Subnational Certification (SNC) : India's Tuberculosis Recognition Program

Overview & Synopsis

This report outlines the development of a novel strategy for an intergovernmental transfer program known as performance-based incentives (PBIs). The Government of India initiated the Sub-National Certification for Tuberculosis (SNC) to consolidate efforts aimed at eradicating Tuberculosis (TB). A detailed understanding of the TB burden at subnational levels, along with more granular insights into interventions in various contexts, is critical for TB control. The World Health Organization certifies member states for disease elimination globally; however, the prevalence of diseases varies significantly among Indian states and regions. In response, India’s Ministry of Health and Family Welfare developed a ‘Sub-National Certification of Progress towards TB Free Status’ initiative to measure progress toward ending TB at district and state/Union Territory levels. The early introduction of the TB Index, designed to complement the SNC scheme, ensures compatibility between the two. This SNC initiative, which is a provider recognition program, rewards increasing levels of tuberculosis elimination relative to a 2015 baseline through public recognition and financial incentives. During its implementation amid over two years of disruption due to the COVID-19 pandemic, the SNC initiative aims to achieve several objectives: (i) assess the current pace, challenges, and lessons from the SNC's initial implementation to inform future improvements and scale-up; (ii) promote this domestic innovation on an international scale; and (iii) contextualize this innovation within other performance-based innovations in the health sector, offering a range of options for countries aiming to eliminate TB. This document aligns with the Lighthouse India Initiative. The World Bank documents lessons and evidence from India while sharing global lessons and best practices with Indian policymakers and technocrats. By situating India’s innovation within the broader scope of international health experiences with various award-based, incentive-based, performance-based, and results-based approaches, the report provides a comprehensive menu of options for future efforts to combat Tuberculosis.