The need for universal and equitable health coverage : the Hindu editorial /सार्वभौमिक एवं समतापूर्ण स्वास्थ्य कवरेज की आवश्यकता

Why it is Important for UPSC Mains ?

1. General Studies Paper II (Governance, Health, and Social Justice):
   • It addresses health policy, government schemes (Ayushman Bharat, NTEP), and issues of equitable access to healthcare, which are critical for questions on social sector initiatives and governance.
2. General Studies Paper III (Science & Technology, Economic Development):
   • Innovations like AI-enabled diagnostics, molecular testing, and the BPaLM regimen highlight the role of technology in public health, a frequent UPSC theme. It also ties into economic implications of healthcare costs and UHC.
3. Essay Paper:
   • Topics like “Health for All: Challenges and Opportunities” or “India’s Journey Towards Sustainable Development” often require candidates to discuss TB elimination, UHC, and equity, making this a valuable case study.
4. Current Affairs Relevance:
   • India’s goal to eliminate TB by 2025 (ahead of the global SDG target of 2030) and initiatives like the 100 Days Campaign are frequently in the news, aligning with UPSC’s focus on contemporary issues.
5. Ethics Paper (GS IV):
   • Equity in healthcare, addressing vulnerabilities (gender, caste, disability), and reducing stigma reflect ethical governance and compassion in administration.

Gist of the Article:

• The article outlines India’s significant progress in tuberculosis (TB) care through innovative strategies under the National Tuberculosis Elimination Programme (NTEP) and its integration with the Ayushman Bharat scheme.
• Key advancements include expanded molecular testing, the BPaLM regimen, increased nutritional support via Ni-kshay Poshan Yojana (NPY), TB preventive therapy, and community engagement, leading to a 17.7% decline in TB incidence and a 21.4% reduction in TB deaths from 2015 to 2023.
• However, the vertical nature of TB programs has limitations, necessitating integration into universal health coverage (UHC) frameworks like Ayushman Bharat’s Pradhan Mantri Jan Arogya Yojana (PMJAY) and Ayushman Arogya Mandirs (AAMs). The article emphasizes five steps for equitable TB care: strengthening person-centered approaches, addressing intersectionalities (gender, caste, etc.), integrating TB screening with other diseases, reducing out-of-pocket expenses (OOPE), and improving public awareness to combat stigma and misinformation. These efforts aim to achieve TB elimination by 2025 and align with UHC goals.

Understanding this topic equips candidates to tackle questions on health policy, social equity, and India’s development goals with data-backed arguments and a holistic perspective.

Key Points:

1. Progress in TB Care:
   • 17.7% decline in TB incidence (237 to 195 per lakh population, 2015-2023) and 21.4% reduction in TB deaths.
   • Key strategies: Molecular testing, BPaLM regimen, NPY (₹1,000/month), TB preventive therapy, and TB survivor involvement.
2. Integration with Ayushman Bharat:
   • TB services integrated into PMJAY (insurance) and AAMs (primary care), decentralizing care and improving access.
   • AAMs act as sputum collection centers, optimizing diagnostics and treatment proximity.
3. Challenges:
   • Over 50% of TB patients seek private care, leading to delays, poor outcomes, and high OOPE.
   • Vertical TB programs limit holistic integration with broader health systems.
4. Five Steps for Equitable TB Care:
   • Person-Centered Care: Scale up models like Tamil Nadu’s TN-KET to reduce mortality.
   • Intersectionalities: Address gender, caste, disability, and socio-economic barriers (e.g., gender-responsive TB framework).
   • Integrated Screening: Use AI-enabled chest X-rays for TB/COPD and screen for NCDs (hypertension, diabetes).
   • Financial Protection: Expand NPY, pilot wage-loss schemes, and introduce livelihood programs to minimize OOPE.
   • Awareness: Combat stigma and misinformation with COVID-19-style communication campaigns.
5. Goal and Vision:
   • Achieve TB elimination by 2025 and equitable UHC, setting global benchmarks through decentralized, inclusive health strategies.

This comprehensive framework provides a robust foundation for UPSC aspirants to analyze India’s public health landscape, critique policy implementation, and propose solutions in their answers.