India's TB mortality is declining faster than the global average, yet elimination remains elusive. Critically examine the gaps in the National TB Elimination Programme.

WHO's Global TB Report 2026 shows India's TB mortality rate down 38% since 2015, from 28 to 18 per lakh, against a 35% global fall [1]. Yet incidence was still 187 per lakh in 2024, and the 2025 elimination goal was missed [2]. The National TB Elimination Programme (NTEP) has bent the curve but not closed the gap.

Strengths behind the decline

• Active case finding: intensified screening detected 48.64 lakh cases, of which 14.97 lakh were asymptomatic [1].
• Treatment and technology: 94% treatment success for drug-susceptible TB [1]; AI-enabled hand-held X-rays; the 6-month BPaLM regimen for drug-resistant TB (DR-TB) [2].
• Support and ownership: Ni-kshay Poshan Yojana (₹1,000/month via DBT), Ni-kshay Mitra [2], and 96% domestic funding [1].

Gaps in the programme

• Measurement: the 94% success rate counts only notified patients. Undiagnosed and unreported private-sector cases fall outside it. Asymptomatic cases (about 31% of detections) show how much passive detection missed [1].
• Human resources: CAG found Senior Treatment Supervisor and Lab Supervisor posts vacant in sampled Delhi districts [4]. These staff trace patients who drop out.
• DR-TB oversight: CAG Report No. 3 of 2024 found District DR-TB Committees not formed or delayed [3], though BPaLM needs six months of close follow-up.
• Implementation and targets: CAG called NTEP implementation deficient in an audited state and the 2025 goal uncertain [5]; the target now points toward 2030 [2].
• Nutrition timeliness: the ₹4,454.68 crore paid to 1.38 crore beneficiaries [2] is a total. It does not show whether cash arrives in the early months, when dropout risk peaks.
• Perverse incentive: 67,933 Panchayats were certified TB-free for 2025 even as the campaign seeks hidden cases [1]. A low count may reflect low screening.

Way forward

• A private-sector inventory study to measure under-reporting.
• States to fill supervisor posts; District Collectors to run DR-TB committees with monthly reviews.
• Ni-kshay to publish time to first NPY payment by district.
• Link TB-free Panchayat status to minimum screening coverage.

The NTEP's shift to active, technology-led, community-backed care explains its faster decline. Turning that into elimination needs staff, oversight and honest measurement to match the ambition. That would fulfil SDG 3.3 and Article 47's duty to improve public health, making TB-Mukt Bharat real.