A much-needed plan for TB in India
Despite government efforts and the Nikshay Poshan Yojana, India struggles to meet its tuberculosis elimination targets due to systemic gaps in private healthcare and nutrition.
A much-needed plan for TB in India
India entered mid-2026 without having achieved its goal to eliminate tuberculosis by 2025. The target, announced in March 2018 during World TB Day, sought to end the disease five years ahead of the global 2030 deadline. While the government has implemented expanded diagnostics and digital tracking, the country remains the highest TB burden nation globally, accounting for nearly 27% of the global incidence.
According to the National TB Elimination Programme (NTEP), India estimated 2.82 million new TB cases and 331,000 deaths in 2022. This represents a TB incidence of 199 cases per 100,000 population and a mortality rate of 23 deaths per 100,000. Despite these numbers, the government reports progress faster than the global average, noting a 16% decline in incidence and an 18% drop in deaths between 2015 and 2022.
The Private Sector Challenge
A critical gap in the elimination strategy is the role of private healthcare. Approximately 50% of TB cases in India are diagnosed and treated within the private sector. Public health specialist Chapal Mehra argues that government efforts yield limited results when they fail to effectively engage these private providers.
The NTEP reports that private sector notifications have increased more than 7 times over the last 8 years. In 2023, the private sector notified 8.44 lakh cases, which accounted for 33% of total notifications. However, critics suggest a top-down approach to these partnerships will not work, calling instead for collaboration and empathy to bridge the remaining gap.
Social Determinants and Nutritional Support
Tuberculosis persists in India as a social, economic, and human rights issue. Poverty, inequality, overcrowding, and malnutrition are cited as primary drivers that allow the disease to spread. The airborne nature of the pathogen makes transmission rapid in India's high-density population.
To combat undernutrition, the government launched the Nikshay Poshan Yojana (NPY) in April 2018. This scheme provides ₹ 500 per month via direct benefit transfer to support the nutrition of patients. By 2023, the NTEP had disbursed ₹ 2781 crores to approximately 1 crore beneficiaries. Despite this, Mehra suggests this amount is insufficient due to inflation and food prices, proposing an increase to ₹ 3,000 per month to ensure food security and prevent latent infections from becoming active.
Treatment and Systemic Gaps
The NTEP has scaled up infrastructure, increasing Designated Microscopy Centers by 80% between 2014 and 2023. The program also reports a treatment success rate that reached 87.6% in 2023. However, challenges remain regarding drug-resistant TB (DR-TB), which affected 2.5% of new cases and 13% of previously treated cases in 2022.
Current treatment focuses heavily on compliance rather than quality of care, often leaving patients with little support for severe side effects. There are also significant inequities in care for migrant workers, tribal populations, and gender minorities. Mehra emphasizes that care must become more gender-responsive, noting that women and trans folks remain particularly vulnerable to systemic discrimination in clinical settings.
As the 2025 target has passed, the path forward requires a reimagined response. This includes moving beyond the "Detect – Treat – Prevent – Build" pillars to incorporate the lived experiences of survivors, ensuring treatment literacy, and establishing a true partnership with the private sector to move toward a TB-free India.
