India - Program Towards Elimination of Tuberculosis

Overview & Synopsis

Ratings of the Program Towards Elimination of Tuberculosis for India were as follows: outcome was satisfactory; Bank performance was satisfactory; m&e quality was substantial. Expanding public health initiatives to involve the private sector increases service access and improves outcomes, with Technical Support Units (TSUs) and Patient Provider Support Agencies (PPSAs) proving effective in strengthening central and state capacities for private sector engagement. Implementing system reforms through a central authority enables nationwide adoption, including digitization via Ni-kshay and enhancements to Direct Benefit Transfer (DBT) such as faster first pay-outs, higher benefit amounts, and consolidated disbursements. Social protection for TB-affected households is essential, and DBT payments are strongly associated with treatment success; patient-centered approaches should include food and cash support for patients and households, and prioritize timely disbursement. The design of disbursement-linked indicators (DLIs) should anticipate early target achievement and ensure sustained performance, and future programs should consider minimum stock thresholds for critical commodities to prevent procurement bottlenecks. Baselines for DLIs that scale new approaches should explicitly present uncertainties and outline strategies and timelines for future adjustments. The innovative loan buy-down mechanism with the Global Fund to Fight AIDS, TB and Malaria effectively strengthened incentives, reduced borrowing costs, and improved alignment across the national tuberculosis program. Results-based approaches should remain the principal strategy to drive health system reforms, fostering innovations such as subnational certification and a TB-free village initiative. To meet national and global TB targets, India should accelerate the transition from passive and risk-based case finding to population-based TB screening, a feasible and economically sensible approach that will require substantial additional resources to realize its macroeconomic benefits.