The Need for Universal and Equitable Health Coverage

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