National Tuberculosis Elimination Programme (NTEP)

Background and Renaming

• Effective 1 January 2020, the Revised National TB Control Programme (RNTCP) was renamed to NTEP, reflecting India's commitment to eliminate TB 5 years ahead of the global WHO End TB target of 2030 - i.e., by 2025.
• India accounts for approximately 26% of the world's TB burden (WHO Global TB Report 2024).

Historical Timeline

Vision and Goals

• Reduce TB incidence by 80%
• Reduce TB-related deaths by 90%
• Achieve zero catastrophic costs for TB-affected families

Four Strategic Pillars (DTPB)

1. DETECT

• Universal Drug Susceptibility Testing (UDST) for all diagnosed TB patients
• Expansion of Designated Microscopy Centres (DMCs)
• Rapid Molecular Testing (CBNAAT/TrueNat) rolled out across districts
• Culture and Drug Susceptibility Testing (C-DST) labs at state and national levels
• Active Case Finding (ACF) in vulnerable and high-risk populations

2. TREAT

• All TB patients treated with daily fixed-dose combination (FDC) regimens
• Drug-Sensitive TB (DS-TB): 2HRZE + 4HR (6-month regimen)
• Drug-Resistant TB (DR-TB) managed through Programmatic Management of Drug-resistant TB (PMDT) framework
• Nikshay Poshan Yojana: nutritional support of ₹500/month per patient
• Free drugs, diagnostics, and treatment throughout the government health system

3. PREVENT

• BCG vaccination (continues via Universal Immunisation Programme)
• TB Preventive Therapy (TPT) for household contacts and PLHIV
• Infection control measures (AIC - Airborne Infection Control)
• Addressing social determinants - nutrition, diabetes, silicosis

4. BUILD

• Nikshay digital platform for TB notification, tracking, and surveillance
• Community engagement and inter-sectoral collaboration
• Public-Private Mix (PPM) to bring private sector TB patients into the fold
• Human resource strengthening and capacity building

Organisational Structure (5 Levels)

National Level   →  Central TB Division (DDG-TB, Ministry of H&FW)
State Level      →  State TB Cell (State TB Officer)
District Level   →  District TB Centre / District TB Officer (DTO)
Sub-district     →  Tuberculosis Unit (TU) - one per 250,000 population
PHI Level        →  Peripheral Health Institutions (PHC, CHC, hospitals)

• Central TB Division is headed by the Deputy Director General - TB (DDG-TB)
• National Expert Committees advise on policy, guidelines, and research
• State TB Cell and District TB Office govern state and district activities respectively

Laboratory Network

Treatment Categories and Regimens (DS-TB)

Patient Categories

• New patients - never treated or treated <1 month
• Previously treated - relapse, treatment after failure, treatment after loss to follow-up (LTFU)

Standard Regimens (Daily FDC - Daily Regimen since 2016)

Drug-Resistant TB (DR-TB) Management - PMDT

Decentralized "Test and Treat" Approach

Key DR-TB Regimens (Shorter/Longer)

• Shorter MDR-TB regimen: BDQ-based (Bedaquiline) 9-11 months
• Longer MDR-TB regimen: Individualized 18-20 months
• XDR-TB managed with newer drugs: Bedaquiline, Delamanid, Linezolid, Clofazimine

Key Schemes and Initiatives Under NTEP

TB Notification - Mandatory Obligation

DOT Strategy (Directly Observed Treatment)

• A DOT provider (health worker, community volunteer, family member) directly observes drug ingestion
• DOT centres function at PHCs, CHCs, DOTS corners, and community sites
• Video-observed treatment (VOT) is now piloted using smartphones for remote areas

TB/HIV Co-infection Management

• Collaborative TB-HIV activities are fully integrated under NTEP-NACO partnership
• All TB patients tested for HIV (Provider-Initiated HIV Testing and Counseling - PITC)
• All TB/HIV co-infected patients receive ART (regardless of CD4 count)
• Co-trimoxazole preventive therapy (CPT) for all HIV-positive TB patients

India's TB Status (WHO Report 2024)

• India: ~2.8 million estimated TB cases per year (26% of global burden)
• TB incidence rate: ~196 per 100,000 population
• TB elimination definition: <1 case per million population per year
• Treatment success rate (DS-TB): ~85%
• India still faces significant gaps in achieving the 2025 target

Challenges

1. Huge private sector TB caseload not fully captured
2. Drug-resistant TB burden - 32% increase in reported cases
3. TB-diabetes and TB-malnutrition co-morbidity
4. Social stigma and adherence issues
5. Missed TB cases ("missing millions")
6. COVID-19 disruption set back TB services (2020-2021)

