Context:

• The Covid-19 pandemic caused severe disruptions in migration, halting mobility and exacerbating migrant vulnerabilities.
• Five years later, migration patterns have largely reverted to pre-pandemic trends, but new challenges and emerging factors such as climate change and economic transformations continue to shape migration in India.

Reverse Migration During Covid-19:

• The pandemic triggered an unprecedented urban-to-rural reverse migration.
• Government estimates suggest a net reverse migration of 44.13 million during the first lockdown and 26.3 million during the second.

Migrants faced wage theft, food insecurity, lack of healthcare and education, discrimination, and brutality.

Many families dependent on remittances suffered severe economic strain.

Return to Urban Migration and Rural Economic Challenges:

• The rural economy was unable to absorb the returning workforce.
• MGNREGA provided limited relief but could not sustain long-term employment.
• Factors driving return migration to urban areas:
  • Rural distress and low wages
  • Urban aspirations and economic opportunities
  • Climate change significantly impacts agriculture and allied activities, contributing to distress and aspirational out-migration (as observed in Odisha by FAO and IOM studies).

Urban Migration Trends and Government Initiatives:

• Urbanization is projected to continue, with 40% of India’s population expected to live in cities by 2026.
• Government initiatives like Smart Cities Mission (aims to develop 100 cities into modern urban hubs) encourage migration for economic growth.

Impact on International Migration:

• Indian emigrants faced job losses, wage cuts, poor living conditions, and health risks.
• Despite hardships, remittances remained resilient, sustaining many Indian households.
• Migration trends post-pandemic:
  • Gulf Cooperation Council (GCC) countries remain key destinations.
  • Europe is attracting more skilled migrants, with Indians being top recipients of the EU Blue Card in 2023.
  • African nations are emerging as migration hubs for employment in IT, manufacturing, and healthcare, though challenges persist (e.g., 47 Jharkhand workers stranded in Cameroon).
  • Healthcare workers from India continue to be in high demand globally.
  • Student migration surged post-pandemic:
    • The Kerala Migration Survey 2023 indicates that the number of student emigrants from Kerala nearly doubled from 1.29 lakh in 2018 to 2.5 lakh in 2023.
    • The RBI data shows that outward remittances for studies abroad (peaking at $3,171 million in 2021) reflected a sharp increase in spending on international education.
    • We have also witnessed the student crisis during the Russia-Ukraine war.

Challenges in Migration Governance and Policy Interventions:

• Data gaps and the need for improved migration governance:
  • 2021 Census delay has hindered accurate assessment of post-pandemic migration trends.
  • Periodic Labour Force Survey (PLFS) 2020-21 recorded a 28.9% migration rate, a marginal increase from 28.5% in NSS 64th Round (2007-08), but does not reflect long-term trends.
  • Lack of a comprehensive Indian emigrant database limits policy effectiveness.
• Social security and welfare initiatives:
  • e-Shram portal (2021) aims to create a National Database of Unorganised Workers (NDUW) and provide social security benefits, including insurance and access to subsidised food grains.
    • However, it faces issues due to lack of awareness and digital access.
  • One Nation One Ration Card (ONORC) scheme (2018) helps migrants access PDS benefits, but many still remain excluded.

The Kerala Model and Future Policy Directions:

• Kerala Migration Surveys (every five years since 1998) have significantly improved migration policy formulation.
• States like Odisha, Goa, Punjab, Gujarat, Jharkhand, and Tamil Nadu have replicated this model.
• Expanding this approach nationwide would enhance migration governance and aid in better policy responses.

Conclusion:

• Five years after the Covid-19 crisis, India’s migration landscape is evolving.
• While urban migration is resuming and international emigration diversifying, new factors like climate change, global economic shifts, and policy interventions are influencing movement patterns.
• Strengthening migration governance through data-driven policy reforms and improved social security mechanisms is crucial for ensuring migrant welfare and economic stability.

Q1. What were the key factors that contributed to the large-scale reverse migration in India during the Covid-19 pandemic?

