National Tuberculosis Elimination Programme (NTEP)

Introduction

Tuberculosis (TB), a communicable disease caused by Mycobacterium tuberculosis, has been a persistent public health challenge in India. The country accounts for nearly one-fourth of the global TB burden, making it a critical concern for national development and public health planning.

In response to this challenge, the Government of India is implementing the National Tuberculosis Elimination Programme (NTEP), earlier known as the Revised National Tuberculosis Control Programme (RNTCP). The goal is to eliminate TB by 2025, five years ahead of the global target set under the Sustainable Development Goals (SDGs).

Background and Evolution

• 1962:
  • National TB Programme (NTP) launched
• 1997:
  • Revised National TB Control Programme (RNTCP) initiated using DOTS strategy
• 2006:
  • Entire country covered under RNTCP
• 2020:
  • RNTCP renamed as National Tuberculosis Elimination Programme (NTEP) to reflect a shift from control to elimination

This change in nomenclature marked a more ambitious and outcome-driven approach, aligning with Prime Minister Narendra Modi’s vision of a TB-free India by 2025.

Objectives of NTEP

• Early detection of TB cases including drug-resistant TB
• Ensure prompt and appropriate treatment through Directly Observed Treatment (DOT)
• Prevent emergence of drug resistance through patient adherence
• Reduce TB incidence, mortality, and transmission
• Implement universal drug-susceptibility testing (DST)

Constitutional and Legal Dimensions of TB Elimination

Although health is a State subject under the Seventh Schedule, TB elimination is a national priority, justified under:

• Article 21 –
  • Right to Life, which includes the right to health and a life with dignity.
• Article 47 –
  • Directive Principle of State Policy mandates the State to improve public health and nutrition.
• Article 39(e) –
  • +Directs the State to prevent health hazards due to abuse or neglect.

Key Features of NTEP

1. Universal Access to TB Services

NTEP ensures access to high-quality TB diagnosis and treatment for all segments of society, including vulnerable populations such as migrants, urban poor, tribal communities, and people with HIV/AIDS.

2. Free Diagnosis and Treatment

TB diagnosis and treatment are provided free of cost in public health facilities, including free medicines, diagnostics, and follow-up.

3. Nikshay Ecosystem

“Nikshay” is a real-time online patient management system used under NTEP for case notification, treatment tracking, and adherence monitoring.

4. Public-Private Partnership (PPP)

The programme encourages private sector participation to ensure comprehensive coverage and timely notification of TB cases.

5. Community Engagement

Introduction of Nikshay Mitras under “Pradhan Mantri TB Mukt Bharat Abhiyan”, where individuals and organizations can adopt TB patients and support them nutritionally and emotionally.

6. Multisectoral Accountability Framework

Adoption of a framework to engage ministries beyond the health sector, such as housing, nutrition, education, and urban development.

Strategies under NTEP

Strategy	Description
DOTS (Directly Observed Treatment, Short Course)	Ensures adherence to treatment through supervised medication intake
TB Preventive Treatment (TPT)	Prophylactic treatment for high-risk groups
Active Case Finding (ACF)	Proactive screening in high-risk populations
TB-HIV Collaborative Activities	Integrated management for co-infected individuals
Drug-Resistant TB Management	Includes second-line treatment and follow-up
Airborne Infection Control (AIC)	Promotes environmental and personal protection practices

TB Types Covered under NTEP

• Pulmonary TB (affects lungs)
• Extra-Pulmonary TB (affects other organs)
• Drug-Sensitive TB (DS-TB)
• Multidrug-Resistant TB (MDR-TB)
• Extensively Drug-Resistant TB (XDR-TB)

Recent Initiatives and Milestones

Pradhan Mantri TB Mukt Bharat Abhiyaan (2022)

A nationwide campaign to eliminate TB by engaging civil society. Citizens can volunteer as Nikshay Mitras to support TB patients with nutritional aid, vocational training, and psychosocial support.

Nikshay Poshan Yojana (2018)

Provides ₹500/month nutritional support to all TB patients for the duration of their treatment.

Universal Drug Susceptibility Testing (U-DST)

All diagnosed TB patients are tested for drug resistance at the outset to ensure appropriate treatment regimens.

