Tuberculosis Elimination Strategy

[op-ed snap] India’s TB report must be seen in light of the country’s slide in Hunger Index


From UPSC perspective, the following things are important :

Prelims level : Nothing much

Mains level : TB elimination in India - links to Nutrition, Sanitation


The Annual India Tuberculosis (TB) report released by the government says that India is now home to about a quarter of the total global TB patients. The current government is committed to ending TB in India by 2025.

TB in the context of Malnutrition and Sanitation

  • Prime Minister declared that rural India was open defecation free (ODF). 
  • The Global Hunger Index 2019 put India at 102 in a list of 117 countries. India’s ranking was below Nepal, Bangladesh and Pakistan. 
  • It has been established beyond doubt that TB is more of a social disease owing to its roots to poverty, malnutrition and poor sanitary conditions.

State of TB in India

  • The TB report reveals the progress on the government’s action plan on combating TB. 
  • The highest number of TB cases – As per the report, 21.5 lakh TB cases were reported in the country in 2018. This is the highest number of TB cases registered in any country. 
  • Nikshay – The report says that with the introduction of Nikshay – the computer-based surveillance programme for TB patients, the reporting of TB cases has improved dramatically.

Barriers to TB notifications

  • The working of such a surveillance programme in an unequal country like India should be taken with a pinch of salt. 
  • In a paper published in the BMJ Open concluded that despite a national notification system — of Nikshay — other factors decide notification of patients.
  • Issues like patient confidentiality, poor knowledge of notification system, etc, prevented notification of TB patients in a hospital setting. 
  • These factors are social and without intervening at that level, it is hard to believe that notification of TB cases can reach a significant number by 2025.
  • Of the total notifications, 5.4 lakh cases were from the private sector, an increase of 40% from last year. More than 80% of healthcare is now being delivered by private health enterprises.

Issues in TB control for public health system

  • Public health – An increase in the notification of TB patients could be heartening for the government. But is not a good indicator for the public health system.
  • Hunger
    • The GHI report reminds that a hungry India cannot be free of TB.
    • Dietary deprivation is a direct indicator of inequality. Unequal societies cannot be made free of disease and infirmity.
    • BMC Pulmonary Medicine journal from Ethiopia shows that the proportion of malnutrition in TB patients was nearly 60%. 
    • Even a very distal reason for malnutrition in the community became a proximal cause for TB.
  • Open Defecation
    • TB and sanitation have a direct causal relationship. 
    • The Integrated Disease Surveillance Programme run by the National Centre for Disease Control maintains a web portal that details the outbreak of epidemics.
    • The validity of the claims of the Swachh Bharat Abhiyan (SAB) through this data shows that there was no statistically significant reduction in the occurrence of vector-borne epidemics in the country, two years after the launch of SAB.


An end to TB is not possible till we end malnutrition, poverty and poor sanitation. We need a paradigm shift in the response to TB. This should include a more sensitive approach on gender and towards the underprivileged.

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