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1. India’s winding road to ‘#EndTB’
Introduction:
India leads the global tuberculosis (TB) burden, with 26% of cases worldwide, according to the WHO Global Tuberculosis Report 2024. Despite ambitious targets to end TB by 2025, significant challenges, such as drug shortages, inadequate diagnostic facilities, and social determinants like undernutrition and overcrowding, hinder progress. While there have been positive strides, systemic issues persist in the fight against this deadly disease.
Key Challenges in India’s Fight Against TB
- Vulnerable Groups and Social Determinants:
- High-risk populations include miners, stone carvers, and migrant workers, who face increased exposure to TB due to conditions like silicosis, undernutrition, overcrowding, and poor access to healthcare.
- Migrant workers often return to their native places when ill, disrupting their treatment and making follow-ups difficult.
- Drug Supply Chain Issues:
- Despite the NTEP’s success in initiating treatment for over 95% of notified cases, a nationwide drug shortage in 2023 disrupted patient care.
- This shortage increases the risk of drug resistance and catastrophic health expenses, particularly as essential drugs are often unavailable in the open market.
- Focus on Pulmonary TB:
- Pulmonary TB remains the primary focus of NTEP, though extrapulmonary TB (EP-TB) accounts for 24% of cases.
- EP-TB often goes undiagnosed due to vague symptoms and limited diagnostic capabilities, particularly in rural areas.
- Inadequate Diagnostic Infrastructure:
- Molecular tests like CBNAAT and Truenat, critical for TB diagnosis, are often available only at district-level facilities.
- Equipment shortages, lack of trained staff, and delays in test results add to the burden on patients.
- Shortage of Trained Personnel:
- A lack of adequately trained human resources hampers the effective implementation of NTEP.
- Frequent updates to TB guidelines require constant training, which remains insufficient in many areas.
- Reluctance in Private Sector Notification:
- Many private practitioners fail to notify TB cases, often prescribing antibiotics without proper diagnostic tests.
- This leads to delays in treatment and increases the risk of advanced disease and transmission.
Lessons from Success Stories
- Community Participation in Kerala:
- Idukki district’s collaboration with Kudumbashree, a women’s self-help network, achieved significant community engagement and advocacy, aiding in TB elimination efforts.
- Political leadership and cross-learning from best practices played a crucial role in sustaining the programme.
- Vietnam’s Active Case Finding Approach:
- Vietnam demonstrated the success of active case finding for TB in high-risk groups, improving targeted interventions.
- Adopting similar strategies in India could enhance early detection and treatment outcomes.
Recommendations for India
- Strengthen Diagnostic Infrastructure:
- Expand access to molecular testing at primary healthcare centers and ensure an uninterrupted supply of cartridges and other diagnostic tools.
- Train frontline workers and general practitioners to identify TB symptoms early, especially in cases of EP-TB.
- Ensure Drug Availability:
- Stabilize the drug supply chain by improving procurement, storage, and distribution mechanisms.
- Introduce real-time monitoring systems to track drug availability and prevent shortages.
- Focus on Vulnerable Populations:
- Implement tailored interventions for high-risk groups, addressing factors like silicosis, undernutrition, and overcrowding.
- Strengthen healthcare delivery for migrant workers, ensuring treatment continuity across states.
- Enhance Public-Private Partnerships:
- Engage private practitioners through incentives and training to improve case notification and adherence to TB guidelines.
- Promote awareness campaigns to encourage early diagnosis and treatment among the general population.
- Encourage Community Participation:
- Leverage local self-help groups and community organizations to increase awareness and facilitate treatment adherence.
- Promote advocacy by political leaders to sustain TB elimination efforts at the grassroots level.
Progress and Way Forward
India’s TB case notification rates have reached their highest levels, and deaths have declined by 24% compared to 2015. While the 2025 target seems unattainable, these achievements highlight the potential for further progress. To truly combat TB, India must restructure its healthcare frameworks, incorporate global best practices, and address systemic gaps with a multisectoral approach. Ending TB is not just a health challenge but a social imperative that demands collective ownership and action at all levels.
Disclaimer: This content is for informational purposes only and does not substitute professional medical advice or consultation. Always seek expert guidance for health-related issues.
2. A grey birthday for the Election Commission of India
The Election Commission of India (ECI), established to ensure free and fair elections, celebrated its 75th anniversary on January 25, also observed as National Voters’ Day. However, concerns over discrepancies in electoral rolls, especially in the Maharashtra elections, highlight challenges to its integrity and the sanctity of India’s democratic process.
Key Points:
1. Significance of Electoral Rolls
- Dr. B.R. Ambedkar emphasized that electoral rolls are fundamental to democracy.
- He warned against executive interference, advocating for the independence of elections as a fundamental right.
2. Role of the Election Commission of India (ECI)
- ECI was established to ensure free, fair, and independent elections.
- The 75th anniversary of ECI (January 25) is observed as National Voters’ Day.
3. Concerns Raised in Maharashtra Elections
- Discrepancy in Voter Data:
- ECI enrolled 9.7 crore voters for the 2024 Maharashtra State election.
- Ministry of Health estimated the adult population at 9.54 crore, indicating 16 lakh more voters than the projected population.
- Unprecedented Increase in Voters:
- 48 lakh new voters were added within six months between Lok Sabha and State elections.
- This was a significant jump compared to 32 lakh voters added in the preceding five years.
4. Voting Pattern and Analysis
- BJP-led Mahayuti alliance gained 72 lakh additional votes in the State election compared to the Lok Sabha election.
- Of these, only 24 lakh votes came from voters shifting away from the Congress-led alliance.
- The remaining 48 lakh votes aligned with the number of new voters added by the ECI.
