Government Efforts to Make India TB-Free by 2025

The Government of India has committed to the ambitious goal of eliminating tuberculosis (TB) by 2025, five years ahead of the global target set by the World Health Organization (WHO) under the End TB Strategy (2030). This commitment reflects India’s determination to overcome one of its most pressing public health challenges through a comprehensive, multi-sectoral, and patient-centric approach. The elimination target is defined as reducing the annual TB incidence to less than one case per 1,00,000 population.

Background and Context

India bears the world’s largest burden of tuberculosis, accounting for nearly one-fourth of global TB cases. Despite the availability of effective diagnosis and treatment, factors such as poverty, undernutrition, inadequate healthcare access, and stigma have hindered progress. Recognising the disease’s social and economic impact, the Government of India made TB elimination a national priority and launched an intensified strategy under the National Tuberculosis Elimination Programme (NTEP).
The programme aims to detect, treat, prevent, and build resilience against TB through a patient-centred framework. India’s accelerated target of 2025 was first articulated by the Prime Minister in 2018 during the End TB Summit in New Delhi.

National Tuberculosis Elimination Programme (NTEP)

Formerly known as the Revised National Tuberculosis Control Programme (RNTCP), the NTEP serves as the cornerstone of India’s TB elimination efforts. It was renamed in 2020 to reflect the shift from control to elimination. The NTEP functions under the Ministry of Health and Family Welfare (MoHFW) and operates across all states and Union Territories through a network of laboratories, treatment centres, and community-based initiatives.
Key pillars of the NTEP include:

• Early and Accurate Diagnosis: Use of modern molecular diagnostic tools like CBNAAT (Cartridge-Based Nucleic Acid Amplification Test) and TrueNat for rapid and precise TB detection, including drug-resistant strains.
• Universal Drug Susceptibility Testing (DST): Ensuring that all diagnosed patients undergo DST to determine appropriate drug regimens.
• Free Treatment and Patient Support: Provision of free anti-TB drugs under Directly Observed Treatment, Short-course (DOTS), now expanded into patient-centric models.
• Digital Health Systems: Adoption of Nikshay, an online TB surveillance system, for case notification, monitoring, and follow-up of all TB patients.

Major Government Initiatives and Interventions

1. National Strategic Plan (NSP) for Tuberculosis Elimination (2017–2025):
   • Serves as the guiding framework for TB elimination efforts.
   • Structured around four pillars—Detect, Treat, Prevent, and Build (DTPB).
   • Focuses on strengthening healthcare delivery, patient engagement, and use of technology.
2. Nikshay Ecosystem:
   • A digital platform for case-based TB surveillance.
   • Integrates public and private healthcare providers to ensure universal case notification.
   • Enables real-time tracking of treatment adherence and outcomes.
3. Nikshay Poshan Yojana (NPY):
   • Launched in April 2018 under the Direct Benefit Transfer (DBT) system.
   • Provides a nutritional support incentive of ₹1,000 per month to each TB patient during the treatment period.
   • Aims to address malnutrition, one of the key determinants of TB vulnerability.
4. TB Harega Desh Jeetega Campaign:
   • A nationwide awareness and advocacy campaign to mobilise communities and destigmatise TB.
   • Encourages active case finding and community participation in TB detection and treatment.
5. Private Sector Engagement:
   • Partnerships with private hospitals, clinics, and laboratories through Public–Private Mix (PPM) initiatives.
   • Ensures that TB cases diagnosed or treated in the private sector are notified and managed under NTEP standards.
6. Universal Drug-Resistant TB Care:
   • Strengthening of the National Drug Resistance Survey to track multi-drug-resistant (MDR) and extensively drug-resistant (XDR) TB.
   • Introduction of newer and more effective drug regimens such as Bedaquiline and Delamanid for MDR-TB.
7. Community-Based Active Case Finding (ACF):
   • Periodic screening drives in high-risk populations, including urban slums, tribal areas, and migrant communities.
   • Use of mobile diagnostic vans and point-of-care testing to improve early detection.
8. Integration with Ayushman Bharat and Health and Wellness Centres:
   • Delivery of TB care as part of Comprehensive Primary Health Services through Health and Wellness Centres (HWCs).
   • HWCs serve as local hubs for TB screening, awareness, and follow-up care.

Multi-Sectoral and Collaborative Approach

The government recognises that TB elimination cannot be achieved through the health sector alone. Hence, a multi-sectoral approach involving ministries, state governments, civil society, and community-based organisations has been adopted.

• Inter-Ministerial Coordination: Collaboration with ministries such as Rural Development, Women and Child Development, Labour and Employment, and Housing and Urban Affairs to address social determinants of TB.
• Corporate Social Responsibility (CSR) and Ni-kshay Mitra Initiative: Under the Pradhan Mantri TB Mukt Bharat Abhiyan (2022), individuals, corporates, and NGOs are encouraged to “adopt” TB patients by providing nutritional and psychosocial support.
• Partnership with Global Agencies: Engagement with the World Health Organization (WHO), The Global Fund, USAID, and other international partners for technical and financial assistance.

Monitoring and Evaluation

• Regular quarterly and annual reviews are conducted to monitor programme performance and state-wise progress.
• Indicators include case notification rates, treatment success rates, and reduction in TB incidence and mortality.
• The use of Nikshay Sampark Centres facilitates telephonic counselling and adherence support for patients.

Achievements and Progress

• India has reported significant improvement in case detection and notification, especially from the private sector.
• The number of TB cases notified annually has increased from around 17 lakh in 2015 to over 24 lakh in 2022.
• Treatment success rates have improved consistently, and Nikshay Poshan Yojana has benefited millions of patients.
• Several states and districts, such as Lakshadweep, Puducherry, and Budgam (Jammu and Kashmir), have been declared TB-free ahead of schedule.

Challenges Ahead

Despite progress, several challenges persist in achieving the 2025 target:

• Drug-Resistant TB (DR-TB): Increasing cases of MDR and XDR-TB require continuous surveillance and access to advanced treatment.
• Under-Reporting and Stigma: Many patients still seek care in the unregulated private sector, leading to underreporting and incomplete data.
• Social Determinants: Poverty, malnutrition, and inadequate living conditions continue to drive TB transmission.
• COVID-19 Disruptions: The pandemic caused temporary setbacks in TB detection and treatment continuity.

Future Roadmap

The government’s roadmap for achieving TB elimination by 2025 focuses on:

• Expanding access to rapid diagnostics and new drug regimens.
• Strengthening community-level care and nutritional support.
• Enhancing private sector engagement and data integration.
• Promoting research and innovation in vaccine development, diagnostics, and drug discovery.
• Implementing district-level micro plans to monitor progress and address local challenges.

Significance

The efforts to make India TB-free by 2025 represent one of the world’s largest and most ambitious public health missions. By combining technological innovation, community engagement, and cross-sectoral collaboration, India aims not only to end the TB epidemic within its borders but also to serve as a global model for disease elimination.