National Strategic Plan for Tuberculosis Control

The National Strategic Plan for Tuberculosis (TB) Elimination 2017–2025 serves as India’s comprehensive framework to eradicate tuberculosis as a public health threat. It was launched under the National TB Elimination Programme (NTEP) of the Ministry of Health and Family Welfare, Government of India. The plan aligns with global efforts such as the World Health Organization’s End TB Strategy and the United Nations Sustainable Development Goals, advancing India’s commitment to eliminate TB by 2025, five years ahead of the global target of 2030.

Background and Vision

Tuberculosis continues to be a major health concern in India, which bears one of the world’s largest burdens of TB cases and deaths. The disease not only affects health but also exacerbates poverty, malnutrition, and social inequity. Recognising this, the government developed the National Strategic Plan (NSP) to provide a structured, multi-sectoral, and evidence-based approach to elimination.
The vision of the plan is:“A TB-free India with zero deaths, disease and poverty due to tuberculosis.”
Its mission is to achieve a rapid decline in TB morbidity and mortality through universal access to early diagnosis, quality treatment, social support, and preventive measures.

Key Targets and Indicators

The NSP sets specific and measurable targets to be achieved by 2025:

• TB incidence rate: To be reduced from about 217 per 100,000 population in 2015 to 44 per 100,000 by 2025.
• TB prevalence rate: To be reduced from around 320 per 100,000 in 2015 to 65 per 100,000 by 2025.
• TB mortality rate: To be reduced from about 32 per 100,000 in 2015 to 3 per 100,000 by 2025.

These ambitious goals require a significantly accelerated decline in TB burden through intensified prevention, detection, and treatment measures.

Strategic Pillars of the NSP

The National Strategic Plan is built around four main pillars: Detect, Treat, Prevent, and Build.

Detect

• Expansion of active case finding among high-risk and vulnerable populations.
• Strengthening diagnostic capacity with rapid molecular tests and universal drug-susceptibility testing.
• Engagement of the private health sector through mandatory notification and standardised reporting of TB cases.

Treat

• Provision of free, quality-assured treatment for all TB patients, including those with drug-resistant forms of TB.
• Introduction of patient-centred care, digital adherence systems, and community-based treatment support.
• Nutritional and financial assistance through schemes like the Nikshay Poshan Yojana to support recovery.

Prevent

• Implementation of TB preventive treatment (TPT) for household contacts and high-risk groups.
• Addressing social determinants such as malnutrition, overcrowding, tobacco use, and diabetes.
• Enforcing infection control practices in healthcare facilities and workplaces.

Build

• Strengthening health systems and surveillance, including use of digital tools like the NIKSHAY portal for case tracking.
• Capacity building of human resources through training and research in TB diagnostics and management.
• Promoting intersectoral partnerships between public health systems, private providers, and civil society.

Implementation Framework

The NSP follows a decentralised and result-oriented approach with clear roles at the national, state, and district levels. Each administrative level develops its own plan consistent with NSP objectives, including budgeting, timelines, and performance indicators.
Monitoring is carried out using a Results Framework, which tracks progress through input, output, outcome, and impact indicators. Continuous evaluation allows policy adjustments and performance improvement.

Special Focus Areas

• Private Sector Engagement: Given that a large proportion of TB patients seek treatment in the private sector, the NSP emphasises partnerships for case notification, diagnosis, and treatment adherence.
• Drug-Resistant TB: Special attention is given to the prevention and management of multidrug-resistant (MDR-TB) and extensively drug-resistant (XDR-TB) cases.
• Vulnerable Populations: Focused interventions target high-risk groups such as people living with HIV, migrants, prisoners, tribal communities, and slum populations.
• Social Support: Financial incentives and nutrition support are provided to improve treatment completion and quality of life.

Significance

The National Strategic Plan marks a major shift from disease control to disease elimination, positioning TB eradication as a national priority. It introduces an integrated model that links medical, social, and economic interventions to break the chain of transmission and reduce vulnerability.
The NSP also serves as a platform for innovation and research, encouraging the use of new diagnostics, shorter treatment regimens, and digital health tools. It enhances accountability and transparency through performance-based monitoring and data-driven evaluation.

Challenges and Limitations

Despite significant progress, several challenges hinder full implementation:

• Underdiagnosis and underreporting of TB cases, especially in private and informal healthcare sectors.
• Ensuring adherence to long treatment regimens and preventing drug resistance.
• Addressing social determinants like poverty, malnutrition, and poor living conditions that perpetuate infection.
• Maintaining adequate funding and human resources across all levels of the health system.
• Recovering from disruptions caused by the COVID-19 pandemic, which affected TB services and detection rates.

Current Progress and Way Forward

Recent years have seen notable improvements in TB notification rates, diagnostic coverage, and treatment success under the NTEP. Digital platforms such as NIKSHAY have improved monitoring, while community outreach and awareness campaigns have enhanced public participation.
Moving forward, the focus lies on:

• Expanding active case finding and preventive therapy.
• Scaling up molecular diagnostics and digital adherence tools.
• Strengthening multi-sectoral coordination to tackle social determinants of TB.
• Ensuring sustainable financing and private sector engagement.