What to Read in The Hindu Editorial( Topic and Syllabus wise)

Editorial 1: India’s winding road to ‘#EndTB’

Context

The chances of ending TB by 2025 appear bleak, but there is some hope.

 

Introduction

Last year, tuberculosis (TB) emerged, once again, as the leading infectious disease killer globally. The goals, i.e., End TB targets of 90% reduction in TB deaths, 80% reduction in new cases, and zero TB-affected families facing catastrophic costs by 2030, seem to be a distant dream. In 2018, India extended the highest level of political commitment for the cause by pledging to achieve End TB targets on an accelerated timeline by 2025. However, the COVID-19 pandemic was a huge pushback to the efforts.

• According to the World Health Organization’s Global Tuberculosis Report 2024, India continues to lead in the global TB burden (26% of cases) and is also the hub for drug-resistant TB (DR-TB) and TB deaths.
• While ambitious policies and initiatives are rolled out from the national level, the ground reality in India needs to be better understood to translate them into effective interventions.

 

Focus on vulnerable groups

• High-Risk groups: NTEP defines vulnerable groups at risk of contracting TB and facing adverse outcomes.
• Severe Lung Damage cases: Around 1000 TB cases annually in clinics, many with severe lung damage.
  1. Contributory factors: Fine dust inhalation from mining and stone carving.
• Risk factors for TB:
  1. Silicosis: Resulting from exposure to dust.
  2. Undernutrition
  3. Overcrowding
  4. Uncontrolled Co-morbidities: Such as diabetes.
• Migrant workers' challenges:
  1. Limited Access to Healthcare: Often prefer returning to native places when ill.
  2. Difficulty for Healthcare Delivery System: Hard to track their treatment.

 

Multisectoral Action to Address Contributory Factors

• Tackling undernutrition: Significant focus on addressing undernutrition among persons with TB (pwTB).
• Need for Local Geography-Specific Actions:
  1. Each geography has unique factors requiring a multisectoral approach.

 

India's Achievements in TB Treatment

• Treatment Initiation Success:
  1. More than 95% of notified cases have treatment initiated.
• Procurement & Supply Chain:
  1. A dedicated procurement and supply chain system has been set up for NTEP drugs.

 

 

Challenges in 2023 – Break in the Supply Chain

• Ongoing Drug Shortages:
  1. Break in the supply chain continued in 2023, affecting many parts of the country.
  2. Shortage of key drugs in centers, some unavailable in the open market.
• Impact on Patients:
  1. Struggle for Families: Beneficiaries and their families faced difficulties in accessing treatment.
• Consequences of Drug Shortages:
  1. Disrupted treatment, risking antibiotic resistance and poor disease outcomes.
  2. Patients may need to purchase drugs from outside sources, leading to catastrophic health expenses.

 

On extrapulmonary TB

• Affects any organ of the body:
  1. Lymph nodes, kidneys, brain, spinal cord, bones, joints, and skin.
• Focus of NTEP:
  1. The main focus of NTEP has been on pulmonary TB affecting the lung, as it is most common and transmissible.
• EP-TB Share:
  1. The share of EP-TB is about 24% of the notified cases, but with wide geographical variations.
• Challenges in Diagnosis:
  1. Often missed or delayed due to symptoms that are vague and mimic other diseases.
• High Index of suspicion for TB: Doctors in Indian settings should have a high index of suspicion for TB in the cases they see.
• Diagnosis process: Proper history taking, thorough clinical examination, and simple tests such as pus staining from a non-healing ulcer can help diagnose TB.
• Challenges with diagnosis: Expensive, advanced tests are often relied upon to start treatment, leading to substantial delays and advanced disease.
  1. Dependence on specialists for diagnosis increases delays.
• Recommendations: Emphasis on training general practitioners to pick up EP-TB at the earliest.
  1. Sensitising frontline workers and integrating EP-TB into their screening algorithms.
• Diagnosis accuracy: Only 35% of private practitioners and 75% of government doctors could correctly diagnose a patient presenting with classical symptoms of TB.
• Reluctance to Notify TB: Private practitioners prescribe antibiotics and refer without any diagnostic tests, which further impacts diagnosis.

 

Challenges in TB Diagnosis and Treatment

• Frequent updates to guidelines: Guidelines are updated quite frequently, but challenges persist in their implementation.
• Shortage of Adequately Trained Human Resources: A shortage of adequately trained human resources is a major challenge affecting implementation of the NTEP.
• Molecular test: Molecular tests are expensive and often take time to access, as they are mostly available only at the district level.
  1. Results take time due to the heavy workload and shortage of trained staff.
• Patient travel & expenses: Patients have to travel and incur more expenses due to the lack of local testing facilities.
• CBNAAT and Truenat Machines Availability: The CBNAAT and Truenat machines are not available at many places, as they are mostly placed at the district level.
  1. Often, when a machine is available, the lab technician will not be there, and if the lab technician is there, cartridge supply for the test would not be there.
• Staffing Challenges: The staff pattern within the NTEP does not meet the growing demands, with most now having more work.

 

What needs to be done

• Ownership at all levels is essential to make programmes work.
  1. Idukki district in Kerala collaborated with Kudumbashree, one of the largest women’s self-help networks in the world, for their TB elimination efforts.
  2. This resulted in widespread community participation and advocacy by government/leadership levels created a huge impact. “It helped us achieve our targets and sustain the activities,” says Dr. Cency B., former District TB Officer of Idukki district, and current Assistant Director, Kerala Health Services.
• Advocacy by political leadership helps in providing platforms for cross learning from best practices across geographies.
  1. But programme implementers will have to go beyond their routine work scope to achieve this.”
• While the chances of ending TB by 2025 look bleak, there is some hope. India’s case notification reached the highest level and deaths due to TB declined by 24% as compared to 2015, which is way more than the global decline.