• Park's Textbook of Preventive and Social Medicine (23rd ed.), Chapter on NTEP/RNTCP, pp. 480-490
• NTEP Wikipedia overview
• PIB - India Speeding Towards TB Elimination
• WHO Global Tuberculosis Report 2024

All National Health Programmes of India

THE NATIONAL HEALTH MISSION (NHM) - The Umbrella Framework

• NRHM - National Rural Health Mission (2005)
• NUHM - National Urban Health Mission (2013)

1. Health systems strengthening (rural + urban)
2. Reproductive - Maternal - Newborn - Child - Adolescent Health (RMNCH+A)
3. Control of communicable diseases
4. Control of non-communicable diseases

• ASHA (Accredited Social Health Activist) - community health volunteer, 1 per 1,000 population
• ANM (Auxiliary Nurse Midwife) - at sub-centre level
• Rogi Kalyan Samiti - hospital management committees
• Sub-centres, PHCs, CHCs, District Hospitals as service delivery points

A. REPRODUCTIVE, MATERNAL, NEWBORN, CHILD & ADOLESCENT HEALTH (RMNCH+A)

1. Janani Suraksha Yojana (JSY) - 2005

• Cash incentive to promote institutional deliveries
• Rural BPL mothers: ₹1,400 (low performing states), ₹700 (high performing states)
• Urban BPL mothers: ₹1,000 (LP states), ₹600 (HP states)
• ASHA incentivized for escorting mother to facility

2. Janani Shishu Suraksha Karyakram (JSSK) - 2011

• Free and cashless delivery (including C-section) at public health facilities
• Free drugs, diagnostics, blood transfusion, diet, referral transport
• Also covers sick newborns up to 30 days

3. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) - 2016

• Free antenatal checkup on the 9th of every month
• By Ob/Gyn or specialist; covers all pregnant women in second/third trimester

4. LaQshya Programme - 2017

• Labour room and maternity OT quality improvement initiative
• Aims to reduce preventable maternal and newborn deaths during delivery

5. Rashtriya Bal Swasthya Karyakram (RBSK) - 2013

• Child health screening and early intervention
• Covers 4 Ds: Defects at birth, Diseases, Deficiencies, Developmental delays/Disabilities
• Mobile Health Teams screen children (0-18 years) including school children

6. Home Based Newborn Care (HBNC) / Navjaat Shishu Suraksha Karyakram (NSSK)

• ASHA visits newborn at home for first 42 days
• NSSK: basic newborn care and resuscitation training for providers

7. Facility-Based Newborn Care (FBNC)

• Special Newborn Care Units (SNCUs) at district hospitals
• Newborn Stabilization Units (NBSUs) at CHCs

8. IMNCI - Integrated Management of Neonatal and Childhood Illness

• Algorithm-based approach for frontline workers to manage sick children <5 years
• F-IMNCI: Facility-based version for medical officers

9. Rashtriya Kishor Swasthya Karyakram (RKSK) - 2014

• Adolescent health programme (10-19 years)
• Adolescent Friendly Health Clinics (AFHC) - "Aarogya Kendras"
• Weekly Iron and Folic Acid Supplementation (WIFS)
• Menstrual Hygiene Scheme (MHS) - subsidized sanitary napkins
• Peer education, counselling, ARSH services

10. Family Planning Programme

• Mission Parivar Vikas (2016) - for 146 high-fertility districts
• Basket of contraceptive choices: condoms, OCP, IUCD, injectables (Antara), sterilization
• Compensation scheme for sterilization acceptors

B. COMMUNICABLE DISEASE CONTROL PROGRAMMES

11. National TB Elimination Programme (NTEP) - formerly RNTCP

• Renamed from RNTCP to NTEP on 1 January 2020
• Target: Eliminate TB by 2025 (5 years ahead of WHO's 2030 goal)
• Strategy: DTPB - Detect, Treat, Prevent, Build
• Free diagnosis (CBNAAT/TrueNat) + daily FDC regimen (2HRZE + 4HR)
• Nikshay Poshan Yojana: ₹500/month nutritional support
• Pradhan Mantri TB Mukt Bharat Abhiyaan: Ni-kshay Mitras (patient sponsors)
• (See detailed NTEP notes for full breakdown)

12. National Vector Borne Disease Control Programme (NVBDCP)

• National Framework for Malaria Elimination (NFME) 2016-2030: Zero indigenous cases by 2027; certified malaria-free by 2030
• Kala-azar Elimination target: <1 case per 10,000 population at sub-district level

