Mains Paper 2
Context: As per the World Health Organization’s Global Tuberculosis Report 2024, India bears the highest TB burden worldwide, contributing to 26% of the total cases and fatalities associated with the disease.
Although India has ambitious national policies, a deeper understanding of on-ground realities is essential to implement effective interventions for TB elimination.
About World Health Organization (WHO):
| Aspect | Details |
| Full Name | World Health Organization |
| Abbreviation | WHO |
| Founded | April 7, 1948 |
| Headquarters | Geneva, Switzerland |
| Mandate | To promote and protect global health, set health standards, and provide leadership on international public health issues. |
| Member Countries | 194 (as of 2024) |
| Director-General | Dr. Tedros Adhanom Ghebreyesus (since 2017) |
| Key Functions | – Coordinating international health responses- Setting health standards- Providing technical support to countries- Conducting research |
| Focus Areas | – Communicable diseases (e.g., TB, HIV/AIDS)- Non-communicable diseases (e.g., cancer, diabetes)- Mental health- Health systems strengthening |
| Global Programs | – Global Immunization Agenda- World Health Day- International Health Regulations (IHR)- Global Burden of Disease Study |
| Funding | Primarily funded by contributions from member states, donations, and other partnerships. |
| Slogan | “Health for All” |
| Key Highlights by WHO 2024 Report on India’s TB Burden: High Burden: In 2023, India accounted for 26% of the global TB cases, maintaining its status as the country with the highest number of TB-related cases and deaths worldwide. Decline in Incidence: Between 2015 and 2023, India achieved a significant 17.7% reduction in TB incidence, surpassing the global average decline of 8.3% recorded during the same period. Improved Treatment Coverage: TB treatment coverage in India saw a rise from 72% in 2015 to 89% in 2023, reflecting enhanced access to healthcare and support services for affected individuals. Multidrug-Resistant TB: India continues to have the highest burden of multidrug-resistant (MDR) and Rifampicin-resistant TB globally, underscoring persistent challenges in addressing drug resistance. TB Case Numbers: In 2023, India reported approximately 2.7 million TB cases, with around 2.51 million individuals diagnosed and initiating treatment. Challenges to Elimination Goals: Despite advancements, India is unlikely to achieve the WHO’s End TB Strategy targets, which aim for a 75% reduction in TB-related deaths and a 50% decline in incidence from 2015 levels by 2025. Demographic Insights: The report indicates that TB cases were distributed as follows: 55% in men, 33% in women, and 12% in children and young adolescents, emphasizing the need for tailored interventions across different population groups. |
What are the current challenges hindering TB elimination in India?
- Socio-Economic Challenges: A large number of TB patients belong to marginalized communities with limited financial and social resources, which hampers their ability to access timely diagnosis and treatment. Additionally, the persistent stigma surrounding TB often prevents individuals from seeking medical assistance or openly discussing their condition.
- Healthcare System Limitations: India’s healthcare system struggles with challenges such as insufficient infrastructure, a lack of adequately trained medical professionals, and unequal healthcare access across various regions. These issues create obstacles in effectively detecting and managing TB cases.
- Impact of the COVID-19 Pandemic: The disruptions caused by the COVID-19 pandemic have negatively affected TB control efforts, resulting in delays in diagnosis and treatment, with vulnerable groups bearing the brunt of these setbacks.
- Strengthening Private Sector Collaboration: Many TB patients prefer seeking treatment from private healthcare providers, which can lead to gaps in reporting and adherence to national TB guidelines. Strengthening collaboration with the private sector is essential for a more cohesive and effective TB management strategy.
| National Tuberculosis Elimination Programme In 2020, the Revised National Tuberculosis Control Program (RNTCP) was rebranded as the National TB Elimination Program (NTEP) to reflect the Government of India’s commitment to eradicating TB in the country by 2025, which is five years ahead of the global target set for 2030. The Sustainable Development Goals (SDG) related to TB, using 2015 as the baseline, aim to achieve: An 80% reduction in TB incidence, A 90% decrease in TB-related deaths, and The elimination of catastrophic costs for TB patients and their families due to the disease. The program is guided by the National Strategic Plan (NSP) for 2017-2025, with key activities carried out under four strategic pillars known as “Detect – Treat – Prevent – Build” (DTPB). |
How effective are the current strategies and initiatives under the NTEP?
