In a parliamentary system of governance such as ours, legislative (parliament) discussions assume paramount importance for they are intended to discuss and debate on several key issues facing the nation, especially those of the voiceless poor, and more so in the case of their ailments. However, as one peruses debates over years, or decades, parliament appears to have failed the marginalised sections. The opposition is mired in inconsequential issues, crowding out key concerns of ordinary Indians. It has largely failed in scrutiny of government actions and policies, pointing out its faults and foibles, suggesting alternative policies and – where the government is intransigent – engaging and rallying public.

The lamentable attitude of both government and opposition has become much discernible in the case of the burden of diseases on the nation. The SDG (Sustainable Development Goal) target 3.3 set by India aims to end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases, and combat hepatitis, water-borne diseases, and other communicable diseases by 2030. The country has even pledged to achieve the “End TB” targets by 2025 – as announced by PM Narendra Modi in March 2018 – five years ahead of the SDG deadline of 2030. The PM reiterated the pledge at a Varanasi meet two years ago.

However, as 2025’s first quarter is nearing the end, concerns are becoming pronounced that it is unlikely that the ambitious targets will be met, given the high TB burden and challenges in detection and treatment. India TB Report 2024 pointed out how India will not even meet its 2025 deadline set by the WHO’s ‘End TB’ Strategy. India has not met End TB Strategy 2025 milestones of 75% reduction in TB mortality and 50% reduction in its incidence. The WHO global TB report 2024 stated that the TB incidence rate for India in 2023 was 195 (237 in 2015) per 1,00,000 population. The mortality rate was 22 as against 28 in 2015. Now, India needs to bring down the death rate to seven per 1,00,000 by 2025 and the TB incidence to 118.5 by 2025. Thus, it is clear that the progress of TB elimination drive has not been at the desired pace. On Wednesday, Congress MP Sonia Gandhi flagged a severe lack of funds for providing maternity benefits to pregnant women, which affects the poor most. Likewise, it is hoped that the main opposition, and also others, will raise pertinent issues such as TB elimination.

It is not that the National Strategic Plan (NSP) for TB Elimination (2017–2025) implemented by National Tuberculosis Elimination Program (NTEP) has not made any significant progress in narrowing the gap between targets and achievements. Its key achievements include around 1.89 crore sputum smear tests and 68.3 lakh nucleic acid amplification tests in 2023, which reflect the programme’s commitment to expanding access to diagnosis at all healthcare levels. Besides, comprehensive care packages and decentralized TB services have been put in place. Rollout of shorter oral regimens for patients with drug-resistant TB (DR-TB) is a key measure which can minimise treatment delays and enhance the quality of TB care.

There has been a focus on malnutrition, diabetes, HIV, and substance abuse through a differentiated care approach and by encouraging early diagnosis. Expanded access to TB preventive treatment (TPT) has seen the number of beneficiaries rise to about 15 lakh. They are being provided shorter regimen. Alas! All these measures, however lofty, have not proved enough. India has to strive harder for significant declines in incidence and strengthen its health response framework. The governments, central and state, have to find innovative care solutions. There is a much greater responsibility than ever before on the lawmakers, particularly from the opposition, to keep an eye on government measures.