Expansion of CB-NAAT and TRUENAT machines

Rapid molecular diagnostics for early and accurate TB detection.

Achievements of NTEP (as of 2024)

Parameter	Status
TB Notifications (2023)	Over 24 lakh cases
Private Sector Notifications	~35% of total cases
Nikshay Poshan Yojana Beneficiaries	45+ lakh TB patients
Drug-Resistant TB Treatment Sites	500+ across India
Labs with Molecular Diagnostic Tools	Over 3,000

International Commitments and India’s Role

India is a signatory to multiple global declarations and SDG targets:

International Framework	India’s Commitment
UN Sustainable Development Goals (SDG 3.3)	End TB by 2030
WHO End TB Strategy (2014–2035)	90% reduction in TB deaths, 80% reduction in TB incidence
UN High-Level Meeting on TB (2018)	India pledged to eliminate TB by 2025, ahead of the global target

Challenges in TB Elimination

• Despite India’s aggressive efforts under the National Tuberculosis Elimination Programme (NTEP), multiple challenges continue to impede the goal of eliminating TB by 2025.
• One of the foremost barriers is the deep-rooted social stigma associated with the disease, which often compels patients to hide their illness and delay seeking treatment, thereby increasing community transmission.
• Drug-resistant TB (DR-TB) presents another formidable challenge, as improper or incomplete treatment regimens have led to the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains, which are harder and costlier to treat.
• Moreover, underreporting from the private healthcare sector, which handles a large portion of TB cases in India, limits the scope of surveillance and case tracking, despite mandatory notification norms.
• The urban-rural divide in healthcare infrastructure further aggravates the issue, with rural and remote areas lacking access to quality diagnostics and specialized treatment facilities.
• Additionally, malnutrition, poverty, and overcrowded living conditions remain critical socio-economic determinants that fuel the spread and severity of TB, particularly among vulnerable communities.
• The program also faces systemic hurdles such as inadequate human resources, gaps in monitoring and follow-up, and limited coordination between different sectors and ministries.
• These multifaceted challenges demand a comprehensive, multisectoral, and community-driven approach if India is to realize its vision of a TB-free nation by 2025.

Challenge	Explanation
Social Stigma	TB patients often hide illness, delaying treatment
Drug Resistance	Rising MDR and XDR cases due to incomplete or inappropriate treatment
Urban-Rural Disparity	Healthcare access and reporting are skewed toward urban centers
Underreporting in Private Sector	Many private practitioners do not notify TB cases
Malnutrition & Poverty	These are major underlying causes and worsen TB outcomes
Health System Gaps	Lack of infrastructure, trained staff, and follow-up in remote areas

TB Elimination Target – India vs Global

Parameter	India (NTEP Target)	Global (WHO Target)
Elimination Year	2025	2030
Reduction in TB incidence	80% (from 2015)	80% (by 2030)
Reduction in TB deaths	90% (from 2015)	90% (by 2030)

NTEP & Sustainable Development Goals (SDGs)

The National TB Elimination Programme directly supports:

• SDG 3.3: End the epidemic of tuberculosis by 2030
• SDG 1: End poverty (by reducing the economic burden of TB)
• SDG 2: End hunger (via nutritional support)
• SDG 10: Reduce inequalities in healthcare access

Way Forward

• Enhanced Awareness Campaigns: Combat stigma and promote early diagnosis
• Strengthen Public-Private Partnerships: Ensure accountability in private sector notifications
• Expand Nutrition and Social Support: Address underlying causes like malnutrition
• Innovation in Vaccines: Expedite research and deployment of new TB vaccines
• Integrated Primary Health Systems: Strengthen HWCs and PHCs to handle TB cases efficiently
• Use of AI and Data Analytics: For surveillance, monitoring, and prediction of TB trends

Conclusion

The National Tuberculosis Elimination Programme (NTEP) represents a bold and strategic vision to eradicate one of India’s oldest public health threats. Its success depends on strong political will, community participation, innovative healthcare delivery, and robust health infrastructure. With an aggressive target of elimination by 2025, India is on a mission to not just treat TB but to eliminate its very existence from society.