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

Editorial 1: The need for universal and equitable health coverage

Context

Integrating TB services into the wider public health system is essential for India's goal of achieving equitable and universal health coverage.

 

Introduction

India has made significant progress in fighting Tuberculosis (TB) by adopting new methods for detection, treatment, and prevention. Key improvements include expanding molecular testing for faster TB and drug-resistance diagnosis, introducing the shorter all-oral BPaLM treatment (a mix of four medicines: Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin), increasing nutrition support under the Ni-kshay Poshan Yojana to ₹1,000 per month, rolling out preventive TB therapy, and involving TB survivors and community champions. These efforts have led to a 17.7% drop in TB cases, from 237 per 1,00,000 people in 2015 to 195 per 1,00,000 in 2023, along with a 21.4% decline in TB-related deaths.

• Since independence, India’s public health system has relied on vertical health programs for disease control, such as the National Tuberculosis Elimination Programme (NTEP).
• This vertical approach has enabled focused efforts and brought significant benefits.
• However, it has also created certain limitations in the healthcare system.
• Integrating TB services into the broader public health system is crucial.
• Such integration is key to achieving equitable and universal health coverage (UHC) in India.

 

Decentralising TB care for all

Ayushman Bharat and TB Integration

• Launch & Objective: The Ayushman Bharat National Health Protection Scheme was launched in 2018 to ensure universal health coverage (UHC) for the Indian population.
• TB Integration in Ayushman Bharat: TB services have been integrated into both key components of Ayushman Bharat:
  1.  
     1. Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) – The world’s largest insurance scheme.
     2. Ayushman Arogya Mandirs (AAMs) – Formerly known as Health and Wellness Centres, providing comprehensive primary healthcare in rural and urban areas.

 

TB Services at Ayushman Arogya Mandirs (AAMs)

Services
First Point of Contact	People with TB symptoms can access high-quality services.
Comprehensive Care	Diagnosis, treatment, and preventive care under one umbrella.
Sample Collection	AAMs function as sputum collection centres for TB testing.
Diagnostic Network	Optimized sample collection and transportation under NTEP.
Treatment Accessibility	TB patients diagnosed at secondary/tertiary centres can continue treatment at a nearby AAM to reduce time and costs.
Support for Weak Patients	Community Health Officers at AAMs must identify and refer high-risk TB patients (especially in the first two months) for hospital admission.

 

Challenges in TB Care & Private Sector Involvement

• Preference for Private Sector: Despite free TB services in public healthcare, over 50% of TB patients seek care in the private sector.
• Concerns in Private Healthcare: Uneven care standards lead to delayed diagnosis and poor treatment outcomes.
  1. High out-of-pocket expenditure (OOPE) burdens families.
• Solutions & Recommendations: Strengthening referrals from private to public healthcare for cost-effective treatment.
  1. Ensuring AB-PMJAY covers full insurance for TB treatment in both public and private sectors.
  2. Prioritizing coverage for severely ill patients who may face financial difficulties.

 

The Road to Equitable TB Care: Five Key Steps

1. Strengthening Person-Centered Care at Scale
   • Decentralization & Care Accessibility:
   • While decentralizing TB care, we must ensure person-centered approaches are delivered at scale.
   • Model Interventions:
   • Several states have implemented initiatives linking socially and clinically vulnerable TB patients to care.
   • Tamil Nadu’s TN-KET (TB death-free project) successfully reduced TB mortality by identifying high-risk patients and ensuring timely referrals for hospitalization.
   • Other initiatives focus on tribal communities, migrants, and homeless populations.
   • Enhancing Public Health Utilization:
   • Strengthening human resources, medical supplies, and infrastructure will drive UHC and improve TB care.

 

Intersectional Factor	Impact on TB Outcomes
Gender	Women, men, and LGBTQIA persons experience TB differently.
Age & Socio-Economic Status	Determines healthcare access and intent to seek care.
Caste & Occupation	Influences TB risk and treatment-seeking behavior.
Disability	Early efforts exist but need further development for equitable TB care.

• National TB Elimination Programme (NTEP) Approach:
• The gender-responsive TB framework acknowledges diverse TB experiences.
• Improving gender and disability understanding will challenge norms but is essential for equitable care.

 

Integration Challenge	Proposed Solutions
TB patients may also suffer from COPD, asthma, depression, or hypertension.	Implement general health screenings alongside TB testing.
Lack of comprehensive screening at community levels.	AI-enabled chest X-rays for TB & COPD, plus routine BP, glucose, and BMI checks.

• Objective:
• Adopt multi-disease screening models in community healthcare settings for early detection and treatment.

 

Financial Barrier	Mitigation Strategies
High indirect costs (e.g., travel, lost wages).	Expand nutrition support for TB patients & families.
Income loss during treatment.	Pilot wage-loss compensation schemes for TB patients.
Lack of financial security for TB survivors.	Introduce livelihood programs for TB survivors.

• Existing Initiatives:
• Nikshay Poshan Yojana (NPY) provides monetary support for nutrition.
• ‘100 Days’ case-finding campaign helps detect TB early and reduce pre-diagnosis costs.

