Deepankshi Agnihotry
Policy Update
Last summer, my househelp’s kid fell unconscious on the streets while returning from school. He often complained of sharp pain in his lower back that radiated to his left foot. Ignoring any serious complications, his pain was seen as part of playing football, dehydration, or just a part of growing up since he was only 15 years old. But this time, it was serious. When consulted at the hospital and run through several tests, as we insisted their parents take it seriously, it was found that he had extrapulmonary TB, specifically bone TB, which had now reached a point where he needed a hip replacement.
TB is an infectious bacterial disease caused by Mycobacterium tuberculosis, which can affect any part of the body, primarily the lungs, but can spread to any organ, as seen in this kid’s case. According to the Global Tuberculosis Report 2024 Edition published by WHO, most people who develop TB each year are in 30 high TB burden countries, which account for 87% of the global total in 2023.
Five countries—Indonesia, China, the Philippines, Pakistan, and India—account for 56% of the worldwide total, with India alone contributing 26%. The report further highlighted that despite a decline in the number of cases in 2023 after two of the worst years during COVID-19, TB has likely returned as the leading cause of death from a single infectious agent, replacing COVID-19.
Coming to India, which has set ambitious goals to eliminate TB by 2025—five years ahead of the global target—the country has high hopes for eradicating this deadly disease. Under the National Tuberculosis Elimination Programme (NTEP), India has strengthened its TB response with advanced diagnosis, innovative policies, private partnerships, and a patient-first approach. This program is guided by the National Strategic Plan (2017-25), which is based on four pillars: DETECT – TREAT – PREVENT – BUILD. It envisions a TB-free India, free from disease, deaths, and poverty related to TB.
Under this, a 100-day intensified TB elimination program was conducted last year. The major focus of this initiative was to strengthen diagnosis and treatment services, particularly for vulnerable populations. Spanning 347 districts across 33 states and union territories, the campaign represents a critical component of India’s strategy to eliminate TB and build a TB-free nation.
As part of this, the Drug-Resistant TB Elimination Action Plan was also included, as India bears the burden of 27% of such cases worldwide. The BPaLM regimen, consisting of a four-drug combination—Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin—has been proven to be a safer, more effective, and quicker treatment option than the previous MDR-TB treatment procedure.
Other schemes aiming at TB elimination include PM TB Mukt Bharat Abhiyan and Ni-Kshay Poshan Yojana – Implemented by MoHFW, a community-driven initiative guided by three basic objectives:
1. Provide Additional Patient Support to Improve Treatment Outcome
- This is done through Ni-Kshay Poshan Yojana, a DBT scheme, which provides ₹1,000 per patient for the entire duration of treatment.
- Recently, the government decided to provide energy-dense supplements to patients with BMI below 10.5 and to expand the scope & coverage of the Ni-Kshay Mitra initiative under Pradhan Mantri TB Mukt Bharat Abhiyaan (PMTBMBA) to the family members (household contacts) of TB patients.
- Under the Ni-Kshay Poshan Yojana, additional nutritional support of ₹3,000 and ₹6,000 will be given.
- Ni-Kshay Mitras will adopt the household contacts of TB patients for the distribution of food baskets with the aim to improve the immunity of family members of TB patients.
- This would lead to a significant reduction in out-of-pocket expenses (OOPE) incurred by TB patients and their families.
2. Augmenting Community Involvement in Meeting India’s Goal of Ending TB by 2025
- Ni-Kshay Portal 2.0 and the Abhiyan aim to leverage community support.
- The Ni-Kshay Mitra initiative, comprising individuals, NGOs, cooperative societies, political parties, and others, adopts TB patients under the scheme, promoting a community-driven approach toward ending the epidemic.
3. Leveraging Corporate Social Responsibility (CSR) Activities
- By engaging the private sector, it directs CSR funds toward additional monetary support for TB treatment.
Both Initiative aims to create a Jan Andolan, which is much needed for the epidemic to end.
Other Strategic Interventions Include:
- TB Mukt Panchayat Campaign (2023) – A commendable initiative that leverages local self-government in the fight against TB. LSGs, being responsible for conducting multiple initiatives, serve as an excellent choice to address social determinants of health that will further the mission. Determinants like housing, sanitation, poverty alleviation, and social security would be addressed with the help of ground-level workers like ASHA workers and primary healthcare centers, which will help spread awareness and serve as points for primary detection and diagnosis of the disease.Additionally, pilot projects are being run to transform local pharmacy units into screening centers and sample collection hubs. There is also engagement with local medium and small industries for an augmented TB-free workplace intervention. Data collected from these projects could help in a nationwide scale-up and integration into policy.
- Active Case Finding (ACF) Drives (2017 – Present) – A very helpful initiative in finding hidden cases of TB through mass screening campaigns. Mobile vans are deployed in slums, prisons, and tribal areas for large-scale screenings.
- Genome Sequencing – Union Minister Dr. Jitendra Singh announced the completion of genome sequencing of 10,000 isolates of Mycobacterium tuberculosis at a summit organized on “World TB Day” at Vigyan Bhawan. The genome sequencing initiative is part of the Dare2eraD TB program (Data-Driven Research to Eradicate TB), launched on March 24, 2022, which focuses on data-driven research to eradicate TB.A key component of this initiative is the Indian Tuberculosis Genomic Surveillance (InTGS) Consortium, spearheaded by the Department of Biotechnology (DBT), the Council of Scientific and Industrial Research (CSIR), and the Indian Council of Medical Research (ICMR), in collaboration with major clinical institutions. The program aims to sequence over 32,000 TB isolates to identify drug resistance mutations and improve treatment outcomes.