- Decline in TB Incidence and Mortality: Between 2015 and 2022, India saw a 16% decrease in TB incidence and an 18% drop in TB-related deaths. This progress suggests that the NTEP is making significant headway toward achieving its goal of TB elimination by 2025, which is five years earlier than the global target.
- Increase in Case Notifications: The NTEP reported 24.2 lakh TB cases in 2022, reflecting a growth of over 58%, with the number rising further to 25.5 lakh in 2023.
- Private Sector Collaboration: Over the past eight years, TB case notifications from private healthcare providers have increased sevenfold. In 2022, private sector notifications accounted for 30% of total cases, which further increased to 33% in 2023, demonstrating the effectiveness of engaging private practitioners in reaching more patients.
- Successful Treatment Outcomes: TB treatment success rates have consistently remained above 80%, reaching 87.6% in 2023. This indicates the efficiency of the treatment strategies implemented under the NTEP.
- Expansion of Diagnostic Facilities: The program has significantly strengthened its diagnostic capabilities, with an 80% rise in the number of Designated Microscopy Centers (DMCs) and the establishment of several molecular diagnostic laboratories. In 2023, around 1.89 crore sputum smear tests and 68.3 lakh nucleic acid amplification tests (NAAT) were conducted.
- Efforts to Combat Drug-Resistant TB: The NTEP identified 63,939 cases of multidrug-resistant TB (MDR-TB), demonstrating its dedication to addressing drug resistance through specialized treatment approaches.
| The Nikshay Poshan Yojana, aimed at providing financial support for the nutritional needs of TB patients, has benefited over 1 crore individuals, with a total disbursement of around ₹2781 crores by 2023. This initiative plays a crucial role in combating undernutrition, which is a major risk factor for TB. |
What role do public-private partnerships play in achieving TB elimination goals?
- Higher Case Notification: Partnerships between public health programs and private healthcare providers have resulted in increased case notifications, which are crucial for efficient management and treatment.
- Improved Treatment Success: Research shows that private healthcare providers involved in these partnerships often surpass the national treatment success rate target of 85% for newly diagnosed TB patients, highlighting the success of these collaborations in ensuring quality care.
- Holistic Care Approaches: The Patient Provider Support Agency (PPSA) model has been expanded across multiple districts and states, strengthening the NTEP’s capacity to effectively address TB.
- Training and Skill Development: To ensure alignment with national TB guidelines, the NTEP offers training and supervision for private healthcare providers. This initiative helps equip them with the necessary skills to deliver standardized and high-quality TB care.
A grey birthday for the Election Commission of India
Mains Paper 2
Context: January 25 marks the 75th anniversary of the Election Commission of India and is observed as ‘National Voters Day’ to acknowledge its contribution to safeguarding democracy and conducting free and fair elections in the country.
What are the current challenges facing the ECI?
- The Election Commission of India (ECI) is currently grappling with several challenges that put its credibility and efficiency at risk:
- Electoral Roll Concerns: Allegations of large-scale enrollment of questionable voters have surfaced, particularly during the Maharashtra State elections, where the ECI registered 9.7 crore voters, exceeding the estimated adult population of 9.54 crore. This discrepancy has raised apprehensions about possible government influence in the electoral process.
- Verification Challenges: Doubts have been raised regarding the verification process for newly registered voters, with reports indicating 48 lakh new registrations within a span of six months. Concerns persist about whether adequate verification procedures were followed to ensure the legitimacy of these voters.
- Erosion of Public Confidence: The perceived lack of transparency and responsiveness from the ECI in addressing these issues has led to growing public skepticism. Critics argue that the commission’s dismissive approach toward concerns related to electoral integrity is weakening its credibility.