 

Conclusion

The administrative levels of the NTEP are designed to adapt to the innumerable contextual challenges. New bodies of knowledge from different parts of the world need to be considered. Vietnam, a high burden country, recently showed the effective use of active case finding for TB (advocated for high-risk groups) among the general population, so that targeted interventions could work better. Perhaps India too needs to restructure and redefine its many conventional frameworks, to combat this deadly disease.

Editorial 2: A grey birthday for the Election Commission of India

Context

The sanctity of electoral rolls is the foundation of India’s electoral democracy; the Election Commission of India has nothing to celebrate on the anniversary of its founding day.

 

Introduction

“The executive Government is instructing or managing things in such a manner that those people who do not belong to them either racially, culturally or linguistically, are being excluded from being brought on the electoral rolls. Electoral rolls are a most fundamental thing in a democracy… Independence of elections and avoidance of any interference by the executive should be regarded as a fundamental right,” said Dr. B.R. Ambedkar in June 1949 in the Constituent Assembly while introducing the Constitutional provision to set up the Election Commission of India (ECI). All of India’s founding leaders agreed with this unanimously.

Tomorrow (January 25) is the 75th anniversary of the birth of the ECI — also celebrated as National Voters Day (January 25). Sadly, India’s founding leaders will feel let-down by the ECI and not deem it to be a happy 75th birthday.

 

The case of Maharashtra

• Dr. Ambedkar was prescient in his warnings about electoral roll manipulation by the executive.
• While he was more concerned about exclusion of voters through identity discrimination, government interference in electoral rolls can also be through a process of mass inclusion of voters to tilt an election — as seen in the recently held Maharashtra State elections.

 

Voter Enrollment in Maharashtra

• The ECI enrolled 9.7 crore voters for the 2024 Maharashtra State election.
• The Narendra Modi government’s Ministry of Health report estimated the entire adult population of Maharashtra (18-plus years) in 2024 as 9.54 crore.
• The ECI, by its own admission, registered 16 lakh more voters than the official estimate of the total adult population.

 

Discrepancy in Voter Enrollment

• Even if one were to accept that the government’s estimate is only a projection, and can vary,
  1. it still implies that nearly 100% or more of all the adults in Maharashtra were registered as voters for the State election.
• This is very strange because the ECI neither enrolled nearly all adults as voters for the Maharashtra Lok Sabha election held just six months earlier, nor ever before in any of the other large States.
• Then, how were more people than the entire estimated adult population of Maharashtra enrolled as voters only for the State election?

 

Mass enrolment in just months

• 48 lakh people were registered as new voters in just six months between the Lok Sabha and the State elections.
• For context, between 2019 to 2024, only 32 lakh new voters were enrolled.
• 50% more people were enrolled as voters in just six months compared to the previous five-year period.
• What led to this sudden rush of Maharashtrians to register and vote in the State election alone?

 

Analysis of the BJP Alliance’s Vote Gain

• The BJP-led Mahayuti alliance gained 72 lakh more votes in the State election compared to the Lok Sabha election.
• One might logically presume this gain came from voters who shifted allegiance from the Congress-led Maha Vikas Aghadi alliance to the BJP alliance.
• However, only 24 lakh such voters moved from the Congress alliance.
• The remaining 48 lakh votes (72 lakh – 24 lakh) are unaccounted for.

 

Where Did the Additional 48 Lakh Votes Come From?

• The remaining votes did not come from other parties or independents, as this group also gained more votes in the State election compared to the Lok Sabha election.
• It seems rational to assume that the 48 lakh people who may not have voted in the Lok Sabha election enrolled themselves as new voters for the State election and voted for the BJP alliance.
• The ECI confirmed officially that it enrolled the exact same number, i.e., 48 lakh people, as new voters for the Maharashtra election.
• Is this a miraculous coincidence, a case of divine intervention, or executive interference, as Dr. Ambedkar had warned 75 years ago?
• Questions sbout the validity of new noters:
  1. What explains the sudden rush of new voters in six months for the State election?
  2. Are they real voters? Or are they ghosts?
  3. Were their documents verified when they were enrolled as voters?
  4. How is it that all the new voters enrolled seem to have voted for just one alliance?

 

ECI's Response and Lack of Transparency

• Regardless of political affiliations, it is clear that something seems amiss with the electoral rolls in the Maharashtra election.
• ECI should release all the data in the public domain and issue clarifications in a transparent manner.
• However, the ECI has been silent and dismissive of these questions.

 

ECI's Counter-Argument

• A counter-argument by the Chief Election Commissioner is that if such a large-scale addition of dubious or ghost voters occurred, why were Opposition parties with their war-rooms not alert enough to catch this in time?
• This defense attempts to absolve the ECI by blaming political party inefficiencies.
• It is unfair and illegal to add vast numbers of dubious voters to influence an election and its outcome.
• It is the ECI's constitutional responsibility to run a fair election.
• India's founding leaders entrusted an independent ECI with the responsibility of preserving India’s electoral sanctity and not to rely on political parties.

 

Conclusion: Use Aadhaar

The Maharashtra incident reveals the importance of using Aadhaar to ‘unghost’ and de-duplicate electoral rolls and use its biometric verification for voting. Of course, not even a single eligible citizen should be denied his vote, and an appropriate backup process can be evolved for those whose biometric verifications fail. The sanctity of electoral rolls is of supreme importance and is the foundation of India’s electoral democracy. Aadhaar verification of electoral rolls and voting is the birthday cake that the ECI must be given to preserve and strengthen India’s electoral democracy. It is an idea that even Dr. Ambedkar and other founding leaders may approve of.