Content:
- Petty politics
- Not the only path
- The need for universal and equitable health coverage
- Imagining a 360° and comprehensive TB care response
Petty Politics
Background
- Delimitation refers to redrawing parliamentary and assembly constituencies based on population changes.
- The 42nd Amendment (1976) froze the number of constituencies based on the 1971 Census, preventing states with lower population growth from losing representation.
- The 84th Amendment (2002) extended this freeze until 2026.
- The upcoming delimitation exercise is expected post-2026, raising concerns among states that have successfully controlled population growth, particularly in South India.
Relevance : GS 2(Polity ,Delimitation ,Election)
Practice Question:
The delay in conducting the Census has far-reaching implications for India’s representative democracy, particularly in the context of the upcoming delimitation exercise. Discuss the concerns raised by various states and suggest measures to ensure a fair and transparent process. (250 words)
Current Issue & Forward Linkages
- Delimitation Debate Revived:
- Joint Action Committee (JAC) on Fair Delimitation formed, with participation from multiple state leaders, including four Chief Ministers (Tamil Nadu, Kerala, Telangana, and Punjab).
- Demand: Extend the freeze for another 25-30 years to prevent states with lower fertility rates from losing seats.
- Concerns that population control success could lead to reduced representation in Parliament.
- Southern states leading the resistance, but participation from Punjab and Odisha broadens the issue’s appeal.
- Delay in Census – Political Motives?
- The 2021 Census has been indefinitely postponed, impacting data accuracy for delimitation.
- Delaying the Census prevents an informed delimitation process, creating space for arbitrary political decisions.
- The Union government has not provided clarity on Census timelines, leading to suspicion of political motives.
- Transparency and consultation missing, raising fears of electoral gains influencing decisions.
- Alternative Suggestions:
- Fiscal contribution as a factor (proposed by K.T. Rama Rao, BRS) to balance representation, acknowledging southern states’ economic role.
- However, economic metrics fluctuate, making them unreliable for long-term political structuring.
Concerns & Implications
- Federal Tensions:
- Southern states fear marginalization in national policymaking due to their lower population growth.
- Raises questions on fiscal federalism and political equity in governance.
- Electoral Politics:
- A delayed Census benefits parties looking to manipulate constituency boundaries for electoral advantage.
- The lack of clarity benefits status quo politics, preventing a rational, consensus-driven approach.
- Way Forward
- Conduct the 2021 Census without further delay to ensure data-driven delimitation.
- Initiate nationwide consultations before forming the Delimitation Commission.
- Ensure transparent and inclusive discussions to address regional concerns and uphold representative democracy.
Conclusion
- The delimitation issue is not just a southern concern but a national issue affecting federalism and democracy.
- The delay in Census appears politically motivated, adding to suspicions of manipulative tactics in the delimitation process.
- A fair and transparent approach is needed to balance representation and maintain the integrity of India’s democratic framework.
Not the only path
Background
- The Communist Party of India (Maoist) has been active for over 20 years but is now at its weakest.
- The insurgency peaked in the mid-to-late 2000s, leading the government to label it the “greatest security threat.”
- Currently, Maoist influence is largely restricted to forested areas of southern Chhattisgarh and adjoining regions.
- Maoists follow an outdated strategy of armed struggle, prioritizing militarism over mass mobilization, weakening their support base.
- Government strategies have combined counter–insurgency operations with development initiatives in tribal regions.
- Over 100 alleged Maoists have been killed in operations in 2024 alone, including 30 in Bastar recently.
Relevance : GS 3(Internal Security )
Practice Question
A purely militaristic approach to countering the Maoist insurgency can lead to tribal repression and further alienation. Critically analyze the need for a balanced strategy in addressing Left-Wing Extremism (LWE) in India. (250 words, 15 marks)
Forward Linkages and Challenges
- Security Approach and Risks:
- The Indian state has adopted an aggressive military approach, leading to a decline in Maoist influence.
- However, past errors like Salwa Judum highlight the risks of excessive militarization.
- Civilian casualties and tribal repression could fuel resentment and inadvertently aid Maoist recruitment.
- International Comparisons:
- The experience of FARC (Colombia) and Nepali Maoists suggests that negotiated settlements can work.
- Militaristic crackdowns alone may not permanently resolve ideological insurgencies.
- Socio-Economic Dimension:
- The root causes of Maoist insurgency—tribal alienation, land rights issues, and governance deficits—need stronger redressal.
- Addressing economic backwardness and political inclusion could provide a sustainable solution.
Way Forward
- Balanced Approach:
- While security forces must tackle violence, an exclusively militaristic solution may deepen tribal disenchantment.
- A dual strategy of firm law enforcement and socio-economic upliftment is essential.
- Engagement with Civil Society:
- NGOs and community leaders should be involved in peacebuilding efforts.
- A credible rehabilitation policy should incentivize Maoists to surrender.
- Message to Maoists:
- Maoists must recognize that their violent strategy has failed and that negotiations could lead to a dignified resolution.
- Tribal communities should not be caught between state repression and Maoist coercion.
The need for universal and equitable health coverage
Background and Progress in TB Care
- India has made significant progress in TBelimination through new strategies:
- Molecular testing: Rapid detection of TB and drug resistance.
- BPaLM regimen: Shorter, all-oral treatment with Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin.
- Nutrition support: Ni-kshay Poshan Yojana (NPY) entitlement doubled to ₹1,000/month.
- TB preventive therapy and community engagement: Involvement of TB survivors and Champions.
