While the world was still coping with the unsparing effects of the COVID-19 pandemic in 2020 & 2021, the fight against Tuberculosis encountered setbacks in decades of gain. The COVID-19 pandemic created a pathway to strengthen the health system and solutions to expand the reach of public health program delivery. Sustainable Development Goal 3 includes a target to end the global TB epidemic by 2030, with TB incidence per 100 000 populations per year defined as the indicator for measuring progress. For TB incidence, the first milestone of the End TB Strategy is a 20% reduction in the TB incidence rate (the number of new and relapse cases per 100 000 population per year) by 2020 compared with 2015. The next 2025 milestone is a 50% reduction compared with 2015, followed by targets for reductions of 80% by 2030 and 90% by 2035.

According to the World TB report, 2021; the estimated incidence of all forms of TB in India for the year 2021 was 210 per 100,000 population (178-244 per 100,000 population). The percentage of change since 2015 is 18% reduction only. The program geared up the efforts in identifying the TB cases and put up them on appropriate treatment despite having the two major covid waves in India. The country has taken up the TB epidemic as a challenge and directed many interventions under the National TB elimination Program (NTEP) like; advocacy, community empowerment, newer Tb diagnostic modalities, new treatment regimens trials, ensuring the supply chain of required drugs and consumables for diagnosis and providing monetary support through Nikshay Poshan Yojana, etc. The steps to end TB are also supported by newer research studies, TB prevalence surveys, and subnational certification to encourage the districts and states for their efforts in reducing the TB incidence over the period. 

Achieving the SDG and End TB targets for India is driven by the DETECT - TREAT - PREVENT - BUILD approach designed under the National Strategic Plan 2017-25. The focus is on early diagnosis of all the TB patients, prompt treatment with the right drugs and regimens along with suitable patient support systems including financial and nutritional support.

The health system includes the private sector which still program has a long mile to go. The involvement of the private sector in TB case notification reporting and ensuring the evidence-based follow-up of the protocol are hidden challenges. Few States are showing an increasing trend of private sector involvement but still, informal providers are scattered and unorganized, to include them in the mainstream notification reporting of TB patients; the health system has to think beyond the conventional approach. In recent times; programmatic TB infection management, multidrug-resistant TB, treatment dropouts, treatment failure, relapse cases, out-of-pocket expenditure, and above all deaths of TB patients are major challenges. 

Death of the TB patients is one of the crucial indicators to assess the status of system surveillance and response. It's like a scorecard of a health system. There has been a slight increase in the mortality rate due to all forms of TB between 2019 and 2020 by 11% in the country. In absolute numbers, the total number of estimated deaths from all forms of TB excluding HIV, for 2020 was 4.93 lakhs (4.53-5.36 lakhs) in the country, which was 13% higher than the year 2019 estimate. (India TB Report 2022). The covid19 pandemic may have contributed to overall lung health. 

India and States are pushing all the efforts in the system strengthening while creating the health infrastructure and developing new interventions of diagnostics, treatment adherence, and programmatic response. Human resources across the health system are a major pillar that maintains the all materials related activity (provider related) of patient management and also ensures the community engagement via ASHA / TB champion / Front line workers. The creation of Health and wellness centers at the village level also added more manpower and machines to expand the health services.

Health services, particularly those that feature work-based learning experiences, often require designated staff to spend most of their time in patient management. They also require that staff has the skills and support to deliver health services properly and effectively. Healthcare workers and professionals offer an entry point to the health care system whether it is the public or private sector. Challenges experienced by healthcare providers include limited resources, poor or inadequate knowledge, skills, and attitudes in the management of TB patients, and delay in identification and referral from the field to the primary care level and to further levels of care. These contribute to poor outcomes and delays in getting the services ultimately leading to morbidity and mortality of TB patients. 

The battle against tuberculosis can be won when healthcare professionals would be supported with evidence-based knowledge and protocol-based learning. In the direction toward, capacity enhancement of the health staff to fight against TB, a web-based and android-based application: NIKSHAY SETU was developed by IIPHG to address the need of digital platform to disseminate the program guidelines and recent evidence of TB patient management to healthcare workers.

The NTEP has constantly been evolving, encouraging innovations, and recalibrating strategies at all levels, collaborating with corporates and national institutes, facilitating research of new tools, and anticipating various dimensions of health systems challenges—both unfinished and emerging. I Hope, we sustained these efforts to achieve a true sense of TB-free India; not only diseases but stigma too.