13. National Leprosy Eradication Programme (NLEP) - 1983

• Goal: Eradicate leprosy (elimination achieved as public health problem in 2005: <1/10,000)
• Free Multi-Drug Therapy (MDT): Rifampicin + Dapsone + Clofazimine
• Paucibacillary (PB): 6 months; Multibacillary (MB): 12 months
• SPARSH Leprosy Awareness Campaign
• Disability prevention and rehabilitation services

14. National AIDS Control Programme (NACP)

• Managed by NACO (National AIDS Control Organisation) since 1992
• NACP phases: I (1992-99), II (1999-2006), III (2007-12), IV (2012-17), V (2021-26)
• Free ART (Antiretroviral Therapy) at ART centres
• ICTC (Integrated Counselling and Testing Centres) - free HIV testing
• PPTCT (Prevention of Parent to Child Transmission)
• Targeted Interventions for high-risk groups (FSW, MSM, IDU, truckers)
• Goal: End AIDS by 2030 (90-90-90 targets: 95-95-95 by 2030)

15. Integrated Disease Surveillance Programme (IDSP) - 2004

• Nation-wide disease surveillance network
• Weekly reporting: S (Syndromic), P (Presumptive), L (Laboratory confirmed) forms
• State and district surveillance units (SSU/DSU)
• Central Surveillance Unit (CSU) at NCDC, New Delhi
• Outbreak investigation and response

16. National Programme for Containment of Antimicrobial Resistance (AMR)

• National Action Plan on AMR (NAP-AMR) 2017-2021, extended to 2025
• Rational use of antibiotics, surveillance of drug resistance
• Red Line Campaign (awareness on prescription antibiotics)

17. National Viral Hepatitis Control Programme (NVHCP) - 2018

• "Test and Treat" for Hepatitis B and C
• Free diagnostics and treatment (Sofosbuvir + Daclatasvir/Velpatasvir for Hep C)
• Hepatitis B vaccination integrated into UIP

C. IMMUNIZATION

18. Universal Immunisation Programme (UIP) - 1985

• Covers 12 vaccine-preventable diseases (under national programme)
• BCG, OPV, IPV, Pentavalent (DPT+Hep B+Hib), PCV, Rotavirus vaccine, MR/MMR, JE, Td, Adult Hep B
• Mission Indradhanush (2014): Intensified effort to reach unvaccinated/under-vaccinated children
• Intensified Mission Indradhanush (IMI) phases: 2017, 2019-20, 4.0 (2022)
• Target: >90% full immunization coverage

19. Pulse Polio Programme - 1995

• Oral Polio Vaccine (OPV) on National Immunization Days (NIDs)
• India declared polio-free on 27 March 2014

D. NON-COMMUNICABLE DISEASE (NCD) PROGRAMMES

20. National Programme for Prevention & Control of Cancer, Diabetes, CVD & Stroke (NPCDCS) - 2010

• Now merged into National NCD Programme under NHM
• NCD clinics at district and sub-district level
• Free screening for Oral, Breast, Cervical cancers + Diabetes + Hypertension
• Screening target: All persons ≥30 years at Health and Wellness Centres (HWC)
• Cancer care: Early detection, chemotherapy, palliative care

21. National Cancer Control Programme (NCCP) - 1975 (revised 1984/2004)

• Three-pronged approach: Primary prevention, early detection, treatment
• Regional Cancer Centres (RCCs) - tertiary care
• District Cancer Control Programme
• Oral cancer, cervical cancer, breast cancer focus

22. National Mental Health Programme (NMHP) - 1982

• Oldest NCD programme in India
• District Mental Health Programme (DMHP) launched 1996 - decentralized mental health care
• Objectives:
  1. Availability of minimum mental health care for all
  2. Integration of mental health into general health care
  3. Community participation in mental health
• DMHP services: OPD, inpatient, emergency, day care, community outreach
• National Tele Mental Health Programme (Tele MANAS) - 2022 (helpline: 14416)

23. National Programme for Control of Blindness & Visual Impairment (NPCBVI) - 1976

• Target: Reduce blindness prevalence to 0.3%
• National Blindness prevalence reduced from 1.4% (1971) to ~1% currently
• Cataract surgeries (>6 million/year), school eye screening, low vision care
• Free cataract surgery at government facilities
• Vitamin A supplementation to prevent nutritional blindness

24. National Programme for Prevention & Control of Deafness (NPPCD) - 2006

• Early detection of hearing loss (newborn screening, school screening)
• Free hearing aids distribution
• Cochlear implant programme for children
• Target: Reduce hearing impairment prevalence to <2%

25. National Iodine Deficiency Disorders Control Programme (NIDDCP) - 1962 (National Goitre Control Programme, renamed 1992)

