PM IAS EDITORIAL ANALYSIS – JAN 24

Editorial #1 India’s winding road to ‘#End TB’

India’s Journey Towards Ending Tuberculosis: Challenges and Opportunities

Context
Despite ambitious goals and political commitment, India’s efforts to eliminate tuberculosis (TB) by 2025 face significant hurdles. While some progress has been made, the road to achieving the ‘End TB’ targets—90% reduction in TB deaths, 80% reduction in new cases, and zero catastrophic costs for TB-affected families—remains steep, especially in the wake of disruptions caused by the COVID-19 pandemic.

India’s TB Burden
According to the World Health Organization’s Global Tuberculosis Report 2024, India accounts for 26% of global TB cases, making it the country with the highest TB burden worldwide. The prevalence of drug-resistant TB (DR-TB) and TB-related deaths further complicates the challenge.

Key Challenges in India’s TB Elimination Efforts

1. Vulnerable Groups and Risk Factors

• High-risk populations: The National TB Elimination Programme (NTEP) identifies vulnerable groups such as those exposed to fine dust from mining and stone carving, migrant workers, and people with severe lung damage.
• Contributory factors:
  • Silicosis from prolonged dust exposure.
  • Undernutrition, overcrowding, and uncontrolled co-morbidities like diabetes exacerbate TB risk.
• Migrant workers’ challenges: Limited access to healthcare and difficulty in tracking treatment due to frequent movement hinder effective intervention.

2. Gaps in Diagnosis and Treatment

• Extrapulmonary TB (EP-TB): While pulmonary TB remains the primary focus of NTEP, EP-TB—which affects organs like lymph nodes, kidneys, brain, and spinal cord—accounts for 24% of notified cases. However, vague symptoms and reliance on expensive, advanced diagnostic tools often delay treatment.
• Shortages in infrastructure:
  • Diagnostic equipment and trained personnel: Limited availability of CBNAAT and Truenat machines, coupled with shortages of trained lab technicians, delays diagnosis and treatment initiation.
  • Supply chain disruptions: Drug shortages in 2023 caused widespread treatment interruptions, risking antibiotic resistance and catastrophic health expenditures for affected families.

3. Implementation Challenges

• Frequent updates to guidelines: While guidelines are revised regularly, their implementation is hindered by inadequate training of healthcare workers.
• Human resource gaps: Overburdened staff and insufficient training compromise the quality of care delivery.

India’s Achievements in TB Control

1. High treatment initiation rates: Over 95% of notified TB cases have treatment initiated under NTEP.
2. Procurement and supply chain system: A dedicated mechanism ensures the availability of NTEP drugs, although gaps remain.
3. Decline in TB deaths: Deaths due to TB in India have decreased by 24% compared to 2015, significantly outperforming the global average.

Multisectoral Interventions and Global Lessons

1. Tackling Underlying Factors

• Addressing undernutrition among persons with TB (pwTB) is crucial to improving treatment outcomes.
• Localized, geography-specific approaches are needed to tackle region-specific risk factors.

2. Learning from Success Stories

• Vietnam’s active case-finding model: Vietnam’s success in targeting high-risk groups through active case detection offers valuable insights for India.
• Community participation in Kerala: Idukki district leveraged the Kudumbashree self-help group network to mobilize widespread community participation in TB elimination efforts. Political advocacy and innovative local initiatives contributed significantly to achieving targets.

Recommendations

1. Strengthen Diagnosis and Treatment

1. Expand diagnostic infrastructure to the block level and ensure the availability of CBNAAT/Truenat machines and cartridges.
2. Train general practitioners and frontline workers to recognize extrapulmonary TB symptoms for early detection.
3. Ensure Uninterrupted Supply Chains

2. Strengthen procurement and distribution systems to avoid drug shortages.
3. Create buffer stocks at district and block levels to address emergencies.
4. Improve Human Resources

3. Recruit and train healthcare workers to meet growing demands.
4. Sensitize private practitioners to notify TB cases and follow established protocols.
5. Leverage Community and Political Advocacy

4. Foster collaborations with self-help groups and local organizations to enhance community participation.
5. Promote cross-learning from best practices across states to ensure effective implementation.

Conclusion

India’s commitment to eliminating TB by 2025 faces significant hurdles, but with strategic interventions and innovative approaches, there is hope. The administrative flexibility of NTEP must be leveraged to adapt to contextual challenges. By incorporating global best practices and addressing systemic gaps, India can accelerate progress towards the ambitious ‘End TB’ target. The fight against TB requires sustained multisectoral efforts, political will, and community engagement to make this vision a reality.

