- Tuberculosis (TB) remains a critical global health issue, with India accounting for 26% of the world’s TB cases, according to the WHO Global Tuberculosis Report 2024, highlighting the urgent need for strengthened prevention, diagnosis, and treatment strategies.
National Tuberculosis Elimination Programme (NTEP)
- The National Tuberculosis Elimination Programme (NTEP) aims to eliminate tuberculosis (TB) in India by 2025. The target includes reducing TB incidence by 80%, decreasing TB-related deaths by 90%, and ensuring zero catastrophic costs for TB patients.
- The programme is guided by the National Strategic Plan 2017-2025 and is implemented under four strategic pillars: Detect, Treat, Prevent, and Build (DTPB). These pillars focus on comprehensive approaches to address the disease.
- Aligned with the World Health Organization’s (WHO) End Tuberculosis Strategy and the United Nations (UN) Sustainable Development Goals (SDGs), the program works towards eliminating TB as a public health threat.

Key Objectives
- Early Diagnosis and Prompt Treatment: Ensuring timely diagnosis of TB cases and providing quality-assured drugs and treatment regimens.
- Private Sector Engagement: Expanding outreach to patients seeking care in the private sector to enhance coverage.
- Prevention Strategies: Focusing on contact tracing in high-risk and vulnerable populations.
- Airborne Infection Control: Implementing measures to control the spread of airborne infections in communities.
- Multi-Sectoral Response: Addressing the social determinants of health, ensuring a collaborative approach across sectors to fight TB.
Challenges to Tuberculosis Elimination by 2025
Structural Challenges
- Weak Healthcare Infrastructure: India’s healthcare system, particularly in rural areas, faces a shortage of advanced diagnostic tools like Cartridge-Based Nucleic Acid Amplification Testing (CB-NAAT) machines, essential for rapid TB and Drug-Resistant TB (DR-TB) diagnosis, hindering early detection and treatment.
- Uneven Accessibility: Geographic and socio-economic disparities restrict access to TB services. Migrant workers, tribal populations, and people in remote areas face significant challenges in reaching medical facilities, undermining nationwide efforts to control TB.
- Shortage of Trained Personnel: A lack of skilled healthcare workers for diagnosis, treatment, and patient support in high-burden areas delays TB detection and treatment, especially for DR-TB, where specialised care is needed.
- Supply Chain Disruptions: Frequent stockouts of essential TB medicines lead to treatment interruptions, drug defaults, delayed treatment initiation, and increased reliance on the private sector, undermining public trust and hampering progress toward TB elimination.
- High Burden of Drug-Resistant TB (DR-TB): India accounts for about a quarter of the global DR-TB burden, with 1.47 lakh cases annually. Treating DR-TB is complex and costly due to the use of second-line drugs with severe side effects and prolonged treatment durations.
Systematic Challenges
- Late Diagnosis and Stigma: Delayed diagnosis due to lack of awareness and cultural stigma, leading to advanced-stage cases.
- Catastrophic Costs: High out-of-pocket expenses for diagnostics, transport, and nutrition push vulnerable populations into poverty.
- Lack of Multi-Sectoral Collaboration: Weak coordination between sectors like health, nutrition, and sanitation limits the effectiveness of interventions.
- Monitoring and Evaluation Gaps: Inadequate data collection and analysis hinder real-time monitoring of TB cases and treatment outcomes.
- Focus on Pulmonary TB Over EPTB: Extrapulmonary TB (EPTB) often goes undiagnosed due to lack of effective testing, despite comprising 24% of cases.
Innovative and Sustainable Solutions for Achieving TB Elimination by 2025
Strengthening Healthcare Infrastructure
- Increase Investments: Boost funding to improve diagnostic and treatment facilities, especially in rural and remote areas.
- Decentralised Care: Establish TB care units at community levels and as part of local governance structures to bring services closer to patients.
Expanding Diagnostic Capacity
- Technology Integration: Scale up the use of advanced diagnostic tools like CB-NAAT and TrueNat machines.