About the Election Commission of India (ECI):
| Aspect | Details |
| Full Name | Election Commission of India (ECI) |
| Established | 1950 |
| Headquarters | New Delhi, India |
| Main Role | To administer election processes in India at both the central and state levels. |
| Structure | – Chief Election Commissioner (CEC)- Election Commissioners (2 other commissioners ) |
| Current Chief Election Commissioner | Rajiv Kumar (as of 2024) |
| Election Commissioners | Gyanesh KumarSukhbir Singh Sandhu |
| Main Functions | – Conducting elections to Parliament, State Legislatures, and offices of the President and Vice President.- Administering electoral reforms.- Ensuring fairness and transparency in the election process. |
| Independence | The ECI is independent of the executive and has the authority to act freely without interference from the government. |
| Key Responsibilities | – Supervision of voter registration- Voter education- Issuing election notices- Managing election funds- Monitoring party expenditures |
| Major Initiatives | – Introduction of Electronic Voting Machines (EVMs)- Voter ID cards- Voter awareness campaigns |
| Significance in Democracy | The ECI plays a pivotal role in upholding the democratic process in India by ensuring free, fair, and transparent elections. |
| Slogan | “Every Vote Counts” |
How has the role of the Election Commission evolved over time?
- Founded in 1950, the Election Commission of India (ECI) was created to ensure that elections in the country are free, fair, and free from government interference.
- Leaders like Dr. B.R. Ambedkar highlighted the need for an independent body to uphold the integrity of the electoral process.
- Technological Progress: The ECI has embraced technological innovations by introducing electronic voting machines (EVMs) and online voter registration systems, aiming to streamline elections and encourage greater voter participation.
- Voter Awareness Programs: The commission has put a stronger focus on educating voters and raising awareness, particularly through National Voters’ Day celebrations, designed to engage younger voters and reinforce democratic values.
What reforms are necessary to strengthen the EC’s authority and public trust?
- To improve its effectiveness and rebuild public trust, several reforms are essential:
- Biometric Verification: Introducing Aadhaar-based biometric verification for voter registration could help eliminate fraudulent voters and ensure only eligible citizens are included, thereby enhancing the credibility of electoral rolls.
- Transparency Initiatives: The ECI should increase transparency by making data on voter enrolment and verification publicly accessible. This would help address concerns about manipulation of electoral rolls and foster trust among the public.
- Strengthening Legal Framework: Updating current laws to grant the ECI greater authority to monitor and enforce electoral integrity could prevent political interference and ensure the fairness of elections.
Conclusion:
- The ECI should create strong systems for public oversight by publishing detailed data on voter enrolment and verification, along with conducting regular audits, to restore trust and ensure accountability.
Is poverty being underestimated in India?
Mains Paper 1
Context: The government has recently released a factsheet on the 2023-24 Household Consumption Expenditure Survey (HCES), noting a decrease in poverty levels in both urban and rural areas.
| What are the key findings of the report? Average MPCE and Imputed Values: In 2023-24, the average Monthly Per Capita Expenditure (MPCE) stood at Rs. 4,122 in rural areas and Rs. 6,996 in urban areas, excluding the value of free items provided through social welfare schemes.Growth in MPCE and Urban-Rural Disparity: From 2022-23, the MPCE in nominal terms increased by about 9% in rural areas and 8% in urban areas. The urban-rural MPCE gap decreased from 84% in 2011-12 to 71% in 2022-23, further narrowing to 70% in 2023-24, signaling strong consumption growth in rural regions.Consumption Trends by Population Segments: The largest rise in MPCE in 2023-24, compared to 2022-23, was seen among the bottom 5-10% of India’s population, both in rural and urban households.Expenditure Composition: Non-food items made up 53% of the rural MPCE and 60% of the urban MPCE in 2023-24. Within the food category, beverages, refreshments, and processed foods had the largest share of expenditure. In the non-food category, significant contributors included conveyance, clothing, entertainment, and durable goods. Urban households spent about 7% of their non-food expenditure on rent. Reduction in Consumption Inequality: The rural Gini coefficient dropped from 0.266 in 2022-23 to 0.237 in 2023-24, while the urban coefficient decreased from 0.314 to 0.284 during the same period. |
What are the concerns related to the HCES data?
- Incomparability of Data Sets: The methodology employed in the 2022-23 HCES differs considerably from earlier surveys, making it challenging to draw comparisons over time. The introduction of a “modified mixed reference period” further complicates direct comparisons with previous data collected using different methods.