 

5. Lessons from COVID-19, communication
   • Equal access to information and knowledge is crucial in addressing TB effectively.
   • TB continues to be widely misunderstood, requiring targeted awareness efforts.
   • The swift public understanding of COVID-19 was achieved through extensive, science-based communication across various platforms.
   • A similar multi-platform approach is needed for TB to encourage timely diagnosis, treatment, and preventive measures within households and communities.
   • Spreading awareness about drug-resistant TB is essential, especially in the context of rising antimicrobial resistance (AMR).
   • Reducing TB-related stigma is vital for promoting early detection and improving treatment success rates.

 

Conclusion

An equitable TB program ensures that every individual receives high-quality, person-centered care tailored to their specific needs. Equity is fundamental to healthcare and crucial for achieving TB elimination and universal health coverage. India’s TB response is well-positioned to set global standards and benchmarks, and prioritizing equity will further accelerate progress.

Editorial 2: Towards better TB control

Context

A comprehensive approach is required, integrating system-wide and community-level actions with a strong focus on individuals affected by TB.

 

Introduction

India reports approximately 2.8 million new TB cases each year, accounting for over 25% of the global TB burden. More than half of TB patients in the country seek treatment from private healthcare providers. Currently, TB treatment is available either in public hospitals, where it is free but the environment may not be very welcoming, or in private hospitals, which offer a more comfortable setting but can be expensive.

 

Public and private care

Government hospitals can offer a standardised clinical algorithm and Challenges in TB Treatment

• Concerns in Public Healthcare:
  1. Free treatment is available.
  2. Patients worry about the quality of drugs and testing.
  3. The healthcare environment may not be welcoming.
  4. Strong monitoring and contact tracing are in place.
• Challenges in Private Healthcare:
  1. More comfortable and patient-friendly environment.
  2. Treatment protocols may not always follow standardized guidelines.
  3. Compliance and follow-up monitoring may be weak.
  4. Higher costs can make treatment unaffordable for many.

 

Aspect	Public Healthcare	Private Healthcare
Cost	Free treatment	Expensive
Quality Concerns	Doubts on drug & testing quality	Higher quality perceived
Environment	Less welcoming	More comfortable
Standardized Protocols	Strict adherence	May not always follow protocols
Patient Monitoring	Strong follow-up & compliance	Weak monitoring & follow-up

 

Need for Innovations in TB Care

• To achieve the WHO goal of TB elimination, innovative approaches in diagnosis and treatment are necessary.
• A public-private partnership (PPP) model can address system inefficiencies by:
  1. Providing patients with treatment choices.
  2. Ensuring better treatment outcomes.
  3. Encouraging shared responsibility between public and private health sectors.

 

A Balanced Healthcare Model

• Hybrid Approach: Combines the strengths of public and private healthcare.
• Clearly Defined Diagnostic Pathways:
  1. Evidence-based protocols to minimize variability.
  2. Standardized treatment methods across both sectors.
• Ensuring Compliance & Monitoring:
  1. Stronger follow-up mechanisms in private care.
  2. Improved drug quality and testing in public care.
• This integrated approach ensures patient choice without compromising outcomes, making it a strong step toward TB elimination.

 

Availability of medicines

• Certain anti-TB medicines for drug-resistant TB are available only in government hospitals to prevent misuse and resistance development.
• To ensure strict adherence to treatment, public health policies require two weeks of hospital admission at the start of treatment for drug-resistant cases.
• This can be challenging for patients who need these novel medicines but are unwilling to be admitted to government hospitals.
• Follow-up care is better in government hospitals, where:
  1. Free medicines are provided.
  2. Patients have access to social workers for support.
• Proposed Solution: A collaboration between public and private systems, ensuring:
  1. Flexible care pathways for patient convenience.
  2. Wider access to essential medicines.
  3. No compromise on diagnostic and treatment protocols.
• This integrated approach will benefit patients while maintaining treatment standards.

 

The way forward

• Patient Care & Transition:
  1. Establish contact and ensure smooth transition between healthcare providers.
  2. Define logistics of cooperation to prevent patients from being lost in the system.
  3. Address accountability issues in treatment and follow-up.
• Regulating TB Treatment & Diagnosis:
  1. Unregistered practitioners treating TB pose a risk.
  2. Diagnosis should follow standard definitions and testing methods.
  3. Regulated drug supply is needed to prevent misuse and ensure adherence to treatment protocols.
  4. Strong follow-up mechanisms must be in place for better patient outcomes.

Area of Concern	Challenges	Proposed Solutions
Patient Care Transition	Patients may be lost in the system	Define clear transition protocols
Accountability	No clear responsibility for treatment outcomes	Establish accountability measures
Unregistered Practitioners	Non-standardized TB treatments	Ensure only licensed professionals treat TB
Diagnosis	Variability in testing methods	Use standardized definitions & tests
Drug Supply & Adherence	Risk of misuse and non-compliance	Regulate drug distribution & protocols
Follow-Up	Patients not monitored after treatment starts	Implement strict follow-up systems

 

Future Directions in TB Treatment

• Regulation of Laboratories:
  1. Laboratories must follow strict quality control standards.
  2. Clinical details should accompany TB test specimens to improve accuracy.
• Centralized Monitoring of TB Cases:
  1. All TB test results should be reported to a centralized cell for coordination.
  2. Pharmacies selling TB medicines should be monitored to prevent misuse.
  3. An expert committee should provide feedback to treating doctors to ensure best practices.

 

Conclusion

There is no single path to success. Rethinking partnerships, challenging conventional norms, and reframing problems can provide more effective strategies and pathways for achieving success in TB control, fostering innovation and improved outcomes in the fight against the disease.