India's TB elimination strategy has moved from a biomedical model to a Jan Andolan model. Examine the role of community participation, citing recent initiatives.

India has about a quarter of the world's TB cases [1]. The Pradhan Mantri TB Mukt Bharat Abhiyaan (2022) treated TB elimination as a Jan Andolan (people's movement) [2]. Since then, the strategy has gone beyond drugs and tests. Communities now share ownership of finding patients, keeping them on treatment and fighting stigma.

Why the biomedical model was not enough

• Hidden cases: people with TB but no symptoms rarely visit clinics. The 100-Day campaign found 2.85 lakh such cases [3].
• Adherence: treatment lasts at least 6 months [2]. Worldwide, about half of TB-affected households face catastrophic costs, which leads many patients to stop treatment [1].
• Stigma and myths make people delay seeking care [4].

Role of community participation: recent initiatives

• Nutrition: Ni-kshay Mitras, now 6.77 lakh, have given out 45+ lakh food baskets. This adds to the Ni-kshay Poshan Yojana cash transfer of ₹1,000/month [2].
• Active case-finding: the 100-Day Intensified Abhiyaan (December 2024) screened 12.97 crore people and detected 7.19 lakh cases [3]. More than 30,000 elected representatives took part [2].
• Local ownership: 67,933 Panchayats were recognised as TB Mukt in 2025 [4].
• Youth mobilisation: JOSH (Joint Squad for Health) Teams bring together Class-I Officers, MY Bharat volunteers and NCC cadets. They work in 55 districts across 11 States and are supported by the Khushi Avatar AI chatbot [4].
• Result: India's TB incidence fell 21% between 2015 and 2024 [2]. The global fall was 12% [1].

Limits

• Awareness does not replace food or income. Undernutrition is the biggest TB risk factor worldwide [1].
• Worldwide, only 25% of household contacts get preventive treatment [1]. JOSH talks about prevention only in general terms [4].
• Screening counts measure effort, not a fall in new cases. Health is a State subject, so referrals only help if labs and drugs are ready.

Way forward

• Link every JOSH team to Ni-kshay Mitras, so that finding a patient also leads to food and income support.
• Track referrals and treatment completion, not events held. Test Phase I before scaling up, as the 100-Day model did [2].
• Add preventive therapy and drug-resistant TB to what community teams tell people.

Medicines cure TB, but communities make sure patients are found, fed and followed up. Jan Bhagidari works best when it is tied to nutrition support, preventive therapy and strong State health systems. This combination can move India towards the SDG 3.3 goal of ending TB by 2030 [2].