Ans. The reverse migration was driven by job losses, wage theft, food insecurity, lack of healthcare access, and discrimination.

Q2. How has climate change influenced migration patterns in India post-pandemic?

Ans. Climate change has exacerbated rural distress by impacting agriculture and allied activities, leading to increased aspirational and distress-driven migration to urban centers.

Q3. What are the major post-pandemic shifts in India's international migration trends?

Ans. While migration to GCC countries remains strong, there is a rising trend of highly skilled migration to Europe and Africa due to economic opportunities.

Q4. How effective have government initiatives like the e-Shram portal and ONORC scheme been in addressing migrant welfare?

Ans. While these schemes aim to provide social security and food security to migrants, challenges such as lack of awareness, digital access barriers, and exclusion of many beneficiaries limit their effectiveness.

Q5. Why is improving migration data governance crucial for policy formulation in India?

Ans. The delay in the 2021 Census, gaps in emigrant data, and the lack of updated migration statistics hinder effective policy planning and migrant welfare interventions. 

Source: IE

Context

• Tuberculosis (TB) remains a significant public health challenge in India, but substantial progress has been made in its detection, treatment, and prevention.
• Integrating TB services into the broader healthcare system, particularly within the Ayushman Bharat National Health Protection Scheme, has played a crucial role in decentralising TB care.
• However, to accelerate TB elimination and achieve universal health coverage (UHC), India must address key challenges such as inequitable access to healthcare, high out-of-pocket expenditure (OOPE), and the need for integrated care.

Advancements in TB Care and Their Impact

• Improved TB Diagnosis through Molecular Testing
  • One of the most significant advancements in India’s TB response is the expansion of molecular testing.
  • Conventional diagnostic methods, such as sputum smear microscopy, often led to delays in detection and lower sensitivity, resulting in missed cases.
  • However, the rollout of molecular testing platforms, such as CBNAAT (Cartridge-Based Nucleic Acid Amplification Test) and TrueNat, has revolutionised TB diagnosis.
  • Molecular tests detect TB within hours and identify drug-resistant strains, enabling early initiation of appropriate treatment.
  • The government has set up molecular testing laboratories across districts to ensure faster and more accessible diagnosis, even in rural areas.
  • With rapid and accurate diagnosis, patients begin treatment sooner, reducing transmission and improving survival rates.
• Introduction of the Shorter, All-Oral BPaLM Treatment Regimen
  • India has transitioned towards better and shorter TB treatment regimens to improve patient compliance and reduce side effects.
  • Traditionally, TB treatment required long-term, multi-drug therapies, often leading to high dropout rates and the development of drug-resistant TB.
  • The introduction of the all-oral BPaLM (Bedaquiline, Pretomanid, Linezolid, Moxifloxacin) regimen is a major breakthrough in treating multidrug-resistant TB (MDR-TB).
  • Unlike older regimens that lasted 18–24 months, BPaLM reduces treatment to just 6 months, lowering the burden on patients.
  • The regimen eliminates painful injectable drugs that caused severe side effects, such as hearing loss.
  • Patient completes treatment faster, reducing the likelihood of treatment failure and further resistance development.
• Strengthened Nutritional Support through Ni-kshay Poshan Yojana (NPY)
  • Malnutrition is a key risk factor for TB. Many TB patients, particularly from economically weaker sections, struggle to maintain proper nutrition, which affects their immune response and recovery.
  • Under the NPY, the government increased the monthly entitlement from ₹500 to ₹1,000 per patient, helping them access nutritious food.
  • The scheme ensures direct cash transfers to patients’ bank accounts, minimising financial stress.
  • This has resulted in access of proper nutrition which improves immunity, helping TB patients recover faster.
  • With improvement in health, fewer patients drop out of treatment midway.
• Integration of TB Services into Ayushman Bharat
  • India has traditionally delivered TB services through vertical programs, such as the National Tuberculosis Elimination Programme (NTEP).
  • While effective, these programs often operated separately from general healthcare services, leading to gaps in accessibility.
  • Government has integrated TB services into Ayushman Bharat, ensuring that TB diagnosis, treatment, and prevention are part of routine healthcare.
  • Ayushman Arogya Mandirs (AAMs) AAMs serve as sputum collection centres, enabling quick testing.
  • Patients diagnosed at tertiary hospitals can now access treatment at local health centres, reducing travel costs and dropout rates.
  • Community health officers are trained to monitor early-stage TB patients, ensuring timely hospitalization for severe cases.
  • Patients receive seamless care at their nearest health facility, making TB services more accessible and affordable.
  • Reduced financial and logistical barriers encourage early treatment-seeking behaviour.
• Community Involvement and TB Champions
  • Recognising the importance of community support in TB care, India has encouraged TB survivors and Champions to play a larger role in spreading awareness and supporting patients.
  • Survivors share their experiences to encourage patients to adhere to treatment and overcome stigma.
  • NGOs, self-help groups, and health workers actively engage in case-finding, awareness drives, and counselling.
  • It has led to greater awareness and social support for higher treatment adherence, also reduced stigma makes patients more willing to seek care early.