• Universal iodization of salt (minimum 15 ppm iodine at production, 7 ppm at consumer level)
• Surveys every 5 years to assess IDD magnitude
• Urinary iodine excretion monitoring
• Banned sale of non-iodized salt for human consumption

26. National Programme for Prevention & Control of Fluorosis (NPPCF) - 2008

• Covers fluorosis-endemic districts
• Identification of endemic areas (excess fluoride in groundwater)
• Provision of safe water, nutritional interventions, rehabilitation

27. National Tobacco Control Programme (NTCP) - 2007-08

• Enforcement of COTPA 2003 (Cigarettes and Other Tobacco Products Act)
• No tobacco sale to minors (<18 years), no smoking in public places
• Tobacco cessation centres and helplines (iQUITnow: 1800-11-2356)
• Anti-tobacco IEC campaigns; warning labels on tobacco products
• mCessation: Mobile technology-based quit support

28. National Programme for Health Care of the Elderly (NPHCE) - 2010-11

• Health care for persons ≥60 years
• Dedicated OPD and wards at district hospitals
• Geriatric clinics at PHC/CHC level
• Emphasis on: Hypertension, diabetes, dementia, falls, incontinence

29. National Programme for Prevention & Management of Burn Injuries (NPPMBI)

• Strengthening burn care at district hospitals
• Training health workers in burn management

30. National Oral Health Programme (NOHP)

• Integrated with NCD programme at primary care level
• IEC on tobacco-related oral cancer, oral hygiene
• Dental services at CHC/District Hospital

E. NUTRITION-RELATED PROGRAMMES

31. National Iron Plus Initiative (NIPI) / Anaemia Mukt Bharat (AMB) - 2018

• Iron supplementation across all lifecycle stages (children, adolescents, pregnant/lactating women, women of reproductive age)
• WIFS (Weekly Iron and Folic Acid Supplementation) for adolescents
• Target: Reduce anaemia prevalence by 3% per year

32. Vitamin A Supplementation Programme

• High-dose Vitamin A to children 9 months - 5 years, every 6 months
• Reduces under-5 mortality from infections

33. National Iodine Deficiency Disorders Control Programme (see above)

F. AYUSHMAN BHARAT - FLAGSHIP PROGRAMME (2018)

34. PM-JAY (Pradhan Mantri Jan Arogya Yojana)

• Health insurance: ₹5 lakh/family/year for secondary and tertiary care
• Covers bottom 40% of population (~107.4 million families)
• Cashless, paperless at empanelled public and private hospitals
• Covers 1,949+ medical procedures across 27 specialties
• Extended to all citizens >70 years (2024)

35. Health and Wellness Centres (HWCs) / Ayushman Arogya Mandirs

• Upgraded sub-centres and PHCs
• Provides Comprehensive Primary Health Care (CPHC)
• 12 service packages including: NCDs, RMNCH, oral health, eye care, ENT, mental health, emergency care, palliative care
• Target: 1.5 lakh HWCs across India

G. WATER, SANITATION & ENVIRONMENT-LINKED PROGRAMMES

36. National Programme for Prevention & Control of Leptospirosis

37. Acute Diarrhoeal Disease (ADD) Control / ORS Programme

38. Oral Rehydration Therapy (ORT) Programme

H. OCCUPATIONAL & ENVIRONMENTAL HEALTH

39. National Programme on Climate Change & Human Health (NPCCHH) - 2014

• Under National Action Plan on Climate Change (NAPCC)
• Heat action plans, disease surveillance linked to climate events

I. DIGITAL HEALTH

40. Ayushman Bharat Digital Mission (ABDM) - 2021

• ABHA ID (Ayushman Bharat Health Account) - 14-digit unique digital health identity
• Health Facility Registry (HFR) + Healthcare Professionals Registry (HPR)
• Unified Health Interface (UHI) for interoperability
• Digital health records linked to ABHA ID

J. OTHER KEY NATIONAL PROGRAMMES

41. Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) - 2003

• Setting up new AIIMS-like institutions in underserved states
• Upgradation of existing government medical colleges

42. National Dialysis Programme (PMNDP) - 2016

• Free dialysis services at district hospitals for BPL patients
• PPP model with private dialysis operators

43. Free Drugs Service Initiative & Free Diagnostics Service Initiative (FDSI)

• Essential medicines free at all public health facilities
• Free diagnostic tests at PHC/CHC/DH level

Summary Classification Table

• Park's Textbook of Preventive and Social Medicine (23rd ed.), Chapters on NHM and National Health Programmes, pp. ~470-510 and pp. ~999-1005
• iHatePSM - Complete NHP List
• PRS India - Budget Analysis 2026-27 Health
• Ministry of Health & Family Welfare, NHM Programme Documents