In India’s fight against TB, Bihar remains a champion

Under the TB Mukt Bharat Abhiyaan, India no longer waits for patients to arrive with symptoms. It goes looking for them. Bihar took that mandate seriously

Few public health transformations in India’s history match the shift underway against tuberculosis. Under the TB Mukt Bharat Abhiyaan, India no longer waits for patients to arrive with symptoms. It goes looking for them.

When Prime Minister Narendra Modi, addressed the Delhi End TB Summit in 2018 and made TB a personal political commitment, it signalled something that India was no longer a country defined by its TB burden, but one confidently charting its path out of it. (HT Archive)

Bihar took that mandate seriously. Against a target of screening 10 million people for TB by August 14, I was informed, that we have screened nearly double that number.

Nearly half of all TB cases present without symptoms, silently spreading transmission, and Bihar’s incidence remains well above the national average. Closing that gap meant expanding the tools to find people before they knew they were sick.

This is not the first time Bihar has led rather than followed. Patna was one of three cities chosen to pilot a model for engaging private health care providers to deliver quality TB care. The evidence gathered here went on to inform the scale-up of that model across 200 districts nationally. That early engagement with the private sector has shown incredible results in the state.

When Prime Minister Narendra Modi, addressed the Delhi End TB Summit in 2018 and made TB a personal political commitment, it signalled something that India was no longer a country defined by its TB burden, but one confidently charting its path out of it.

The private sector has been drawn into this effort with equal purpose. Doctors and facilities outside the public system are now required to report every TB case they diagnose, and private practitioners account for over 35% of case notifications today.

The results speak for themselves. According to the World Health Organization, India recorded a 21% reduction in TB incidence since 2015, nearly double the global rate of decline, alongside a 25% fall in mortality due to TB.

Since 2018, direct cash transfers have been mandated for every notified TB patient, to meet their nutritional needs during treatment. And in keeping with the Jan Bhagidari spirit, over 700,000 Ni-kshay Mitras, citizens, corporations and community organisations, have stepped forward to offer psychosocial and nutritional support of their own.

Closing Bihar’s remaining gap will take more than government machinery alone. Elected representatives, community leaders and popular figures across the state are carrying forward the same Jan Bhagidari spirit that has powered the movement so far.

Eliminating TB requires a social response that matches it in clinical scale. Together, we must build an environment of empathy and support rather than discrimination.

Every ministry whose mandate touches the conditions that make people vulnerable to TB is being drawn into this effort.

Young people are carrying peer-led awareness further than any government campaign could reach on its own. The media has an equally vital part to play: Sustained, informed coverage can ease stigma and encourage people to seek care.

Science is moving in our favour. A new generation of diagnostic tools, portable, non-invasive, closer to the patient, is within reach. While the country continues to adopt newer technologies, what closes the distance to elimination is not technology alone. It is resolve. And that resolve, I see in Bihar, and across the country.

Lieutenant General Syed Ata Hasnain (retd.) is the governor of Bihar. The views expressed are personal