Steps Required to Achieve Equitable TB care

• Strengthening Person-Centred Care
  • Initiatives like Tamil Nadu’s Kasanoi Erappila Thittam (TN-KET), which focuses on identifying and admitting high-risk TB patients, have demonstrated success in reducing TB mortality.
  • Similar targeted interventions should be scaled up nationwide, particularly for vulnerable groups like tribal communities, migrants, and the homeless.
• Recognizing Intersectional Barriers
  • Factors such as gender, socio-economic status, and disability influence healthcare access.
  • The NTEP’s gender-responsive framework is a step forward in addressing these disparities, but further efforts are needed to understand and mitigate the impact of intersectional vulnerabilities on TB outcomes.
• Integrating TB Care with General Health Services
  • Many TB patients suffer from coexisting conditions like chronic obstructive pulmonary disease (COPD) or depression.
  • Implementing AI-enabled chest X-rays for TB and COPD screening, along with routine tests for non-communicable diseases, can improve overall patient health.
• Reducing Financial Burdens on Patients
  • While initiatives like NPY provide financial support, indirect costs such as wage loss during treatment remain high.
  • Expanding social protection measures, such as wage-loss compensation and livelihood programs for TB survivors, can help mitigate these economic challenges.
• Enhancing Public Awareness and Stigma Reduction
  • Misinformation about TB continues to hinder early diagnosis and treatment adherence.
  • Lessons from the COVID-19 pandemic show that large-scale public health communication campaigns can drive awareness and behaviour change.
  • A similar approach is needed to combat TB stigma and improve treatment-seeking behaviour.

Conclusion

• India has made significant strides in TB care, but achieving TB elimination and UHC requires a sustained focus on equity, integration, and financial protection.
• By decentralising TB care, strengthening person-centred approaches, and addressing intersectional vulnerabilities, India can ensure that every TB patient receives high-quality care, regardless of their socio-economic background.
• Applying an equity lens to TB policies will not only accelerate India’s progress but also set global benchmarks in TB elimination efforts.

Q1. What is the significance of molecular testing in TB diagnosis?
Ans. Molecular testing ensures faster and more accurate detection of TB and drug resistance, leading to early treatment initiation.

Q2. How does the BPaLM regimen improve TB treatment?
Ans. It shortens treatment duration to 6 months, eliminates painful injectables, and reduces side effects, improving patient adherence.

Q3. What role does the Ni-kshay Poshan Yojana (NPY) play in TB care?
Ans. It provides ₹1,000 per month for nutritional support, improving recovery and reducing treatment dropouts.

Q4. How has Ayushman Bharat helped in TB care decentralization?
Ans. It integrates TB services into primary healthcare centers, making diagnosis and treatment more accessible and affordable.

Q5. Why is community involvement crucial in TB elimination?
Ans. TB Champions and health workers help spread awareness, reduce stigma, and encourage patients to complete their treatment. 

Source:The Hindu