Falling Short
India’s dedicated journey towards tuberculosis (TB) elimination has been recognized globally, with a noteworthy 17.7% decline in TB incidence from 2015 to 2023. This rate is more than twice the global average decline of 8.3%, as reported by the World Health Organization (WHO) in its Global Tuberculosis Report 2024.
Despite significant progress, the dream of eliminating TB by 2025 still seems far-fetched.
- Undiagnosed Cases – Even with massive diagnostic drives, many cases remain undiagnosed, especially extrapulmonary TB. For example, a 15-year-old boy’s TB was diagnosed only at a stage where surgery was the last resort.
- Unhygienic Conditions – While campaigns like Swachh Bharat Abhiyan have helped introduce hygienic practices and the importance of clean surroundings, India still struggles to maintain proper hygiene due to its vast population. The Global Multidimensional Poverty Index 2024 highlights that India’s poverty rate has decreased from 55.1% in 2005-06 to just over 16.4% in 2019-21. However, despite this progress, India still ranks 126th out of 144 countries in the index.
- Unsanitary conditions, congested living spaces without proper patient isolation, poverty, and low literacy rates (India’s overall literacy rate is 74%, with some states even lower) make it difficult to eliminate TB.
- Comorbidities – The prevalence of multiple diseases significantly impacts TB treatment. Conditions like HIV, diabetes, malnutrition, and substance abuse increase the risk of TB. Poor nutritional standards, increasing consumption of trans-fatty foods, and rising obesity levels make preventing the disease even more challenging.
- Lack of Awareness – Lack of awareness about different government schemes forced a household worker’s child to rely on crowdfunding and MP/MLA sources for financial assistance. Even the government hospital where he was admitted never provided information about the schemes available for TB patients. Crowdfunding was the only option.
Additionally, digital illiteracy, combined with exclusion from census data( such as in case of my household help child), meant that many patients couldn’t apply for Ayushman Bharat health insurance and had to bear the burden of out-of-pocket expenses. In such cases, crowdfunding remained the primary source for treatment and recovery.
Way Forward
For India to achieve SDG Target 3.3, which 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 needs to meet the following goals:
- An 80% reduction in the TB incidence rate (new cases per lakh population) compared to 2015 levels.
- A 90% reduction in the TB mortality rate compared to 2015 levels.
- Zero TB-affected households experiencing catastrophic expenses due to the disease.
India has set an advanced target to achieve this by 2025, and for this, it needs to act on a war footing.
First, it must expand awareness campaigns and mandate both government and private hospitals empaneled under Ayushman Bharat to compulsorily inform people about the ongoing financial aid schemes for TB.
Second, movements like Eat Right and Fit India should be given a boost, as they will help India develop its human capital fully and fight the deadly disease effectively. Additionally, India can take lessons from neighboring countries that have successfully eliminated TB, such as China, which has integrated TB care with general health services and ensured universal access to rapid diagnostics. Similarly, Japan has focused on latent TB treatment to prevent new infections from progressing to active disease, while South Africa has implemented an integrated HIV-TB co-management strategy, improving survival rates in immunocompromised patients. In the USA and Western Europe, strict infection control measures have been implemented in healthcare settings and among high-risk populations.
At an individual level, maintaining proper hygiene, staying informed about our fundamental right to health, and following a healthy diet are the least we can do to support the government and the nation in eliminating TB. Ensuring early detection and reporting symptoms such as persistent cough, rapid weight loss, or persistent pain in certain body parts can help in effective treatment. Regular lung exercises, yoga, and maintaining a good quality of life can further aid in combating the epidemic.
World TB Day, observed on March 24, has once again brought renewed focus to this deadly disease with the theme “Yes! We Can End TB: Commit, Invest, Deliver.” India must truly commit to ending the disease by 2025, invest in overall TB treatment, and deliver on its promise of providing the fundamental right to health to its citizens.
References
Directorate General of Health Services. (n.d.). National Tuberculosis Elimination Programme. Ministry of Health and Family Welfare, Government of India. Retrieved from https://dghs.mohfw.gov.in
Unitaid. (2025). World TB Day 2025. Retrieved from https://unitaid.org
Press Information Bureau. (2025, March 24). India’s goal to eliminate TB by 2025. Government of India. Retrieved from https://pib.gov.in
Vikaspedia. (n.d.). Pradhan Mantri TB Mukt Bharat Abhiyan. Retrieved from https://en.vikaspedia.in
Ministry of Health and Family Welfare. (2025). Press Information. Retrieved from https://mohfw.gov.in
Ministry of Health and Family Welfare. (2025). Ni-Kshay 2.0 Portal and TB Elimination Efforts. Retrieved from https://mohfw.gov.in
Press Information Bureau. (2025). TB Elimination Strategy in India. Retrieved from https://pib.gov.in
NDTV. (2025). World Tuberculosis Day 2025: How You Can Reduce Risk. Retrieved from https://www.ndtv.com
The Lancet. (2025). India’s TB Elimination Efforts: Progress and Challenges. Retrieved from https://www.thelancet.com
The Week. (2025). How India Fared in TB Elimination Efforts So Far. Retrieved from https://www.theweek.in
About The Contributor
Deepankshi Agnihotry is a research intern at IMPRI and holds a postgraduate degree in Electronics, is curious and passionate about sustainability and impactful policy solutions.
Acknowledgement
The author would like to express sincere gratitude to Dr.Arjun Kumar, Dr.Vaishali Singh, Ms. Aasthaba Jadeja and the IMPRI team for giving the opportunity for writing the article.
Disclaimer: All views expressed in the article belong solely to the author and not necessarily to the organisation.
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