- Sampling Bias: Concerns have been raised that the survey may not adequately capture extremely poor households, which could result in an overestimation of average expenditures. This bias may stem from changes in sampling techniques that tend to favor wealthier households.
- Data Availability Challenges: The lack of up-to-date and reliable consumption data before the 2022-23 survey has led to a reliance on older estimates, which may not accurately reflect current poverty levels. The last comprehensive survey prior to this was conducted in 2011-12.
What does the consumption pattern tell about poverty in rural and urban regions?
- Disparities in Poverty Levels: The average monthly per capita expenditure (MPCE) shows notable differences between rural and urban areas, with rural areas averaging Rs 4,122 and urban areas Rs 6,996 in 2023-24. This indicates that urban populations tend to have higher consumption levels.
- Struggling with Low Incomes: Reports suggest that a significant portion of India’s population survives on less than Rs 100 per day, underscoring ongoing poverty despite claims of improvement. This raises concerns about whether the poverty line used for estimates is sufficient.
What are the criticisms faced by the Multidimensional Poverty Index?
- NITI Aayog, the policy think tank of the Government of India, adopted the Multidimensional Poverty Index (MPI) to assess poverty in India.
- Methodological Issues: Critics point out that the MPI’s approach of giving equal weight to health, education, and living standards may oversimplify the complexities of poverty. The choice of indicators can significantly affect the results, potentially leading to biased portrayals.
- Evolving Nature of Poverty: The MPI may not fully capture the dynamic and evolving nature of poverty, as it relies on static indicators that do not account for immediate economic changes or shocks, such as those brought about by the COVID-19 pandemic.
- Political Implications: Some economists argue that using the MPI as a primary poverty measure may be politically driven, aiming to present more favorable statistics while overlooking deeper economic issues like stagnant real wages and growing inequality.
Way forward:
- Enhance Data Collection: Regular and thorough Household Consumption Expenditure Surveys (HCES) should be conducted to ensure that poverty assessments remain up-to-date and accurate. This would address data gaps and provide a more dependable foundation for policy-making.
- Improve Poverty Metrics: The Multidimensional Poverty Index (MPI) should be combined with traditional consumption-based measures to present a more comprehensive and dynamic view of poverty, taking into account region-specific challenges and those arising from events like the pandemic.
Union cabinet extends National Health Mission for another 5 years
Mains Paper 2
Context: The Union Cabinet has approved the extension of the National Health Mission (NHM) for another five years, from 2025 to 2030.
| What are the new Components of the NHM and initiatives launched? Digital Health Initiatives: The U-WIN platform was introduced in January 2023 to enhance vaccination tracking for pregnant women, infants, and children. By the end of FY 2023-24, it had expanded to 65 districts across 36 states and Union Territories.Expansion of Healthcare Programs: Under NHM, programs like the National Sickle Cell Anaemia Elimination Mission and the Measles-Rubella Elimination Campaign have been launched, boosting disease control efforts.Enhancing Human Resources: NHM has worked on strengthening healthcare staffing, with over 1.2 million additional healthcare workers being engaged in various roles since its previous extension. What are the key achievements of the National Health Mission during its previous tenure? Reduction in Maternal and Child Mortality: Maternal Mortality Ratio (MMR): The MMR decreased from 130 per lakh live births in 2014-16 to 97 per lakh in 2018-20, marking a 25% reduction.Under-5 Mortality Rate: It dropped from 45 per 1,000 live births in 2014 to 32 in 2020, reflecting a 75% decrease.Infant Mortality Rate (IMR): The IMR fell from 39 per 1,000 live births in 2014 to 28 in 2020. India is on track to meet the SDG targets for maternal, child, and infant mortality before 2030. Healthcare Workforce Expansion: The NHM supported the engagement of approximately 2.69 lakh additional healthcare workers in 2021-22, enhancing healthcare delivery.Disease Control Enhancements: Improved surveillance and control strategies for diseases like tuberculosis have led to a reduction in incidence rates, contributing to overall public health progress. |
What are the financial implications and commitments associated with the NHM’s extension?
