As we navigate the winding path towards a tuberculosis-free India, it is imperative to recognise the beacon of hope emanating from the country’s steadfast commitment and determination. In the labyrinth of global health challenges, tuberculosis (TB) remains a persistent foe, particularly in countries like India. Despite significant strides in medical science and public health, TB continues to exact a heavy toll on human lives and socio-economic development. However, amidst the adversities, there shine a beacon of hope. In the quest for ending TB in India, political willpower stands as the cornerstone of progress and success.
One of the primary challenges in combating TB globally has been the lack of sustained political commitment. Historically, TB has been overshadowed by other prioritised health issues, and resources allocated to its prevention, diagnosis and treatment have often been inadequate. However, in recent years, there has been a notable shift in this narrative, with political leaders increasingly recognising the gravity of the TB problem and the need for decisive action.
Political leadership serves as the catalyst for mobilising resources, galvanising stakeholders, and driving policy reforms. It sets the agenda, marshals support, and holds accountable those responsible for implementing TB control measures. Without strong political commitment, even the most well-crafted plans risk languishing on paper, leaving millions of people with TB without access to life-saving interventions.
India’s Prime Minister Narendra Modi has led this shift in political commitment to end TB. In March 2018, PM Modi made a firm commitment to end TB in India by 2025, five years ahead of global SDG (sustainable development goals) targets; and from that moment, there was no looking back at the progress in TB elimination efforts in India. His vision and ambition generated incredible efforts in India and served as an example and trigger for several other leaders, Heads of State and Governments from other countries.
The launch of India’s National Strategic Plan (NSP) to end TB by 2025 marked a watershed moment in the country’s fight against the disease. Endorsed at the highest levels of government, the NSP outlines a comprehensive framework for TB elimination, encompassing a range of strategies from improved diagnostics and treatment to strengthened healthcare systems and increased funding.
Government stewardship and accountability, coupled with robust monitoring and evaluation mechanisms, form the cornerstone of India’s TB elimination efforts. The government’s resolute commitment to achieving targets, evident in the preponing of the 2030 goal to 2025, underscores its proactive approach.
The fourfold increase in programme funding reflects a clear and tangible commitment to allocate resources commensurate with the scale of the TB challenge. Notably, India’s proactive stance in raising resources outside the programme demonstrates innovative strategies to bolster financial support for TB control initiatives. The country’s multilevel regular evaluations, a rarity in many other nations, exemplify a commitment to transparency and continuous improvement.
A strong coalition with civil society organisations and communities is instrumental in fostering community engagement and empowerment. India’s diverse array of community engagement projects, including awareness campaigns and family care models, exemplify the power of grassroots mobilisation in combating TB. Initiatives such as Ni-Kshay Mitra and TB champions epitomise the pivotal role of community-driven interventions in bridging gaps in TB care delivery. The establishment of TB-free panchayats underscores the importance of community-based planning and monitoring in driving local-level TB elimination efforts.
Central to India’s TB elimination strategy is the protection and promotion of human rights, ethics and equity. The country’s robust social support systems prioritise the rights of patients to seek care according to their preferences, fostering a patient-centric approach to TB management. Furthermore, India’s commitment to equal support for the private sector underscores a holistic approach to TB care delivery, transcending traditional divides between public and private health sectors.
India’s emphasis on target-setting at various administrative levels, from national to provincial and district levels, reflects a nuanced understanding of the need for tailored approaches to TB control. The introduction of sub-national certification mechanisms incentivises local-level progress, fostering healthy competition and accountability.
Intensified research and innovation drive India’s quest for TB elimination, with a focus on developing and deploying new tools and strategies. Collaborative research initiatives across sectors and ministries underscore India’s commitment to leveraging multidisciplinary approaches to tackle TB.
After the severe struggle we all faced globally due to COVID pandemic, tuberculosis programmes in the countries have showed their resilience and India led the fight back to reach the all-time high number of people with TB detected and treated in 2022. In India, 2.5 million people with TB were diagnosed and treated in the year 2023; 130,000 more than the year before. In 2018, India contributed one-third of the missing 3 million people with TB in the world. That is, one million people with TB were missing from diagnosis and treatment in India. In 2023, the missing people with TB in India are 200,000 only. That is, over 80% reduction in missing people with TB due to these intense efforts. India’s progress in TB control, with 16% reduction in incidence and 19% reduction in mortality, surpasses global averages, reflecting the country’s unwavering dedication and concerted efforts.
In conclusion, political leadership has been the lynchpin of India’s efforts to eliminate TB. As we continue on this path, let us draw inspiration from India’s story of hope and determination, and redouble our efforts towards a future where TB is but a distant memory.
Dr Lucica ditiu
Executive Director, Stop TB Partnership