Editorial #2 A grey birthday for the Election Commission of India

A Grey Milestone for the Election Commission of India

Context
The sanctity of electoral rolls forms the bedrock of India’s electoral democracy. As the Election Commission of India (ECI) marks its 75th anniversary on National Voters Day (January 25), questions about its credibility cast a shadow over this milestone. Upholding its constitutional responsibility of ensuring free and fair elections demands introspection and corrective measures.

The Vision of Electoral Integrity

Dr. B.R. Ambedkar, while introducing the constitutional provision for the establishment of the ECI in 1949, had cautioned against executive interference in the electoral process. He emphasized that electoral rolls are fundamental to a democracy and highlighted the need for an independent election body to safeguard this sanctity. However, recent developments indicate that these principles may be under threat.

Case Study: Maharashtra State Elections

1. Voter Enrollment Discrepancies

• The ECI registered 9.7 crore voters for the 2024 Maharashtra State elections.
• However, the Ministry of Health estimated the total adult population of Maharashtra (18 years and above) in 2024 to be 9.54 crore.
• This means the ECI enrolled 16 lakh more voters than the estimated population—a glaring anomaly.

2. Sudden Surge in Voter Registration

• A comparison of enrollment trends reveals a significant discrepancy:
  • 48 lakh new voters were registered between the Lok Sabha elections and the State elections, a span of just six months.
  • By contrast, only 32 lakh voters were added over the preceding five-year period (2019-2024).
• Such a dramatic surge raises serious questions:
  • What prompted this sudden influx of registrations?
  • Were these registrations verified appropriately?

3. Vote Gain Analysis

• The BJP-led Mahayuti alliance gained 72 lakh additional votes in the State election compared to the Lok Sabha election held six months earlier.
• However, a closer look shows that only 24 lakh voters shifted allegiance from the Congress-led Maha Vikas Aghadi alliance.
• The remaining 48 lakh votes appear unaccounted for, coinciding suspiciously with the number of new voters enrolled.

Key Questions

• Were these new voters genuine or fabricated (“ghost voters”)?
• How is it that the majority of these new voters seem to have favored only one political alliance?
• Was there executive interference in the electoral rolls, as Dr. Ambedkar had warned?

ECI’s Response and Concerns

1. Lack of Transparency

• The ECI has remained largely silent on these discrepancies, dismissing questions without providing detailed clarifications.
• To uphold public confidence, the ECI must:
  • Release all relevant data in the public domain.
  • Ensure transparency in voter enrollment processes.

2. Counter-Argument by ECI

• The Chief Election Commissioner argued that opposition parties failed to detect these anomalies in real time, implying inefficiency on their part.
• However, this reasoning does not absolve the ECI of its constitutional duty to conduct free and fair elections, independent of political party oversight.

Significance of Aadhaar in Electoral Integrity

The Maharashtra incident highlights the need for reforms to prevent electoral roll manipulation. Aadhaar-based biometric verification offers a viable solution:

1. De-duplication and Un-ghosting: Aadhaar integration can eliminate duplicate or fake entries in electoral rolls.
2. Biometric Verification for Voting: Aadhaar-linked verification can ensure that only genuine voters cast their ballots.
3. Safeguards for Genuine Voters: To avoid disenfranchisement, alternative mechanisms must be in place for citizens whose biometric verifications fail.

While concerns regarding privacy and data security must be addressed, Aadhaar-based reforms can strengthen the foundation of India’s electoral democracy.

Way Forward

1. Strengthen Electoral Roll Management

• Conduct regular audits of electoral rolls to identify and rectify discrepancies.
• Leverage technology for real-time monitoring and verification.

2. Enhance Transparency and Accountability

• Make all voter enrollment data publicly accessible for scrutiny.
• Institutionalize independent oversight mechanisms to monitor ECI’s functioning.

3. Promote Electoral Literacy and Participation

• Educate voters on the importance of electoral integrity and their rights.
• Encourage citizen involvement in monitoring electoral processes.

Conclusion

As the ECI celebrates its 75th anniversary, the incident in Maharashtra serves as a sobering reminder of the challenges facing India’s electoral democracy. The sanctity of electoral rolls is non-negotiable, and restoring public trust requires proactive reforms and greater accountability. Aadhaar-based verification, coupled with transparent processes, could be the much-needed “birthday gift” to strengthen India’s electoral framework. Upholding these principles would honor the vision of Dr. Ambedkar and the founding leaders, ensuring that the democratic foundation of the nation remains robust and untainted.