5. Questions Raised
- Were the 48 lakh new voters genuine?
- Were their documents verified during enrolment?
- Why did these voters predominantly vote for a single political alliance?
6. Transparency Issues
- The ECI has been criticized for not releasing detailed data or clarifying discrepancies.
- Arguments citing opposition inefficiency to identify issues are seen as inadequate defenses.
7. Importance of Aadhaar Integration
- Aadhaar can help eliminate “ghost voters” and de-duplicate electoral rolls.
- Biometric verification could enhance the authenticity of the electoral process.
- A backup mechanism is necessary to ensure no eligible voter is disenfranchised.
8. Constitutional Responsibility
- It is the ECI’s mandate to conduct fair elections and ensure the integrity of electoral rolls.
- Political affiliations should not undermine the ECI’s commitment to preserving democracy.
3. Rumour has it: on the Lucknow-Mumbai Pushpak Express accident
1. Overview of the Incident
- The Lucknow-Mumbai Pushpak Express accident near Pachora station in Maharashtra resulted in 12 deaths and at least 10 injuries.
- Cause: Rumour of a fire led to the pulling of the alarm chain, halting the train. Passengers deboarding on the adjacent track were struck by the Karnataka Express.
2. Factors Contributing to the Accident
- Rumour-induced panic: Similar to previous stampedes, passengers reacted instinctively without assessing the situation.
- Reduced visibility: The curve near the accident site limited the Karnataka Express driver’s line of sight, although brakes were promptly applied.
- Passenger behavior: A common tendency in India for passengers to disembark during unscheduled stops increased the risk.
3. Safety Mechanisms and Concerns
- Auto-locking doors:
- Present in premium trains like Vande Bharat and Rajdhani.
- Could prevent unauthorized deboarding but pose logistical challenges, such as ensuring synchronization across bogies.
- Maintenance issues:
- Initial reports indicated “hot axle” and “brake binding” might have caused sparks and smoke, triggering the alarm.
- Brake binding, caused by a failure to disengage brakes, reflects poor maintenance practices.
4. Historical Parallels
- 2017 Elphinstone Road Stampede: A misinterpreted remark led to panic on a crowded bridge, resulting in 23 fatalities.
- The recurring pattern underscores the need for public awareness and systematic safety measures.
5. Institutional Responsibility
- Role of the Commissioner of Railway Safety:
- An independent body, not under the Railway Ministry, tasked with investigating railway accidents.
- Their inquiry is crucial to identify the root causes and recommend corrective measures.
6. Broader Challenges in Railway Safety
- Long-standing safety issues, including poor maintenance and outdated infrastructure, remain unaddressed.
- Recent railway accidents highlight the urgent need for systemic improvements.
7. Way Forward
- Technical upgrades:
- Expansion of auto-locking door systems to general trains, despite logistical and cost challenges.
- Improved track maintenance and inspection protocols.
- Awareness campaigns:
- Educate passengers on safe practices during train journeys to minimize panic-driven actions.
- Policy reforms:
- Strengthen accountability for maintenance lapses.
- Invest in modern safety technologies across all railway categories.
4. WHO is right: On the U.S. leaving the World Health Organization
1. Context and Decision
- Former U.S. President Donald Trump announced the U.S. withdrawal from the World Health Organization (WHO), accusing it of bias and mishandling the COVID-19 pandemic.
- The U.S. plans to cease funding to WHO and terminate its membership within 12 months.
2. Reasons for the U.S. Withdrawal
- Claims of WHO being “owned and controlled by China.”
- Dissatisfaction with WHO’s pandemic response, alleging partisanship and inefficiency.
- Criticism of WHO’s handling of global health emergencies, including COVID-19.
3. Importance of U.S. Membership
- Financial Contributions: The U.S. is WHO’s largest donor, accounting for 18% of its overall funding. Withdrawal will severely affect:
- Health programs for HIV/AIDS, tuberculosis, and eradication of diseases.
- Global efforts to ensure equitable access to life-saving drugs and vaccines.
- Global Health Collaboration:
- WHO coordinates disease prevention, outbreak management, and stronger health systems worldwide.
- Pathogens know no borders; global health cooperation is essential to prevent pandemics.
4. Lessons from the COVID-19 Pandemic
- Global Interdependence:
- No country is immune to global health threats; international collaboration is vital.
- Collective action ensures stronger responses to future pandemics.
- Equity and Science:
- Shared access to medical technologies and data is critical to ensuring global safety.
5. Broader Implications
- Impact on Global Health:
- Reduced funding may derail key health initiatives, especially in low-income countries.
- Trust in multilateral organizations like WHO could be eroded, weakening global health governance.
- Political Ramifications:
- Withdrawal signals isolationist tendencies, undermining U.S. leadership in global health.
- Other nations may follow suit, leading to fragmentation in global health efforts.
6. Call for Reconsideration
- WHO has appealed to the U.S. to reverse its decision and re-engage.
- The health community views the U.S.’s withdrawal as short-sighted and hopes for renewed collaboration.
7. Way Forward
- Reaffirm Global Commitments:
- The U.S. should recognize the interconnected nature of health challenges and resume its WHO membership.
- Strengthen WHO’s Accountability:
- Address criticisms through transparent reforms and increased efficiency in its operations.
- Collaborative Framework:
- Foster open data sharing, joint research, and equitable vaccine access to tackle global health crises.
Disclaimer:
This analysis is based on the editorial content published in The Hindu and is intended solely for informational and educational purposes. The views, opinions, and interpretations expressed herein are those of the author of original article. Readers are encouraged to refer to the original article for complete context and to exercise their own judgment while interpreting the analysis. The analysis does not constitute professional advice or endorsement of any political, economic, or social perspective.
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