Despite a significant decline in incidence, India continues to bear the world's highest TB burden. Analyse the challenges and suggest measures.

India's TB incidence fell 21% between 2015 and 2024, from 237 to 187 per lakh [1]. The global fall was only 12% [2]. Yet India still has about a quarter of the world's cases, and it missed both its own 2025 elimination goal [1] and WHO's 50% milestone [2]. The barriers that remain are mostly social and economic, not only medical.

Challenges

• Missing cases: About 2.4 million TB cases worldwide went undiagnosed or unreported in 2024 [2]. India's 100-Day campaign found 2.85 lakh asymptomatic cases, people who would not have come to a clinic on their own [3].
• Poverty and hunger: Undernutrition is the largest TB risk factor worldwide [2]. About half of TB-affected households face catastrophic costs [2].
• Stigma and dropouts: Treatment lasts at least six months [1]. Myths and stigma delay care and push patients to quit [4].
• Drug-resistant TB: Only 42% of people with MDR/RR-TB worldwide were treated [2].
• Prevention gap: Only 25% of household contacts receive TB preventive treatment (TPT) [2]. Diabetes, alcohol and smoking add further risk [2].
• Uneven State capacity: Health is a State subject, so testing and drug supply vary across States.

Measures

• Active case-finding: Scale up the 100-Day model nationwide, as was done after its first run in 347 districts [1]. Expand AI-enabled handheld X-rays and NAAT labs [3].
• Nutrition and income support: Pay Ni-kshay Poshan's ₹1,000/month through DBT [1] and widen the Ni-kshay Mitra network of food-basket donors [1].
• Community mobilisation: JOSH Teams combine Class-I Officers, MY Bharat volunteers and NCC cadets in 55 districts across 11 States to fight stigma [4]. Every contact they make should end in a referral for testing or support.
• Prevention and drug-resistant TB: Give TPT to every patient's household. Roll out shorter regimens for drug-resistant TB [3].
• Measure outcomes, not activity: Track referrals and treatment completion. Award TB Mukt Panchayat status (67,933 so far [4]) only where testing levels are high.

India's faster-than-global decline shows that the Detect–Treat–Prevent–Build approach of the National Strategic Plan works [1]. The remaining burden needs income and food support alongside medicine. If Jan Bhagidari is combined with nutrition support, preventive treatment and stronger State health systems, India can still meet the SDG 3.3 target of ending TB by 2030 [1].