- Mobile Diagnostic Units: Deploy mobile units to unserved and underserved areas to ensure early detection and treatment.
Capacity Building for Healthcare Workers
- Training & Retention: Train more healthcare professionals, including lab technicians and community health workers, to improve service delivery.
- Incentives: Offer incentives and reduce workloads to retain skilled personnel in high-burden areas.
Ensuring Uninterrupted Drug Supply
- Robust Supply Chain: Implement stronger supply chain management systems to prevent stockouts of critical TB medicines.
- Regional Warehouses: Establish regional drug warehouses and employ digital tools for real-time inventory tracking.
Tackling Drug-Resistant TB
- Shorter, Patient-Friendly Regimens: Introduce regimens like BPaL (Bedaquiline, Pretomanid, and Linezolid) to simplify DR-TB treatment.
- Psychosocial Support: Provide comprehensive psychosocial support to improve treatment adherence and outcomes.
Community Engagement and Stigma Reduction
- Awareness Campaigns: Use local leaders, celebrities, and TB survivors to reduce stigma and educate communities about TB.
- Empowerment: Strengthen the role of community health workers in educating patients and families.
Financial Support for Patients
- Pradhan Mantri TB Mukt Bharat Abhiyan: Expand cash transfers for nutritional support under the Ni-Kshay Poshan Yojana (NPY) to ensure the well-being of TB patients and their contacts.
- Transport & Wage Compensation: Introduce allowances for transportation and wage support for economically disadvantaged TB patients.
Multi-Sectoral Collaboration
- Holistic Approach: Integrate TB elimination efforts with broader programs on nutrition, sanitation, education, and housing.
- Industry Involvement: Engage industries in TB prevention, vaccine development, and healthcare initiatives.
Strengthening Surveillance Systems
- Digital Tools: Leverage tools like Ni-kshay for better case notification, monitoring, and follow-up.
- AI & Machine Learning: Utilise AI for predictive analytics to optimize TB program delivery.
Focusing on EPTB
- Awareness & Services: Raise awareness among healthcare providers about Extrapulmonary TB (EPTB) and its symptoms, and ensure quality healthcare access.
Successful Case Studies of TB Elimination
- Kerala’s Collaborative Model in TB Elimination (2023): Kerala reduced TB incidence by 37.5% between 2015 and 2020, meeting 2030 SDG targets, by empowering local governance, utilizing public-private partnerships (PPP), and engaging women’s self-help groups (SHGs) under the Kudumbashree Initiative for enhanced community participation in TB control.
- Vietnam’s Community-Based Approach to TB Elimination (2020): Vietnam, with 172,000 TB cases in 2020 (10th highest globally), reduced TB prevalence by 35% since 2007 and mortality by 41% from 2015 to 2020 through rapid molecular testing, portable chest X-rays for remote diagnosis, and community health workers ensuring screening and treatment adherence, showcasing the success of technology and community engagement despite global health challenges.
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Eliminating TB by 2025 is ambitious but achievable. PM Modi’s multi-pronged strategy, backed by Jan Bhagidari (people’s participation), strong political will, and innovation, can accelerate progress. Collaboration across sectors and sustained funding are key to a TB-free India.
Reference: The Hindu | PMF IAS: Tuberculosis
PMF IAS Pathfinder for Mains – Question 61
Q. Examine the structural and systemic challenges impeding India’s progress toward the ‘EndTB’ target by 2025. Propose innovative and sustainable solutions to address these issues. (250 Words) (15 Marks)
Approach
- Introduction: Define tuberculosis (TB) as a significant public health challenge in India.
- Body: Mention India’s ambitious ‘EndTB’ target by 2025, briefly highlight the gap between targets and ground realities, and give a gist of the solutions needed to overcome the challenges to achieve the target.
- Conclusion: Reiterate the importance of addressing structural and systemic challenges through a multi-pronged approach.
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