Canvassing India's TB Elimination Journey: A Journey of Action
When you have spent over twenty years working in TB, across programmes, policies, and communities, ‘World TB Day’ feels less like a calendar event and more like a moment of reckoning.
The WHO Global Tuberculosis Report 2025 places India at the top of the global TB burden. With 25% of global TB cases, the toll extends well beyond the clinical: projections for 2021- 2040 [1] include over 62.4 million incident cases, 8.1 million deaths, and a cumulative GDP loss of US$146.4 billion. No income group is spared, though low-income households bear the heaviest health burden.
Yet India's response has been deliberate and sustained. Between 2015- 2024, India’s TB incidence declined 21%, outpacing the global average of 12%. Treatment coverage surged from 53% to over 92%, and the missing cases (patients with TB never reported to the programme) fell from 15 lakh to under one lakh. These numbers reflect a structural shift in how India finds, tracks, and treats TB, backed by a near ten fold increase in government funding over nine years.
The TB Mukt Bharat Abhiyan has since deepened this momentum, screening over 19 crore vulnerable individuals and detecting 24.5 lakh TB patients, including 8.61 lakh asymptomatic cases, since its launch in December 2024 as per recent updates from the Ministry of Health & Family Welfare.
Which brings us to the next question: what now? The answer lies in the quality and reach of care.
What Differentiated TB Care Actually Means
As case detection improves, a sharper question emerges: is every patient who is diagnosed receiving the right care?
Differentiated TB Care is India's answer. Rather than a uniform treatment pathway for all, the approach stratifies patients by clinical risk; those with comorbidities or complex presentations are identified early and routed toward tailored, intensive care, while stable patients are managed efficiently at the appropriate level. The result is a system that is neither overburdened at the top nor underutilised at the base.
The projected outcomes are significant: combining 90% case detection with 95% effective treatment could reduce the disease burden by up to 91% and cut the macroeconomic toll by US$124.2 billion. Differentiated care is not a refinement at the margins; it is the mechanism through which those numbers become achievable.
But a framework is only as strong as its implementation; for differentiated TB care to work, it must reach the communities where most of India's TB burden lives.
The Frontline Is Where It Matters
India's 1.6 lakh+ Ayushman Arogya Mandirs (AAMs) are the country's most distributed health infrastructure, and Community Health Officers (CHOs) are their clinical backbone. Positioned at the intersection of facility care and community outreach, CHOs carry a structural advantage that disease-specific programmes rarely have, they are embedded in everyday health, maternal and child healthcare, immunisation, and general wellness. They are trusted before they ever mention TB.
Community health workers have already demonstrated their value in polio eradication and across SDG health milestones. ASHAs, ANMs, and CHOs are not peripheral to India's TB response; they are its collective backbone. They identify early warning signs, support treatment adherence, facilitate contact tracing, and link patients to nutritional, psychosocial and welfare (DBT) support.
What they need, in equal measure, is current knowledge. As India's national TB programme evolves; with updated guidelines on differentiated TB care pathways, LTBI management, and referral protocols; frontline workers need those updates to reach them quickly and in forms they can apply.
How ECHO India Bridges the Gap
Using the Project ECHO tele mentoring model, ECHO India connects CHOs and frontline health workers with specialist guidance through structured, case-based learning; without pulling them away from their communities for centralised training. The knowledge travels to where the workers are.
In Telangana, ECHO India has been working alongside government health bodies to disseminate the latest differentiated TB care guidelines to CHOs at selected Ayushman Arogya Mandirs spread across all districts through the hub and spoke model, aimed at building practical competence in early identification, triaging, and referral. The training is grounded in field realities, not just protocols.
What makes the ECHO model particularly suited to this moment is speed. As national guidelines are updated, the model disseminates those changes to thousands of frontline workers rapidly, without proportionally scaling cost or infrastructure.
Partnerships that matter in #EndingTB
India's TB elimination goals are within reach, the progress is real, the frameworks are in place, and the frontline workers are there. What sustains and scales this work is investment in training, in knowledge infrastructure, and in the people closest to the problem. TB affects the communities from which India's workforce is drawn. Every investment in frontline training has downstream returns: better case detection, higher treatment success, reduced transmission, reduced mortality and stronger communities.
Twenty years of working in this space has shown me that the biggest gains don't come from the top, they come from the last mile.
If I have one wish for the next five years, it is this: the private sector steps into this moment with the same urgency that the programme demands, and that no frontline worker is left without the knowledge they need to save a life.
The distance to the last mile shortens considerably when public and private hands are moving in the same direction.
[1] https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004491