Despite outperforming global trends in TB incidence decline, India continues to bear the largest share of the global TB burden. Analyse the gaps across the continuum of care and suggest measures.

Citing WHO data, the Health Minister reported that India's TB incidence fell 21% between 2015 and 2024, against 12% globally [1]. Yet India still has about one-fourth of global TB cases, and the world remains far from the End TB milestone of a 50% cut by 2025 [2]. The faster decline still leaves patients lost at each stage of care:

Screening → Diagnosis → Notification → Treatment → Completion
   (missed)    (delayed)    (unreported)   (undernourished) (dropout)

Fig: Leakages along the TB care cascade

Gaps across the continuum

• Detection: Passive case finding misses people with no symptoms. The 100-day campaign found about 9 lakh asymptomatic cases out of 28 lakh diagnosed [5]. Stigma also delays care-seeking [1].
• Notification: Treatment coverage of 92% means about 8% of estimated cases never reach the official system [1]. In 2016, about 1 million cases were "missing", most of them treated by private providers [3].
• Diagnostic capacity: Detecting drug resistance needs rapid molecular tests and AI-supported portable X-rays [1]. Awareness campaigns can bring in people faster than local facilities can test them.
• Treatment and nutrition: About 12 lakh patients a year are underweight (BMI below 18.5) [4]. Undernutrition weakens recovery.
• Completion and costs: Lost wages and health bills push families into poverty and cause patients to drop out. The National Strategic Plan 2017–25 addresses this through social protection [6].

Measures

• Scale active case finding: Extend the district-level screening used in 347 high-priority districts [5]. Increase AI-X-ray and molecular testing capacity before mobilising demand [1].
• Engage the private sector: Enforce mandatory notification and use patient-provider support models. WHO-documented pilots raised notifications three to five times [3].
• Nutrition as treatment: Pay Ni-kshay Poshan at ₹1,000/month via DBT and provide energy-dense supplements to underweight patients [4]. Link families to welfare schemes [6].
• Community ownership: Use JOSH youth teams to counter stigma and refer people for testing [1]. Track their results in Ni-kshay by district: people referred, diagnosed and treatment completed.

India's faster decline shows that its approach works, but the remaining burden lies with patients who are missed, unreported or undernourished. Closing these gaps needs a patient-centred approach that combines technology, private-sector accountability, nutrition rights and Jan Bhagidari. That would put India on track for SDG 3.3 by 2030 and uphold the right to health under Article 21.