- The National Health Mission (NHM) continues with funding recommendations from the Expenditure Finance Committee (EFC) and set spending limits. While the mission has been extended, its budget is regularly reviewed to ensure efficient resource use.
- For financing, most states share costs with the central government in a 60:40 ratio, while northeastern and hilly states follow a 90:10 arrangement. This system ensures states have sufficient resources to implement health programs effectively.
- Performance-Based Funding: The NHM provides additional funds to states for improving key health indicators, such as maternal and child health, motivating states to strengthen their healthcare systems.
- Local committees, like Rogi Kalyan Samitis (RKS), also receive flexible funding, enabling them to directly address patient needs and enhance services.
- Commitment to Health Goals: By 2025, the NHM aims to reach specific health targets, including reducing the Maternal Mortality Ratio (MMR) to 90, the Infant Mortality Rate (IMR) to 23, and the Under-5 Mortality Rate (U5MR) to 23. Achieving these goals will require continuous investment in health infrastructure, workforce training, and community programs.
- The government is also focused on addressing broader factors affecting health, such as nutrition and disease prevention, while improving healthcare access for disadvantaged populations.
What are the challenges?
- Infrastructure Deficiencies: Many Primary Health Centres (PHCs) lack crucial diagnostic tools, medical equipment, and sanitation facilities. In remote regions of Bihar and Uttar Pradesh, PHCs often struggle with electricity and water shortages, affecting their ability to provide quality care.
- Shortage and Distribution of Healthcare Workforce: While 1.2 million healthcare workers have been added, there is still a shortage of specialists like gynaecologists, anaesthetists, and paediatricians in rural areas. States like Rajasthan and Madhya Pradesh continue to face challenges in staffing Community Health Centres (CHCs) with specialized doctors.
- Financial Constraints and Inefficient Fund Utilization: Delays in the release of funds and underutilization of allocated budgets impede the execution of critical initiatives. Northeastern states such as Nagaland and Manipur have encountered difficulties in utilizing NHM funds due to insufficient financial planning and monitoring systems.
Way forward:
- Infrastructure and Workforce Enhancement: Improve the infrastructure of PHCs and CHCs by providing necessary facilities, and ensure the equitable distribution of healthcare specialists through targeted incentives, training, and deployment programs in underserved areas.
- Efficient Fund Utilization: Simplify fund disbursement processes, improve financial planning, and establish strong monitoring systems to ensure the effective use of allocated budgets, especially in resource-limited regions.
Pangsau Pass
Mains Paper 3
Context: The Pangsau Pass International Festival will be held in Nampong, Arunachal Pradesh, from January 20-22, 2025, marking the return of the event after a four-year hiatus. The festival celebrates the cultural connections and heritage between India and Myanmar.
About Pangsau Pass
- Pangsau Pass is an important mountain pass on the India-Myanmar border, linking the Changlang district of Arunachal Pradesh, India, with the Sagaing Region of Myanmar.
- Located in the Patkai Hills, it stands at an elevation of around 3,727 feet (1,136 meters) above sea level.
- Often called “Hell Pass” due to its difficult terrain and dense forests, it is both a geographical wonder and a historical site.
Geographical Significance:
- Strategic Location: Serves as a natural connector between India and Myanmar, promoting cross-border trade and cultural exchange.
- Scenic and Biodiverse: The area is home to attractions such as the Lake of No Return, a legendary body of water in Myanmar linked to World War II stories.
- Tourism Potential: The Pangsau Pass International Festival highlights the region’s tribal cultures, supporting local economies and encouraging tourism.
Historical/Political Significance
- The pass was an essential part of the Stillwell Road (Ledo Road), built during World War II to link India with China via Myanmar.
- It was crucial to the China-Burma-India Theater, supporting supply routes for Allied forces. Today, it serves as a gateway for India’s Act East Policy, which aims to enhance relations with Southeast Asia.
- The pass supports cross-border trade and cultural exchanges, strengthening economic and diplomatic ties between India and Myanmar.
- It also allowed communities on both sides to interact under the Free Movement Regime (FMR) (now suspended), enabling travelers to move up to 16 km into each other’s territories without needing visas or passports.
