, and care. 
•  Ensuring equity in healthcare will accelerate progress towards TB elimination and universal health coverage (UHC).