Relevance : GS 2(Health ,Governance)
Practice Question : Universal and equitable health coverage is essential for achieving India’s public health goals. Discuss the role of integrating TB services within the broader health system in ensuring universal health coverage (UHC). Highlight the challenges and suggest measures to improve accessibility and affordability of TB care in India.(250 Words)
- Impact:
- 17.7% decline in TB incidence (2015: 237 per 1,00,000 → 2023: 195 per 1,00,000).
- 21.4% reduction in TB-related deaths.
Challenges of Vertical Disease Control Programs
- India has relied on vertical health programs (e.g., National TB Elimination Programme – NTEP).
- Vertical approach allows focused intervention but limits integration with the broader health system.
- Need: Integrated TB services within public health to achieve Universal Health Coverage (UHC).
Decentralized TB Care and UHC
- Ayushman Bharat (2018) aims for UHC, integrating TB care through:
- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) – insurance-based coverage.
- Ayushman Arogya Mandirs (AAMs) – primary health centers offering diagnostic, treatment, and preventive services.
- Benefits of integration at primary level:
- TB screening at first point of contact.
- AAMs as sputum collection centers, reducing time and costs.
- Treatment at nearest health facility.
- Trained community health officers to prevent dropout and mortality in the first two months.
Challenges in Private Sector Involvement
- 50% of TB patients seek care in private sector due to:
- Quality gaps in private healthcare.
- Delays in diagnosis, high out-of-pocket expenditure (OOPE).
- Key solutions:
- Strengthen referrals from private to public health system.
- Expand AB-PMJAY coverage for TB treatment in private hospitals.
Forward Linkages: Steps Towards Equitable TB Care
Strengthening Person-Centered Care
- Example: Tamil Nadu’s Kasanoi Erappila Thittam (TB death-free project) – reduced mortality through targeted care.
- Special interventions needed for tribal, migrant, and homeless populations.
- Investments in human resources, supplies, and infrastructure key to UHC.
Recognizing Intersectional Barriers
- TB outcomes affected by gender, caste, disability, and socio-economic status.
- Gender-responsive TB approach in NTEP acknowledges differences in TB experience.
- Need for disability-inclusive policies to address TB among vulnerable groups.
Advancing Integrated Care Models
- Co-screening for other diseases:
- COPD, asthma, hypertension, depression alongside TB.
- AI-enabled chest X-rays, molecular testing, and screening for NCDs (blood pressure, glucose, BMI).
Reducing Out-of-Pocket Expenditure (OOPE)
- Expansion of social protection schemes:
- Extending nutrition support to families.
- Wage-loss compensation for TB patients.
- Livelihood programs for TB survivors.
- Case-finding campaigns like 100 Days to reduce pre-diagnosis OOPE.
Addressing TB Stigma and Misinformation
- Public awareness campaigns like COVID-19 to enhance TB knowledge.
- Communication strategies to tackle anti-microbial resistance (AMR).
- Reducing TB stigma to improve early detection and adherence to treatment.
Conclusion: Towards Equitable and Universal Health Coverage
- Equity in TB care ensures high-quality, person-centered services for all.
- Integration within the public health system accelerates UHC and TB elimination.
- India’s TB response can set global standards with an equity-focused approach
Imagining a 360° and comprehensive TB care response
Background
- Tuberculosis (TB) remains a major public health challenge in India despite being preventable and curable.
- India accounts for the highest TB burden globally, with millions affected annually.
- The stigma and socio-economic vulnerabilities associated with TB hinder early diagnosis and treatment.
- The National TB Elimination Program (NTEP) aligns with WHO’s End TB Strategy, aiming to eliminate TB by 2025.
Relevance : GS 2(Health)
Practice Question : “Despite being a preventable and curable disease, Tuberculosis (TB) continues to be a major public health challenge in India. Analyze the gaps in India’s TB response and suggest a multi-sectoral strategy for its effective elimination by 2025.”(250 Words)
Key Issues in TB Care
Gaps in Diagnosis and Treatment
- Many TB cases go undiagnosed or misdiagnosed due to lack of awareness and stigma.
- Accessibility to diagnostic facilities and medicines remains inconsistent, especially in rural areas.
- Drug-resistant TB (MDR-TB) is an increasing concern, requiring advanced treatment regimens.
Social and Economic Barriers
- Job insecurity leads to financial hardships, discouraging people from seeking medical help.
- Stigma and discrimination from family, workplace, and society hinder disclosure and care-seeking behavior.
- Poor nutritional status among TB patients affects treatment outcomes and recovery.
Health System Challenges
- Shortage of trained personnel and high patient loads impact service delivery.
- The public-private divide in healthcare reduces coordinated TB management.
- Treatment adherence is affected by side effects, travel costs, and lack of follow-up mechanisms.
Strategies for a Comprehensive TB Response
Strengthening Public Health Infrastructure
- Uninterrupted drug supply and decentralized TB care for accessibility.
- Point-of-care diagnostics with faster and more accurate detection.
- Transitioning to person-centered TB care with psychosocial support.
Community and Societal Interventions
- Empowering TB survivors as advocates to combat stigma.
- Integration of TB care within insurance schemes and corporate social responsibility (CSR) initiatives.
- Awareness campaigns leveraging media and digital platforms for sensitization.
Multisectoral Approach for TB Elimination
- Workplace TB policies ensuring job security and social protection.
- Nutritional support programs addressing malnutrition-induced vulnerability.
- Investments in vaccine research and airborne infection control measures.
Way Forward: A Coordinated Approach
- Government, private sector, and civil society must work in synergy.
- TB care should be integrated into universal health coverage policies.
- Data-driven, gender-responsive planning is crucial for equitable TB care.
- Accountability at every level, from policymakers to frontline workers, is essential.
