Harnessing India's medical colleges in the fight against TB
India has made undeniable progress in its battle against tuberculosis (TB). The World Health Organization (WHO) acknowledged a 17.7% drop in TB incidence in the country from 237 to 195 per lakh population between 2015 and 2023 – double the pace observed globally. Despite these advancements, India continues to bear the highest TB burden globally1, making the goal of a TB-free India even more urgent. Against this backdrop, medical colleges have emerged as vital players in the national TB response - providing a template for other disease programmes to tap into their potential for a healthier India. TB (AFP)
Harnessing India's vast network of medical colleges is a cornerstone of the nation's ambitious strategy to eliminate TB by 2025. These institutions have transitioned from peripheral actors to central pillars in the fight against TB, contributing significantly to nearly every facet of the National Tuberculosis Elimination Programme (NTEP). Medical colleges have evolved beyond tertiary referral centres to become critical nodes in India's public health infrastructure and the TB elimination response. They serve patients from both within and beyond their districts and states, offering significant potential for case detection not just in TB and respiratory departments, but across all specialties.
Equipped with advanced laboratories and specialised centres, nearly all of India's 651 medical colleges are working closely with the NTEP. Notably, 336 medical colleges have centres dedicated to managing drug-resistant TB, a more complex and harder-to-treat form of the disease. With cutting-edge diagnostic tools and clinical expertise in handling health complications, these institutions are leading to better TB care and outcomes. In 2023, medical colleges notified nearly 14% of all TB cases in India – a clear sign of their growing role in this national effort.
Medical colleges are playing an increasingly important role in responding to the emerging trends in the TB epidemic. Extra-pulmonary forms of the disease that occur outside the lungs are on the rise and are generally harder to detect and treat. It now makes up 20-24% of all TB cases in India, especially among people with weaker immunity. With their advanced labs, specialist departments, and tertiary care capacity, medical colleges are uniquely positioned to deliver the multi-disciplinary care required to detect and manage these harder-to-treat cases.
Medical colleges are also well placed to design and implement innovative health solutions, with research and practice occurring side by side. For example, the Bharati Vidyapeeth Medical College in Pune repurposed its Family Adoption Programme – where each student engages with five families over three years – to integrate community-based TB screening into the existing medical curriculum. This not only helped detect cases in the community, but also taught students to recognise key TB symptoms, demonstrating a scalable model for active case finding.
One of our standout achievements has been fostering global collaborations. The ongoing partnership between AIIMS Gorakhpur and Johns Hopkins University through the TB-Free Schools initiative aimed at early detection, treatment, and prevention of TB among students in residential schools, demonstrates how Indian medical colleges can drive impactful international engagement. As this model is scaled, it reinforces what we have long championed—that medical colleges, when systematically integrated with state health systems, are among the most cost-effective and scalable platforms for delivering high-impact TB interventions.
By leveraging these institutions, we can enhance passive case finding, improve diagnosis, and ensure timely treatment. With a structured mechanism for accountability under NTEP, medical colleges can become hubs for TB management. Furthermore, they are instrumental in building a competent healthcare workforce by integrating practical, programme-oriented TB management skills into the medical curriculum, thereby preparing a new generation of doctors for the challenges of TB elimination. Through a structured framework of national, zonal, and state-level task forces, medical colleges contribute to operational research, generating vital evidence to refine public health strategies and improve patient outcomes. By embedding themselves within the community through initiatives like the Family Adoption Programme, they also bolster active case finding efforts, ensuring early diagnosis and treatment, thus playing an indispensable and multifaceted role in India's journey towards a TB-free future.
For TB and other critical public health challenges, where understanding patient behavior, treatment barriers, and local epidemiology is critical, the ability of medical colleges to connect science with ground-level implementation is key to turning policy into real-world action. They have technical expertise to strengthen surveillance systems, research capacity to strengthen monitoring and evaluation, and educational mandate to build local capability through supportive supervision.
The integration of medical colleges into the TB elimination framework has been one of the most strategic shifts under the NTEP. Medical colleges have redefined their role in public health, not only by contributing to TB management, but by setting a precedent for how academic institutions can anchor systemic change. Their success is not incidental; it is the result of sustained collaboration, institutional commitment, and a shared vision of making India TB-free. Importantly, the integration of medical colleges into the TB response offers a replicable framework for tackling other complex health challenges in India – such as anti-microbial resistance, non-communicable diseases, and neglected tropical diseases – through a blend of research, education, service delivery, and community engagement.
This article is authored by Dr Ashok Bhardwaj, professor emeritus, MM Medical & Hospital College Solan, Himachal Pradesh and chairperson of the National Task Force for Medical Colleges under NTEP and Dr Bhupendra Tripathi, deputy director, Infectious Diseases and Vaccine Delivery, Gates Foundation, India.
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