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(GIST OF YOJANA) INDIA’S COMMITMENT TOWARDS TB-MUKT BHARAT

(AUGUST-2024)

INDIA’S COMMITMENT TOWARDS TB-MUKT BHARAT

Context:

Tuberculosis (TB) is an infectious disease and found in every part of the world. India carries one of the largest global burden of the disease. The central and state governments are committed to eradicating it by 2025, five years ahead of the global target under the Sustainable Development Goals (SDG) 2030. Let us deep dive into the different aspects of the disease and understand India’s initiatives in this direction.

Global burden of TB

TB is an infectious airborne disease caused by Mycobacterium tuberculosis (M.tb). WHO estimates that close to 1/4th of the global population, are infected with TB. Approximately 13 lakh children get sick with TB each year.
Last year, TB was noted to be the world’s second leading cause of death from a single infectious agent, after COVID-19. It caused almost twice as many deaths as HIV/AIDS. In 2022, 1.06 crore were infected from TB and 14 lakh died due to it. TB results in 3,500 deaths on a daily basis.
Tuberculosis is strongly influenced by different social, economic and health-related risk factors. These are undernutrition, diabetes, HIV infection, alcohol use disorders and smoking.
According to WHO, on the global scale in 2020, an estimated 19 lakh incident cases of TB were due to undernutrition, 7.4 lakh each to HIV infection and alcohol use disorders, 7.3 lakh to smoking and 3.7 lakh to diabetes. Although, there are regional and national variations. For instance, a high incidence is noticed among the urban population living in slums.

Key Initiatives to Make India TB-Mukt

It is important to note that even though Tuberculosis is very infectious, it is entirely preventable and a curable disease when detected in a timely manner and the treatment is fully completed.

With the goal of achieving SDGs related to TB by 2025, Union Ministry of Health & Family Welfare is implementing the National TB Elimination Programme (NTEP) with the following objectives:

1. Early diagnosis of TB patients, prompt treatment with quality-assured drugs and treatment regimens.

2. Engaging with the patients seeking care in the private sector.

3. Prevention strategies include contact tracing in high-risk/vulnerable populations.

4. Airborne infection control.

5. Multi-sectoral response for addressing social determinants.

Nutritional support through Nikshay Poshan Yojana

According to WHO report (2017), people with active TB who suffer from undernutrition usually are linked to a two- to four fold increase in mortality. There is also a five-fold risk of drug-induced hepatotoxicity.
In view of this potent co-relation, the Government introduced a scheme of Nikshay Poshan Yojana (NPY) in April 2018 for providing Rs. 500/month as direct benefit transfer (DBT) to support the nutrition of TB patients for the entire duration of treatment. Till date, more than 1 crore TB patients have benefited. Cumulatively, till March 2024, more than Rs. 2,859.96 crore have been disbursed.

Infrastructure Scale-Up

Diagnostic infrastructure has played a vital role in active TB case detection. Through concerted efforts, there has been a notable infrastructure scale-up of TB laboratory services.
Designated Microscopy Centres (DMCs) have increased by 80%(13,583 in 2014 to 24,449 in 2023) over the past 9 years.
Also, 6,196 new molecular diagnostic laboratories have been established till now. The number of drug-resistant TB treatment centres has increased from 127 in 2014 to 792 in 2022.

Sub National disease-free certification

In order to monitor the trends of the TB epidemic at the State/UTs/District level, the Health Ministry has introduced a novel initiative of estimating disease burden through a methodology of community-level survey (Inverse sampling methodology) and tracking drug sales data in the private sector and measuring the level of under¬ reporting to the programme.
Through this methodology, State/UTs/District level estimates of TB disease are derived and measured against the baseline of 2015. In the year 2020, Lakshadweep and Budgam in J&K were declared as the first UT & the first district in the country respectively to achieve more than 80%
reduction in TB incidence. In 2022, Karnataka received Silver (>40% reduction) and Jammu & Kashmir received Bronze (>20% reduction). Three districts were declared TB-free (>80% reduction), 17 districts received Gold (>60% reduction), 35 districts received Silver and 48 districts received Bronze.

High Level focus during G20 India Presidency Apart from these steps, under the G20 India

Presidency in 2023, the Union Health Ministry has diligently advocated and addressed selected concerns of global importance, which included improving the effectiveness and reach of health services using digital solutions; strengthening cooperation to enhance pharmaceutical development and manufacturing capabilities.
There was a sharp focus on "OneHealth" approach and Anti-Microbial Resistance (AMR) during the deliberations in the Health Working Groups and the Ministerial meeting at Gandhinagar, Gujarat in November 2023. All of these have had strong resonance with India’s and the world’s fight against TB.

Way forward and Conclusion

With less than two years for India to meet its target of being TB Free by 2025, the approach going forward is to focus on prevention of the disease and to saturate coverage of services in the detection and treatment of TB. It is encouraging to note that with continuous efforts of the governments, support agencies and the communities, the number of missing TB cases in India has reduced from 1 million in 2015 to 0.26 million in 2023.
India’s efforts are important, as the PM mentioned, this is a “new model for the global war on TB". India’s big strides in combating TB have won global accolades. Dr Lucica Ditiu, Executive Director of Stop TB Partnership, praised India’s scale in tackling TB and the TB-Free India initiative. She expressed the belief that India will end TB by 2025, and this will make a huge dent in the global TB burden.